Career Choice for Nephrology Fellows

This month’s eJournal Club article is not a traditional, clinical or basic research article but instead one which looks into the state of nephrology training in the US. There has been a significant decline in the number of residents applying for nephrology fellowships over the last 10 years and this has naturally caused some concern for the powers that be. More than half of nephrology trainees are now foreign medical graduates (including yours truly) and a committee has been set up by the ASN to explore means of increasing interest in nephrology careers among trainees and medical students. This article reports the results of a survey of nephrology fellows that was completed over the last 2 years.
The article highlights the importance of early mentoring in the decision to pursue a nephrology career. The second most important factor was interest in nephrology as a subject. I sometimes feel that the way that nephrology is presented to students means that they feel that it is too complicated and difficult and it puts them off. It is important for us to highlight the diversity of opportunities that are available in nephrology.
One good thing to mention is that most fellows who were surveyed were happy with their career choice. Only 7.5% of people for whom nephrology was their first choice regretted their decision. The number was higher for those for whom it was a second choice. Hopefully, the results of this survey will be utilized to try and identify areas to focus on to increase interest in nephrology again. We have a great specialty and we should let people know!
The discussion continues at CJASN


  1. The Renal Association is involved in many joint activities, and liaises with many other relevant groups. Some of the organisations with which we share formal committees are: – renal exam course

  2. The Renal Association is involved in many joint activities, and liaises with many other relevant groups. Some of the organisations with which we share formal committees are: – renal exam course

  3. thanks for sharing..

  4. It is interesting how many Nephrologists chose to work as hospitalists after fellowship. At least one attending during residency was a trained Nephrologist and in our program there were at least 3 people working as hospitalists due to lack of Nephrology jobs in their chosen geographic area. This has probably nothing to do with their satisfaction with Nephrology but rather geographic distribution of jobs.

  5. I am very impressed with the statement made about abuse. If seeing a patient is sick and you find coming to the hospital and doing your job abusive- then that individual is in the wrong profession. I had been a fellow in a busy large city program and came in on call nights for anytime i felt not sure that i could take care of it on the phone. What is wrong in laying eyes and examining a patient? that is not abuse, that is proper care. In general, lot of subspecialty fellows come in to see patients- cardiology, GI, critical care much more than nephrology. Besides, not all programs are as your experience dictates.

  6. 9/25/12

    I work at East Carolina University – Brody School of Medicine in Greenville, NC. We are an academic nephrology group of 8 faculty and have positions for 2 additional faculty in both general nephrology and transplantation. If you are a nephrology fellow with scholarly interests and would like to apply for a positon with us, please contact:

    Tejas Desai, MD
    Twitter: @nephondemand

  7. I would really like to see these important comments migrate to eJC…so I posted this comment there, and invite responses:

    I'm impressed with the comment above: "so much abuse of the nephrology fellows in at least half of the fellowship programs….life of nephrology fellows is pathetic." Do you consider this different than other subspecialty fellowship programs? Is this opinion based on exposure at only a single program or is this a generalized comment based on a broader exposure to nephrology fellows?

  8. In addition there is so much abuse of the nephrology fellows in atleast half of the fellowship programs. For example in our program we are forced to see non urgent consults overnight and life of nephrology fellows is pathetic. At the same time quality of teaching is going downhill. I believe all these has negative effects on residents and medical students. In addition there is unhealthy relationship between various nephrology groups in the area. This applies mostly to community hospitals.

  9. I agree with Flolideu. The demand for nephrologists varies widely with geography. I graduated from a highly reputable New York City program this summer, and none of the five fellows graduating from there (incl. me) were able to find a renal position in the greater NYC area, which includes Northern NJ and Southern CT. All of us are somehow tied to the area, and we were therefore forced to pick up hospitalist jobs. This unfortunate outcome is very likely to have a negative impact on the motivation of residents and students at our fellowship institution to choose a career in nephrology. I can't blame them for making alternative choices.

  10. While it has been pointed out quite a bit that there is a current and/or upcoming shortage of Nephrologists it really depends on where you look. In Metro areas jobs are scarce and the payment is bad so good luck for a position. Try to find a Nephrology job in Massachussetts. Of course one can find a highly paying job in the middle of nowhere and be busy as a Nephrologist (as well as forking in cash) but is that desirable? So cities won't have to worry about a Nephrology shortage

  11. This is by no means an insult to FMGs. I was simply pointing out that I am also an FMG. There is no suggestion that foreign graduates are in any way inferior. However, it is matter of concern that the specialty is not attracting sufficient US graduates and given the moves that the ACGME are making towards restricting access to fellowships by non-US trained doctors, this shortage is going to become acute in the next few years. The ASN and other US nephrology groups should, and are taking this problem seriously.

  12. What is the problem if more than half of nephrology trainees are now foreign medical graduates? Also, your comment '(including yours truly)' on some of the foreign medical graduates is totally uncalled for and derogatory.

Leave a Reply