Pediatric Nephrology Practice in the United States: Survey of Pediatric Nephrology Division Directors

Abstract

Rationale & objectives: Addressing the increasing demand for pediatric nephrology care is challenging because of increasing limitations in the size of this workforce. The objective of this study was to characterize the state of pediatric nephrology practices across the United States to inform possible strategies to address this shortfall.

Study design: Cross-sectional survey.

Setting & participants: The American Society of Pediatric Nephrology interest group comprised 92 pediatric nephrology division leaders of pediatric nephrology programs.

Exposures: Practice size defined by number of full-time equivalent (FTE) pediatric nephrologists.

Outcomes: The scope of inpatient and outpatient services related to dialysis and extracorporeal treatment, kidney transplant, procedures (kidney biopsy, ultrasound, ambulatory blood pressure monitoring), faculty roles, and funding for programmatic activities.

Analytical approach: Descriptive and comparative statistics, including the χ² test, Fisher's exact test, t test, and two-proportion Z-test, with significance defined at P<0.05.

Results: Large programs had more outreach capacity, ancillary staffing, independent transplant programs, and on-site outpatient dialysis units and more diverse kidney replacement options. Smaller programs had fewer ambulatory patients and fewer inpatients per FTE pediatric nephrologists. Medium-sized programs had the highest inpatient and ambulatory volume per FTE pediatric nephrologists. Administrative support for transplant, dialysis, and fellowship programs was often limited.

Limitations: Granularity of data was limited. No assessment of trends was performed, and changes in faculty appointment type were not assessed.

Conclusions: Pediatric nephrologists in medium-sized programs had the highest volume of clinical work, and administrative support for transplant, dialysis, and fellowship programs was often insufficient in many programs. These findings may inform strategies to support pediatric nephrology programs and enhance the care they provide.

Plain-language summary: An imbalance exists between the increasing demand for services provided by pediatric nephrologists and the capacity of the pediatric nephrology workforce. The challenges of this imbalance are compounded by professional stress and burnout among pediatric nephrologists and a low level of interest in pediatric nephrology training. This study aimed to characterize the diverse pediatric nephrology practices across the United States by implementing a survey of the division heads of pediatric nephrology programs and classifying the findings into subgroups defined by the size of these programs. Pediatric nephrologists in medium-sized programs had the highest volume of clinical work, and administrative support for transplant, dialysis, and fellowship programs was often limited. These findings may inform the design of interventions to enhance pediatric nephrology care.

Keywords: Workforce, pediatric subspecialty, relative value units.