Brief Comment: Nephrology at the Crossroads

Virtually every week a Brigham internal medicine resident accompanies me in my outpatient clinic in order learn a bit more nephrology. The residents are very smart and motivated. However, almost all are aiming to either do oncology or cardiology. The best medical residents don’t seem to be going into nephrology.  This is true not only at our training program at the Brigham but also elsewhere.

A fantastic article by Kenar Jhaveri and colleagues published in AJKD examines this issue and is “must-read”.  The article isn’t available open access. It describes an innovative modification to the internal medicine experience in nephrology that seems effective in sparking greater interest in nephrology.

A companion paper from the same group, by Shah et al in CJASN provides an overview of the issues related to nephrology as a career choice. The article is also not available open access.They write:  “The exposure that students and residents have to nephrology is likely to play an important role in the career choices that they make and their ultimate satisfaction with this career choice is likely influenced by several factors, including job opportunities….Failure to understand the factors that influence trainees to choose nephrology as a career and those that affect their satisfaction with this choice may impair the ability to graduate a sufficient number of nephrologists to meet projected demand.”

The articles raise important questions about whether we are being sufficiently innovative in our approach towards attracting the brightest stars in internal medicine to nephrology. The Jhaveri and Shah articles are wake-up calls that we should heed.