Psychonephrology of the Future: A Global Psychiatry and Nephrology Inter-specialty Curriculum for Training the Next Generation of Specialists

The number of subspecialists and “sub-subspecialists” continues to increase in medicine. There is a need for greater degrees of medical sub-specialization as clinical and research knowledge creates a greater range of therapeutic options for specific complex patient groups, such as in the care for kidney patients. The boundaries among present-day subspecialties are “permeable” (e.g., geriatricians see aging kidney disease patients; consultation-liaison psychiatrists see aging psychiatric patients in hospital settings). The clinical and research literature challenges the logical boundaries among illness groups and argues for more integration of the clinical roles among present-day subspecialties and inter-specialties. This evolution illustrates the need for the creation of much-needed new “sub-subspecialties.” Many current subspecialties are not yet certified by the Accreditation Council for Graduate Medical Education or the Royal College of Physicians and Surgeons of Canada. However, some training programs offer approved as well as non-approved fellowships (such as psychonephrology). It is anticipated that many of the present-day “non-approved” fellowships will evolve to be approved sub-subspecialties. This is partially driven by the trend for promoting collaborative care model of integrating behavioral health and general medicine services. This model has been shown to improve patient outcomes and reduce inappropriate excess healthcare utilization. By offering formal training in psychonephrology, such integrated care models could be strengthened and adopted in other specialty care models. Fellows in both psychiatry and nephrology would have increased competence in the prevention, evaluation, and management of the psychiatric aspects of nephrology. By introducing a formal psychonephrology curriculum, the next generation of nephrologists and psychiatrists would be better prepared to offer a more comprehensive and holistic care.