The 2016 match for nephrology was just released. This is the first year following the ALL-in policy for the nephrology match. Clearly, this is a great way to benefit the candidate and the candidate get’s to see all programs and ranks based on their choice.
ASN just released the key points that the match data revealed.
1. There was a increase in programs (18%) and positions certified in the match. Well this is because it was an ALL IN process so most programs participated. No big deal.
2. The number of matched fellows increased—great! That is good news but this doesn’t imply increased interests.
3. The number of applicants rose 11%- Perhaps reflection that we had ALL –in process and last few years-we never saw those candidates data. Since both the numerator and the denominator increased- we are counting candidates that we hadn't accounted for years ago. Not really an improvement!!
4. Slight uptick in USA grads applying and major down trend in IMGs applying- big loss as they were the main stay for nephrology workforce last few years.
5. Unfilled positions rose to a new high 58%-- biggest bummer of this process
More US grads. More overall applicants( skeptic on that one as data is now due to ALL-in)
Still many more unmatched spots and programs. There are programs in the country unmatched 100%.
Do we have solutions?
While increasing interest in med school and residency is important and critical- clearly it is NOT working at a national level. At the end of the day, re-imbursement of nephrologists calls the shots. We need to really push hard on the government level for more reimbursement for renal physicians. A shortage will happen eventually, there will be a major medical need crisis and then hopefully there will be an uptrend in the salaries of nephrologists—even that is a dream in never never land.
What are programs going to do? Many programs fear- "they might be next." Downsizing fellowship spots is an option and perhaps hiring physician assistants to help out with day to day duties. Researchers will be asked to more clinical time, clinical educators will have to more clinical time and teach less--- all trickling down to less innovation and research in nephrology and less time with trainees.
Applicants to research positions are down-trending. This means that pure clinical fellowships that are big university centers( 2 year)- will fill. The ones that won’t will be large research positions and or small community programs( perhaps). Perhaps programs need to cater towards what the applicants want out of a renal fellowship-- times have changed( Nephrology was not what it was 20 years ago).
Time will change this. As any ups and downs in an economy- there will be eventually a shortage of nephrologists as this trend continues and eventually, there will be an upswing.
Clearly, I am being schizophrenic in this post but I am happy and sad with these results.
Clearly, the national strategy we have might not be working. We need to all put our heads together( both academic and private nephrologists) to really come up with OUT of box ideas to change this trend.
It’s a call for HELP and we need it soon!