Challenges Facing Contemporary Pediatric Nephrology

A worldwide paucity of pediatric nephrologists exists, with a median prevalence of 0.69 pediatric nephrologists/million population.1 In a survey of clinicians in 71 countries by the International Pediatric Nephrology Association, 67% indicated regional shortages.2 While most pronounced in under-resourced areas, problematic access to pediatric nephrology care exists in resourced regions.2 This limited number of pediatric nephrologists exacerbates health system challenges arising from complicated care required by children with kidney diseases.3 In many areas, pediatric nephrologists work in academic institutions or within large care systems with complex administrative components allocating resources. These systems often underappreciate challenges faced by pediatric nephrologists and the resources required. Independent of resource availability, many centers rely on a lone pediatric nephrologist whose needs get assigned lower priority. Workforce shortages also contribute to these health system challenges and warrant consideration in proposed solutions.4 In this manuscript, we aim to increase awareness of difficulties faced by pediatric nephrologists balancing professional responsibilities, navigating administrative challenges across practice settings, and troubleshooting key factors affecting care delivery. We grouped these challenges in broad categories to facilitate advocacy efforts germane across the spectrum of practice settings and health systems, ranging from local to international in scope.