Kidney disease physician workforce: where is the emerging pipeline?

A predicted increase in the number of patients with end-stage renal disease in coming years, coupled with significant numbers of qualified nephrologists reaching retirement age, will place great demands on the renal physician workforce. Action is required on several fronts to combat the predicted shortfall in full-time nephrologists. Of particular importance is the need to recruit and train greater numbers of physicians from ethnic minority groups. Changes in the demographics of kidney disease make it increasingly a disease of ethnic minorities and the poor. These demographic changes, together with the existing racial disparities in the diagnosis and treatment of kidney disease, highlight the specific need for nephrologists who are cognizant of the issues and barriers that prevent optimal care of high-risk minority populations. The current lack of academic role models and the drive by medical schools and residency programs to encourage minority group physicians to become primary care providers, rather than specialists, are issues that must be urgently addressed. Equally, changes in the training of renal fellows are required to merge the critical need for cutting edge research activity in renal science and with the insights and sensitivity to equip clinicians with the necessary skills for the team-based approach to patient care that increasingly characterizes the management and care of the patient with chronic kidney disease.