Table 2.

Selected participant quotations for each barrier theme identified

ThemeQuotationsFocus Group Contributing to Theme
Lack of exposure“One reason I haven’t decided I wanted to do nephrology is that I didn’t have a lot of exposure before I delineated down the pathways of subspecialties” (group 4)Groups 1–4
“. . . I think there is a big divide between what we are exposed to for nephrology on the inpatient side, probably to what it’s like as an outpatient . . .” (group 1)
“I would say exposure on the outpatient side is not only limited but poor” (group 2)
Lack of advances in the field“I am mostly frustrated with the field itself. We can’t fix AKI . . . the therapeutics that are there are limited, other than going to something like dialysis. So I am frustrated thinking about if I were to be a nephrologist, how much I can help people” (group 1)Groups 1–4
“. . . The same diuretics, same anti-hypertensives, . . . so I don’t have a great sense of where the field of nephrology is going” (group 2)
“It’s kind of crazy that it’s dialysis, it’s been around forever. Like, the fact that there haven’t been any advances in dialysis” (group 1).
Low monetary compensation“I used to think [nephrology] was interesting, but it’s a long fellowship and you don’t make any more money than you would as a hospitalist . . . I’m not going to do more school for less money” (group 1)Groups 1–4
“I am morally opposed to doing more training for less money” (group 2)
“If you go into a nephrology fellowship, you’re not going to make money, and I think that has overall made it less popular” (group 3)
Too complex“It was just really in depth and confusing to tackle all that as a med student . . . I thought this is so crazy, and I don’t think I can be a nephrologist” (group 1)Groups 1–4
“Our renal lecture-based stuff is very biochemical and not very clinical” (group 2)
“I don’t, honestly, think I am smart enough to do [nephrology]” (group 3)
“When I hear like that level of physiology . . . it’s going to maybe attract the right people. It could also turn away a lot of people that maybe the field needs at this point . . . if it’s not actually important that you have that level of intensity of physiology for management of CKD” (group 4)
“[W]e know people don’t do well on dialysis very long term, so I was always worried about establishing connections with people, very sick people, that likely won’t be there in maybe 5 years” (group 1)
Lack of role models/mentors“I chose hospital medicine because some of my mentors, some of my best teachers in medical school were all hospitalists” (group 1)Groups 1–4
“I think having mentors super early on [in medical school] helped me kind of guide where I wanted to go for my career and residency” (group 2)
“That is what really drove me to choose my field [allergy and immunology], was that the types of interactions with faculty were just overwhelmingly positive . . . and it was like hey this is something you enjoy and the people are really cool so I might as well go for it” (group 4)
Low-prestige/noncompetitive field“People who feed into [nephrology] are not necessarily competitive applicants, and then it kind of gets this bad rap as like a not that great specialty which is a really unfortunate cycle” (group 3)Groups 1–4
“Years of build up against nephrology, like it’s a very unsexy field” (group 2)
“There are some sentiments towards [nephrology] since that isn’t one of your highly competitive really sought after specialties . . . it’s almost stigmatized and faculty are like ‘Why are you doing that?’ or they’re like ‘Oh well that’s a waste’” (group 4)