Table 2.

Recommendations

Recommendations
Asserting the value of nephrology to the health system
(1) Obtain benchmark data on the financial return and costs for nephrology care in various health systems and practices
(2) Provide division chiefs with resources and a road map to address the value of nephrology to their institutions. Through division chiefs, educate hospital administrators on the true value that nephrology brings to the health system with regard to inpatient care, clinical program support, revenue, medical education, and collaborative clinical research
Physician productivity and compensation
(1) Establish national benchmarks for nephrology productivity and compensation, along with a reanalysis of the RVU system
(2) Optimize nephrology compensation through CMS/ASN exchange to promote a better understanding of the patient complexity in care of the patient with CKD or kidney failure
(3) Benchmark PhD salaries against national data
(4) Convert nephrology completely from a fee-for-service to a value-based model
Financial support of faculty’s and divisions’ educational efforts
(1) Develop a seminar and written information designed for division chiefs on educational financial resources and funds flow to assist nephrology leadership in division budgeting and faculty assignment
(2) Host an early program dedicated to advanced training in education. More intermediate and long-term solutions could be to develop an education academy that regularly meets and is highlighted at ASN Kidney Week and to develop a scholarship fund for career advancement in education
(3) Sponsor a national survey of education-related RVUs
Faculty recruitment, retention, diversity, and inclusion
(1) Leverage current demand outweighing supply of nephrologists to improve compensation
(2) Develop alternative practice models to improve work-life balance and attract a diverse pool of practitioners
(3) Improve and modernize our pedagogical approaches
Ensuring that fellowship programs prepare trainees to provide high-value nephrology care and enhance attraction of trainees to nephrology
(1) Develop advanced practice provider nephrology care certification programs for advanced practice providers taking care of patients with underlying kidney disease
(2) Create certificate programs in areas of subspecialization in nephrology (e.g., onconephrology)
(3) Establish ACGME-approved short tracking into nephrology
(4) Revise medical school and medicine residency curricula on clinical nephrology and kidney physiology, increasing exposure to clinical medical students, interns, and residents
(5) Increase or restructure lecture series, case presentations, reverse classroom techniques, and nephrology electives
(6) Require a 1- or 2-wk nephrology block during every third-year medical student’s rotation in internal medicine (39–41)
(7) Restructure the medicine resident elective in nephrology to include outpatient nephrology clinics, transplant clinics, home dialysis therapies, and chronic hemodialysis (42)
(8) Increase awareness of new sub-subspecialty fields, such as onconephrology, glomerular diseases, genetics of kidney disorders, new targeted molecular therapies especially for transplant and glomerular diseases, and new devices for ESKD
(9) Enhance mentorship of students and residents to provide them with a “role model “for their career path
(10) Use advances in social media for new ideas to teach nephrology (43)
(11) Address geographical deficiencies regarding lack of training expertise by building regional training programs in specific components of nephrology and providing small training centers appropriate support
(12) Establish an accurate estimate of the minimum number of board-certified nephrologists needed to lead the field of nephrology, understanding that with appropriately trained and certified advanced practice providers' support, this may be substantially fewer than the number currently being trained

ASN, American Society of Nephrology; RVU, relative value unit; CMS, Centers for Medicare & Medicaid Services; ACGME, Accreditation Council for Graduate Medical Education.