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Rudolph A. Rodriguez, MD, Chair of the Nephrology Board

The Nephrology Board, which meets twice a year and is responsible for oversight of policy and assessment in the specialty, held its spring meeting on March 18, 2025. Representatives from the American Society of Nephrology (ASN), the American Society of Transplantation (AST), the National Kidney Foundation (NKF) and the Renal Physicians Association (RPA) joined for a portion of the meeting*.

The following is a summary of the spring meeting. Visit the ABIM Blog for reports of prior meetings. To share your feedback with the Nephrology Board on this report or other issues that are important to you, please complete this brief survey.

ABIM and the Nephrology Board gratefully acknowledge the service of Deborah B. Adey, MD, and Linda Awdishu, PharmD, whose terms on the Specialty Board end June 30, 2025.

Contents:

ABIM Leadership Update*

Furman S. McDonald, MD, MPH, President and Chief Executive Officer of ABIM and the ABIM Foundation, joined the Specialty Board to discuss progress on key initiatives and ongoing areas of focus for ABIM, including:

  • Exploring the alignment of Maintenance of Certification (MOC) requirement due dates with the Longitudinal Knowledge Assessment (LKA®) cycle to help make the MOC program more reliably predictable.
  • Enhancements made to the LKA in response to feedback from physicians who identified areas for improvement, which are intended to keep the program relevant and effective.
  • Expanding ABIM’s engagement with stakeholder communities such as early career physicians, specialty societies and patient-focused organizations.
  • Upgrades to the ABIM website and Physician Portal for 2025 designed to make it easier to find information for both physicians and the public.

Rudolph A. Rodriguez, MD, Chair of the Nephrology Board, and John C. Lieske, MD, raised concerns about how new government policies may affect international medical graduates and health equity work at ABIM. Dr. McDonald acknowledged systemic changes and potential shifts on the horizon, noting that ABIM is an independent organization that does not receive federal funding. The Equity Committee remains committed to continuing ABIM’s work and ABIM continues to coordinate with societies and other internal medicine organizations on how new policies and executive orders may affect the work they do.

Dr. McDonald addressed some Specialty Board members’ concerns about physicians who find the MOC program unclear or confusing. He emphasized that ABIM is working toward a clear and predictable program that is simple to follow while remaining responsive to physicians’ needs. Several members expressed satisfaction with the enhancements to the LKA and inquired about the possibility of further changes, such as allowing physicians to enroll before their assessment due year and take a break between five-year LKA cycles. He discussed how ABIM has been working with early career physicians to better understand their needs and shared that similar assessment pathways exist in other primary specialties.

Dr. Awdishu expressed appreciation for ABIM’s exploration of innovations in assessment and pointed out the potential of artificial intelligence (AI) in creating effective distractors for assessment items. Dr. McDonald explained that among other innovations, ABIM is exploring the use of AI tools to support Item-Writers as part of a larger focus on improving efficiency in how it creates assessments.

Specialty Board Oversight of Assessment*

Each spring, the ABIM Specialty Boards review data related to certification and assessment trends in their disciplines to help guide their decisions on assessments. At this meeting, the Nephrology Board received statistics on the current state of active certification in nephrology, assessment enrollment, demographics and pass rates, and data from post-assessment surveys. (Some data, such as exam pass rates and resident and fellow workforce trends, are publicly available on ABIM’s website.) One notable trend was a higher representation of international medical graduates and osteopathic physicians in the specialty. Additionally, participation in LKA remains a leading choice. In 2024, 77% of ABIM Board Certified nephrologists due for an assessment opted for the LKA over the traditional, 10-year MOC exam.

Jeffrey S. Berns, MD, FASN, Councilor for ASN and past chair of both the ABIM Council and the Nephrology Board, encouraged ABIM to publish fellowship program pass rates and information about how it develops assessments more prominently on the ABIM website and Physician Portal in the interest of transparency. ABIM currently publishes internal medicine residency program pass rates for three-year periods.

Initial Certification and Training Data in Nephrology*

The Nephrology Board also reviewed new data from the National Resident Matching Program (NRMP), Board Eligibility data, outcomes for candidates requiring retraining, faculty pathway pass rates and approved Advancing Innovation in Residency Education (AIRE) programs in nephrology.

Matthew A. Sparks, MD, mentioned that several combined nephrology/hospice and palliative medicine AIRE pilot fellowship programs had ended due to a lack of participation. The Specialty Board discussed a proposal to invite the pilot leaders to the next Specialty Board meeting to learn more about why the programs closed and how the Nephrology Board can better support innovation for future AIRE programs.

Diplomate Professional Profile*

The Diplomate Professional Profile is a questionnaire built into the ABIM Physician Portal and required of all ABIM Board Certified physicians. The questionnaire gathers information about clinical work and practice patterns, and ABIM uses the information to inform operations, such as updating exam blueprints, developing  policies for initial certification and MOC, and ensuring adequately diverse representation of the profession in research and governance. To date, 44% of physicians have completed the DPP with a higher completion rate of 48% among nephrologists. Siddharta G. Reddy, MPH, Senior Research Associate for ABIM, reviewed aggregate data gathered so far related to nephrologists, including practice setting, practice size and physician ownership of practices.

Of note, the findings so far indicate that 90% of nephrologists who responded are clinically active. Practice types, size and ownership models vary widely, but more than half of respondents indicated that they work in private practice, with a single-specialty group practice as the predominant structure and independent or physician-owned practice the predominant ownership model.

Community Practice in ABIM Governance*

Erica N. Johnson, MD, FACP, FIDSA, Senior Vice President for Academic and Medical Affairs, led a discussion with the Nephrology Board on community practice in nephrology to create a more inclusive understanding of its role and scope. She also sought input on overlapping aspects of community practice across the disciplines of internal medicine to inform ABIM’s recruitment efforts for broad physician representation in governance roles.

Since 2013, ABIM Specialty Boards have been required to include at least one physician member primarily engaged in community practice, defined broadly in applications as “clinical practice in a non-university, community setting.” A workgroup convened in 2020 found that the existing practice categories candidates could choose were inadequate to the real scope of community practice and proposed updates drawn from the American Medical Association and the Diplomate Professional Profile.

The group discussed what makes nephrology unique from other specialties with its variable and complex range of practices and settings, and how nephrology practice has been affected by the move toward value-based care.

The Nephrology Board does not currently have a member who is a private practice general nephrologist and agreed to give special consideration to applicants from non-university, community settings for the next opening that will occur in July 2026. The Specialty Board will also be seeking an early career physician (someone who earned initial certification within the last 10 years) to join. ABIM will begin accepting applications for that opening and others later this year.

Visit ABIM’s Openings page for the latest governance openings.

Program Accreditation in Transplant Nephrology*

Last year, a joint task force of ASN and AST developed a proposal for the Accreditation Council for Graduate Medical Education (ACGME) to accredit transplant nephrology fellowships. Dr. Adey has provided updates to the Nephrology Board about this process at the last two meetings (fall 2024 and spring 2024). At the time of the spring 2025 meeting, ACGME had reviewed the proposal, which outlines clear roles for program directors and emphasizes both patient care and transplant knowledge. Currently the program requirements submitted by the ASN-AST ACGME task force are being reviewed by ACGME. These will largely mirror the AST accreditation committee requirement set forth by AST when accreditation was established.

The group also discussed the potential for recognition of transplant nephrology as a tertiary subspecialty with its own distinct ABIM certificate. At present, transplant nephrology lacks a formal certification process, relying instead on training and experience. While not acting at this time, the Specialty Board acknowledged that any proposal to consider an ABIM certificate in transplant nephrology would need to come from the transplant nephrology community. If that kind of request came forward, a rigorous vetting process would be essential to determining the necessity and viability of transplant nephrology as a distinct subspecialty within general nephrology.

Leading Issues in Nephrology*

Dr. Rodriguez invited the group to discuss current issues that affect the nephrology field. The topics they touched on included:

  • The importance of ABIM and specialty societies collaborating to share data that can help refine and improve assessment and education programs for physicians.
  • Potential cuts to Medicare and Medicaid and the need to protect patients, promote health equity and address misinformation by providing credible information and research funding.
  • The growing concern in the physician community over financial difficulties and the risk of losing nephrologists due to insufficient compensation.

In discussion, the group emphasized the need for more research, particularly around home dialysis, infection control and equity in kidney care. They also recognized that this could be achieved in part through continued partnership with ASN and RPA.

Innovations in Assessment*

ABIM’s Research and Innovations Department has been leading a program of research on enhancing assessments through three main areas: supporting efficiency for assessment development staff, facilitating the item development process and enhancing the assessment experience for physicians. The Nephrology Board received an overview of the team’s current projects.

Jerome Clauser, Ed.D., Senior Director, Research and Innovations, responded to several inquiries by members of the group about the use of AI, both as a tool for developing assessments and as a resource for physicians taking the assessment. He clarified that ABIM’s current policy does not prohibit physicians from using AI to help answer questions on the LKA (though it is not an option on the traditional exam). He also explained that ABIM staff is researching the use of existing large language models to help generate assessment content but not to reinvent assessment development models.

Annual Diplomate Report*

ABIM’s Research and Innovations Department is looking into the potential for ABIM to publish annual reports with specific data highlighting broad statistics for each discipline of internal medicine, both for a given year and historic trends over time. This would include the current number of physicians certified in each discipline and its geographic distribution, MOC participation rates, demographic characteristics and assessment pass rates. While some of these data have been made available upon request for research purposes, ABIM has never published a consolidated report.

Staff invited the Nephrology Board to review a prototype report based on 2023 data and provide feedback on how it could be improved to be of greater value to the internal medicine community. Suggestions included details of geographic and practice type data, which staff pointed out would be addressed over time as more physicians complete the Diplomate Professional Profile.

Supporting Research and Important Issues in Nephrology*

Dr. Johnson led the Nephrology Board in a discussion about opportunities for ABIM Governance members to support important issues and research that demonstrates the value of board certification. As a 501(c)3 organization, ABIM is under strict limits with regards to political and lobbying activities but may address issues within those limits and consider policy issues in an educational manner. Dr. Johnson asked the Specialty Board to identify current or emerging issues that affect health care in nephrology, and to consider opportunities for the Specialty Board to address these issues within the appropriate framework of its oversight of the discipline.

The group identified a few issues, such as the accuracy of clinical calculations (like the eGFR, recently updated) and structural bias in assessments, strengthening the integration of home hemodialysis and peritoneal dialysis in fellowship programs, and transplant research. Amy Beckrich, CAE, Director of Projects and Operations for RPA, spoke about the significance of living donor protections, the need to engage private practice nephrologists as a source for training fellows in home dialysis modalities and how quality measures affect care delivery.

Society representatives departed at this point in the meeting.

Candidates for the Nephrology Approval Committees

ABIM Specialty Boards are responsible for selecting members and chairs of the Approval Committees annually and as needed. At the spring meeting, the Nephrology Board reviewed candidate materials for two openings and voted to approve the following appointments:

  • Cybele Ghossein, MD, Northwestern University Feinberg School of Medicine, to join the Nephrology Traditional, 10-Year MOC Exam Approval Committee
  • Amir Kazory, MD, FASN, FAHA, University of Florida, to join the Nephrology LKA Approval Committee

Visit ABIM’s website for a full list of current openings.
Approval Committee openings are usually posted in the fall.

Updates from the Nephrology Approval Committees

Bernard G. Jaar, MD, Chair of the Nephrology Traditional, 10-Year MOC Exam Approval Committee, and C. John Sperati, MD, Chair of the Nephrology LKA Approval Committee, updated the Nephrology Board on the composition and recent meetings of the two Nephrology Approval Committees as well as the Nephrology Item-Writing Task Force. Dr. Sperati noted that the task force had exceeded its goal for creating new questions (items) and that a recently instituted mentor support program had been successful in improving the quality of new items. The Approval Committees continue to work toward their goals of enhancing feedback to Item-Writers, increasing the rate of items that are approved for use on the assessment and integrating health equity into more items.

The Nephrology Board also discussed updates needed for the Nephrology Blueprint specific to peritoneal and home dialysis and agreed to address these at the fall meeting.

ABIM is always looking for physicians to join the Item-Writing Task Forces
and help write questions for assessments. Learn more.

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*Indicates that society representatives and other guests were present for discussion of this agenda topic.