The Fellowship Training Horizon

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