Abstract The nephrology workforce is in trouble. Like other consultative-heavy specialties dealing with the chronically ill, it is increasingly difficult to attract and retain trainees. The reasons are multifactorial but include perceptions of a high workload, poor remuneration and, for regional or remote services, isolation. The rate at which new nephrologists are being added to the workforce is insufficient to replace the projected retirements by 2010 and do not allow for any increase in numbers of patients with chronic kidney disease (CKD). However, both CKD incidence and prevalence are inexorably rising, and the patients within this category bear increasingly complex comorbidities. Who will replace the retirees? Sadly, perhaps the answer is no one – an answer which places this challenging specialty under real and imminent threat.