Nephrology Workforce:
Nephrology Workforce:
Challenges for the Future Challenges for the Future
Jay Wish, MD Jay Wish, MD
The Renal Network Annual Conference The Renal Network Annual Conference The Renal Network Annual Conference The Renal Network Annual Conference
March 11, 2009
March 11, 2009
Ground Zero: 1997
Ground Zero: 1997
Scena io #6 Scena io #6 Scenario #6 Scenario #6
Annual ESRD prevalence growth 5% Annual ESRD prevalence growth 5%
Annual CKD prevalence growth 5% Annual CKD prevalence growth 5% p p g g
Nephrologists provide primary care Nephrologists provide primary care services to CKD and non
services to CKD and non--CKD patients CKD patients pp
Would need total increase in nephrology Would need total increase in nephrology FTEs of 4900 by 2000 (but only 2400 for FTEs of 4900 by 2000 (but only 2400 for y y ( ( y y the renal care)
the renal care)
Actually increased by 1000 so far by 2008 Actually increased by 1000 so far by 2008 y y y y y y
Doom and Gloom in 1997 Doom and Gloom in 1997 Doom and Gloom in 1997 Doom and Gloom in 1997
Intensivists taking over nephrology care in Intensivists taking over nephrology care in ICUs (including CRRT)
ICUs (including CRRT) ( ( g g ) )
Radiologists taking over renal biopsies Radiologists taking over renal biopsies
Nephrology nurse practitioners competing Nephrology nurse practitioners competing
Nephrology nurse practitioners competing Nephrology nurse practitioners competing with nephrologists for business
with nephrologists for business
PCP ithh ldi f l f CKD ti t PCP ithh ldi f l f CKD ti t
PCPs withholding referrals of CKD patients PCPs withholding referrals of CKD patients because of fear of losing patients
because of fear of losing patients
Ho Has Neph olog Adapted?
Ho Has Neph olog Adapted?
How Has Nephrology Adapted?
How Has Nephrology Adapted?
Physician extenders (0.32/FTE Physician extenders (0.32/FTE nephrologist in 2005)
nephrologist in 2005) p p g g ) )
Relinquish care of general medicine Relinquish care of general medicine patients
patients patients patients
Relinquish primary care of CKD and ESRD Relinquish primary care of CKD and ESRD patients
patients patients patients
Sub Sub--subspecialize practice to increase subspecialize practice to increase ffi i
ffi i
efficiency
efficiency
How Many Dialysis How Many Dialysis y y y y Patients Are There?
Patients Are There?
Year
Year 20062006 20072007 20082008 SIMS
SIMS USRDS USRDS
345,280 345,280 354,754 354,754
358,132
358,132 370,014370,014 Prevalence
Prevalence Dec. 31
Dec. 31
,,
Annual Annual Increase
Increase 3.8%3.8% 3.7%3.7% 3.3%3.3%
Projected counts of prevalent dialysis Projected counts of prevalent dialysis
patients through 2020 (autoregression model)
Figure 2.34
Counts projected using forecasting & time series analysis. Original projection uses two models with data from 1982
2007 ADR
through 1997; new projection uses data from 1980 through 2005.
How Many Transplant Patients Are There?
How Many Transplant Patients Are There?
How Many Transplant Patients Are There?
How Many Transplant Patients Are There?
Year
Year 20042004 20052005 20062006 USRDS
USRDS 136,136136,136 141,693141,693 151,502151,502 OPTN
OPTN
(K + K/P) (K + K/P)
102,320
102,320 104,388104,388 (K + K/P)
(K + K/P) Annual Annual Increase
Increase 6.2/6.1%6.2/6.1% 4.1/2.0%4.1/2.0% 6.9%6.9%
Increase Increase
Projected counts of prevalent transplant Projected counts of prevalent transplant
patients through 2020 (autoregression model)
Figure 2.35
OPTN
Counts projected using forecasting & time series analysis. Original projection uses two models with data from 1982 through 1997; new projection uses data from 1980 through 2005. Original actual counts are consistently lower than
2007 ADR
present actual counts; in remaining figures, original actual counts differ substantially from present actual counts.
Stages of CKD and Prevalence Estimates Stages of CKD and Prevalence Estimates
An estimated 8 million patients have later stage chronic kidney disease and an additional 20 million have some degree of renal impairment
GFR Level Prevalence
Stage 1 >90 10,500,000
Stage 2 60-89 7,100,000
17.6 million
Stage 3 30-59 7,600,000
Stage 4 15-29 400,000
8.0 million
Stage 4 15 29 400,000
Stage 5 <15 (or dialysis) 300,000
TreatmentTrendsTM: Nephrology Q208 Published: July 10, 2008
©BioTrends Research Group, All Rights Reserved.
*Data for Stages 1-4 from NHANES III (1988-1994)1. Population of 177 million adults age < 20 years. Data for Stage 5 from USRDS (1998)2include approximately 230,000 patients treated by dialysis, and assume 70,000 additional patients not on dialysis. GFR estimated from serum creatinine using MDRD Study equation based on age, gender, race and calibration for serum creatinine. For stages 1 and 2, kidney damage estimated by spot albumin-to- creatinine ratio >17 mg/g in men or >25 mg/g in women on two measurements.
The prevalence of CKD Stages 1-4 increased from 10.0% to 13.1% between 1988-1994 and 1999-2004
Prevalence Prevalence
of CKD
of CKD Prevalence Prevalence of CKD of CKD
Total Patients Total Patients
(240M US (240M US
of CKD of CKD 1988
1988--19941994 of CKD of CKD 1999
1999--20042004 Adults)Adults) Stage 1
Stage 1gg 1.7%1.7% 1.8%1.8% 4.3 million4.3 million Stage 2
Stage 2 2.7%2.7% 3.2%3.2% 7.7 million7.7 million
St 3
St 3 5 4%5 4% 7 7%7 7% 18 5 illi18 5 illi Stage 3
Stage 3 5.4%5.4% 7.7%7.7% 18.5 million18.5 million Stage 4
Stage 4 0.21%0.21% 0.35%0.35% 840,000840,000 Total
Total 10.0%10.0% 13.1%13.1% 31.3 million31.3 million
Coresh et al: JAMA 298: 2038-2047, 2007
U.S. Medical School First-Year Enrollment, 1998-2008
18500
17500 18000
al school t
16500 17000
ar medica enrollmen
15500 16000
First-yea e
15000
1998
1999
2000
2001
2002 200
3
2004
2005
2006
2007
2008
AAMC Data Warehouse: As of October 10, 2008
Association of American Medical Colleges Association of American Medical Colleges
April 2008 April 2008
85% f di l h l h ith
85% f di l h l h ith
>85% of medical schools have either >85% of medical schools have either already expanded their first
already expanded their first--year year
ll t l t d
ll t l t d
enrollment or plan to expand.
enrollment or plan to expand.
A number of new medical schools plan A number of new medical schools plan to matriculate their first classes in the to matriculate their first classes in the near future.
near future.
Projections indicate that a 30 percent Projections indicate that a 30 percent increase in first
increase in first--year enrollment will be year enrollment will be yy reached by 2017.
reached by 2017.
Analysis in Brief (http://www.aamc.org/data/aib)
Renal Fello ship T aining 2008 Renal Fello ship T aining 2008 Renal Fellowship Training 2008 Renal Fellowship Training 2008
8 new fellowship programs since 2005 8 new fellowship programs since 2005
8 new fellowship programs since 2005 8 new fellowship programs since 2005 (total 136)
(total 136)
About 390 fellows complete training each About 390 fellows complete training each
About 390 fellows complete training each About 390 fellows complete training each year (increased 50 since 2005)
year (increased 50 since 2005)
1/3 ( lik l t k t
1/3 ( lik l t k t titi ))
1/3 are women (more likely to work part1/3 are women (more likely to work part--time)time)
31% stay in academic environment31% stay in academic environment
6% k dd l (
6% k dd l (
6% take additional training (e.g. 6% take additional training (e.g.
interventional) interventional)
48% IMG d 5
48% IMG d 5 7% h7% h ii ii
48% are IMGs and 548% are IMGs and 5--7% have visa issues7% have visa issues
Trends In Adult Nephrology Training Trends In Adult Nephrology Training
800 900
600 700 800
400 500
Number
Trainees Programs
100 200 300
0 100
998
999
000
001
002
003
004
005
006
007 199 199
200
200 200 200
200 200 200
200
Applicants to Internal Medicine Specialties
Cardiovascular disease Endocrinology
Gastroenterology Heme/Onc
Nephrology
1600 1800
Nephrology
Pulm/Critical care Rheumatology
1000 1200 1400
applicants
600 800 1000
Number of a
0 200
N 400
2006 2007 2008
Data from ERAS (http://www.aamc.org/programs/eras/programs/statistics)
Nephrology Match 2008
Nephrology Nephrology
Tracks Tracks
Number of Number of Participating Participating
Number of Number of Programs Filled Programs Filled
Number of Number of
Positions Positions
Number of Number of Positions Filled Positions Filled
p gy
Tracks
Tracks Participating Participating Programs Programs
Programs Filled
Programs Filled Positions Positions Available Available
Positions Filled Positions Filled
Clinical
Clinical 114114 104104 305305 291291
Research Research (general) (general)
16
16 1313 4242 3939
(g )
(g )
Clinical Clinical Research Research
6
6 55 1313 1212
Basic Science
Basic Science 66 55 77 66
Basic Science Basic Science
Research Research
6
6 55 77 66
Total
Total 142142 127127 367367 348348
Nephrology Match 2008 Nephrology Match 2008
Type of Graduate
Type of Graduate Nephrology Fellowship Nephrology Fellowship Positions Filled by SMS Positions Filled by SMS
by Applicant Type by Applicant Type
All Internal Medicine All Internal Medicine Fellowship Positions Filled Fellowship Positions Filled
by SMS by SMS
b li
b li
by Applicant Type by Applicant Type IMG
IMG 170 (49%)170 (49%) 942 (33%)942 (33%) USMG
USMG 132132 15581558
USMG
USMG 132132 15581558
US IMG
US IMG 2727 246246
DO
DO 1717 134134
Other
Other 22 99
Total
Total 348348 28892889
ROLE OF INTERNATIONAL MEDICAL GRADUATES IN THE U.S. PHYSICIAN WORKFORCE
American College of Physicians - 2008
IMG iti ll i t t t U S h lth ti f 36% f i t l
IMGs are critically important to U.S. health care, accounting for 36% of internal medicine physicians.
In FY2005, 45.3% of H-1B visas were granted to computer-related occupations, , % g p p , while 6.2% were awarded in medicine.
Recommendation of the American College of Physicians
Streamline and expand the process for obtaining J-1 and H1B visas for IMGs who desire postgraduate medical training and/or medical practice in the U.S.
USMG applicants to fellowships
Cardiovascular disease Endocrinology
Gastroenterology Heme/Onc
50 60
ants)
/ Nephrology
Pulm/Critical care Rheumatology
40
% of total applica
20 30
MG applicants (%
0
MUS 10
0
2006 2007 2008
Data from ERAS (http://www.aamc.org/programs/eras/programs/statistics)
2007 Nephrology graduates' career plans gy g
Completing training 368
With known plans 305 (82 9%)
With known plans 305 (82.9%)
Pursuing more training 32 (10.5%)
Practicing in the US 192 (63.0%)
Group practice 77 6%
Group practice 77.6%
In NHSC or similar underserved area 1.6%
Academician 76 (24.9%)
http://www0.ama-assn.org/vapp/freida/career/0,1238,148,00.html
Imprinting Nephrology on Medical Imprinting Nephrology on Medical
Students and Residents Students and Residents
Increased clinical involvement Increased clinical involvement
Increased clinical involvement Increased clinical involvement
Follow patient and family through renal Follow patient and family through renal transplant
transplant transplant transplant
Become involved in CKD outreach (NKF Become involved in CKD outreach (NKF KEEP)
KEEP) KEEP) KEEP)
Mentorship Mentorship
Innovative approaches Innovative approaches -- new models that new models that consider gender, race, background
consider gender, race, background
Nephrology fast track Nephrology fast track
Are we meeting fellows’
Are we meeting fellows’
educational needs?
educational needs?
educational needs?
educational needs?
Teaching and evaluation Teaching and evaluation
National core curriculumNational core curriculum
InIn--training examinationtraining examination
InIn training examinationtraining examination
Training the teachersTraining the teachers
Scholarly analysis ofScholarly analysis of
Scholarly analysis of Scholarly analysis of outcomes
outcomes
ACGMEACGME
ACGMEACGME
Milestones Project
•Every 6 months, faculty report fellow's progress through the ACGME portfolio
•Program’s performance compared to specialty-specific national milestones
•Program directors annually report program data
•Accreditation cycles may extend to 8 to 10 years.
•“Within our grasp” in a few years
Are we meeting fellows’
Are we meeting fellows’
d ti l d ?
d ti l d ?
educational needs?
educational needs?
Preparation for practice Preparation for practice
• Effectiveness of renal fellowship training not published since 1991*
Preparation for practice Preparation for practice
• Areas needing improved training
Peritoneal dialysis
Peritoneal dialysis
Geriatric nephrology
Interpretation of radiographic tests
End-of-life care
Business of nephrology
The nephrologist in societyThe nephrologist in society
*Kimmel and Bosch, AJKD, 18: 249
Are we meeting educational needs?
Are we meeting educational needs?
Sub
Sub--specialization and procedures specialization and procedures Sub
Sub--specialization and procedures specialization and procedures
Prior to 2008, no analysis of training program procedural Prior to 2008, no analysis of training program procedural training for almost 20 years*
training for almost 20 years*gg yy
Biopsies and temporary access almost universally taught Biopsies and temporary access almost universally taught despite current practice trends
despite current practice trends
1515--20% of programs train interventionalists20% of programs train interventionalists
Estimate 20Estimate 20--30% of programs will train interventionalists in 30% of programs will train interventionalists in near future, meeting projected needs
near future, meeting projected needs
EvidenceEvidence--based guidelines for all procedures neededbased guidelines for all procedures needed
ACGME accreditation or ABIM certificationACGME accreditation or ABIM certification
Transplant nephrologyTransplant nephrology
Most nephrologists care for transplant patientsMost nephrologists care for transplant patients
All fellows should be trainedAll fellows should be trained
Are separate transplant fellowships valuable?Are separate transplant fellowships valuable?
ACGME accreditation or ABIM certificationACGME accreditation or ABIM certification
*Berns and O’Neil, CJASN, 2008
Developing system awareness Developing system awareness
and responsibility:
and responsibility:
and responsibility:
and responsibility:
Our future at risk Our future at risk
Training fellows to understand the forces Training fellows to understand the forces
driving changes in academic internal medicine driving changes in academic internal medicine driving changes in academic internal medicine driving changes in academic internal medicine and to develop the tools to help challenge
and to develop the tools to help challenge traditional beliefs*
traditional beliefs*
Training fellows to understand the renal Training fellows to understand the renal
healthcare system in the context of national healthcare system in the context of national priorities and evolving economic pressures.
priorities and evolving economic pressures.
Training fellows as leaders in social and Training fellows as leaders in social and
i l h l h li Th R l
i l h l h li Th R l
economic renal healthcare policy: The Renal economic renal healthcare policy: The Renal MPH.
MPH. *Ibrahim, CJASN, 2008
U.S. Academic Nephrology Faculty
1,200 1,000
,
y
600 800
er of facult
200
eNumb 400
0 200
2005 2006 2007
Data from http://www.aamc.org/data/facultyroster/reports.htm
Increasing Nephrology Research Increasing Nephrology Research
Amongst Trainees Amongst Trainees
Mentoring Mentoring -- new models are needed new models are needed
Research opportunities Research opportunities
Target all, particularly MDTarget all, particularly MD--PhDsPhDs
Local, regional and national meetingsLocal, regional and national meetings
Workshops for traineesWorkshops for trainees
Conferences with trainee focusConferences with trainee focus
Loan payback Loan payback
Nephrology fast track Nephrology fast track
Nephrology fast track Nephrology fast track
Target Areas for Nephrology Workforce Enhancement Target Areas for Nephrology Workforce Enhancement
EnrollmentEnrollment
Enrollment Enrollment
Increase interest in nephrology as a careerIncrease interest in nephrology as a career
Increase interest in nephrology research as a careerIncrease interest in nephrology research as a career
EducationEducation
Meeting RRC regulationsMeeting RRC regulations
Core curriculumCore curriculum
Core curriculumCore curriculum
Teaching toolkit onlineTeaching toolkit online
ConferencesConferences
Specialized training centers and simulationsSpecialized training centers and simulations
Specialized training centers and simulationsSpecialized training centers and simulations
Testing Testing -- summative and formativesummative and formative
EvaluationEvaluation
Scholarly analysis and publications/abstractsScholarly analysis and publications/abstracts
Outcomes data used to direct education training and RRC rulesOutcomes data used to direct education training and RRC rules
Multicenter studiesMulticenter studies
Interaction with other societiesInteraction with other societies
Interaction with public policy makersInteraction with public policy makers
Workforce Catching Up ? Workforce Catching Up ? Workforce Catching Up ? Workforce Catching Up ?
+4 390
+4
Hi lf b t l JASN 18 2021 2007 Himmelfarb et al: JASN 18: 2021, 2007
Current Workforce Issues Current Workforce Issues
About 5500 FTE nephrologists in the US About 5500 FTE nephrologists in the US (increased from 4500 in 1997 or 22% or (increased from 4500 in 1997 or 22% or (increased from 4500 in 1997 or 22% or (increased from 4500 in 1997 or 22% or
~2%/yr)
~2%/yr)
Emphasis on the MCP for dialysis (G codes) hasEmphasis on the MCP for dialysis (G codes) haspp yy (( ))
Increased the role of physician extenders to roundIncreased the role of physician extenders to round
Shifted resources from CKD to ESRDShifted resources from CKD to ESRD
N t i d ti t t
N t i d ti t t
Not improved patient outcomesNot improved patient outcomes
Increased duties for the Medical Director in new Increased duties for the Medical Director in new Conditions of Coverage (25% effort)
Conditions of Coverage (25% effort) Conditions of Coverage (25% effort) Conditions of Coverage (25% effort)
Will increased role of LDOs in preWill increased role of LDOs in pre--ESRD care ESRD care make it more cost
make it more cost--effective and shift nephrology effective and shift nephrology gg work in that direction?
work in that direction?
How Nephrology PAs Spend Their Time How Nephrology PAs Spend Their Time How Nephrology PAs Spend Their Time How Nephrology PAs Spend Their Time
Anderson et al: AJKD 33: 647, 1999
Be Careful What You Wish For Be Careful What You Wish For
19.3 million stage 3 and 4 CKD patients means 19.3 million stage 3 and 4 CKD patients means 3450 per FTE nephrologist
3450 per FTE nephrologist
Based on 20/80 rule, only 3.7 million stage 3 Based on 20/80 rule, only 3.7 million stage 3 and all stage 4 CKD patients require a
and all stage 4 CKD patients require a
nephrologist’s care (818 CKD patients per nephrologist’s care (818 CKD patients per nephrologist’s care (818 CKD patients per nephrologist’s care (818 CKD patients per nephrologist)
nephrologist)
Currently each FTE nephrologist cares forCurrently each FTE nephrologist cares for
Currently, each FTE nephrologist cares for Currently, each FTE nephrologist cares for
about 500 stage 3 and 4 CKD patients*about 500 stage 3 and 4 CKD patients*
70 stage 5 CKD patients not yet on RRT*70 stage 5 CKD patients not yet on RRT*
85 ESRD patients (dialysis + transplant)**85 ESRD patients (dialysis + transplant)**
Triggers for nephrology referral vary widely by Triggers for nephrology referral vary widely by practice
practice practice practice
*BioTrends data **Prevalent/FTEs
Practice Demographics Practice Demographics
z 182 Respondents
39% in practice 2 - 10 years
42% in practice 11 - 20 years
In Q108, 59% of the respondents had been in
practice 2-10 years
19% in practice 21 - 30 years
z Practice location is urban (56%), suburban (36%), and rural (8%)
z An average of 5.6 Nephrologists per practice
s 50%
60%
70%
ercent of Nephrologists
20%
30%
40%
50% 78% of respondents
are office-based
Pe
0%
10%
20%
Office (Neph Office (Multi- Hospital- Hospital- VA
TreatmentTrendsTM: Nephrology Q208 Published: July 10, 2008
©BioTrends Research Group, All Rights Reserved.
Q2. How long have you been in practice? (n=182)
Q9. Would your practice best be described as office based nephrology specialty, office based multi-specialty group, hospital based academic center, hospital based community hospital, VA, or Other (n=182)
Q10. Including yourself, how many TOTAL Nephrologists are in your practice? (n=182) Q11. Is your practice located in an urban, suburban, or rural location? (n=182)
Office (Neph Specialty)
Office (Multi Specialty)
Hospital Academic
Hospital Community
VA
Prevalence of CKD: Nephrologists Prevalence of CKD: Nephrologists
Nephrologists report having an average of more than 500 CKD Stage 3 and CKD Stage 4 patients
Patients Under Management Patients Seen in a Given Month
Mean Median Mean Median
Mean Median Mean Median
Stage 1 CKD Patients (GFR > 90) 76 40 12 10
Stage 2 CKD Patients (GFR 60-89) 160 80 28 15
Stage 3 CKD Patients (GFR 30-59) 315 200 64 45
Stage 4 CKD Patients (GFR 15-29) 192 150 48 30
Stage 5 CKD - Not on Dialysis 71g y 40 21 15
(GFR <15)
BioTrends Research Group, Inc Special Report: Referrals in Nephrology Published: May 2008 How many patients in the following categories are currently under your management whom you have seen at least once in the past year?
How many patients do you typically see in a given month?
Reasonable Triggers for Reasonable Triggers for
N h l R f l
N h l R f l
Nephrology Referral Nephrology Referral
Early age of onsetEarly age of onset
Rapid progressionRapid progression
Uncertain etiologyUncertain etiology
Significant proteinuriaSignificant proteinuria
DuBose: ASN Presidential Address, 2006
All patients with stage 4 CKDAll patients with stage 4 CKD
Known autoimmune diseaseKnown autoimmune disease
Severe or difficultSevere or difficult--toto--control hypertensioncontrol hypertension
Roderick P, et al: QJM. 2002;95:363-70.
How Do Nephrologists How Do Nephrologists
Prove Their Worth?
Prove Their Worth?
Prove Their Worth?
Prove Their Worth?
Is the decrease in growth of the ESRD Is the decrease in growth of the ESRD
Is the decrease in growth of the ESRD Is the decrease in growth of the ESRD population due to improved CKD care or population due to improved CKD care or more deaths among a sicker CKD
more deaths among a sicker CKD gg population?
population?
Will the CKD and ESRD elements in the Will the CKD and ESRD elements in the PQRI and the Phase III ESRD CPMs show PQRI and the Phase III ESRD CPMs show good patient care?
good patient care?
Will nephrologists be marginalized by the Will nephrologists be marginalized by the LDOs in a (possible) global capitated
LDOs in a (possible) global capitated
i t f ESRD?
i t f ESRD?
environment for ESRD?
environment for ESRD?
Physicians Quality Reporting Physicians Quality Reporting Physicians Quality Reporting Physicians Quality Reporting
Initiative (PQRI) Initiative (PQRI)
Voluntary, associated with a 1.5% Voluntary, associated with a 1.5%
bonus payment on Medicare patients bonus payment on Medicare patients bonus payment on Medicare patients bonus payment on Medicare patients
Inevitably the first step toward Inevitably the first step toward
physician P4P and public accountability physician P4P and public accountability physician P4P and public accountability physician P4P and public accountability
Chose Column A or Column B Chose Column A or Column B
Column B ESRD Column A – CKD
•ACE or ARB Rx
T ti f C h
Column B – ESRD
•% HD patients with AVF or referred to surgeon
•Testing for Ca, phos and PTH
•BP management
or referred to surgeon
•% patients who received flu vaccine
BP management
•Plan of care for Hgb
>12 in patients taking
•% patients with Hgb >11 or with plan of care
% HD ti t ith Kt/V
p g
ESAs •% HD patients with Kt/V
>1.2 or with plan of care
•% PD patients with Kt/V
•% PD patients with Kt/V
>1.7 or with plan of care
CKD patients under the care of a nephrologist in the two years prior nephrologist in the two years prior to ESRD, by age & race/ethnicity
Figure hp.9
Incident ESRD patients, age 67 & older at initiation; pre-ESRD nephrologist care identified through at least one physician/supplier claim with a physician specialty code of “nephrologist.” For Hispanic patients we present data beginning in 1996, the first full year after the April 1995 introduction of the revised Medical Evidence form, which
2007 ADR
contains more specific questions on race & ethnicity.
Objective 4.3: Pre-ESRD counseling, j g, (nephrologist care)
Figure hp.28
lla illi
lla
illi Incident dialysis
patients, 2005, with new (revised edition) M di l E id
Medical Evidence forms. Only includes patients for whom it is known whether they saw a nephrologist.
2007 ADR
Realities of the Future Realities of the Future
The entry of new nephrology trainees will The entry of new nephrology trainees will
increase the workforce by <3% annually after increase the workforce by <3% annually after yy yy departures figured in (390 in, 240 out)
departures figured in (390 in, 240 out)
There are 2 open positions available for each There are 2 open positions available for each nephrology trainee entering practice
nephrology trainee entering practice nephrology trainee entering practice nephrology trainee entering practice
Average FTE nephrologist in 2005 (RPA)Average FTE nephrologist in 2005 (RPA)
Worked 58 hours/weekWorked 58 hours/week
Billed 12,993 RVUsBilled 12,993 RVUs
Made $282,280Made $282,280
In the future nephrologists will have to workIn the future nephrologists will have to work
In the future, nephrologists will have to work In the future, nephrologists will have to work harder
harder
To maintain incomeTo maintain income
T k f h i
T k f h i
To take care of the patientsTo take care of the patients
Thanks to Thanks to Thanks to Thanks to
Dale Singer, RPA Dale Singer, RPA
Jennifer Robinson BioTrends Research Jennifer Robinson BioTrends Research
Jennifer Robinson, BioTrends Research Jennifer Robinson, BioTrends Research Group Inc.
Group Inc.
Martin Osinski American Medical Martin Osinski American Medical
Martin Osinski, American Medical Martin Osinski, American Medical Consultants
Consultants
D ld K h MD
D ld K h MD