Nair Devika, Pivert Kurtis A, Baudy Adrian, Thakar Charuhas V
Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North S-3223, Nashville, TN, 37232-2372, USA.
American Society of Nephrology, Washington, DC, USA.
BMC Nephrol. 2019 Apr 29;20(1):146. doi: 10.1186/s12882-019-1289-y.
Fewer trainees are choosing to pursue nephrology. Only 60.1% of positions filled in the 2018 fellowship Match, which is concerning given the rising prevalence of end-stage kidney disease. Identifying factors influential in career choices is critical to inform focused approaches to recruit qualified applicants.
To understand perceptions of nephrology and assess factors influential in specialty choice among early career trainees, an anonymous survey was distributed to upper-level medical students and internal medicine residents at programs identified through the American Association of Medical Colleges (AAMC) and American Medical Association's Fellowship and Residency Electronic Interactive Database (FREIDA).
Of 4199 recipients, 644 (15.3%) participants responded, including 315 upper-level medical students, 308 residents, and three chief residents from 30 institutions. An interest in the subject was the most critical factor in selecting a specialty (92%). Other key factors included a suitable work-life balance (73%), access to mentors (70%), and subject exposure (66%). Lack of interest was the most frequently-cited reason to forgo a nephrology fellowship (79%), followed by concerns regarding remuneration (43%), work-life balance (39%), and subject exposure (32%). In free-text responses, several participants described frustration with managing patients on hemodialysis and desired combined training with specialties such as critical care. Respondents who had considered nephrology at any point cited an interest in physiology or interface with a mentor as key driving factors.
A lack of interest in and exposure to the subject, perceptions of poor earning potential and patient nonadherence, and concerns regarding work-life balance were influential in participants' decisions to forgo nephrology training. Incorporating novel educational tools and broadening the scope of the nephrology elective, highlighting ongoing areas of clinical and research innovation, expanding opportunities for interdisciplinary collaboration and procedural skills, and cultivating strategies to reduce burnout may be useful areas on which to focus future recruitment efforts.
选择从事肾脏病学的受训人员越来越少。在2018年专科医师匹配中，仅有60.1%的职位得到填补，鉴于终末期肾病患病率不断上升，这一情况令人担忧。确定影响职业选择的因素对于制定有针对性的方法以招募合格申请人至关重要。
为了解对肾脏病学的看法并评估影响早期职业受训人员专业选择的因素，我们向通过美国医学院协会（AAMC）和美国医学协会的专科医师和住院医师电子互动数据库（FREIDA）确定的项目中的高年级医学生和内科住院医师发放了一份匿名调查问卷。
在4199名收件人中，644名（15.3%）参与者做出了回应，包括来自30个机构的315名高年级医学生、308名住院医师和3名总住院医师。对该学科的兴趣是选择专业时最关键的因素（92%）。其他关键因素包括适当的工作与生活平衡（73%）、获得导师指导（70%）以及学科接触（66%）。缺乏兴趣是放弃肾脏病学专科医师培训最常被提及的原因（79%），其次是对薪酬的担忧（43%）、工作与生活平衡（39%）以及学科接触（32%）。在自由文本回复中，几名参与者描述了对管理血液透析患者的沮丧，并希望接受与重症医学等专业的联合培训。曾在任何时候考虑过肾脏病学的受访者将对生理学的兴趣或与导师的交流视为关键驱动因素。
对该学科缺乏兴趣和接触、对收入潜力低和患者不依从的看法以及对工作与生活平衡的担忧影响了参与者放弃肾脏病学培训的决定。纳入新颖的教育工具、拓宽肾脏病学选修课的范围、突出临床和研究创新的持续领域、扩大跨学科合作和操作技能的机会以及培养减少职业倦怠的策略，可能是未来招聘工作应重点关注的有用领域。
