the fellowship training horizon
TRANSCRIPT
Pediatric NephrologyThe Fellowship Training
Horizon
John D Mahan, MD
Nationwide Children’s Hospital
The Ohio State University
Objectives
• Define the number of Pediatric Nephrologists in US and distribution by age and geography
• Define the trends in Pediatric Nephrology Trainees from 1998 to present
• Define the ABP board pass rates for Pediatric Nephrology Fellow Graduates
• Define three obstacles to increasing the number of trainees in Pediatric Nephrology
Pediatric NephrologyABP Certified Diplomates
Age Distribution
29.2% > 60 years old
Total = 631 Avg Age= 56.3 years
Number of ABP Certified Nephrology Diplomates by State
ABP Number of Diplomate Certificates Granted through 12/06
• Total General Pediatricians 87,515• Pediatric Subspecialties 17,490
Adolescent Medicine 505 2.89%Cardiology 2015 11.52%Critical Care Medicine 1454 8.31%Developmental-Behavioral 520 2.97%Emergency Medicine 1446 8.27%Endocrinology 1055 6.03%Gastroenterology 872 4.99%Hematology-Oncology 2051 11.73%Infectious Diseases 992 5.67%Medical Toxicology 31 0.18%Neonatal-Perinatal Medicine 4421 25.28%Nephrology 668 3.38%Neurodevelopmental Disabilities 241 1.38%Pulmonology 821 4.69%Rheumatology 237 1.36%Sports Medicine 120 0.69%Transplant Hepatology 41 0.23%
Pediatric Nephrology Job Market
• Number of open positions in US is unclear
• If all BC pediatric nephrologists > 60 retire in the next 10 years, will need 189 replacements (19/yr)
• Growth in need for pediatric nephrology services?
Number of Pediatric Residency Programs and Residents (end June 30, 2006) - AAP
Specialty/
Subspecialty
# of Accredited
Programs
# of Matched
Residents
Specialty/
Subspecialty
# of Accredited
Programs
# of Matched
Residents
General Pediatrics 204 7936 Pediatric Hematology-Oncology
60 320
Adolescent Medicine 25 72 Pediatric Infectious
Diseases
62 165
Neonatal-Perinatal
Medicine
97 525 Pediatric Nephrology 35 95
Pediatric Cardiology 48 276 Pediatric Pulmonology
46 118
Pediatric Critical Care
Medicine
60 300 Pediatric Rheumatology
25 49
Pediatric Emergency
Medicine
45 238 Pediatric Sports Medicine
8 12
Pediatric Endocrinology 67 191 Developmental-Behavioral Pediatrics
26 51
Pediatric Gastroenterology
51 181 Total 859 10,529Source: Accreditation Council for Graduate Medical Education, 2005.2
Pediatric Nephrology Fellowship Programs
• 2008 - 36 accredited programs in US
• 150 approved training positions
• 105 trainees (70% filled)
ACGME.org/adspublic/ 4/4/08
Pediatric NephrologyFellowship Trainees
0
10
20
30
40
50
60
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
First Yr
Second Yr
Third Yr
Pediatric NephrologyAll Fellowship Trainees
Nephrology Trainees Lost
Pediatric NephrologyAll Fellowship Trainees
0
20
40
60
80
100
120
140
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
First Yr
Total
191% increase
Pediatric NephrologyFellowship Trainees
0
10
20
30
40
50
60
70
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
AMG
IMG
Pediatric NephrologyFellowship Trainees
0
10
20
30
40
50
60
70
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Male
Female
ABP DataTotal Fellows in Training 1998-2006
ABP Pediatric Nephrology Board Results
0
10
20
30
40
50
60
70
80
90
1995 1997 1999 2001 2003 2005
NumberTakers
Pass Rate - AllTakers
Pass Rate - 1stTime Takers
ABPPediatric Subspecialty Board Results
Drop-out/Replacement Issues
• 1999-2005: We qualified 139 board certified nephrologists out of 187 eligible third year fellows (74% of third years take and pass the exam).
• We lose people at each stage – the reasons are not known and likely vary.
• Overall, approximately 45-50% of 1st year fellows become board certified pediatric nephrologists.
• If all currently certified nephrologists > age 60 (n=196) retire in the next five years, we need to produce approximately 40 new successful graduates/year.
• In 2005 there were 52 candidates who took the Boards (26/year).
Pediatric Nephrology Fellowship Training Challenges
• Pool of qualified applicants• Funding• Costs of program (fellow salary, administration,
teaching, etc)• Shared training experiences• Shared program content
– Curriculum– Competency assessments– Board preparation
• Training tailored to career needs• PD Support• Future efforts – ASPN, ASN