Nephrology Training in the Time of COVID-19
The 2021 ASN Nephrology Fellow Survey
Kurtis A. Pivert, MS
Suzanne Boyle, MD
Anna M. Burgner, MD, MEHP
Lili Chan, MD, MS
Susan M. Halbach, MD
Koyal Jain, MD, MPH
Benjamin S. Ko, MD
Hitesh H. Shah, MD
Joshua S. Waitzman, MD, PhD
Stephen M. Sozio, MD, MHS, MEHP
Disclaimers
This report’s findings are solely those of the authors and do not reflect the views of the Johns Hopkins University School of Medicine (JHUSOM) or the ASN Alliance for Kidney Health. Please provide your comments and feedback on this report to workforce@asn-online.org.
Suggested Citation
Pivert KA, Boyle S, Burgner AM, Chan L, Halbach SM, Jain K, Ko BS, Shah HH, Waitzman JS, Sozio SM. Nephrology Training in the Time of COVID-19: The 2021 ASN Nephrology Fellow Survey. Washington, DC: ASN Alliance for Kidney Health, 2021. Available at: https://data.asn-online.org/reports/2021-Nephrology-Fellow-Survey.
Executive Summary
As the annual American Society of Nephrology (ASN) Nephrology Fellow Survey entered its eighth year, the project explored continued response to the COVID-19 pandemic and its impact on training and careers of fellows. This year, 501 of the 920 current adult, pediatric, and adult/pediatric nephrology fellows who received the survey participated, for a gross response rate of 54.6% (the highest response in the survey’s 8-year history). A majority of respondents were international medical graduates (IMGs, 54%), male (56%), white (36%) or South Asian (32%), and in their second year of fellowship (51%).
Our analysis of the 2021 ASN Nephrology Fellow Survey revealed five key insights into how nephrology fellows are navigating COVID-19 and pandemic-related changes to training and providing patient care.
Nephrology Training Has Been Minimally Affected by the Pandemic
A majority (83%) believed their training programs had successfully maintained their education even though nephrology conferences, which quickly pivoted to video in the initial days of the pandemic, remain online for 64% of respondents. Fellows’ sense of community, breadth of clinical exposures, ability to advance their research, and relationships with mentors were likewise highly ranked. Most participants (87%) believed they would be prepared for independent practice upon graduation.
Telehealth Adoption Continues
Telehealth uptake remained strong into the pandemic’s second year with 83% of fellow respondents seeing some patients virtually in the outpatient setting, and 36% using telehealth for some cases on inpatient wards.
COVID-19 is Challenging Fellows’ Well-Being
As the pandemic continues more fellows are vulnerable for burnout and poor mental quality of life (QOL). The proportion of fellows at risk for distress as measured by the Resident Well-Being Index (RWBI) increased 47% between 2020 (15% of respondents at risk) and 2021 (22% of respondents). This year more women met the distress threshold than men (55 women, 27%; 46 men, 18%) (see figure at right).
\[\\[3in]\]
Employment Perceptions Improved Yet Local Job Market Remains Tight
Less than half (47%) of fellows in their second or greater year of training perceived an “Appropriate,” “Too Many,” or “Far Too Many” number of local jobs (within 50 miles of their fellowship) despite steady improvements since the survey started in 2014 (see figure below). While national market impressions have been more positive, they’ve varied in a narrower range. Clinical nephrology (91%), joint nephrology–other specialty (12%), and research (11%) positions were the top jobs sought after fellowship.
Most Fellows Recommend Nephrology
A record 87% of fellow participants (see figure at right) would recommend nephrology to medical students and residents, including 85% of international medical graduates (IMGs) and 91% of US medical graduates (USMGs). Longitudinal patient relationships, case variety, and providing public health to underserved communities were among the reasons cited for recommending the specialty.
\[\\[3in]\]
I. Sustaining Education Through a Pandemic
COVID-19 has altered not only patient care but also medical education. Nephrology conferences, which quickly migrated to video in early 2020, remained exclusively online for two-thirds of fellows (65%) (Figure 1). Telehealth retained traction for outpatient encounters (384 respondents seeing some patients virtually) and, to a lesser extent, inpatient visits (164 respondents using telehealth for some encounters). As COVID-19 protocols evolved from 2020 (when many trainees stopped in-person evaluations) fellows returned to all clinical settings with only a few indicating rounding was still suspended due to the pandemic (\(\le\) 13 respondents) (Table 1).
Figure 1: Nephrology Conference Medium.
Table 1: Frequency of Telehealth Use by Clinical Setting.
| Telehealth Usage | Inpatient Consults | Outpatient Consults | Outpatient Dialysis |
|---|---|---|---|
| All Patients Telehealth | 1 | 14 | 1 |
| Some Patients Telehealth | 164 | 377 | 84 |
| No Patients Telehealth | 212 | 48 | 237 |
| On Hold Since Pandemic | 4 | 5 | 13 |
| Not Applicable/Have Not Started | 78 | 15 | 124 |
\[\\[2in]\]
Despite these pandemic-driven changes, participants were generally positive in assessing their fellowship training. Most rated the quality of instruction as either excellent (47%) or good (36%), and 83% agreed their programs had successfully sustained their education through the pandemic. This carried over to fellows’ self-assessments of their preparedness for independent practice, 87% of whom agreed they would be prepared upon graduation (“Strongly Agree” 41%, “Agree” 46%) (Figure 2).
Figure 2: Self-Assessment of Preparedness for Independent Practice.
Other aspects of the training environment—fellows’ sense of community, breadth of clinical exposures, ability to advance their research, and relationships with mentors—were likewise ranked highly (range 76%–95% combined “Strongly Agree” and “Agree”). However, fewer fellows believed they had adequate board preparation time (70% combined “Strongly Agree” and “Agree”), and fewer participants expressed satisfaction with their work-life balance (59%) and contract negotiation advice they received (51%) (Figure 3).