National Assessment of Nephrology Fellow Attitudes Towards and Perceptions of Patient Health Equity in Kidney Care and Training

Background: Equity in kidney care is clinically and ethically important. We conducted a national survey of nephrology fellows to assess their attitudes towards, and perceptions of, health equity in fellow training and kidney care. Methods: We administered a 13-question survey in 2022 to all nephrology trainees through the American Society of Nephrology (ASN) in-service training exam (ITE). We asked fellows about their perceptions of training and confidence in caring for underserved patients, their level of concern about health disparities, and the sense of responsibility they felt to address these disparities. Baseline characteristics were summarized, and survey responses were analyzed using factor analysis and multivariate modeling. Results: The response rate was 84% (689 out of 816). The survey reliability factor was 0.77, i.e. very good to excellent. Respondents were a mean (Standard Deviation) of 34 (4) years old, 57% were men, and 11% Hispanic. The majority (72%) reported working with underserved populations “often/always”. Over 80% of fellows “agreed/strongly agreed” that they were concerned about healthcare disparities. Only 61% “agreed/strongly agreed” they were well-trained to reduce disparities. Individuals of self-reported Hispanic and Black race, as well as U.S. Medical School-based graduates, were more likely to report working with underserved patients. Black trainees demonstrated greater concern for addressing health disparities and higher confidence in their ability to work effectively with underserved populations (p = 0.04). Nonetheless, they reported feeling less well-trained in cross-cultural communication compared with White trainees (p = 0.01). In factor-weighted, multi-variate analysis, concern in women versus men was not significantly different, yet confidence to address disparities, cross-cultural communication, and self-efficacy caring for underserved patients was lower in women (all p≤0.05 compared to men). Conclusions: Although a physician’s skills in cross cultural communication, and abilities to care for underserved individuals and to address health disparities are critically important, a significant proportion of nephrology fellows reported not feeling confident and/or lacking experience in these areas. There is an urgent need to optimize nephrology training in these areas, to empower the next generation of nephrologists to provide disease-specific communication and care for the diverse populations they serve.