From the Chair: Nephrologists are Among the Most Happy Subspecialists in the US

Ajay K. Singh

Recent data on happiness among nephrologists should be a reason to celebrate the New Year. In the 2019 Medscape Physician Lifestyle and Happiness Report1 for “happiness outside work,” 55% of nephrologists are happiest outside work (the best ratings were for rheumatologists at 65% and the worst was for neurologists at 45%). If that were not enough, 65% of nephrologists had high self esteem (only exceeded by plastic surgeons, urologists, ophthalmologists, endocrinologists, and orthopedists; the worst self esteem was among infectious disease specialists at 47%).

Remarkably, 60% of nephrologists have happy marriages—only otolaryngologists, plastic surgeons, and urologists had happier marriages than nephrologists; psychiatrists had the least happy marriages.

The survey was of 15,069 physicians in 29 specialties, practicing medicine in the US, and weighted to the American Medical Association’s distribution by specialty and state. It was conducted between July and October 2018. About 45% of the respondents were over the age of 50 and 62% were male physicians.

One could legitimately quibble with the Medscape survey, arguing that it isn’t truly representative because of the relatively small number of nephrologists who where interviewed (approximately 150). Still, the findings were provocative because there seems to be a gap between how nephrologists regard themselves during their career versus the perceptions of nephrology as a subspecialty among fellows considering it as a career.

Recall that a paper by Jhaveri and colleagues in 2013 of 714 US Internal Medicine Subspecialty fellows pointed to nephrology being an unpopular career choice2. According to the authors, “Most nonnephrology internal medicine subspecialty fellows never considered nephrology as a career choice. A significant proportion were dissuaded by factors such as the challenges of the patient population, lack of role models, lack of procedures, and perceived difficulty of the subject matter.”

Likewise a recent paper by Beckwith and colleagues from the UK reinforced the unpopularity of nephrology as a career3. The Beckwith study was based on semistructured face-to-face interviews of 11 nephrologists followed by interpretative phenomenological analysis. One of the key findings was the importance of ‘inspirational’ role models.

Nephrology continues to grow as a specialty because the burden of kidney disease is rising steeply. According to Bowe and colleagues4, in the United States alone from 2002 to 2016, the number of healthy life-years lost from chronic kidney disease increased 52.6%, to nearly 2 million.  The complexity of our patients is well established. Yet, if we believe the survey data from US internal medicine fellows, nephrology isn’t thought much of as a career choice. Counter that with nephrologists, according to the Medscape survey, being in the top tier among subspecialists in happiness and esteem. Now there’s a happy message to begin the New Year!


1. Martin KL. Jan 9, 2019, Medscape Physician Lifestyle & Happiness Report 2019

2. Jhaveri KD, Sparks MA, Shah HH, et al. Why not nephrology? A survey of US internal medicine subspecialty fellows. Am J Kidney Dis. 2013;61(4):540-6.

3. Beckwith H, Kingsbury M, Horsburgh J. Why do people choose nephrology? Identifying positive motivators to aid recruitment and retention. Clin Kidney J. 2018;11(5):599-604.

4. Bowe B, et al. Changes in the US burden of chronic kidney disease from 2002 to 2016: an analysis of the Global Burden of Disease study. JAMA Network Open 2018; doi:10.1001/jamanetworkopen.2018.4412.