Interest in nephrology as a career is declining and has been on the decline for nearly a decade, according to a new study.

Researchers found that medical students report receiving minimal exposure to nephrology in clinical rotations and perceive the specialty as too complex, uninteresting, and lacking professional opportunity.

Mark Parker, MD, of the Maine Medical Center in Portland, and his colleagues found that from 2002 to 2009, all internal medicine subspecialties except geriatric medicine increased the number of available fellowship positions.

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Only two subspecialties attracted fewer U.S. medical graduates in 2009 than in 2002: nephrology and geriatric medicine. During the study period, the number of medical graduates in nephrology fellowships dropped from 401 in 2002 to 365 in 2009, Dr. Parker’s team reported online in the Clinical Journal of the American Society of Nephrology.

The drop is occurring at a time when demand for nephrologists is increasing and when the specialty is having a harder time benefitting from the contribution of  international medical graduates (IMGs). Kidney disease now affects one in nine U.S. adults, and, by 2020, more than 750,000 Americans are expected to be on dialysis or awaiting kidney transplant. Although IMGs have historically contributed substantially to the U.S. nephrology workforce, it is increasingly difficult for IMGs to obtain American visas.

“In medical school, students primarily work with hospitalized kidney patients, whose care is the most complex and daunting,” Dr. Parker said. “And many students believe nephrologists to be overworked and underpaid.”

In a survey conducted by the American Society of Nephrology in 2010, 95% of nephrology fellows indicated they are happy with their career choice.

The researchers wrote that greater efforts are needed to inspire interest in nephrology through training experiences and social media. “Ultimately, the future of nephrology and the health of millions of people with kidney disease will depend on the ability of each nephrologist to help students and residents love the specialty,” the researchers concluded.