title: Why not nephrology? A survey of US internal medicine subspecialty fellows.
abstract: BACKGROUND
  There is a decreased interest in nephrology such that the number of trainees likely will not meet the upcoming workforce demands posed by the projected number of patients with kidney disease. We conducted a survey of US internal medicine subspecialty fellows in fields other than nephrology to determine why they did not choose nephrology.
  
  
  METHODS
  A web-based survey with multiple choice, yes/no, and open-ended questions was sent in summer 2011 to trainees reached through internal medicine subspecialty program directors.
  
  
  RESULTS
  714 fellows responded to the survey (11% response rate). All non-nephrology internal medicine subspecialties were represented, and 90% of respondents were from university-based programs. Of the respondents, 31% indicated that nephrology was the most difficult physiology course taught in medical school, and 26% had considered nephrology as a career choice. Nearly one-fourth of the respondents said they would have considered nephrology if the field had higher income or the subject were taught well during medical school and residency training. The top reasons for not choosing nephrology were the belief that patients with end-stage renal disease were too complicated, the lack of a mentor, and that there were insufficient procedures in nephrology.
  
  
  CONCLUSIONS
  Most non-nephrology internal medicine subspecialty fellows never considered nephrology as a career choice. A significant proportion were dissuaded by factors such as the challenges of the patient population, lack of role models, lack of procedures, and perceived difficulty of the subject matter. Addressing these factors will require the concerted effort of nephrologists throughout the training community.
authors: Division of Kidney Diseases and Hypertension, Department of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra North Shore-LlJ School of Medicine, Great Neck, NY 11021, USA. kdj200@gmail.com
authors: Kenar D
authors: KD
authors: Jhaveri
authors: Matthew A
authors: MA
authors: Sparks
authors: Hitesh H
authors: HH
authors: Shah
authors: Seyyar
authors: S
authors: Khan
authors: Arun
authors: A
authors: Chawla
authors: Tejas
authors: T
authors: Desai
authors: Edward
authors: E
authors: Iglesia
authors: Maria
authors: M
authors: Ferris
authors: Mark G
authors: MG
authors: Parker
authors: Donald E
authors: DE
authors: Kohan
mesh_terms: D002321:Career Choice; D005257:Fellowships and Scholarships; D006801:Humans; D007388:Internal Medicine / Q000193:education; D008019:Life Style; D008611:Mentors / Q000706:statistics & numerical data; D009398:Nephrology / Q000193:education; D014481:United States; D000078329:Workforce