Future workforce needs for pediatric nephrology: an analysis of the nephrology workforce and training requirements by the Workforce Committee of the American Society of Pediatric Nephrology.

A national re-examination of the physician workforce in the United States has been the focus of professional and governmental bodies in recent years. There is general agreement that a surplus of specialists, a shortage of minority and general physicians, and a maldistribution of physicians may exist (1). On the other hand, relatively little discussion has centered on the appropriate number of pediatric subspecialists, either in total or in specific subspecialties. A decidedly different ratio of general physicians to subspecialists exists between pediatricians and internal medicine specialists; yet, sweeping recommendations for modifying the ratio of subspecialists to general physicians frequently fail to consider the differing health care needs of children and adults (2). Similarly, a call for reducing the number of international medical graduates (1MG) who receive their graduate medical education in the United States had wide support (3). The influence of this action on the workforce in pediatric specialties has not been clarified. Failure to evaluate the specific training needs for pediatric subspecialty disciplines carefully could result in inadequate or substandard care for children with serious and/or chronic disorders in the future. Maintaining an appropriate number of skilled pediatric nephrologists to meet the clinical needs of children with renal disease and sustain the academic mission of pediatric nephrology has been, and continues to be, a long-term objective of the American Society of Pediatric Nephrology (ASPN) (4). The ASPN was founded in 1968 and worked with the American Board of Pediatrics to establish a Sub-Board of Pediatric Nephrology in 1970. Since the first examination in 1974, 496 pediatric nephrologists have received certification in this subspecialty. In 1995, the American Medical Association physician master file database documented 260 physicians who reported a primary specialty in pediatric nephrology, with an additional 123 who had a secondary specialty in pediatric nephrology (5). Pediatric nephrologists represent 6.4% (383 of