Increasing work demands and high rates of burnout among nephrologists in the United States are leading to reduced job satisfaction and may be impacting the quality of care being delivered to patients with kidney disease, a series of articles recently published in the Clinical Journal of the American Society of Nephrology (CJASN) suggests. These factors may also be contributing to a continual decline in interest in the specialty among medical students in nephrology, with medical school fellowship slots routinely going unfilled.

“As we worry about how to recruit residents into the field of nephrology, we need to consider how each resident is highly motivated to make the best career decision, not only for personal interests but also, for their health and family responsibilities,” John K. Roberts, MD, wrote in his article, “Burnout in nephrology: Implications on recruitment and the workforce.”

“If we let overwork, emotional exhaustion and depersonalization creep into our specialty, we are putting ourselves and the future of nephrology at risk,” he wrote.

Other articles written by nephrologists Amy Williams, Mitch H. Rosner and Jeffrey S. Berns, with an overview by Ian H. de Boer, suggest that advocates of the specialty need to help define what makes kidney care a rewarding profession.

“It is critical for us to take a step back, ask why we chose nephrology as our specialty, and consider how we can recapture joy and excitement in our practice of nephrology,” Rosner and Berns wrote in their article, “Transforming nephrology.” The authors propose a series of measures that could lead to improvement, focusing on fellowship training, practice transformation, creating a stronger community of nephrologists, stimulating the cognitive aspects of practice and enhancing the clinical scope of practice of nephrology.

In his summary of the papers, de Boer urged leadership in the specialty to address burnout.

“The perspectives by Rosner and Berns and Williams eloquently lay out the scope of challenges facing nephrologists today, including long work hours, multiple clinical practice sites, heavy burden of documentation, increasing regulatory intrusiveness, demanding payment models and lower salaries relative to other subspecialties,” he wrote.

“Further dissected are the downstream consequences of these stressors, including cynicism, pessimism, emotional exhaustion, low sense of accomplishment and deterrence of trainees choosing nephrology as a career … It is apparent that the nephrology community is at a crossroads — either we accept this fate,” wrote de Boer, “or we take a new direction that
restores job satisfaction and enables the highest quality of care for our patients.” – by Mark E. Neumann

de Boer IH. Clin J Am Soc Nephrol. 2018;doi:10.2215/CJN.09070817.
Roberts JK. Clin J Am Soc Nephrol. 2018;doi: doi:10.2215/CJN.09870917.
Rosner MH, et al. Clin J Am Soc Nephrol. 2018;doi:10.2215/CJN.02310317.

Disclosures: The authors report no relevant financial disclosures.