What Are We Doing? A Survey of United States Nephrology Fellowship Program Directors

Abstract

Interest in nephrology has been declining in recent years. Long work hours and a poor work/life balance may be partially responsible, and may also affect a fellowship's educational mission. We surveyed nephrology program directors using a web-based survey in order to define current clinical and educational practice patterns and identify areas for improvement. Our survey explored fellowship program demographics, fellows' workload, call structure, and education. Program directors were asked to estimate the average and maximum number of patients on each of their inpatient services, the number of patients seen by fellows in clinic, and to provide details regarding their overnight and weekend call. In addition, we asked about number of and composition of didactic conferences. Sixty-eight out of 148 program directors responded to the survey (46%). The average number of fellows per program was approximately seven. The busiest inpatient services had a mean of 21.5±5.9 patients on average and 33.8±10.7 at their maximum. The second busiest services had an average and maximum of 15.6±6.0 and 24.5±10.8 patients, respectively. Transplant-only services had fewer patients than other service compositions. A minority of services (14.5%) employed physician extenders. Fellows most commonly see patients during a single weekly continuity clinic, with a typical fellow-to-faculty ratio of 2:1. The majority of programs do not alter outpatient responsibilities during inpatient service time. Most programs (approximately 75%) divided overnight and weekend call responsibilities equally between first year and more senior fellows. Educational practices varied widely between programs. Our survey underscores the large variety in workload, practice patterns, and didactics at different institutions and provides a framework to help improve the service/education balance in nephrology fellowships.

Keywords: United States; demography; education; faculty; fellowships and scholarships; humans; inpatients; internet; minority groups; nephrology; nephrology fellowship; outpatients; physician assistants; religious missions; survey; surveys and questionnaires; workload.

Figure 1.

Census characteristics of busiest and second busiest services. Distribution of mean number of patients on average and at their maximum for the busiest (A and B) and second busiest (C and D) services.

Figure 2.

Census characteristics of different services based on intended patient population. Mean (±SD) number of patients on average (white bars) and at their maximum (gray bars) for different intended service populations. *P=0.01 versus ESRD, P=0.001 versus general, P<0.001 versus ICU, P=0.001 versus mixed; **P=0.03 versus ESRD, P=0.001 versus general, P=0.01 versus ICU, P=0.002 versus mixed. ICU, intensive care unit.

Figure 3.

Night and weekend call responsibilities. Average number of night (A) and weekend (B) calls covered by a single fellow over a 3-month period.

Figure 4.

Outpatient continuity clinic characteristics. Number of patients (A) and fellow-to-faculty ratio (B) for a typical fellows’ continuity clinic session.