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7 Things to Know About the Nephrologist Shortage

An aging workforce and increased demand is putting pressure on the nephrology workforce.

Doctor talking to patient during pandemic
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A 2021 report on doctor supply and demand from the Association of American Medical Colleges projects that by 2034, we’ll see a shortage of up to 77,100 specialists and up to 48,000 primary care physicians. Nephrology isn’t immune to the effects of this shortage and many factors contribute to this deficit, including difficulties in recruitment, a large number of retiring nephrologists, and a growing population of people who need kidney care.

Here are some key things to know about the nephrologist shortage and what the industry must do to combat it.

Poll
What's the best way to combat the physician shortage?
Use more telemedicine
Use more NPs and PAs
Open up more residency slots
Reform malpractice law
Forgive medical school loans
Use more telemedicine
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Use more NPs and PAs
%
Open up more residency slots
%
Reform malpractice law
%
Forgive medical school loans
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Total votes: 941

1. U.S. medical school graduates aren’t choosing nephrology.

The number of U.S. medical school graduates choosing nephrology as their career path has been on the decline for more than a decade. One report showed that approximately 60% of nephrology fellows are international medical school graduates compared to an average of 40% who are U.S. fellows. These numbers are very different than they were 20 years ago, when more U.S. medical school graduates were going into nephrology than internal medicine.

2. The nephrology job market isn’t easy for international medical school graduates. 

Many international medical school graduates are required to practice in federally designated underserved areas to get a work visa. In a study published by the American Society of Nephrology, more than 56% of new international doctors reported difficulties finding a satisfactory position compared to only 22% of U.S. recent graduates. The same study says international graduates in nephrology often have limited opportunities, and the ones that are available (such as in correctional facilities) are not appealing.

3. The National Residency Match Program (NRMP) is noticing fewer applicants for nephrology positions.

The number of applicants for nephrology residencies through the NRMP Specialties Matching Service has been steadily declining over the past decade. In the past, at least one to two applicants were interested in each available position. Now there’s rarely even one person applying per slot. This decline in applications will continue to affect the neurologist shortage as the need for nephrology care increases.

4. The nephrologist shortage is a global issue. 

The U.S. isn’t the only country experiencing a nephrologist shortage. The 2019 Global Kidney Health Atlas reported that more than 70% of nations said they have a shortage of nephrologists. There are an average of 25 nephrologists per million population in Western, Eastern, and Central Europe. Those numbers are much lower in developing economies, such as in parts of Asia, Africa, and Latin America. As the need for kidney care continues to grow across the world, more nephrologists are needed in all regions.

5. Nephrology recruitment and mentorship will be critical to reducing the shortage.

Nephrology has become a less desirable career path over the last few decades. Medical students say they don’t get much exposure to the specialty, they aren’t connected with mentors, and the work is too complex. A multilevel recruitment approach could help by including earlier exposure to the specialty in medical schools and providing positive role models in the field. Mentors are needed to show students the value of long-term relationships with patients and explain how to navigate the complexities of the field. A U.S. survey reported that students considering nephrology ranked access to mentors (70%) and subject exposure (68%) as key factors in their choice of specialty.

6. Reducing burnout and improving work-life balance may help recruit new nephrologists.

A survey of U.S. nephrology fellows reported concerns over burnout in the specialty, and a recent Medscape report showed that half of nephrologists are burned out, depressed, or both. Issues like this can scare off future nephrologists who are looking for a positive work-life balance and less stressful specialty. Some medical school graduates also perceive low compensation as a recruitment deterrent.

7. The work of today’s nephrologists is key to addressing the shortage.

In an article from Nephrology News & Issues, Dr. Robert Provenzano, a DaVita Kidney Care nephrologist, urges today’s nephrologists to step up to preserve their specialty. “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,” he writes. Dr. Provenzano and researchers studying the nephrology shortage encourage doctors to adapt and innovate, so they can champion a new generation of nephrologists to serve a world of patients who need their help.

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  1. Medscape Nephrologist Lifestyle, Happiness & Burnout Report 2023. Medscape.
    https://www.medscape.com/slideshow/2023-lifestyle-nephrologist-6016082#4
  2. Sounding the alarm on the nephrology workforce. Nephrology News & Issues. https://www.healio.com/news/nephrology/20180417/sounding-the-alarm-on-the-nephrology-workforce
  3. The US Nephrology Workforce: Developments and Trends. The American Society of Nephrology. https://www.asn-online.org/education/training/workforce/Nephrology_Workforce_Study_Report_2014.pdf
  4. Myths and Facts: The Physician Shortage. Association of American Medical Colleges. https://aamc-black.global.ssl.fastly.net/production/media/filer_public/88/33/883363b7-fff9-41b3-975f-a52bfcdb744d/myths_and_facts_-_the_physician_shortage.pdf
  5. Workforce capacity for the care of patients with kidney failure across world countries and regions. BMH Global Health. https://gh.bmj.com/content/bmjgh/6/1/e004014.full.pdf
  6. “To Be, or Not to Be” a Nephrologist: Students’ Dilemma and a Strategy for the Field. Brazilian Society of Nephrology. https://www.karger.com/Article/Pdf/513155
  7. The global nephrology workforce: emerging threats and potential solutions! CKJ Review. https://www.researchgate.net/publication/283860038_The_global_nephrology_workforce_Emerging_threats_and_potential_solutions
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