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 a variety of 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,
Oct 30, 2008
“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
·
children during and after kidney
transplantation
·
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 a 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 2008 there are 631
American Board of Pediatrics (ABP) board certified pediatric nephrologists in
the United Stated with average age 53.6 years (www.abp.org).
It is estimated that the US will require at least 20 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 2007, there
were 124 Pediatric Nephrology fellows in ACGME approved programs (a total of 37
programs at that time) and a total of 155 approved fellowship training spots
(80% available spots filled). This included 61% American Medical Grads and 39%
International Medical Grads. They were 68% female and 32% male. There has been
a 191% 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 38 ACGME approved programs (www.acgme.org)
·
Pediatric nephrology fellowship program
directors
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(http://www.aamc.org/programs/eras).
ERAS accepts application completion by applicants on
November 1.
Beginning for the
class of fellows who will start on July 1, 2010, the National Residency Matching
Program (NRMP) will be used (www.nrmp.org).
The time line for the pediatric nephrology fellowship match is listed below.
NRMP Match (http://www.nrmp.org/fellow/index)
o
Match Begins (NRMP open to Programs/Applicant Registration) – 1/21/09
o
Quota Change Deadline – 5/6/09
o
Rank Order List Closes – 5/20/09
o
Match Day – 6/10/09
NRMP Match Information
Proposed Important Match
Dates
|
|
Match Begins |
Rank Order List
Opens |
Quota Change
Deadline |
Rank Order List
Closes |
Match Day |
Pediatric
Nephrology
2010 |
01/21/09 |
04/15/09 |
05/06/09 |
05/20/09 |
06/10/09 |
More information about the pediatric nephrology
match is available in this website in the Fellowship Program Directors page (http://www.aspn.com/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 defined Pediatric Nephrology Board preparation materials (Board
Review CD available from Tej Matoo, MD, Children’s Hospital of Michigan) , the
new AAP Pediatric Nephrology PREP program, adult nephrology board preparation
courses and 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
www.aspneph.com/awards.asp).
December 11, 2008
John Hurley, MD
John D Mahan, MD
Alicia Neu, MD
Rita D Swinford, MD
