The Emerging Nephrology Physician Workforce in the United States: Defining an Impending Shortfall.

Key Points: Consistent growth in the number of nephrology fellowship programs and fellowship positions along with a consistent decline in the number of applicants. Approximately one third of available nephrology fellowship training positions went unmatched. The results from this study suggest that the bottleneck to increasing the future nephrologist workforce exists in recruiting interested applicants.

Background: Given projected inadequacies in the United States (US) nephrologist workforce, we sought to define the annual number of training positions, applicants, and unmatched training positions for US nephrology fellowship training.

Methods: The National Resident Matching Program provided match data for this retrospective study of US nephrology fellowship applicants (2009–2024). Annual trends were analyzed with linear regression.

Results: The annual number of nephrology fellowship programs (142–180, 26.8% higher, < 0.001) and training positions (367–488, 33.0% higher, < 0.001) were higher over the study period. By contrast, the annual number of applicants were lower (578–362, 37.4% lower, < 0.001). The annual applicant-to-training position ratio was lower (1.6–0.7, < 0.001), whereas the annual match rate was higher (60.2%–89.4%, = 0.004). The annual rate of unmatched training positions were higher (5.2%–34.2%, < 0.001) and the percentage of applicants that matched at their first-choice ranked fellowship were higher (37.2%–60.4%, = 0.02). The annual representation of US allopathic graduates were lower (37.9%–25.5%, = 0.05), whereas the annual representation of US osteopathic graduates were higher (4.9%–16.5%, < 0.001). The annual representation of international medical graduates remained similar (57.2%–57.9%, = 0.15).

Conclusions: The annual number of training positions in nephrology have been higher without commensurate growth in the number of applicants. The rate of unmatched training positions is becoming higher with potential deleterious consequences to future US nephrologist workforce adequacy. Accelerated efforts are needed to emphasize the attractiveness of the specialty and stimulate interest among applicants. Surveillance of future nephrology match outcomes is warranted.