Research Article| Volume 29, ISSUE 5, P539-547, September 2009

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The Chronic Kidney Disease Epidemic: A Challenge for Nephrology Training Programs


      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.


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        • American Medical Association
        Physician characteristics and distribution in the US.
        2008 ed. American Medical Association, Chicago2008
        • Neilson E.G.
        • Hull A.R.
        • Wish J.B.
        • et al.
        The ad hoc committee report on estimating the future workforce and training requirements for nephrology.
        J Am Soc Nephrol. 1997; 8: S1-S4
        • Himmelfarb J.
        • Berns A.
        • Szczech L.
        • Wesson D.
        Cost, quality, and value: the changing political economy of dialysis care.
        J Am Soc Nephrol. 2007; 18: 2021-2027
        • Coresh J.
        • Selvin E.
        • Stevens L.A.
        • et al.
        Prevalence of chronic kidney disease in the united states.
        JAMA. 2007; 298: 2038-2047
        • Miller R.S.
        • Dunn M.R.
        • Richter T.
        Graduate medical education, 1998-1999: a closer look.
        JAMA. 1999; 282: 855-860
        • Zeidel M.L.
        • Kroboth F.
        • McDermot S.
        • et al.
        Estimating the cost to departments of medicine of training residents and fellows: a collaborative analysis.
        Am J Med. 2005; 118: 557-564
        • Rosenberg M.E.
        Adult nephrology fellowship training in the united states: trends and issues.
        J Am Soc Nephrol. 2007; 18: 1027-1033
        • Kohan D.E.
        • Rosenberg M.E.
        Nephrology training programs and applicants: a very good match.
        Clin J Am Soc Nephrol. 2009; 4: 242-247
        • American College of Physicians
        Role of international medical graduates in the U.S. physician workforce.
        American College of Physicians, a policy monograph. American College of Physicians, Philadelphia2008
        • Ibrahim T.
        Academic internal medicine in the united states: current trends, future implications for academic nephrology.
        Clin J Am Soc Nephrol. 2008; 3: 1887-1894
        • Lane C.A.
        • Healy C.
        • Ho M.T.
        • Pearson S.A.
        • Brown M.A.
        How to attract a nephrology trainee: quantitative questionnaire results.
        Nephrology (Carlton). 2008; 13: 116-123
        • Fine L.G.
        A proposal to improve the attractiveness of nephrology as a subspecialty choice for residents in internal medicine.
        Am J Kidney Dis. 1990; 15: 302-304
        • Levison S.P.
        The changing face of nephrology.
        Semin Nephrol. 1999; 19: 98-104
        • Muther R.S.
        • Murray M.
        • Bennett W.M.
        Assessing university nephrology training as preparation for community consultative practice.
        Acad Med. 1989; 64: 677-680
        • Pogue V.A.
        • Norris K.C.
        • Dillard M.G.
        Kidney disease physician workforce: where is the emerging pipeline?.
        J Natl Med Assoc. 2002; 94: 39S-44S
        • Jamison R.L.
        • Cummings N.B.
        • Stein J.H.
        Need for faculty members in renal research in clinical departments: report of the scientific advisory board of the national kidney foundation.
        Kidney Int. 1980; 17: 135-138
        • Association of Professors of Medicine
        Action plan for revitalizing the nation's physician-scientist workforce: four major recommendations.
        Recommendations for revitalizing the nation's physician-scientist workforce. Association of Professors of Medicine, Washington DC2007
        • Sukhatme V.P.
        Training the academic nephrologist for the new millennium.
        Semin Nephrol. 2000; 20: 87-91
        • Ley T.
        Demographics of the nation's physician-scientist workforce.
        Recommendations for revitalizing the nation's physician-scientist workforce. Association of Professors of Medicine, Washington DC2007
        • Gitlin S.D.
        • Yuan Z.
        • Little R.J.
        • Todd III, R.F.
        Factors that influence successful training and faculty career development in hematology/oncology patient-oriented clinical research.
        J Cancer Educ. 2005; 20: 72-78
        • Whitcomb M.E.
        • Walter D.L.
        Research training in six selected internal medicine fellowship programs.
        Ann Intern Med. 2000; 133: 800-807
        • Johansen K.L.
        Women in nephrology: one mother's strategies for success in academic medicine.
        Kidney Int. 2008; 74: 401-402
        • Zeidel M.
        • Bonventre J.
        • Forrest J.
        • Sukhatme V.
        A national course for renal fellows: the origins of renal physiology.
        J Am Soc Nephrol. 2008; 19: 649-650