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Background: The shortage of applications for fellowships in nephrology is a worldwide challenge. This is the first survey to explore in Europe the reasons physicians choose (and do not choose) a career in nephrology.

Methods: An anonymous questionnaire was sent to the presidents of societies that are members of the European Renal Association (ERA), who invited trainees and nephrologists to respond. Statistical analysis was performed using SPSS v.26. (SPSS Inc., Chicago, IL, USA). Continuous variables were compared by Student's t-test or by one-way ANOVA.

Results: Responders included 516 (49%) females and 542 (51%) males. They comprised 278 (26%) trainees, and 780 (74%) nephrologists. The majority (64%) believe that students have an unfavourable perception of nephrology. For trainees, nephrology is not considered an attractive option due to ‘chronically ill patients’ (35%), ‘lack of contact during undergraduate training’ (37%), ‘nephrology is too challenging’ (38%), ‘poor remuneration’ (22%), ‘negative role models’ (15%), and ‘long working hours’ (14%). The factors with the greatest impact on choosing a career include a positive role model (46%), practical experience during medical school and early postgraduate training (42%).

Conclusion:Trainees emphasize that work–life balance is very important for the younger generation. A strong mentorship along with early engagement is associated with a higher likelihood of pursuing a career in nephrology. It is crucial to create a strategy that will provide a positive experience, renew the interest in nephrology careers and ensure enough nephrologists to treat the growing number of patients with kidney disease.