The changing phenotype of academic nephrology -- a future at risk?

BACKGROUND AND OBJECTIVES Academic nephrology faces increasing challenges in faculty hiring and development. However, it is unknown how these pressures have affected the number and demographics of academic nephrologists. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using the Association of American Medical Colleges Faculty Roster database, changes were analyzed in MD nephrology, as well as other internal medicine subspecialty, faculty from 1998 to 2008. RESULTS There were 1315 full-time MD nephrology faculty in 2008; this fell by 4.9% over the past decade. There were fewer junior, and more senior, faculty over this period. This was associated with 12.4% fewer tenured, 22.3% fewer tenure track, and an 11.5% increase in nontenure track, academic nephrologists. Academic nephrologists who are U.S. medical school graduates declined by 11.9%, while those who were international medical school graduates increased by 13.2%; nephrology has a greater percentage of international medical school graduates than any other internal medicine subspecialty. Female nephrology faculty increased by 14.3%, while male faculty fell by 9.5%. Asian nephrology faculty increased by 41.3%, while Caucasians declined by 15.2%. Similar changes in all the above parameters were seen for most other internal medicine subspecialties. The nephrology research programs at the top 20 research institutions, as compared with all other nephrology programs, had a greater decline in total MD, male, tenure track, and junior faculty. CONCLUSIONS These data suggest that the future of academic nephrology is at risk. The decline in nephrology faculty provides incentive for leaders in academic nephrology to improve recruiting and retention practices.