Sunday, July 5, 2009

A recession-proof profession?

How many nephrologists does the U.S. need?

I recently heard a thought-provoking calculation from MGH's Dr. David Steele which helps illustrate a likely shortage in the number of American nephrologists.  The calculation is admittedly a rough estimate, but an interesting thought experiment nonetheless.  

Using the numbers from NHANES, as of the year 2000 there were estimated to be 15.5 million Americans with CKD Stage 3 and 0.4 million Americans with CKD Stage 4.  The ESRD program in the U.S. encompasses about 500,000 Americans.  Let's say that we should try and see all patients with CKD Stage 3 twice a year, all patients with CKD Stage 4 four times a year, and all ESRD patients twice a month as mandated.  Taken together, this calculates out to 45.8 million appointments per year.  Let's be ambitious and say that we work every day that the dialysis unit is open:  6 days of the week, but off on Sundays.  This then comes out to 146,326 visits per day.
Let's also say that there are 6000 nephrologists in the United States--probably an underestimate of full-time clinicians, but let's choose 6000 as the denominator.  In order to provide optimal nephrology care to the U.S. population of CKD and ESRD patients, each nephrologist would have to see almost 25 patients per day, 6 days a week.   This calculation does not allow for the growing population of kidney transplant patients, acute kidney injury consults which must be seen by a nephrologist, complex patients who must be seen with greater frequency, and the possibility of an expanding population of CKD given rising rates of hypertension and diabetes in our society.

In sum, based on these calculations, one can make a compelling case that there is a shortage of nephrologists in the U.S.  


Anonymous said...

Nice work... interesting in that getting a "good job" in Nephrology is not as easy as it should be based upon those numbers. Matt Sparks

nathanhellman said...

Hi Matt,

I've heard similar comments when the "shortage of nephrologists" issue comes up--why isn't it easier to find a nephrology job? I'm not sure of the answer, but my guess is that certain regions of the country have a real shortage of nephrology subspecialists while other regions already have multiple nephrology private practice groups competing with one another, and in the latter communities it may be tough to establish a new nephrology practice. Also a lot of CKD treatment is likely occurring under the watchful eye of primary care docs rather than nephrologists, and in my experience there are quite a few CKD Stage 3 and even 4 patients who do not even realize they have such advanced kidney disease.