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.
Am J Kidney Dis. 2013 Apr;61(4):540-6. doi: 10.1053/j.ajkd.2012.10.025. Epub 2013 Jan 16.
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.
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.
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.
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.
人们对肾脏病学的兴趣降低，以至于受训者的数量可能无法满足预计的肾脏病患者数量所带来的即将到来的劳动力需求。我们对从事肾脏病学以外的美国内科亚专业住院医师进行了一项调查，以确定他们为什么不选择肾脏病学。
2011 年夏天，通过内科亚专业项目主任向受训者发送了一份基于网络的调查，其中包含多项选择、是/否和开放式问题。
714 名住院医师对调查做出了回应（回应率为 11%）。所有非肾脏病学的内科亚专业都有代表，90%的受访者来自大学附属项目。在受访者中，31%的人表示肾脏病学是医学院教授的最难生理学课程，26%的人曾考虑过肾脏病学作为职业选择。近四分之一的受访者表示，如果肾脏病学领域的收入更高，或者在医学院和住院医师培训期间这门学科教得更好，他们会考虑肾脏病学。选择不从事肾脏病学的主要原因是认为终末期肾病患者太复杂、缺乏导师，以及肾脏病学中程序不足。
大多数非肾脏病学的内科亚专业住院医师从未考虑过肾脏病学作为职业选择。相当一部分人因患者群体的挑战、缺乏榜样、缺乏程序以及感知到的学科难度等因素而被劝阻。解决这些问题需要肾脏病学家在整个培训社区共同努力。
