Comparing two models that reduce the number of nephrology fellowship positions in the United States
- Published
- Accepted
- Subject Areas
- Nephrology, Science and Medical Education
- Keywords
- education, GME, graduate medical education, fellowship, nephrology training
- Copyright
- © 2014 Desai
- Licence
- This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ PrePrints) and either DOI or URL of the article must be cited.
- Cite this article
- 2014. Comparing two models that reduce the number of nephrology fellowship positions in the United States. PeerJ PrePrints 2:e592v2 https://doi.org/10.7287/peerj.preprints.592v2
Abstract
There has been a steady decline in the number of applications to nephrology training programs. One solution is to decrease the number of available fellowship positions. Proponents believe that training programs have grown too big but the method for reduction has not been established. This investigation analyzes two models that decrease the number of available training positions and compares them head-to-head to identify the least burdensome method by which this reduction should occur. In the survival of the fittest model (SotFM) fellowship positions are eliminated if they were unfilled in the National Residency Match Program’s (NRMP) 2013 Specialty Match. In the equal proportions model (EPM) a formula is used to calculate a priority score using ESRD prevalence data from the 2013 USRDS Report and the geometric mean between a given jurisdiction’s current apportionment (n) and its next position (n+1). The least burdensome model is that which results in the 1) least number of jurisdictions losing fellow positions and 2) lowest percent reduction for any single jurisdiction. There were 416 nephrology positions offered and 47 unfilled in 2013. In the SotFM, 23 jurisdictions would sacrifice these 47 positions. In the EPM, 369 positions were apportioned (=416-47); only 9 jurisdictions would experience a reduction. The largest single-jurisdiction reduction in fellow positions was 67% (SotFM) and 50% (EPM). The EPM results in a less burdensome reduction of fellow positions nationwide. The EPM is a time-tested model that injects fairness into the painful process of reducing the total number of fellow positions across America.
Author Comment
This is the second version of the preprint. I have added information in the "Additional Considerations" section.
Supplemental Information
Table 1
Priority scores for each jurisdiction. Yellow highlighted cell indicates the jurisdiction with the highest priority score for that round