Pediatric nephrology in North America

Abstract

Pediatric nephrology has existed as a recognized subspecialty of the American Board of Pediatrics (ABP) since 1974, coming into official existence after cardiology in 1961 and at the same time as hematology and oncology. In Canada, the clinical practice of pediatric nephrology started in mid 1960s, with the first training programs established in Canada in the late 1960s. To date, the specialty continues to be a joint specialization in pediatrics and nephrology with the Royal College of Physicians and Surgeons of Canada. Despite its longevity, the number of certified nephrologists has remained small, approximately 750 physicians in the USA and 125 in Canada throughout the 40-year history of the subspecialty. There are approximately 450 active pediatric nephrologists in the USA and less than 70 in Canada, making the specialty quite small in the overall population of pediatric subspecialists which number >21,000. The most recent ratios reported by the ABP note 150,158 US children (<18 years of age) per pediatric nephrologist (< age 66); there are no similar data from Canada. Only pediatric rheumatologists and child abuse specialists are less prevalent in US society [1]. Although current individual practice patterns are difficult to assess, recent studies by the American Society of Pediatric Nephrology (ASPN) and the American Academy of Pediatrics suggest that the active nephrologists spend approximately 55–60 % of their efforts in direct clinical practice, 17–21 % in research, 11–13 % in teaching, and 12–14 % in administration [2, 3]. Similar distributions of workload are seen in Canada (Canadian Association of Pediatric Nephrology (CAPN), “2014”). The vast majority practice in academic settings and approximately half have two or fewer partners [2]. Similar patterns exist in Canada with over 90 % of practicing nephrologists associated with academic centers and a new and growing trend of community-based nephrologists practicing in largely urban locations. However, Canadian practice sites now employ on average 4.8 nephrologists (including community-based affiliates) per site (CAPN, “unpublished data”). Despite small numbers, nephrology is very well represented in the leadership of all aspects of child health in the USA and Canada, and our commitment to maximizing the health of all children is well recognized. On the other hand, the relatively small, and shrinking, allocations of time to research activities are leading to concerns that the future research workforce and productivity dedicated to the breadth of pediatric kidney disease may be at risk.