What is it about Pediatric Nephrology that attracted you to pursue a career in the field?

“First, it was the Nephrologists at my medical school—they seemed so energized by their work. Secondly, it was the logic of it all—the kidney seemed to act “responsibly”, and when it didn’t (electrolyte imbalance), one could generally figure it out. Lastly, it was the children—what a joy to be able to help them and their families.”
John Hurley MD, October 30, 2008

“I was attracted to the chance to help kids who were affected by very different and very complicated disorders – conditions requiring complex evaluation and decision making – and to be able to uncover new knowledge through research and education that would help these children.”
John D Mahan MD, Dec 30, 2011

“Pediatric nephrology offered the chance to care for children with a wide range of disorders, perform procedures and not have to make the life-style sacrifices required in many procedure-dominated subspecialties. I also liked the fact that the opportunities in both basic and clinical research were so broad.”
Alicia Neu, MD, Oct 31, 2008

“Ultimately I choose Pediatric Nephrology because it offered a unique blend of complex/critical care and chronic care for which I had something to offer and where I felt I could significantly change outcomes for children.”
Rita D Swinford, MD, Nov 4, 2008

As a prospective pediatric nephrology fellowship candidate, we are pleased that you are interested in evaluating a career in Pediatric Nephrology. Pediatric Nephrology is an exciting field, and career opportunities are abundant whether you plan on a career in basic science, clinical research, clinical nephrology or any combination of the three. We hope this information will be useful to you in your career decision.

Why Should I Choose Pediatric Nephrology?

Pediatric nephrology offers the opportunity to care for children with a wide range of disorders including those with transient conditions such as acute kidney injury that may require acute dialysis in an intensive care setting or chronic conditions such as hypertension and chronic kidney disease that allow long-term follow up. With the opportunity to perform kidney biopsies and provide renal replacement therapies, the subspecialty appeals to those who are “procedure oriented” without the life-style sacrifices often required in procedure-dominated subspecialties. Opportunities in both basic and clinical research are limitless. As a relatively small subspecialty, there is a real spirit of collegiality and fellowship among the practitioners in our discipline.

What Does a Pediatric Nephrology Fellowship Entail?

Pediatric Nephrology is a specialty that involves the diagnosis and treatment of infants, children and adolescents with renal and urinary tract disorders and hypertension from all causes. This includes 1) treatment of common conditions, such as urinary tract infection and hypertension, 2) care for complex problems such chronic kidney disease and end stage kidney disease, 3) provision of dialysis for acute and chronic renal failure, and 4) medical management of renal transplantation in children.

Training consists of a three year fellowship following completion of a pediatric residency or equivalent international training in pediatrics.

Your fellowship training will prepare you for clinical activities, research opportunities, teaching responsibilities and administrative roles. During three years of pediatric nephrology fellowship training you will be provided a variety of clinical training experiences, including care of patients with

acute and chronic kidney disorders
fluid and electrolyte and acid base disorders
hypertension
acute and chronic kidney failure
pre and post kidney transplantation issues
perinatal and neonatal conditions, including congenital anomalies of the kidneys and urinary tract
inherited kidney disorders including genetic syndromes

You will be required to see patients in outpatient and inpatient settings and you will have a group of patients with kidney conditions that you follow in clinic. Your learning will be augmented via clinical instruction, didactic sessions, and self-directed reading. You will develop competence in skills such as kidney biopsy; initiation of hemodialysis, peritoneal dialysis and continuous renal replacement therapies; interpretation of renal biopsies; and interpretation of renal imaging procedures.

You will receive training in research design and evaluation. Laboratory and clinical research techniques and skills essential for your scholarly activity and career development will be acquired. Complementary topics such as biostatistics, epidemiology, ethics, economics and quality improvement will be incorporated into your education. You will develop competency in all of the skills necessary to become an effective pediatric nephrologist.

As a pediatric nephrologist you will have no paucity of children who require your care. You will have opportunities to be a primary clinician, a research investigator, a clinician-educator and/or a medical administrator. It is likely that you will have opportunities to experience many of these roles and develop your abilities in multiple areas during your career.

A complete list of the program requirements for fellowship education in pediatric nephrology can be found at the ACGME website (www.acgme.org)
Is There a Need for Pediatric Nephrologists ? (i.e., Will I Have a Job When I Finish My Fellowship?)

Presently, there are ample opportunities for graduates of pediatric nephrology fellowships in North America. As of 2011 there are 730 American Board of Pediatrics (ABP) board certified pediatric nephrologists in the United Stated with average age 56.4 years with 41% 61 years of age or older(www.abp.org). It is estimated that the US will require at least 25 new pediatric nephrologists per year over the next decade to simply maintain the pediatric nephrology workforce at present levels. The true need is much higher given the increasing number of children with chronic kidney conditions and the increasing effectiveness of kidney transplantation and dialysis in children. The number of patients requiring care from a pediatric nephrologist in the US will only increase during the next decade and this will necessitate an expansion in the supply of pediatric nephrologists. (Andreoli P, et al. American Society of Pediatric Nephrology Position Paper on Linking Reimbursement to Quality of Care. J Am Soc Nephrol 2005;16: 2263–2269.)

Pediatricians are increasingly recognizing the appeal of pediatric nephrology as a career. As of 2010-11, there were 144 Pediatric Nephrology fellows in ACGME approved programs (a total of 39 programs at that time) and a total of 165 approved fellowship training spots (87% available spots filled). This included 65% American Medical Grads and 35% International Medical Grads. They were 68% female and 32% male. There has been a 203% increase in the number of Pediatric Nephrology trainees per year over the last decade and increasing numbers of the fellows are now female. While the majority of trainees are now from American Medical Schools, the majority were from International Medical Schools 10 years ago.

How Do I Apply for a Pediatric Nephrology Fellowship?

Exploring training programs: Many pediatric and medicine-pediatric residents begin to consider a career in pediatric nephrology early during residency training. There are several useful sources for information about specific pediatric nephrology fellowship training programs

Pediatric nephrologists in your pediatric program
AAP subspecialty web site http://www.aap.org/training/nephrology/index.htm
ACGME and Fellowship and Residency Electronic Interactive Dataset Access (FREIDA,http://www.ama-assn.org/go/freida) websites contain information on all 39 ACGME approved programs (www.acgme.org)
Pediatric nephrology fellowship program directors
Pediatric Subspecialty Descriptions on CoPs http://www.pedsubs.org/subdues/nephrology.cfm

You should try to get a sense of the emphasis and special characteristics of the various programs - some emphasize basic science, others clinical science. Other program specificities, for example, may involve developmental, immunological or physiology oriented research, and/or options for a Masters in Clinical Science, Epidemiology, or Public Health.

Application process: The Electronic Application Residency Service (ERAS) is the accepted system for application to pediatric nephrology fellowship programs(https://www.aamc.org/students/medstudents/eras/fellowship_applicants/). ERAS accepts application completion by applicants on July 15 with completion information available on July1.

This is a July Application Cycle program.

Applicants may begin applying to these programs as of July 15th.
Programs may download, review applications and offer interviews starting
July 15th.

Pediatric Nephrology utilizes the National Residency Matching Program (NRMP) (www.nrmp.org) for fellowship selection and matching and is now part of the Pediatric Specialties Fall Match. The time line for the pediatric nephrology fellowship match is listed below.

NRMP Match (http://www.nrmp.org/fellow/index)
Match Begins (NRMP open to Programs/Applicant Registration) – August 2012
Quota Change Deadline – 11/2/2011
Rank Order List Closes – 11/16/2011
Match Day – 12/1/12

NRMP Match Information for the class to start in July 2013 to be released on NRMP web site in January 2012

	Match Begins	Rank Order List Opens	Quota Change Deadline	Rank Order List Closes	Match Day
Pediatric Nephrology 2010	08/10/11	10/5/11	11/2/11	11/16/11	11/30/11

More information about the pediatric nephrology match is available in this website in the Fellowship Program Directors page (http://www.aspneph.com/committees/T&C/Main.asp).

Joint Medicine-Pediatric Nephrology training programs: A limited number of academic centers offer these to allow graduates of medicine-pediatric training programs to become board eligible for adult and pediatric nephrology. It is best to contact the programs directly to clarify the application process. There is no formal certification for combined Med-Peds Nephrology programs. The programs (Internal Medicine Nephrology and Pediatric Nephrology) need to submit an individualized training program to the respective boards for each proposed combined trainee (typically covering 4 years).

Fellowship program starting dates: The typical starting date is July 1 of each year but most programs can provide some flexibility for trainees with special circumstances. With proper warning, residents who must continue training after June 30 to complete requirements are able to be accommodated by fellowship programs. If beginning your fellowship necessitates moving to a new city, discuss the time needed to relocate and possibilities of a later start with your pediatric nephrology fellowship program director.

Fellowship training and work duty hours: Programs are subject to the same work hour limitations as residency. Programs have already spent a great deal of effort to make the call schedule and work days compliant. You will not find any major change between residency and fellowship in the concepts of work hours.

American Board of Pediatrics Scholarly Activity: All fellows are required to have meaningful research/scholarly experience. The mandatory aspects of a core curriculum can be found at the ACGME web site (http://www.acgme.org/acWebsite/home/home.asp - follow the Res. Review Committees link on the left margin down several links to Program Requirements under the Pediatrics links). The ACGME requirements also call for the progress of your scholarly experience to be monitored by a scholarly oversight committee (SOC). Each program will have a defined approach to the SOC requirement.

Pediatric Nephrology Boards: Pediatric Nephrology Boards are administered by the American Board of Pediatrics (www.abp.org) and provided every 2 years. Maintenance of board certification requirements are now being expanded can be found at the ABP web site. Methods to prepare for boards include:

Pediatric Nephrology Board preparation materials
ASPN Board Review Course [http://www.aspneph.com]
Children’s Hospital of Michigan Board Review CD [available from Tej Matoo, MD, Children’s Hospital of Michigan])
AAP Pediatric Nephrology PREP program (http://www.aap.org)
Adult nephrology board preparation courses
Board preparation materials from the journals Pediatric Nephrology and Journal of the American Society of Nephrology.

The Role of ASPN in Pediatric Nephrology

The American Society of Pediatric Nephrology is an organization of pediatric nephrologists and affiliated health care professionals. The primary goals are of the ASPN are to promote optimal care for children with kidney disease through advocacy, education and research; and to disseminate advances in clinical practice and scientific investigation. The ASPN provides support to promote better care of children with kidney diseases (Clinical Affairs Committee), advocacy for quality care of children with kidney diseases (Advocacy Committee), improved research for pediatric kidney disorders (Research Committee), efforts to improve training and maintenance of certification for pediatric nephrologists in the US (Training and Certification Committee) and activities designed to augment the workforce of pediatric nephrologists in the US (Workforce Committee). There are special Sub-Committees devoted to Pediatric Nephrology Fellowship Program Directors (Training Program Directors Sub-Committee) and to Pediatric Nephrology Fellows (PFeNa group).

http://www.aspneph.com/Committees/CommitteeHome.asp

The ASPN sponsors residents to attend the Pediatric Academic Societies/American Society of Pediatric Nephrology Annual Meeting each year (see http://www.aspneph.com/awards/awards.asp).

December 11, 2008
John Hurley, MD
John D Mahan, MD
Alicia Neu, MD
Rita D Swinford, MD

Revised 12.29.11