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Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2002 Aug;94(8 Suppl):39S–44S.

Kidney disease physician workforce: where is the emerging pipeline?

Velvie A Pogue 1, Keith C Norris 1, Martin G Dillard 1
PMCID: PMC2594169  PMID: 12152911

Abstract

A predicted increase in the number of patients with end-stage renal disease in coming years, coupled with significant numbers of qualified nephrologists reaching retirement age, will place great demands on the renal physician workforce. Action is required on several fronts to combat the predicted shortfall in full-time nephrologists. Of particular importance is the need to recruit and train greater numbers of physicians from ethnic minority groups. Changes in the demographics of kidney disease make it increasingly a disease of ethnic minorities and the poor. These demographic changes, together with the existing racial disparities in the diagnosis and treatment of kidney disease, highlight the specific need for nephrologists who are cognizant of the issues and barriers that prevent optimal care of high-risk minority populations. The current lack of academic role models and the drive by medical schools and residency programs to encourage minority group physicians to become primary care providers, rather than specialists, are issues that must be urgently addressed. Equally, changes in the training of renal fellows are required to merge the critical need for cutting edge research activity in renal science and with the insights and sensitivity to equip clinicians with the necessary skills for the team-based approach to patient care that increasingly characterizes the management and care of the patient with chronic kidney disease.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson J. E., Torres J. R., Bitter D. C., Anderson S. C., Briefel G. R. Role of physician assistants in dialysis units and nephrology. Am J Kidney Dis. 1999 Apr;33(4):647–651. doi: 10.1016/s0272-6386(99)70214-3. [DOI] [PubMed] [Google Scholar]
  2. Ayanian J. Z., Hauptman P. J., Guadagnoli E., Antman E. M., Pashos C. L., McNeil B. J. Knowledge and practices of generalist and specialist physicians regarding drug therapy for acute myocardial infarction. N Engl J Med. 1994 Oct 27;331(17):1136–1142. doi: 10.1056/NEJM199410273311707. [DOI] [PubMed] [Google Scholar]
  3. Bednar B. A reduction in the nursing labor market and its impact on the renal industry. Nephrol News Issues. 1999 Oct;13(10):27–32. [PubMed] [Google Scholar]
  4. Braden G. L., Mulhern J. G., O'Shea M. H., Nash S. V., Ucci A. A., Jr, Germain M. J. Changing incidence of glomerular diseases in adults. Am J Kidney Dis. 2000 May;35(5):878–883. doi: 10.1016/s0272-6386(00)70258-7. [DOI] [PubMed] [Google Scholar]
  5. Carrillo J. E., Green A. R., Betancourt J. R. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999 May 18;130(10):829–834. doi: 10.7326/0003-4819-130-10-199905180-00017. [DOI] [PubMed] [Google Scholar]
  6. Couser W. G. The Nephrology Manpower Study: what does it mean and what do we do now? J Am Soc Nephrol. 1997 May;8(5):843–845. doi: 10.1681/ASN.V85843. [DOI] [PubMed] [Google Scholar]
  7. Eadington D. W. Delayed referral for dialysis. Nephrol Dial Transplant. 1996 Nov;11(11):2124–2126. doi: 10.1093/oxfordjournals.ndt.a027123. [DOI] [PubMed] [Google Scholar]
  8. Friedman E. A. Grim projections for American nephrologists. Nephrol Dial Transplant. 1997 Apr;12(4):835–836. doi: 10.1093/ndt/12.4.835. [DOI] [PubMed] [Google Scholar]
  9. Glassock R. J. Nephrology workforce and time allocation: important issues for the future. Am J Kidney Dis. 1998 Oct;32(4):672–675. doi: 10.1016/s0272-6386(98)70036-8. [DOI] [PubMed] [Google Scholar]
  10. Gordon A. K. Deterrents to access and service for blacks and Hispanics: the Medicare Hospice Benefit, healthcare utilization, and cultural barriers. Hosp J. 1995;10(2):65–83. doi: 10.1080/0742-969x.1995.11882792. [DOI] [PubMed] [Google Scholar]
  11. Greenfield S., Nelson E. C., Zubkoff M., Manning W., Rogers W., Kravitz R. L., Keller A., Tarlov A. R., Ware J. E., Jr Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA. 1992 Mar 25;267(12):1624–1630. [PubMed] [Google Scholar]
  12. Hoffart N., Nissenson A. R. The future of end-stage renal disease care: nephrology enters a new millennium. Adv Ren Replace Ther. 1998 Oct;5(4):257–266. doi: 10.1016/s1073-4449(98)70017-2. [DOI] [PubMed] [Google Scholar]
  13. Ifudu O., Dawood M., Iofel Y., Valcourt J. S., Friedman E. A. Delayed referral of black, Hispanic, and older patients with chronic renal failure. Am J Kidney Dis. 1999 Apr;33(4):728–733. doi: 10.1016/s0272-6386(99)70226-x. [DOI] [PubMed] [Google Scholar]
  14. Jones C. A., McQuillan G. M., Kusek J. W., Eberhardt M. S., Herman W. H., Coresh J., Salive M., Jones C. P., Agodoa L. Y. Serum creatinine levels in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis. 1998 Dec;32(6):992–999. doi: 10.1016/s0272-6386(98)70074-5. [DOI] [PubMed] [Google Scholar]
  15. Kasiske B. L., London W., Ellison M. D. Race and socioeconomic factors influencing early placement on the kidney transplant waiting list. J Am Soc Nephrol. 1998 Nov;9(11):2142–2147. doi: 10.1681/ASN.V9112142. [DOI] [PubMed] [Google Scholar]
  16. Kravitz R. L., Greenfield S. Variations in resource utilization among medical specialties and systems of care. Annu Rev Public Health. 1995;16:431–445. doi: 10.1146/annurev.pu.16.050195.002243. [DOI] [PubMed] [Google Scholar]
  17. McClellan W. M., Knight D. F., Karp H., Brown W. W. Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: important differences between practice and published guidelines. Am J Kidney Dis. 1997 Mar;29(3):368–375. doi: 10.1016/s0272-6386(97)90197-9. [DOI] [PubMed] [Google Scholar]
  18. Mitch W., McClellan W. M. Patterns of patient care reported by nephrologists: implications for nephrology training. Am J Kidney Dis. 1998 Oct;32(4):551–556. doi: 10.1016/s0272-6386(98)70016-2. [DOI] [PubMed] [Google Scholar]
  19. Mokdad A. H., Ford E. S., Bowman B. A., Nelson D. E., Engelgau M. M., Vinicor F., Marks J. S. Diabetes trends in the U.S.: 1990-1998. Diabetes Care. 2000 Sep;23(9):1278–1283. doi: 10.2337/diacare.23.9.1278. [DOI] [PubMed] [Google Scholar]
  20. Nissenson A. R. Nephrology in the future. Nephrol News Issues. 1998 Apr;12(4):35–37. [PubMed] [Google Scholar]
  21. Nissenson A. R., Pereira B. J., Collins A. J., Steinberg E. P. Prevalence and characteristics of individuals with chronic kidney disease in a large health maintenance organization. Am J Kidney Dis. 2001 Jun;37(6):1177–1183. doi: 10.1053/ajkd.2001.24520. [DOI] [PubMed] [Google Scholar]
  22. Norris K., Owen W. F. The challenges facing minorities: an overview. Nephrol News Issues. 1995 Sep;9(9):33–33. [PubMed] [Google Scholar]
  23. Owen W. F., Jr, Norris K. Nephrologists should be the primary care physician for minority, poor dialysis patients. Nephrol News Issues. 1994 Jun;8(6):54-5, 58. [PubMed] [Google Scholar]
  24. Palepu A., Carr P. L., Friedman R. H., Ash A. S., Moskowitz M. A. Specialty choices, compensation, and career satisfaction of underrepresented minority faculty in academic medicine. Acad Med. 2000 Feb;75(2):157–160. doi: 10.1097/00001888-200002000-00014. [DOI] [PubMed] [Google Scholar]
  25. Radecki S. E., Blagg C. R., Nissenson A. R., Freeman R. B., Feinstein E. I., Gentile D. E., Capelli J. P. End-stage renal disease and the practice of nephrology. Am J Kidney Dis. 1989 Nov;14(5):402–407. doi: 10.1016/s0272-6386(89)80174-x. [DOI] [PubMed] [Google Scholar]
  26. Stivelman J. C., Soucie J. M., Hall E. S., Macon E. J. Dialysis survival in a large inner-city facility: a comparison to national rates. J Am Soc Nephrol. 1995 Oct;6(4):1256–1261. doi: 10.1681/ASN.V641256. [DOI] [PubMed] [Google Scholar]
  27. Thurmond V. B., Cregler L. L. Specialty choices and practice locales of black graduates from a predominantly white medical school. Acad Med. 1993 Dec;68(12):929–930. doi: 10.1097/00001888-199312000-00016. [DOI] [PubMed] [Google Scholar]
  28. Wish J. B. The impact of workforce issues, accountability for patient outcomes. The specialist's role in the 21st century. Part I. Nephrol News Issues. 1999 Mar;13(3):23–53. [PubMed] [Google Scholar]
  29. Xue J. L., Ma J. Z., Louis T. A., Collins A. J. Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. J Am Soc Nephrol. 2001 Dec;12(12):2753–2758. doi: 10.1681/ASN.V12122753. [DOI] [PubMed] [Google Scholar]

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