Why Nephrology?

Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. In this post, Dr. Ng shares why she chose the field of Nephrology!

Prior to submitting a nephrology fellowship application, I heard mutterings of how unpopular the field had become. Online Student Doctor Network forums had toxic threads on nephrology:

“Do not go into nephrology, it is a DOOMED field”

“You work hard but you are paid nuts”

“Patients with kidney problems are difficult and complicated”

As obstinate as I was, I closed the website, swore never to look at it again, and applied to nephrology. Later that year, I matched at my top choice while 40% of the nephrology fellowship programs were left unfilled. I began my fellowship training with a chasm of doubt, unclear if what I saw on the online forums were true. As time progressed, I learned that the negativities that plagued nephrology were misconceptions. Moreover, I witnessed the field evolving and changing its course in response to the needs of a new work force. My uncertainty vanished and I felt that I had chosen the right path.

Five Reasons Why You Should Consider Nephrology

1. Intellectually Stimulating

During my first year of fellowship, the same narratives played like old movie reels: choppy and repetitive. Dialysis patients missed their treatments, fresh kidney transplants kept me awake at night, and consults for acute kidney injury never paused for a moment’s rest. I calculated water clearance, osmolar gap, and acid-base compensation. With time and practice, my lenses changed.

By the second year, I knew the shortest way to get from one ward to the other and memorized the fewest necessary clicks to get data from the EMR. With the time to think and read during my second year, I found renal physiology to be fascinating. I began to manage hyponatremia cases without referring to UpToDate, a skill that was not present before fellowship. Every new consult turned into an opportunity to solve a problem and to learn from clinicians outside of my field. The diverse range of medicine in nephrology keeps my mind constantly challenged.

2. Meaningful Doctor-Patient Connection

Patients are the souls of our field. With an average of 14 prescribed medications and 4 comorbid conditions per person, patients with kidney diseases are among the most complex of all the medical subspecialties1. This complexity comes with a doctor-patient relationship that is deep and meaningful. Sometimes we become more than just their doctors, we become their friends. As nephrologists we diagnose chronic kidney disease, fight to slow the progression of disease, discuss dialysis modality choices, initiate dialysis, advocate for kidney transplant, and celebrate our patient’s new found kidney function post-transplant. Yet if we pause and reflect, we learn valuable life lessons from our patients - courage, resilience and resolve. How privileged are we to be part of their journey?

3. Dedicated Teachers and Mentors

The word doctor came from the Latin word docere, meaning ‘to teach’. Assuming this role, nephrology educators are devoted to make learning fun. At the bedside, we aim to invigorate teaching rounds and clinic precepting sessions2. In the digital realm, a new generation of nephrologists are expanding the medical education sphere through several social media platforms3. The Renal Fellow Network blog distills complicated nephrology topics into easy-to-understand concepts. NephJC, a twitter-based journal club that discussed journal articles that drive nephrology forward. In 2015, the American Society of Nephrology launched Innovations in Kidney Education Contest, in an effort to spur interactive education tools for nephrology. What’s more? The introduction of NephMadness, an online game based on the NCAA March Madness, drives excitement and discussion about nephrology topics!

4. Business Savvy Nephrologists

With the changing reimbursement landscape and a shrinking workforce, the dissatisfaction towards nephrology has arisen from the high workload and the perceived lack of compensation and career options compared to other fields. Previously, nephrology practices relied on high patient volume to generate income, an approach that led to burnout. Now, nephrologists are pursuing alternative business models to generate passive revenue streams and more efficient practice structures. This new approach allows nephrologists to perform impactful work without sacrificing their work-life balance.

Historically, medical training has failed to educate physicians on the business of medicine. Fellows often feel overwhelmed when transitioning into practice. With the goal of helping fellows successfully transition into new jobs, a private-practice-academia partnership formed the Nephrology Business Leadership University. This 5-day course provides an avenue for graduating fellows to learn the business side of nephrology and acquire skills to become effective leaders. In addition to offering practical tools to fellows, the intimate setting of this course creates a network of lifetime mentors and friends.

5. Rewarding Nephrology Careers

The opportunities in nephrology are vast with a number of alternative paths emerging: nephrology-hospitalist, interventional nephrology, critical care nephrology, and even lifestyle/preventive nephrology. Beyond direct patient care, some nephrologists conduct meaningful work through patient advocacy and population health management. Others pursue non-traditional career paths as health insurance experts, health investors, or pharmaceutical industry researchers. Nephrologists who are drawn to leadership positions see potential in both the clinical and the non-clinical worlds. A number of positions are available including dialysis unit medical directorships, hospital chief medical officers, medical society board members, and government agency leadership roles.

Nephrology is a field where you can significantly improve the lives of patients through life-saving procedures such as dialysis and kidney transplants. Beyond these two procedures however, impactful advancement in nephrology had been sluggish. After a stagnation of innovation for half a century, we now see immense interest in advancing the field of nephrology. A public-private partnership formed KidneyX to spur innovation in nephrology, and on July 10, 2019, the US Department of Health and Human Services launched Advancing American Kidney Health to revolutionize the prevention, diagnosis, and treatment of kidney diseases. Exciting times ahead!

As my fellowship concludes, I see nephrology as a field with growing intellectual vigor and boundless potential. I now enter the workforce with energy and anticipation, feeling confident that a career in nephrology will continue to bring me fulfilment and joy.

Jia Hwei Ng, MD

Dr. Ng is an Assistant Professor of Medicine at Northshore University Hospital, Long Island. You can follow her @jiahweing on Twitter

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References:

1. Comparison of the Complexity of Patients Seen by Different Medical Subspecialists in a Universal Health Care System. Marcello Tonelli, Natasha Wiebe, Braden J. Manns et al. JAMA Netw Open. 2018; 1(7):e184852.

2. Share Your Passion for Nephrology: Ten Tips to Invigorate Attending Rounds and Precepting Sessions. Melanie Hoenig. American Journal of Kidney Diseases. July 2015 Volume 66, Issue 1, Pages 28–32.

3. The Social Media Revolution in Nephrology Education. Gates B. Colbert, Joel Topf, Kenar D. Jhaveri, Tom Oates, Michelle N. Rheault, Silvi Shah, Swapnil Hiremath, Matthew A.Sparks. Kidney International Reports. May 2018, Volume 3, Issue 3, Pages 519-529.