Friday, September 21, 2012

Want to be an attending physician on the ward - or not??

Can Nephrologists be medicine attendings or co-attendings on ward months for residents?

One of the reasons that residents don't get a good flavor of nephrology is because nephrologists have started to back off on serving as medicine attendings at many places and are only focused on subspecialty care consultation services.  Although, studies have shown that replacement of specialists with general-hospitalists in the last 15 years on the wards has had a positive impact on trainees medical education. A recent editorial by Wachter and Verghese in JAMA suggests that specialty attendings might not be ideal in the current health care settings to serve as medicine ward attendings. But they do emphasize that their presence is important. Hence, their exposure to residents can be via conferences or even " short bursts of co-attending."

What does co- attending mean? Do you manage the patient together? What is the second attending's role? Certain academic centers to have two attendings that round with the teams. Perhaps that might work. This might be one of the reasons why many residents don't get exposed to nephrology related education or other specialty related education. A ward "work" attending along with a subspecialty " teaching attending" might be another approach that might work as well.

I wonder how many practicing academic nephrologist do inpatient medicine ward months in 2012?
Would love to hear from many that do and what their experience is compared to 1980s or 1990s?

Check out the full viewpoint in JAMA Sept 2012 issue. 
Check out the podcast that goes along with this topic as well on the main JAMA website


  1. Do Nephrologists run their own inpatient services anymore or has that been supplanted by the Hospitalist movement? In my training there was a very vigorous Renal Medicine inpatient service and clinic that was typically staffed by two attendings, two fellows and 4 Medicine residents. It was one of the best teaching services if not the best that I ever experienced. From a clinical perspective there was also great continuity of care for the patients.

  2. Certain centers do that a service like you say- and at certain centers its run by Nephrologists.
    I know at Weill Cornell its run by nephrologists. Renal services creation could be another way to increase exposure to nephrology.


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