The Emerging Nephrology Physician Workforce in the United States: Defining an Impending Shortfall

Abstract

ded match data for this retrospective study of US nephrology fellowship applicants (2009-2024). Annual trends were analyzed with linear regression. Results: The annual number of nephrology fellowship programs (142 to 180, 26.8% higher, P<0.001) and training positions (367 to 488, 33.0% higher, P<0.001) were higher over the study period. In contrast, the annual number of applicants were lower (578 to 362, 37.4% lower, P<0.001). The annual applicant-to-training position ratio was lower (1.6 to 0.7, P<0.001) while the annual match rate was higher (60.2% to 89.4%, P=0.004). The annual rate of unmatched training positions were higher (5.2% to 34.2%, P<0.001) and the percentage of applicants that matched at their first-choice ranked fellowship were higher (37.2% to 60.4%, P=0.02). The annual representation of US allopathic graduates were lower (37.9% to 25.5%, P=0.05 while the annual representation of US osteopathic graduates were higher (4.9% to 16.5%, P<0.001). The annual representation of international medical graduates remained similar (57.2% to 57.9%, P=0.15). Conclusions: The annual number of training positions in nephrology have been higher without commensurate growth in the number of applicants. The rate of unmatched training positions is becoming higher with potential deleterious consequences to future US nephrologist workforce adequacy. Accelerated efforts are needed to emphasize the attractiveness of the specialty and stimulate interest among applicants. Surveillance of future nephrology match outcomes is warranted. Copyright © 2025 by the American Society of Nephrology...