ASN Presidential Address 2013: innovation and individualization--the path forward for nephrology.

Welcome to the 47th Annual Meeting of the American Society of Nephrology (ASN)—Kidney Week 2013. Thank you for helping to lead the fight against kidney disease in the United States and across the globe. As ASN President, I would like to thank you for the opportunity to lead this outstanding organization over the past year. I did it with the help of a remarkable and interactive ASN Council and the wonderful ASN staff. Special mention goes to the ASN Program Committee (chaired by Anupam Agarwal, MD, FASN) and the Postgraduate Education Committee (chaired by Mark E. Rosenberg, MD, FASN). There are no sufficient accolades to describe what they were able to accomplish and what you will benefit from over the next 4 days. The ASN staff directly responsible for Kidney Week deserves special recognition for their steadfast support. Finally, I would like to acknowledge ASN Executive Director Tod Ibrahim, whose leadership, sense of responsibility, and dedication are reflected throughout the entire organization. ASN is an outstanding, creative, and growing organization with great leadership. I am pleased to report that ASN has never been inbetter shape than it is today. However, nephrology faces many challenges now and in the future. Why am I concerned? And what must we do to reinvigorate one of the most potentially exciting and important areas of medicine? In the United States and manyother countries, interest amongmedical students and residents in nephrology careers is at an all-time low and has been declining over the past 10 years.1–3 This finding is evidenced by a markedmultiyear decline in the number of United States medical students entering the nephrology match (most recently, less than 32% of available positions). The United States is fortunate, because talented graduates from international medical schools have filled the available fellowship positions (Figure 1).However,when this year’smatch results are announced next month, I anticipate that there will not be enough total applicants to fill the available positions, primarily because of a decrease in thenumbers of international graduates participating. What does it say about a discipline unable to attract future generations into the field from our own medical schools?