Factors in career choice among US nephrologists

Abstract

Background and objectives: There is a projected shortage of kidney specialists, and retention of trainees in nephrology is important. Determining factors that result in choosing a nephrology career could inform future strategies to attract nephrology fellows.

Design, settings, participants, & measurements: An anonymous, internet-based survey was sent to members of the American Society of Nephrology in June 2009. Respondents answered questions about demographics, training background, and career choices.

Results: Of the 3399 members, 913 (23%) returned the survey. Mean age was 51.1 ± 10.5 years, and 46.1% were academic nephrologists. In addition, 38.4% of respondents graduated between 2000 and 2009. Interest in nephrology began early in training, with the intellectual aspects of nephrology, early mentoring, and participation in nephrology electives named as the most common reasons in choosing nephrology. Academic nephrologists were more likely to have participated in research in medical school, have a master's degree or PhD, and successfully obtained research funding during training. Academic debt was higher among nonacademic nephrologists. Research opportunities and intellectual stimulation were the main factors for academic nephrologists when choosing their first postfellowship positions, whereas geographic location and work-life balance were foremost for nonacademic nephrologists.

Conclusions: These findings highlight the importance of exposing medical students and residents to nephrology early in their careers through involvement in research, electives, and positive mentoring. Further work is needed to develop and implement effective strategies, including increasing early exposure to nephrology in preclinical and clinical years, as well as encouraging participation in research, in order to attract future nephrology trainees.

Figure 1.

Sex ratios among nephrology graduates over time. The number of practicing nephrologists who are women has been increasing steadily over the last 30 years, with the proportion increasing from 10% of pre-1980 graduates to almost 40% of the most recent graduating classes.

Figure 2.

Initial interest in nephrology. Although overall, the majority of practicing nephrologists reported that their initial interest began in residency, more academic nephrologists reported developing an interest in nephrology before or during medical school (P=0.01).