When somebody asks me what
nephrologists are, I usually respond with ‘superheroes.’ Sure, my perspective
may be a bit skewed since I write for a comic series, and yes, superheroes may
not be the first thing that pops into one’s mind when discussing the kidney.
But in clinical practice, nephrology is a multidisciplinary field within
medicine that requires deep knowledge of numerous organ systems. Acid-base
disorders, dialysis, oncology, rheumatologic diseases, and transplantation
are just some of the subjects in which a budding nephrologist gains expertise.
Combine this prowess with the everyday challenges of providing primary care to
chronic kidney disease patients, one can’t help but think of nephrologists as
‘superheroes’ in medicine.
When intensivists are struggling with
an ABG, who do they call? The nephrologist. When cardiologists are struggling
with hypertension and volume management, who do they call? The nephrologist.
When endocrinologists are baffled by unexplained hypercalcemia, who do they
call? You get the picture. Superheroes are wanted---and needed---in order to
save the day.
You would think that young residents
would be clamoring to don their capes and join the field of nephrology. But on
the contrary, interest in nephrology has steadily been declining in recent
years. According to Dr. Warren Kupin of U-Miami, the field of nephrology is
suffering from an ‘acute fellowship insufficiency’, with fewer than 50% of programs filling
their open fellowship positions, and some large academic programs going without
even a single fellow. This lack of interest can be attributed to perceptions
that this field is too complex, or perhaps to a lack of exposure to nephrology
in residency. We may see ourselves as superheroes, but in actuality we
are perceived more as “mutants” by the rest of the medical profession.
The mutants of X-Men are a group of individuals that were born with superhuman
powers, but needed guidance, direction and purpose in order to flourish. They
were constantly being targeted for their distinct abilities and talents that no
humans could ever dream of possessing. The X-Men frequently had to fight for
their mere survival. While on the pathway to annihilation, a bright light
shined over these mutants. A gentleman by the name of Professor X would fill
the void and provide mentorship to these troubled youth. He was a scholar and a
role model for his students. It was through him alone that the X-Men were able
to hone their powers for the good of mankind and recruit other mutants to
Xavier’s Academy for Gifted Youngsters. Had it not been for the mentorship of
Professor X, the mutants would have surely fallen into extinction.
Simply stated, we need more Professor
Xs in nephrology. There needs to be a drive from within the field itself to
demonstrate the attractiveness of our specialty. A systematic approach towards
creating interest in our field must be undertaken to draw in the next
generation of renal specialists. One way to make nephrology appealing to
medical students and residents is through effective mentorship and education
from the people within.
When I was in medical school, I
was assigned to a nephrologist as my attending physician for much of my
internal medicine rotation. This was my first real exposure to what I would
come to find as my life’s calling. I was intrigued by the complexities of renal
physiology and its application in practice. I was excited by the life saving
procedures of catheter placement and emergent hemodialysis in the emergency
room and ICU. I was challenged by the detective work involved with diagnosing
glomerular diseases. Now, in fellowship, my passion for the field has been
furthered by being a part of the kidney transplant team.
It is time we all do our part
and take on the tradition of actively engaging and mentoring young physicians
in the field of nephrology. Medical students and residents should be encouraged
to rotate through nephrology electives with inspiring clinicians and passionate
educators. By motivating a new trainee to consider a career in nephrology, you
become more than a role model- you become a superhero. In the words of
Professor X, “when you can access all that, you’ll possess a power no one can
match. Not even me.”
Post by Dr. Khurram Mehtabdin, NSMC intern, who is a graduate of Syracuse University and
TouroCOM NY. He completed his residency in internal medicine at Flushing
Hospital Medical Center and is in his nephrology fellowship at the Northwell
Health and Hofstra Northwell School of Medicine. Khurram is the co-creator of
the comic book series Zindan,
available at TheLastAnsaars.com