tag:blogger.com,1999:blog-5872673930112727345.post7745752801526884963..comments2024-03-28T05:54:38.356-04:00Comments on Nephron Power: Take care of your Nephrologists; a burnout in the makingKenar D Jhaveri( kidney 007)http://www.blogger.com/profile/08654527832183917798noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-5872673930112727345.post-30182946695102399202020-10-12T14:19:12.325-04:002020-10-12T14:19:12.325-04:00This comment has been removed by a blog administrator.SIGURON GmbHhttps://www.blogger.com/profile/09446332463186583452noreply@blogger.comtag:blogger.com,1999:blog-5872673930112727345.post-89789641976379941872018-02-09T13:38:26.391-05:002018-02-09T13:38:26.391-05:00After finishing renal fellowship, I am embarking o...After finishing renal fellowship, I am embarking on another unrelated IM fellowship. I plan to practice the other fellowship primarily, general IM secnodarily, and practice nephrology as a hobby. Fear not, I will refer to the HD center and medical director for ESRD patients and remain as their PMD and other specialty physician and send to a GN center in the event of a disease far out of my league. <br /><br />Nephrology as a discipline is amazing and rekindles the inner medical student wonder and awe. Being a (community) nephrologist makes me very depressed. All of the rats of deserting the sinking ship and taking the treasure with them. Gregory Househttps://www.blogger.com/profile/09044847066127604819noreply@blogger.comtag:blogger.com,1999:blog-5872673930112727345.post-91011761184662021162018-01-29T12:08:16.759-05:002018-01-29T12:08:16.759-05:00A change in the clinical model of care will be nee...A change in the clinical model of care will be needed before the relationship between an aging population with increased complexity of chronic diseases is broken. The current model of care often places the Nephrologist in the role of both specialist and Primary Care Physician, without colocated easy availability of the specialists we need to really perform our mission---that of keeping patients from devolving into ESRD. Lack of immediate help from a PCNP for day-to-day tactical issues, a Pharm D for regular reconciliation of multiple Providers' medication additions and changes, a Clinical Social Worker for those issues of environmental interactions that are unsolvable by the Nephrologist, a Nurse Educator to help with rampant medical illiteracy and motivation away from noncompliance based on lack of understanding, a Nutritional medicine specialist for the all-important issues of dietary education, and a data-management expert to troll the clinical database of the patient for indications of changes in the known risk factors and their relationship to the rate of decline of eGFR. Lacking these, in an environment where productivity is defined by the income generated by the number of daily encounters and the EMR provided is simply a note-writer joined to a coding engine designed primarily to insert the right words into the note to extract the maximum RVU's, and the result is an intellectually stifling professional life where economic gratification is the only gratification available. No wonder intelligent people who felt that they were getting into a line of work that would allow them to help other human beings become despondent and burn out! <br />It its reasonable to ask "Where would the money come from to support the salaries of these other partners in care?" Here is where one of the greatest humanitarian pieces of legislation in history --- the Medicare ESRD Act--- inadvertently went terribly wrong. If we consider ESRD to be largely a failure of prevention at the primary care level, then the cost of that institutional failure of prevention was transformed into an economic externality for the primary care institutions by a bill that devolved the cost of that failure onto the Federal Government. Since there is no feedback on the primary care organizations to fund those additional colleagues for the Nephrologist to slow the pace of CKD, there is no reason for them to spend that money. <br />Mind you, I am not saying by any means that the Medicare ESRD Bill should not have been signed. Far from it. But, in the current era with 120,000 Americans entering ESRD every year and 100,000 dying, m the result is an annual increase of 20,000 dialysis patients at a cost of ~$60,000-$80,000 per patient-year. If the Medicare ESRD program was altered to reflect back even a fraction of that $12-16Billion annually on the primary care insurance industry, Nephrologists would have all the resources they need to fight the preventable causes of declining ESRD. And, Nephrology would not remain the near-hopeless fight against the Reaper that leaves so many of our colleagues feeling hopeless/helpless.<br />Just my thoughts, after 45 years of military and Federal service in Nephrology.<br />TJO'Neil, MD FASN FACP COL USAFMC(Ret)TJ O'Neil MD FACP FASN COLUSAFMC(Ret)https://www.blogger.com/profile/18264059064279122472noreply@blogger.com