Patterns of patient care reported by nephrologists: implications for nephrology training

The recent estimate of the nephrology workforce indicates that more nephrologists must be trained to care for the increasing number of patients with end-stage renal disease (ESRD). This conclusion was based on a 1996 survey indicating that nephrologists devote an average of 35% of their activities caring for ESRD patients. We compared data in that survey with those from a 1991 survey of members of the American Society of Nephrology to determine similarities between the different periods. The 1,590 responders in the 1991 survey (35% of the American Society of Nephrology membership) indicated that 50% devoted more than 75% of their effort to patient care, predominately for patients with general nephrology and hypertension problems. Approximately 69% of respondents cared for fewer than 50 hemodialysis patients, and the majority of respondents felt the maximum number of dialysis patients for whom they could provide adequate medical care would be 50. Most respondents felt that there would be a deficiency of nephrologists in their community within 5 years. Results from both the 1991 and 1996 surveys indicate that practice patterns have not changed markedly; combining results from the two surveys makes it clear that more nephrologists are needed to care for the projected increase in dialysis patients. Because nephrologists should be involved in the management of the pre-ESRD patient, training programs will have to broaden the preparation of future nephrologists.