Medical Service, Dallas North Texas VA, Dallas, TX; Department of Medicine, University of Texas Southwestern School of Medicine, Dallas, TX.
Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ.
Adv Chronic Kidney Dis. 2020 Jul;27(4):281-290.e1. doi: 10.1053/j.ackd.2020.07.007. Epub 2020 Oct 24.
The number of individuals with CKD and end-stage kidney disease continues to rise as the interest in nephrology as a career choice is declining among internal medicine residents. Simultaneously, the emergence of integrated healthcare delivery models encompassing multiple levels of nonphysician healthcare workers plus advanced technological capabilities offer innovative mechanisms for the delivery of optimal care for patients at risk for and suffering from CKD. Critical to the success of these models is the identification of aspects of nephrology care specific to and appropriate for each type of kidney care professional and the development of organizational structures that both define and facilitate the flow of patient care. However, several factors in addition to the declining interest in nephrology pose significant obstacles to the development of the optimal nephrology work force including gender imbalance in leadership and nonleadership positions, gender disparity in compensation, inadequate diversity in ethnicity of nephrologists, and perceptions of inadequate compensation and a poor work life balance. Recent studies suggest that some, but not all, of these challenges are being addressed, though full resolution will require creative and concerted efforts.
随着内科住院医师对肾病学作为职业选择的兴趣下降，患有 CKD 和终末期肾病的个体人数持续上升。与此同时，涵盖多个级别的非医师医疗工作者以及先进技术能力的综合医疗保健提供模式的出现，为为患有和患有 CKD 的患者提供最佳护理提供了创新机制。这些模式成功的关键是确定肾脏病护理的各个方面，这些方面是针对每种类型的肾脏护理专业人员的，并且制定组织结构，既定义又促进患者护理的流程。然而，除了对肾病学的兴趣下降之外，还有其他几个因素对最佳肾病劳动力的发展构成了重大障碍，包括领导和非领导职位中的性别失衡、薪酬方面的性别差距、肾脏科医生种族多样性不足，以及对薪酬不足和工作生活平衡不佳的看法。最近的研究表明，这些挑战中的一些（但不是全部）正在得到解决，尽管要完全解决这些问题需要创造性和协调一致的努力。
