tag:blogger.com,1999:blog-4230162007222918868.post8125745420305617297..comments2023-09-19T05:50:03.130-04:00Comments on Renal Fellow Network: The future of nephrology training: A fellow's perspectiveGearoid McMahonhttp://www.blogger.com/profile/08049723797363526138noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-4230162007222918868.post-21307460327734940102014-12-21T17:08:32.551-05:002014-12-21T17:08:32.551-05:00Everyone here is missing the MAIN reason why there...Everyone here is missing the MAIN reason why there are so less residents choosing Nephrology- REIMBURSEMENTS. <br /><br />Over the years medicare has cut the reimbursements a lot. Unless you go to a rural area where is a dearth of nephrologists- it is hard to compare the salaries to Cardiology, GI, Oncology, Critical Care and even Rheumatology. Reimbursements for nephrology are one of the lowest. Compare for an injection of zolandronate medicare reimburses an oncologist 180$ and for 4 dialysis visits (including a comprehensive visit + patients care plan) we get 240$. <br /><br />I don't think people are not choosing nephrology as there is a lack of interest. nephrology has been one of the most interesting and intriguing specialty of medicine. Also most of the fellowship programs do a good job in training fellows. As a fellow I did not have much exposure to outpatient dialysis. When I started private practice did not have any i but highly problem and never felt under trained in dialysis. <br /><br />If we do want the specialty to survive- we do need to open up to discussion about reimbursements. It is the hard truth- nobody wants to do nephrology because our patients are complex and reimbursement is one of the lowest.<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4230162007222918868.post-3298972325746650932014-12-18T18:15:17.747-05:002014-12-18T18:15:17.747-05:00Does the Medical Education Institute (MEI), which ...Does the Medical Education Institute (MEI), which Dori Schatell heads, have an education product to teach nephrologists about dialysis?<br /><br />Until everyone is completely open about their financial and organizational interests, an honest and productive dialogue about fixing dialysis/nephrology is unlikely.<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4230162007222918868.post-86446616617235226222014-12-18T09:05:25.077-05:002014-12-18T09:05:25.077-05:00I am struck by what is missing in this blog post--...I am struck by what is missing in this blog post--any reference apart from population to the PATIENTS with kidney disease that a freshly-minted nephrologist will care for. Nephrology is, like endocrinology, an IM subspecialty that is highly complex, and therefore attracts some of the best and brightest. But, for years, the ABIM certification exam has been a mismatch for clinical nephrology practice--and, thus, fellowship training programs have been a mismatch as well. The ABIM exam has 240 items--and only a dozen (5%!) focus on ANY aspect of dialysis, which occupies as much as 60% of the time of practicing nephrologists. Don Berwick points out that systems are designed to obtain the results that they get. We have a system of nephrology training designed to develop chairs of academic nephrology departments at universities who can attract NIH research dollars--not take care of PEOPLE. Since there are so few dialysis questions on the exam, it's easy for training programs to ignore it entirely. I'm told that of the 140 or so training programs, just 10 require a hands-on chronic dialysis rotation. (Imagine if oncologists were not trained in chemotherapy!) Is it possible that one reason nephrology is no longer attracting fellows is the LACK of focus on taking care of people? Isn't caring for people the reason many people enter the field of medicine in the first place? The ASN is now offering dialysis coursework, and my understanding is that the new chair of the ABIM is looking at better fitting the exams to clinical practice. Perhaps steps like these will help to make nephrology practice more appealing to future physicians.Dori Schatell, MShttp://www.meiresearch.orgnoreply@blogger.com