American Journal of Kidney Diseases

Why Not Nephrology? A Survey of US Internal Medicine Subspecialty Fellows

Published:January 18, 2013DOI:


      There is a decreased interest in nephrology such that the number of trainees likely will not meet the upcoming workforce demands posed by the projected number of patients with kidney disease. We conducted a survey of US internal medicine subspecialty fellows in fields other than nephrology to determine why they did not choose nephrology.


      A web-based survey with multiple choice, yes/no, and open-ended questions was sent in summer 2011 to trainees reached through internal medicine subspecialty program directors.


      714 fellows responded to the survey (11% response rate). All non-nephrology internal medicine subspecialties were represented, and 90% of respondents were from university-based programs. Of the respondents, 31% indicated that nephrology was the most difficult physiology course taught in medical school, and 26% had considered nephrology as a career choice. Nearly one-fourth of the respondents said they would have considered nephrology if the field had higher income or the subject were taught well during medical school and residency training. The top reasons for not choosing nephrology were the belief that patients with end-stage renal disease were too complicated, the lack of a mentor, and that there were insufficient procedures in nephrology.


      Most non-nephrology internal medicine subspecialty fellows never considered nephrology as a career choice. A significant proportion were dissuaded by factors such as the challenges of the patient population, lack of role models, lack of procedures, and perceived difficulty of the subject matter. Addressing these factors will require the concerted effort of nephrologists throughout the training community.

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        • Parker M.G.
        • Ibrahim T.
        • Shaffer R.
        • Rosner M.H.
        • Molitoris B.A.
        The future nephrology work force: will there be one?.
        Clin J Am Soc Nephrol. 2011; 6: 1501-1506
        • Desai T.
        • Ferris M.
        • Christiano C.
        • Fang X.
        Predicting the number of US medical graduates entering adult nephrology fellowships using search term analysis.
        Am J Kidney Dis. 2012; 59: 467-469
        • National Resident Matching Program
        Match Results Statistics: Specialties Matching Service 2012 Appointment Year.
        National Resident Matching Program, Washington, DC2011
        • Shah H.H.
        • Jhaveri K.D.
        • Sparks M.A.
        • Mattana J.
        Career choice selection and satisfaction among United States adult nephrology fellows.
        Clin J Am Soc Nephrol. 2012; 7: 1513-1520
        • Parker M.G.
        • Owens S.
        • Rosner M.H.
        Nephrology as a career choice [abstract SA-PO2868].
        J Am Soc Nephrol. 2009; 20: 767A
        • Ferris M.
        • Trachtman H.
        • Jhaveri K.D.
        • et al.
        Pediatric nephrology as a specialty: survey of USA non-renal pediatric fellows [abstract FROR268].
        J Am Soc Nephrol. 2011; 22: 64A
        • Calderon K.
        • Vij R.
        • Mattana J.
        • Jhaveri K.D.
        Innovative teaching tools in nephrology.
        Kidney Int. 2011; 79: 797-799
        • Jhaveri K.D.
        • Chawla A.
        • Shah H.H.
        Case based debates: an innovative teaching tool in nephrology education.
        Ren Fail. 2012; 34: 1043-1045
        • Sparks M.A.
        • O'Seaghdha C.
        • Sethi S.K.
        • Jhaveri K.D.
        Embracing the internet as a means of enhancing medical education in nephrology.
        Am J Kidney Dis. 2011; 58: 512-518
        • Sethi S.K.
        Invited manuscript poster on renal-related education American Society of Nephrology, Nov. 16-21, 2010.
        Ren Fail. 2011; 33 (E-pediatric nephrology in India): 751-752
        • Sethi S.K.
        • Desai T.P.
        • Jhaveri K.D.
        Online blogging during conferences: an innovative way of e-learning.
        Kidney Int. 2010; 78: 1199-1201
        • Desai T.
        • Talento II, R.
        • Christiano C.
        • Ferris M.
        • Hewan-Lowe K.
        Web-based nephropathology teaching modules and user satisfaction: the nephrology on demand experience.
        Ren Fail. 2011; 33: 1046-1048
        • Desai T.
        • Stankeyeva D.
        • Chapman A.
        • Bailey J.
        Nephrology fellows show consistent use of, and improved from, a nephrologist-programmed teaching instrument.
        J Nephrol. 2011; 24: 345-350
        • Jhaveri K.D.
        • Shah H.H.
        • Mattana J.
        Enhancing interest in nephrology careers during medical residency.
        Am J Kidney Dis. 2012; 60: 350-353
        • West C.P.
        • Drefahl M.M.
        • Popkave C.
        • Kolars J.C.
        Internal medicine resident self report of factors associated with career decisions.
        J Gen Intern Med. 2009; 24: 946-949
        • Kaminetzky C.P.
        • Keitz S.A.
        • Kashner T.M.
        • et al.
        Training satisfaction for subspecialty fellows in internal medicine: findings from the Veterans Affairs (VA) Learners' Perceptions Survey.
        BMC Med Educ. 2011; 11: 21
        • Girard D.E.
        • Choi D.
        • Dickey J.
        • Dickerson D.
        • Bloom J.D.
        A comparison study of career satisfaction and emotional states between primary care and speciality residents.
        Med Educ. 2006; 40: 79-86
        • Dorsey E.R.
        • Jarjoura D.
        • Rutecki G.W.
        Influence of controllable life style on recent trends in specialty choice by US medical students.
        JAMA. 2003; 290: 1173-1178
        • Lane C.A.
        • Healy C.
        • Ho M.T.
        • Pearson S.A.
        • Brown M.A.
        How to attract a nephrology trainee: quantitative questionnaire results.
        Nephrology. 2008; 13: 116-123
        • Leigh J.P.
        • Tancredi D.J.
        • Kravitz R.L.
        Physician career satisfaction within specialties.
        BMC Health Serv Res. 2009; 9: 166
        • Leigh J.P.
        • Tancredi D.
        • Jerant A.
        • Kravitz R.L.
        Physician wages across specialties: informing the physician reimbursement debate.
        Arch Intern Med. 2010; 170: 1728-1734
        • Leigh J.P.
        • Tancredi D.
        • Jerant A.
        • Kravitz R.L.
        Annual work hours across physician specialties.
        Arch Intern Med. 2011; 171: 1211-1213
        • Langdon L.O.
        Subspecialty internal medicine in the United States: in and outside the hospital.
        Schweiz Med Wochenschr. 1999; 129: 1970-1976
        • Glasheen J.
        The fast, furious future.
        (The Hospitalist 2009) (Accessed August 29, 2012)
        • Hinami K.
        • Whelan C.T.
        • Wolosin R.J.
        • Miller J.A.
        • Wetterneck T.B.
        Worklife and satisfaction of hospitalist: toward flourishing careers.
        J Gen Intern Med. 2012; 27: 28-36
        • McDonald F.S.
        • West C.P.
        • Popkave C.
        • Kolars J.C.
        Educational debt and reported career plans among internal medicine residents.
        Ann Intern Med. 2008; 149: 416-420
        • Al-Awqati Q.
        Basic research in nephrology: are we in decline?.
        J Am Soc Nephrol. 2012; 23: 1611-1616