The adult nephrology workforce crisis has been well publicized (see previous AJKD Blog posts one & two), but concerning trends in the pediatric nephrology workforce have also been noted in recent years. These include an aging physician cohort with imminent retirees and a dearth of fellowship applicants. Pediatric nephrologists average an age of almost 58 years, the oldest group of all pediatric subspecialists, and 43% of first-year fellowship positions went unfilled in the match between 2010 and 2014. In 2015, only 36% of fellowship positions filled. The challenges facing pediatric nephrology recruitment appear to be similar to those in adult nephrology (Jhaveri et al, AJKD), namely an arduous subject matter, an intimidating workload, lack of mentors, and perceived poor financial compensation. Negative lifestyle issues may be particularly detrimental to pediatric programs as woman make up >70% of pediatric residency positions, and need flexibility to manage family commitments.
A timely report was published by AJKD from the American Academy of Pediatrics (AAP) on the current state of the US pediatric nephrology workforce. In 2013, a survey was sent to 766 physicians, including doctors who were ever board eligible in pediatric nephrology or were members of the American Society of Pediatric Nephrology or the AAP Section on Nephrology. A total of 504 surveys were completed, giving an impressive 65.8% response rate. Notable findings included:
- Most US pediatric nephrologists work in an academic setting, with almost half teaching fellows. Despite this, very few participated in research.
- The average distribution of duties was direct patient care (59%), administration (13%), teaching (10%), clinical research (9%), basic research (6%), and other activities (3%).
- Mean work week was 56.1 ± 14.3 hours (men working 3.5 hours more than women; p<0.05).
- Median on call commitment of 16 weeks and 14 weekends annually; 58% without a junior colleague/trainee.
Some concerning statistics were revealed regarding the current workforce:
- 33% plan to reduce or stop clinical activities within 5 years.
- A similar number were not sure if they would choose the specialty if they had the choice again. Financial compensation and workload dominated reasons not to choose pediatric nephrology.
- International medical graduates have more difficulty finding appropriate jobs (as per adult nephrology).
This well-conducted survey of pediatric nephrologists highlights concerns for the future workforce and several issues that impact the perceived attractiveness of the specialty. The results are not entirely surprising, being consistent with data from their adult nephrology colleagues. Both the pediatric and adult nephrology specialties have a battle on their hands for the future physician workforce. There is no quick fix and the solutions will require a culture change in nephrology. We must embrace our trainee doctors, innovate in medical education, create an environment where life balance may be achieved, demonstrate leadership, and provide thoughtful mentorship. It’s our collective responsibility and a task in which we must succeed.
Dr. Paul Phelan
AJKD Blog Contributor