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The Transplant Nephrology Workforce in the United States: Current State and Future Directions

      The population of patients with kidney transplants in the United States is growing. The delivery of transplant care is complex, involves a multidisciplinary transplant team, and care coordination between transplant and community providers. The transplant nephrologist is central to the delivery of this care and assumes a multitude of clinical and nonclinical roles and responsibilities. With a growing population of patients requiring transplant care that spans a continuum from pretransplant referral to long-term posttransplant management, an understanding of the current state of the transplant nephrology workforce in the United States and the future that it faces is important in ensuring that current and future needs of both patients and physicians are met. In this article, we (1) review the scope of practice of the transplant nephrologist, (2) discuss the state of training in the field of transplant nephrology, (3) review the role of the referring primary nephrologist in the care of patients undergoing kidney transplant, and (4) discuss challenges and opportunities facing the transplant nephrology workforce.

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      References

        • Wolfe R.A.
        • Ashby V.B.
        • Milford E.L.
        • et al.
        Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.
        N Engl J Med. 1999; 341: 1725-1730
        • Axelrod D.A.
        • Schnitzler M.A.
        • Xiao H.
        • et al.
        An economic assessment of contemporary kidney transplant practice.
        Am J Transpl. 2018; 18: 1168-1176
      1. Organ Procurement and transplantation Network. U.S. Department of health and human services.
        (Available at:)
        https://optn.transplant.hrsa.gov/data/
        Date accessed: January 22, 2020
        • Hart A.
        • Smith J.M.
        • Skeans M.A.
        • et al.
        OPTN/SRTR 2018 annual data Report: kidney.
        Am J Transpl. 2020; 20: 20-130
        • Haugen C.E.
        • Thomas A.G.
        • Chu N.M.
        • et al.
        Prevalence of frailty among kidney transplant candidates and recipients in the United States: Estimates from a National Registry and Multicenter Cohort Study.
        Am J Transpl. 2020; 20(4): 1170-1180
        • Pérez Fernández M.
        • Martínez Miguel P.
        • Ying H.
        • et al.
        Comorbidity, frailty, and waitlist mortality among kidney transplant candidates of all Ages.
        Am J Nephrol. 2019; 49: 103-110
        • Advancing American Kidney Health. U.S
        Department of Health and human services.
        (Available at:)
        • Hippen B.E.
        • Reed A.I.
        • Ketchersid T.
        • Maddux F.W.
        Implications of the advancing American kidney health initiative for kidney transplant centers.
        Am J Transpl. 2020; 20(5): 1244-1250
        • Kasiske B.L.
        • Cangro C.B.
        • Hariharan S.
        • et al.
        The evaluation of renal transplant candidates: clinical practice guidelines.
        Am J Transpl. 2001; 1: 3-95
        • McAdams-DeMarco M.A.
        • King E.A.
        • Luo X.
        • et al.
        Frailty, length of stay, and mortality in kidney transplant recipients: a National Registry and Prospective Cohort Study.
        Ann Surg. 2017; 266: 1084--1090
        • Nguyen M.N.
        • Avila C.L.
        • Brock G.N.
        • et al.
        “Early” and “late” hospital Readmissions in the first Year after kidney transplant at a Single center.
        Clin Transpl. 2020; 34(3): e13822
        • Haugen C.E.
        • King E.A.
        • Bae S.
        • et al.
        Early hospital Readmission in older and Younger kidney transplant recipients.
        Am J Nephrol. 2018; 48: 235-241
      2. Organ Procurement and transplantation Network (OPTN) Bylaws: primary kidney transplant physician requirements Appendix E.3.A. U.S. Department of health and human services.
        (Available at:)
        • The Transplant Nephrology Fellowship Training Accreditation Program
        American Society of transplantation.
        www.txnephaccreditation.org
        Date accessed: January 24, 2020
        • Samaniego M.
        • Rothstein D.
        • Josephson M.
        The transplant nephrology fellowship: current and future challenges. ASN Kidney News Online. 2009.
        (Available at:)
      3. ACGME program requirements for graduate medical education in nephrology (subspecialty of internal medicine). Accreditation Counc Graduate Med Education. 2019.
        (Available at:) (Accessed September 21, 2020)
        • ABIM: Nephrology Certification Examination Blueprint
        American board of internal medicine (ABIM). 2020.
        (Available at:)
        • Quigley L.
        • Salsberg E.
        • Mehfoud N.
        • Collins A.
        Report on the 2017 survey of nephrology fellows.
        (Available at:)
        • Masselink L.S.E.
        • Quigley L.
        • Mehfoud N.
        • Collins A.
        Report on the 2016 survey of nephrology fellows.
        (Available at:)
        • American Society of Transplantation (AST)
        Transplant nephrology core curriculum.
        (Available at:)
        • American Society of Transplantation (AST)
        Timely Topics in transplantation.
        (Available at:)
        https://www.myast.org/education/webinars/t3
        Date accessed: February 29, 2020
        • Sozio S.M.
        • Pivert K.B.S.
        • Chan L.
        • et al.
        Nephrology Fellow Survey—Results and Insights.
        (Available at:)
        • Quigley L.S.E.
        • Collins A.
        Report on the 2018 survey of nephrology fellows.
        (Available at:)
        • Masselink L.S.E.
        • Wu X.
        • Quigley L.
        • Collins A.
        Report on the 2015 survey of nephrology.
        (Available at:)
        • Agrawal V.
        • Jhaveri K.D.
        • Shah H.H.
        Enhancing outpatient nephrology experience for internal medicine residents.
        Clin Kidney J. 2017; 10: 429-436
        • Jhaveri K.D.
        • Sparks M.A.
        • Shah H.H.
        Novel educational approaches to enhance learning and interest in nephrology.
        Adv Chronic Kidney Dis. 2013; 20: 336-346
        • Bayliss G.P.
        • Cobb J.
        • Decker B.
        • et al.
        • ASN Workforce Committee
        Kidney Mentoring and Assessment Program for Students: a guide for engaging medical students in nephrology.
        Clin Kidney J. 2019; 12: 761-766
      4. Fellows Symposium in transplantation. Am Soc Transplant.
        (Available at:)
        • Giacoma T.
        • Ayvaci M.U.S.
        • Gaston R.S.
        • Mejia A.
        • Tanriover B.
        Transplant physician and surgeon compensation: a sample framework accounting for nonbillable and value-based work.
        Am J Transpl. 2020; 20(3): 641-652
        • Abouljoud M.
        • Whitehouse S.
        • Langnas A.
        • Brown K.
        Compensating the transplant professional: time for a model change.
        Am J Transpl. 2015; 15: 601-605
        • Forbes R.C.
        • Rybacki D.B.
        • Johnson T.B.
        • Hannah Gillis A.
        • Shaffer D.
        • Hale D.A.
        A cost comparison for telehealth utilization in the kidney transplant waitlist evaluation process.
        Transplantation. 2018; 102 (2): 279-283
      5. Concepcion BP, Forbes RC. The role of telemedicine in kidney transplantation: opportunities and challenges. Kidney360. 2020;1(5):420-423.