Responding to the workforce crisis: consensus recommendations from the Second Workforce Summit of the American Society of Pediatric Nephrology

Danielle E Soranno; Sandra Amaral; Isa Ashoor; Meredith A Atkinson; Gina-Marie Barletta; Michael C Braun; Joann Carlson; Caitlin Carter; Annabelle Chua; Vikas R Dharnidharka; Keri Drake; Elif Erkan; Dan Feig; Stuart L Goldstein; David Hains; Lyndsay A Harshman; Elizabeth Ingulli; Alexander J Kula; Mary Leonard; Sudha Mannemuddhu; Shina Menon; Zubin J Modi; Marva Moxey-Mims; Arwa Nada; Victoria Norwood; Michelle C Starr; Priya S Verghese; Darcy Weidemann; Adam Weinstein; Jodi Smith

doi:10.1007/s00467-024-06410-9

Responding to the workforce crisis: consensus recommendations from the Second Workforce Summit of the American Society of Pediatric Nephrology

Pediatr Nephrol. 2024 Dec;39(12):3609-3619. doi: 10.1007/s00467-024-06410-9. Epub 2024 Jul 8.

Authors

Danielle E Soranno^{1

2}, Sandra Amaral³, Isa Ashoor⁴, Meredith A Atkinson⁵, Gina-Marie Barletta⁶, Michael C Braun⁷, Joann Carlson⁸, Caitlin Carter⁹, Annabelle Chua¹⁰, Vikas R Dharnidharka¹¹, Keri Drake¹², Elif Erkan¹³, Dan Feig¹⁴, Stuart L Goldstein¹³, David Hains¹⁵, Lyndsay A Harshman¹⁶, Elizabeth Ingulli⁹, Alexander J Kula¹⁷, Mary Leonard¹⁸, Sudha Mannemuddhu¹⁹, Shina Menon¹⁸, Zubin J Modi²⁰, Marva Moxey-Mims²¹, Arwa Nada²², Victoria Norwood²³, Michelle C Starr¹⁵, Priya S Verghese¹⁷, Darcy Weidemann^{24

25}, Adam Weinstein²⁶, Jodi Smith²⁷

Affiliations

¹ Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA. [email protected].
² Department of Bioengineering, Purdue University Weldon School of Engineering, 1044 W. Walnut Street, West Lafayette, IN, R4-42146202, USA. [email protected].
³ Departments of Pediatrics and Biostatistics, Epidemiology and Informatics, Children's Hospital of Philadelphia and University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
⁴ Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
⁵ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA.
⁷ Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
⁸ Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
⁹ Rady Children's Hospital, University of California San Diego, San Diego, CA, USA.
¹⁰ Duke Children's Hospital and Health Center, Durham, NC, USA.
¹¹ Washington University in St. Louis, St. Louis, MO, USA.
¹² University of Texas Southwestern Medical Center, St. Louis, MO, USA.
¹³ Department of Pediatrics, University of Cincinnati College of Medicine, Indianapolis, IN, USA.
¹⁴ Department of Pediatrics, University of Alabama, Heersink School of Medicine, Birmingham, AL, USA.
¹⁵ Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁶ Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA.
¹⁷ Ann & Robert H Lurie Children's Hospital, Chicago, IL, USA.
¹⁸ Department of Pediatrics, Stanford University, Stanford, CA, USA.
¹⁹ East Tennessee Children's Hospital, Knoxville, TN, USA.
²⁰ Department of Pediatrics and Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA.
²¹ Department of Pediatrics, Children's National Hospital/George Washington University SOM, Washington, D.C, USA.
²² Department of Pediatrics, Le Bonheur Children's Hospital, UTHSC, Memphis, TN, USA.
²³ Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
²⁴ Department of Pediatrics, Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA.
²⁵ University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
²⁶ Department of Medical Sciences and Pediatrics, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA.
²⁷ Department of Pediatrics, University of Washington, Seattle, WA, USA.

Abstract

Importance: Pediatric patients with complex medical problems benefit from pediatric sub-specialty care; however, a significant proportion of children live greater than 80 mi. away from pediatric sub-specialty care.

Objective: To identify current knowledge gaps and outline concrete next steps to make progress on issues that have persistently challenged the pediatric nephrology workforce.

Evidence review: Workforce Summit 2.0 employed the round table format and methodology for consensus building using adapted Delphi principles. Content domains were identified via input from the ASPN Workforce Committee, the ASPN's 2023 Strategic Plan survey, the ASPN's Pediatric Nephrology Division Directors survey, and ongoing feedback from ASPN members. Working groups met prior to the Summit to conduct an organized literature review and establish key questions to be addressed. The Summit was held in-person in November 2023. During the Summit, work groups presented their preliminary findings, and the at-large group developed the key action statements and future directions.

Findings: A holistic appraisal of the effort required to cover inpatient and outpatient sub-specialty care will help define faculty effort and time distribution. Most pediatric nephrologists practice in academic settings, so work beyond clinical care including education, research, advocacy, and administrative/service tasks may form a substantial amount of a faculty member's time and effort. An academic relative value unit (RVU) may assist in creating a more inclusive assessment of their contributions to their academic practice. Pediatric sub-specialties, such as nephrology, contribute to the clinical mission and care of their institutions beyond their direct billable RVUs. Advocacy throughout the field of pediatrics is necessary in order for reimbursement of pediatric sub-specialist care to accurately reflect the time and effort required to address complex care needs. Flexible, individualized training pathways may improve recruitment into sub-specialty fields such as nephrology.

Conclusions and relevance: The workforce crisis facing the pediatric nephrology field is echoed throughout many pediatric sub-specialties. Efforts to improve recruitment, retention, and reimbursement are necessary to improve the care delivered to pediatric patients.

Keywords: Academic RVUs; Pay equity; Pediatric Nephrology; Pediatric sub-specialties; Reimbursement and salary benchmarks; Workforce crisis.

MeSH terms

Child
Consensus*
Delphi Technique
Health Workforce / statistics & numerical data
Humans
Nephrologists
Nephrology* / organization & administration
Nephrology* / standards
Pediatrics* / organization & administration
Pediatrics* / standards
Societies, Medical
Vereinigte Staaten
Workforce / standards

Grants and funding

Foundation support/ASPN Foundation