May 01, 2018
3 min read

Sounding the alarm on the nephrology workforce

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If you throw a party and no one comes, maybe what you are offering is not appealing.

Finding young physicians interested in entering nephrology during the past decade has been like chasing ghosts. With retirement tugging on the white coat of those who have and continue to serve the older, more complicated patient, it is unclear what the future of the profession will look like. Not far behind them are nephrology nurses. More on that later.

Care is local, but workforce issues are not

There are multiple issues at play here, and abysmal results from recruitment could not come at a worse time. People are living longer and demand more from health care professionals.

“Amidst the rising tide of [chronic kidney disease] CKD, the global nephrology workforce has shrunk and is failing to meet the growing health care needs of this vulnerable patient population,” Muhammad U. Sharif, Mohamed E. Elsayed, and Austin G. Stack, wrote in Clinical Kidney Journal. “In truth, this global shortage of nephrologists is seen in many parts of the world ... Moreover, many expert groups on workforce planning, as well as national and international professional organizations, predict further reductions in the nephrology workforce over the next decade, with potentially serious implications. Although the full impact of this has not been clearly articulated, what is clear is that the delivery of care to patients with CKD may be threatened in many parts of the world unless effective country-specific workforce strategies are put in place and implemented.”

Mark E. Neumann

Where we have come from

There was a time in nephrology where that element of excitement carried the day for young internists. In the first of three articles published in this month’s Nephrology News & Issues, veteran nephrologists Tom F. Parker III, MD, and Richard J. Glassock, MD, talk about what made this profession so exciting 40-plus years ago. “It was one of the most challenging and satisfying of internal medicine specialties; a premier thinking person’s profession,” they wrote. “The curious physician vied for much-sought-after fellowship openings. The opportunities in academia and clinical practice were without boundaries, creating the ‘doctor’s doctor.’”

Parker and Glassock remind readers of the gilded era of nephrology, but also propose new ways to bring more young residents into the profession, including a set of four possible pathways.

Much of this responsibility must lie in the hands of those who currently make up the profession, Robert Provenzano, MD, writes. Provenzano is a DaVita Kidney Care nephrologist who has spent a lot of time discussing how physician practices can make nephrology a better place. “Our specialty is at a pivotal juncture and in need of decisive leadership to defend our future, protect the value and viability of our practices and ensure patients have greater access to quality kidney care,” Provenzano wrote. “We have an opportunity, if not a duty, to scrutinize the way we are currently conducting our work and chart a new course ... Now is the time to decide if the legacy we leave behind is one of a failure to adapt, or one of a courageous reinvention of the way we practice – both in terms of how we serve patients and how we groom the next generation of nephrologists to do so.”


In our third article, professional recruiter Martin Osinski said the specialty must change to meet the demands of young nephrologists. That includes balancing a home life with patient care

Efforts to revive interest in nephrology come at a crucial time. Retirement is not only on the minds of many doctors, but nephrology nurses, too. Results from a survey launched in January by Nephrology News & Issues and the American Nephrology Nurses Association show 40% of respondents (n= 1,070) indicate they will leave kidney care in the next 3 years, and close to 17% will do so in the next 12 months. More than 70% of the respondents who said they would be leaving nephrology said they would retire.

With a lackluster interest in the profession and many heading for the exits of their careers, it is time to band together and look for real solutions. Collectively, the door of the renal community is open to ideas. Let’s hear from you.