Friday, March 11, 2016

Nephrologists as Super Heroes

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


  1. Good analogy to which I agree. A major obstacle is reimbursement which lags the other major specialties such as cardiology, gastroenterology, and anesthesiology. The message is not getting out about how complex these patients are and the value of timely intervention to prevent ESRD, which is brutally expensive AND devastating.

  2. I myself am a lifelong ESRD patient. As a teenager,I had what was found to be a rare cases then of membrano proliferative glommerula nephritis, type 2.There wasn't much known of this then, and became 1 of few case studies. After massive doses of steroid injections every other day at a hospital through my teen years, it went into "remission." Not until age 29 did it start to fail and I had my first transplant from my brother. Seven years later, unfortunately it failed with no answer even with biopsy. I then went on peritoneal dialysis for a year and a half and am now with my second transplant a year out this month. It is truly amazing as you stated, the knowledge that is needed by one,as well as interest that is gained by the patient in this field. There is definitely a lack of specialists in this field, a field that is so complex and intriguing. Your article is so on point with the value of these patients and timely intervention. Fabulous article. Thank you.


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