Over the past thirty-odd years, Spanish nephrology has experienced a rollercoaster ride with regards the number of nephrology specialists, with numbers plummeting and rocketing on various occasions. Since the middle of this decade, we are to experience a surplus of specialists again, if we do not correct the problem immediately. The Spanish Nephrology Commission (Comisión Nacional de la Especialidad de Nefrología) has put forward two options to resolve this situation. Firstly, considering available data, it has considered drastically reducing the number of internal medicine residency (IMR) positions assigned to nephrology, initially from 93 (a number that the Commission itself had deemed appropriate) to 59, to further reduce it to forty-something. On the other hand, it is planning on examining the matter further to have better scientific grounds for decision making.
This issue of Nefrología has published an article on this matter: “Trends in resident positions offered in nephrology (1985-2008)”,1 by Carmen Bernís Carro, Spanish Nephrology Commission (President: F. Ortega Suárez. Vice president and Secretary: C. Quereda Rodríguez-Navarro. Members: A. Martínez Castelao, J.A. Górriz Teruel, R. Matesanz Acedos, A. Sans Boix, P. Abáigar Luquin, A. Sánchez Casajús, C. Bernis Carro, I. Auyanet Saavedra, M.J. Pérez Sáez).
The article’s main objective was to report the trends related to the importance of nephrology, considering junior doctors’ preference towards choosing nephrology for their IMR training.
As such, one of the conclusions reached was that graduated doctors are less and less interested in choosing nephrology. This phenomenon, which also occurs in the USA and several other European Union countries, has been caused by many factors:
1. Lack or poor information given at university level.
2. Nephrology is considered as a complicated and demanding training area; however, nephrology training programmes are perceived as excellent training for junior resident doctors in many specialisation areas (although there are some gaps).
3. Nephrology is not well-paid; there are very little possibilities of working for the private sector, and significant work load.
4. In general, junior doctors are not likely to gain the most fulfilling experience in a hospital department as all positions are already filled. Therefore, a vast proportion of young nephrologists are having to work in outpatient haemodialysis centres or on-duty programmes, where in some cases they unfortunately have very little contact with the hospital departments.
5. Dialysis has also been described as not being very rewarding, as it offers very poor quality of life to patients (the opposite of what is said when working with kidney transplantation, glomerulonephritis and kidney physiology problems).
6. Dependence on other departments (e.g. vascular surgery).
Financial factors are not deemed of utmost importance for changing this situation, although we must consider the following work styles2-6:
1. Evidence-based medicine.
2. Clinical and basic research incorporated into daily nephrology departments’ routines.
3. Greater clinical independence, and recovery of aspects that are often forgotten (acute kidney failure, kidney biopsy, etc.).
4. Reintroduce a greater weighting of transplant patients, primary and secondary nephrology disorders, hydroelectrolyte disorders and acid-base balance, calcium-phosphorus metabolism problems, as well as all types of dialysis patients.
5. Improved coordination with outpatient centres and primary care.
6. Improved education, i.e. showing university medical students (in theoretical and practical classes) what they could learn if they were to choose nephrology.
7. Adjusting the number of quality work positions offered in accordance with demand.
EDITOR’S NOTE
The content of this article is without a doubt extremely important for the future of Spanish nephrology. The editors therefore invite Spanish nephrologists to send their opinions and observations on the matter, using the “Letters to the editor” format.
