Advertisement

Current State and Future of Private Practice Nephrology in the United States

      Chronic kidney disease remains highly prevalent and exerts a heavy economic burden. The practice of nephrology has come a long way in managing this disease, though there remains room for improvement. The private domain, where more than half of the adult nephrology workforce operates, faces serious challenges. Interest has decreased in the field, leading to diminished recruitment. There has been a reduction in both reimbursement rates and revenues. We discuss the current state of private practice nephrology and strategies to reinvigorate our discipline. There needs to be a focus on preparing fellows during training not only for academic careers, but also for effective functioning in the environment of private practice and development of pathways for growth. We believe that private practice nephrology must expand its frontiers to be fulfilling professionally, challenging academically, and successful financially. The United States government has recently announced the Advancing American Kidney Health Executive Order which seeks to prioritize optimal treatments for patients with kidney disease. We are optimistic that there is a renaissance afoot in nephrology and that our field is in the process of rediscovering itself, with its best days yet to come.

      Graphical abstract

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Advances in Chronic Kidney Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • United States Renal Data System
        Annual Data Report.
        2019 (Available at:) (Accessed October 4, 2020)
        • Wang V.
        • Vilme H.
        • Maciejewski M.L.
        • Boulware L.E.
        The economic burden of chronic kidney disease and end-stage renal disease.
        Semin Nephrol. 2016; 36: 319-330
        • Saunders M.R.
        • Cifu A.
        • Vela M.
        Screening for chronic kidney disease.
        JAMA. 2015; 314: 615-616
        • Jhaveri K.D.
        • Sparks M.A.
        • Shah H.H.
        • et al.
        Why not nephrology? A survey of US internal medicine subspecialty fellows.
        Am J Kidney Dis. 2013; 61: 540-546
        • Hsiao L.-L.
        Raising awareness, screening and prevention of chronic kidney disease: it takes more than a village.
        Nephrology. 2018; 23: 107-111
        • Manns L.
        • Scott-Douglas N.
        • Tonelli M.
        • et al.
        A population-based analysis of quality indicators in CKD.
        Clin J Am Soc Nephrol. 2017; 12: 727-733
        • Greer R.C.
        • Ameling J.M.
        • Cavanaugh K.L.
        • et al.
        Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy: a qualitative study.
        BMC Nephrol. 2015; 16: 37
        • Pivert K.
        AY 2020 nephrology match.
        (Available at:) (Accessed August 2020)
      1. Executive Order on Advancing American Kidney Health.
        (Available at:) (Accessed August 2020)
        • Eknoyan G.
        Nephrology: as it was then, but is not now.
        Am J Kidney Dis. 2017; 69: 129-135
        • Maddux D.W.
        A history of leadership in dialysis: perspectives from seasoned leaders.
        Adv Chronic Kidney Dis. 2018 Nov; 25: 474-479
      2. CRS report RS22195, Social Security Disability Insurance (SSDI) and Medicare: the 24-month waiting period for SSDI beneficiaries under age 65. Available at: https://www.everycrsreport.com/reports/RS22195.html. Accessed October 14, 2020.

        • Saha S.
        • Wish J.B.
        Leading the dialysis unit: role of the medical director.
        Adv Chronic Kidney Dis. 2018; 25: 499-504
        • Scheel Jr., P.J.
        Business of dialysis and role of the medical director.
        Semin Dial. 2018; 31: 177-182
      3. Renal Physicians Association: 2018 Nephrology practice business benchmarking survey report.
        (Available at:) (Accessed August 2020)
      4. Centers for Medicare and Medicaid Services.
        (Available at:) (Accessed August 2020)
        • Honeycutt A.A.
        • Segel J.E.
        • Zhuo X.
        • Hoerger T.J.
        • Imai K.
        • Williams D.
        Medical costs of CKD in the Medicare population.
        J Am Soc Nephrol. 2013; 24: 1478-1483
        • Norouzi S.
        • Zhao B.
        • Awan A.
        • Winkelmayer W.C.
        • Ho V.
        • Erickson K.F.
        Bundled payment reform and dialysis facility closures in ESKD.
        J Am Soc Nephrol. 2020; 31: 579-590
        • Gilbert S.J.
        Does the kidney biopsy portend the future of nephrology?.
        Clin J Am Soc Nephrol. 2018; 13: 681-682
        • Yuan C.M.
        • Nee R.
        • Little D.J.
        • et al.
        • Nephrology education research and development Consortium (NERDC)
        Survey of kidney biopsy clinical practice and training in the United States.
        Clin J Am Soc Nephrol. 2018; 13: 718-725
        • Quigley L.
        • Salsberg E.
        • Collins A.
        Report on the 2018 Survey of Nephrology Fellows.
        American Society of Nephrology, WA, DC2018 (Available at: https://www.asnonline.org/education/training/workforce/Nephrology_Fellow_Survey_Report_2018.pdf. Accessed October 14, 2020)
        • Berns J.S.
        A survey-based evaluation of self-perceived competency after nephrology fellowship training.
        Clin J Am Soc Nephrol. 2010; 5: 490-496
        • Liebman S.E.
        • Moore C.A.
        • Monk R.D.
        • Rizvi M.S.
        What are we doing? A survey of United States Nephrology Fellowship Program directors.
        Clin J Am Soc Nephrol. 2017; 12: 518-523
        • Tandon A.
        • Wang M.
        • Roe K.C.
        • Patel S.
        • Ghahramani N.
        Nephrologists' likelihood of referring patients for kidney transplant based on hypothetical patient scenarios.
        Clin Kidney J. 2016; 9: 611-615
      5. Fellows Career Development Retreat.
        (Available at:) (Accessed August 2020)
        • Dave N.
        • Sparks M.
        • Farouk S.
        An introduction and guide to becoming a social media savvy nephrologist.
        Nephrol Dial Transpl. 2015; 30: 1790-1797
        • Colbert G.
        • Topf J.
        • Jhaveri K.
        • et al.
        The social media revolution in nephrology education.
        Kidney Int Rep. 2018; 3: 519-529
        • Sparks M.A.
        • South A.
        • Welling P.
        • et al.
        Sound science before quick judgement regarding RAS blockade in COVID-19.
        Clin J Am Soc Nephrol. 2020; 15: 714-716
        • Poyan Mehr A.
        • Sadeghi-Najafabadi M.
        • Chau K.
        • et al.
        The Glomerular Disease Study and Trial Consortium: a grassroots initiative to foster collaboration and innovation.
        Kidney Int Rep. 2018; 4: 20-29