Summary

Interest in nephrology as a career is declining and has been on the decline for nearly one decade. From 2002 to 2009, all internal medicine subspecialties except geriatric medicine increased the number of avail-able fellowship positions. However, only two subspecialties attracted fewer United States medical gradu-ates (USMGs) in 2009 than in 2002: geriatric medicine and nephrology. This drop occurred at a time when demand for nephrologists is increasing and when the specialty is having a harder time benefiting from the substantial contribution of international medical graduates (IMGs). Today’s USMGs possess fundamentally different career and personal goals from their teachers and men-tors. Medical students report receiving minimal exposure to nephrology in clinical rotations, and they per-ceive that the specialty is too complex, uninteresting, and lacks professional opportunity. Meanwhile, the demographics of kidney disease in the United States, as well as recent national health pol-icy developments, indicate a growing need for nephrologists. Efforts to improve the educational continuum in nephrology and enhance mentorship are essential to restoring interest in nephrology for USMGs, main-taining its appeal among IMGs, and developing a workforce sufficient to meet future demand for renal care