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International review of nephrology workforce
Editor’s note: Finding enough nephrologists to care for the growing number of patients who need kidney care is not only a challenge in the United States, but in other countries as well. This special section includes an interview with Kurtis Pivert and Stephen Sozio, MD, on results from the Comparing Realities Across the Global Nephrology Workforce Survey, along with viewpoints from experts in New Zealand/Australia, United Kingdom and Canada on workforce issues in their respective countries.
NN&I: How did the workforce study come about?
Stephen Sozio, MD: The American Society of Nephrology, the International Society of Nephrology and the European Renal Association/European Dialysis and Transplant Association collaborated on this new report on workforce issues. Chief investigators include myself, from the Johns Hopkins School of Medicine; Fergus Caskey, MD, from University of Bristol in the United Kingdom; and Adeera Levin, MD, from University of British Columbia. Kurtis Pivert is director of data analytics for ASN and for this project.
NN&I: ASN has produced workforce studies before. Did this survey have a broader focus?
Sozio: As a group, we believe there are a wide range of issues that impact the nephrology workforce, from pre-med, medical school and residency. We wanted to offer kidney health professionals a better understanding of our specialty and ensure future communications about the nephrology workforce are consistent across countries and regions. Our surveys cover important issues for nephrology fellows, nephrologists at mid-career and at the end of their career so we could gauge how the specialty had changed. Beyond workforce numbers, we wanted to understand issues revolving around recruitment and training nephrologists to be good physicians.
NN&I:Can you share some of the details of the survey?
Kurtis Pivert: The survey instrument acknowledges that the specialty currently faces regional challenges. The introduction says: “In many high-income countries, we know there is a declining number of medical students and residents who are choosing to specialize in nephrology, raising questions about the adequacy of the workforce to meet future patient demand. Low- and middle-income nations may lack the resources to provide nephrology specialty training despite an often strong demand for specialized kidney care. We want to accurately describe the kidney health workforce at the country- and region-specific level in terms of nephrologists’ training, certification, and scope of practice; number of nephrologists per country; and the range of kidney care provided by other physicians and non-physicians.” The complete survey contains 33 questions and was made available in English, French and Spanish.
NN&I: When will the survey results be released?
Pivert: Some preliminary data are included in an abstract accepted for Kidney Week entitled, “Will the nephrologist see you now?” and it covers some of the results from the survey and provides some details on how the survey tool was assembled. As stated, we wanted to determine how kidney care delivery trends may affect future workforce demands by quantifying variation in nephrology scope of practice at the country- and region-specific level. The survey was designed to capture national kidney health delivery measures, including nephrology training/certification and scope of practice; number of nephrologists per country; and range of kidney care provided by nephrologists, other physicians and extenders. To date, we have had a total of 71 countries (43%) respond to the survey.
The preliminary data show there was little variation between regions in the scope of nephrology practice, with nephrologists the primary physicians for most key kidney health services/therapeutic areas. Yet, more than 50% of respondents noted nephrologists were not the primary physician for chronic kidney disease stages 1 to 3 and hypertension.
Some other responses included:
Nephrologists commonly (98%) prescribe biopsies, yet are less likely (71%) to perform these procedures;
Stratified by region, Europe demonstrated the most intra- and interregional variability in scope of practice (eg, 42% of European respondents reported nephrologists were primarily responsible for continuous renal replacement therapy vs. 64% globally);
Most respondents (60%) worked at clinics where nephrologists were required to be present in the dialysis facility; and
Many nephrologists rounded each dialysis session (hospitals, 50%; other facilities, 41%).
NN&I: When can we expect to see the final report?
Pivert: The final data collection will be analyzed by later this year, and we are looking at the first or second quarter of 2019 for a final report.
Disclosures: The authors report no relevant disclosures.