Abstract
BackgroundFewer trainees are choosing to pursue nephrology. Only 60.1% of positions filled in the 2018 fellowship Match, which is concerning given the rising prevalence of end-stage kidney disease. Identifying factors influential in career choices is critical to inform focused approaches to recruit qualified applicants.MethodsTo understand perceptions of nephrology and assess factors influential in specialty choice among early career trainees, an anonymous survey was distributed to upper-level medical students and internal medicine residents at programs identified through the American Association of Medical Colleges (AAMC) and American Medical Association’s Fellowship and Residency Electronic Interactive Database (FREIDA).ResultsOf 4199 recipients, 644 (15.3%) participants responded, including 315 upper-level medical students, 308 residents, and three chief residents from 30 institutions. An interest in the subject was the most critical factor in selecting a specialty (92%). Other key factors included a suitable work-life balance (73%), access to mentors (70%), and subject exposure (66%). Lack of interest was the most frequently-cited reason to forgo a nephrology fellowship (79%), followed by concerns regarding remuneration (43%), work-life balance (39%), and subject exposure (32%). In free-text responses, several participants described frustration with managing patients on hemodialysis and desired combined training with specialties such as critical care. Respondents who had considered nephrology at any point cited an interest in physiology or interface with a mentor as key driving factors.ConclusionsA lack of interest in and exposure to the subject, perceptions of poor earning potential and patient nonadherence, and concerns regarding work-life balance were influential in participants’ decisions to forgo nephrology training. Incorporating novel educational tools and broadening the scope of the nephrology elective, highlighting ongoing areas of clinical and research innovation, expanding opportunities for interdisciplinary collaboration and procedural skills, and cultivating strategies to reduce burnout may be useful areas on which to focus future recruitment efforts.
Highlights
Fewer trainees are choosing to pursue nephrology
Our analyses were exploratory in nature, we hypothesized that mentorship and concerns about income potential would emerge as two of the most influential factors in choosing or forgoing a nephrology fellowship
The survey audience was identified using publicly available data sources per the following inclusion criteria: 1) allopathic medical schools listed in the American Association of Medical College (AAMC) database; and 2) internal medicine residencies listed in the American Medical Association’s Fellowship and Residency Electronic Interactive Database (FREIDA)
Summary
Fewer trainees are choosing to pursue nephrology. Only 60.1% of positions filled in the 2018 fellowship Match, which is concerning given the rising prevalence of end-stage kidney disease. Prior studies which sought to identify reasons for the declining interest in nephrology have focused on trainees. Nair et al BMC Nephrology (2019) 20:146 who had already chosen a subspecialty fellowship These studies have pointed to fellows’ concerns regarding the medical complexity of nephrology as well as perceptions of limited long-term income potential as reasons for a lack of interest in choosing the field [7, 8]. Early career trainees have never been directly queried regarding their perceptions of nephrology and their considerations when choosing subspecialty training. We hoped to provide insight into applicants’ perceptions of nephrology during a formative time in their career development and provide an outline of areas on which to strengthen existing recruitment efforts and develop new initiatives
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