A major challenge facing the nephrology community in the United States is the training of adequate numbers of nephrologists to meet patient care and research needs. There is particular cause for concern because of the increasing incidence and prevalence of patients with chronic kidney disease. Data on the clinical and research nephrology workforce are incomplete or absent. However, the number of such individuals likely is inadequate to meet current and projected needs. To solve these workforce shortages, significant issues with regard to clinical and research training need to be addressed. These include funding of fellowship training, increasing the pipeline of medical students and internal medicine residents, and enhancing interest in nephrology among international and particularly US medical graduates. This review discusses these challenges facing the renal community, with emphasis on the care, prevention, and treatment of chronic kidney disease, and identifies potential pathways to developing solutions.
Bibliographical noteFunding Information:
New strategies for funding nephrology training must be developed. 10 Nephrologists must act together, and work with leadership of other organizations (such as the Academic Alliance for Internal Medicine), to make the case for correction of current and pending nephrology workforce shortages through increased GME funding. Carefully assessing the impact of the CKD population on workforce needs is essential to this process. With threatening diminished Medicaid GME support and increasing financial pressures on Medicare GME funding, convincing new arguments, such as one that takes into account the burgeoning CKD population, will be necessary. Another issue relates to federal determination of the payments per nephrology trainee. Currently, hospitals receive only half of the financial support (payment for indirect medical education) for fellows in subspecialty training compared with residents in primary care specialties. The case could be made to designate nephrology as a primary care specialty that serves a defined chronic disease population. Doing so would qualify hospitals for a higher level of reimbursement and should have advantageous downstream effects for nephrology training programs. Finally, new and existing partners need to be approached to fund additional nephrology fellowship positions. Examples of new partnerships include affiliated hospitals, nephrology practices, or even large health plans (along the lines of an all-payer fund).
Copyright 2011 Elsevier B.V., All rights reserved.
- Chronic kidney disease