Future nephrology workforce needs likely influenced by Medicare push for integrated care

PHILADELPHIA – New studies show that nephrology fellowships slots are going unfilled, but workforce needs in the future may ultimately be influenced by change based on Medicare’s interest in a more integrated approach to patient care.

Mark Parker, MD, head of the American Society of Nephrology’s task force looking into work force issues, and part of a three-member panel at the session, “The future direction of nephrology: How shall we live long and prosper” held during the American Society of Nephrology’s Kidney Week 2014, acknowledged there were no clear answers yet about future work force needs. The panel included the Christopher R. Blagg, MD, Lectureship in Renal Disease and Public Policy presented by Richard J. Baron, MD. Baron is president and CEO of the American Board of Internal Medicine.

The panel discussion comes on the heels of a new report released by ASN this past week that takes an in-depth look at the nephrology workforce. Authored by health workforce researchers from George Washington University (GWU), the report outlines several challenges for the specialty, notably a declining interest in nephrology careers among medical students and residents and an uncertain job market for recent graduates.

Parker, who co-authored an article published in the Journal of the American Society of Nephrology three years ago entitled, “The future nephrology workforce: Will there be one?” said there are a number of factors that point to a continued decrease in nephrology. Although the number of fellowship slots has grown from around 600 from 1990–2001 to around 900 today, it has become more difficult to fill those positions.

“We knew that we had trouble attracting U.S. medical school graduates to nephrology,” said Parker. But interested foreign medical graduates had always supplemented those positions. Over the last two years, however, even that segment of students has seen a big drop, he said.

The nephrology workforce has been enhanced with about 250–300 physician assistants and around 1,000 nurse practitioners, he noted, saying they were “an important part” of the nephrology specialty.

ASN report addresses residents, research

The first of several reports to be released by ASN, “The US Nephrology Workforce: Developments and Trends,” provides an overview of the nephrology workforce and factors influencing supply, demand, and use, to begin to answer three workforce questions:

Will the United States have an adequate supply of nephrologists to assure access to needed care?

Will nephrology be able to continue to attract highly qualified applicants?

Will nephrology continue to produce investigators, particularly physician-scientists?

Those questions were addressed by the panel speakers, which also included Michael Fischer, MD. Fischer, an associate professor of medicine at the Institute for Health Research and Policy at the University of Illinois, discussed how health care will be provided in the future—and how that might impact the workforce need. Baron also talked about how health care payment policy—moving away from fee-for-service medicine to a global fee for patient care—was influencing physician recruitment and need in all internal medicine specialties.

Parker cited several findings outlined in the report, including:

The number of nephrology fellowship positions has increased over the past few decades, which will lead to substantial future increases in supply.

Fewer U.S. medical graduates are selecting nephrology careers.

A survey conducted for the study indicates the current job market for new nephrologists is limited, especially for international medical graduates.

The number of applicants to nephrology through the National Residency Match Program’s Medical Specialties Matching Program is decreasing.

“The decreasing number of U.S. medical school graduates selecting nephrology is a warning signal for the specialty. Monitoring and assessing the impact of the major forces impacting the specialty and responding to these developments is necessary for a vibrant specialty,” the report said.

The next GWU report, to be released in December, will focus on nephrology fellows and trainees and the future generation of nephrologists. -by Mark Neumann