Perspectives

ASN President Eleanor Lederer, MD, FASN talks with ASN Executive Vice President Tod Ibrahim about recent advances in nephrology, her career path, and music -- from the Grateful Dead to the Dandy Warhols to the Hives.

 

 

Harvard Medicine Magazine takes a close look at current transplant policy and the dead donor rule.

Saturday's State-of-the-Art lecture features Ross L. Cagan, PhD; read about Dr. Cagan. 8:45 am W375C-E

Some practical advice for rural practices transitioning to value-based payments, including focusing on population health.

ASN Data Science Officer Kurtis Pivert takes a look at a new survey of American physicians: regulatory and administrative pressures are taking a big bite out of the joy of practicing medicine.

ASN Data Science Officer Kurtis Pivert takes a look at the nephrologists' responses in the Medscape Young Physicians Compensation Report.

Raymond C. Harris, MD, FASN is ASN’s 50th president. Each month, he will share his thoughts on items of interest to ASN members and others in the kidney community, and request your insights on specific issues.

In this month's column, ASN President Raymond C. Harris, MD, FASN discusses initiatives that are changing the practice landscape in nephrology.

When I think back over the time that I have been in nephrology, I am struck by how many advances we have made in our understanding of kidney function and the pathogenesis of kidney disease.

Nephrologists have always been considered among the best educators in medicine. Our commitment to excellence in patient care and research extends to finding innovative ways to teach students, residents and fellows about some of the most complex (and interesting) issues physicians and scientists face. Nephrologists also provide complete care for a complex patient population in ways that most other specialties do not.

The Australian government is assessing undergraduate medical slots: predictions indicate an excess number of doctors in cities, and a shortage in rural areas.

Doctors used to climbing the career ladder are used to saying "yes" -- in this AMA post, some suggestions for saying "no."

In this opinion piece Prof. Bernd Huber, President of LMU Munich and former Chair of the League of European Universities, addresses how research in Europe will be affected by the Brexit vote.

The Canadian Institutes of Health Research, the federal grant funding agency, cancelled in-person peer review of funding applications.

Is their new system broken, and what does that mean for scientists in Canada?

This study found that cognitive changes occur early in CKD, and skills decline at different rates.

 

Are doctors "escalating care" to move patients up the list? Read this commentary by Matthew Movsesian, MD.

Is cost sharing forcing some patients to delay care? The American College of Physicians issues recommendations regarding cost sharing and its potential effects on patient care.

Interesting perspective in Genetic Engineering News on recent gene editing advances by scientists in CHINA.

Also of interest:

KN Online resources on gene editing technologies

The Office of the Inspector General has noted ongoing weaknesses among healthcare organizations despite growth in ransomware attacks and other breaches.

"There has been a dramatic shift in our understanding of potential patient outcomes following AKI."

Are young scientists facing undue pressure to publish and get funding? Is the system interfering with the science? A feature news article in Nature explores the landscape for young basic scientists.

ASN President Raymond C. Harris, MD, FASN comments on the concerns highlighted in this article:

Doctors are more likely than the general public to experience depression or take their own lives. Some medical institutions are working to make a difference.

Usability, functionality, helpful to patient care? EHR vendors are not scoring well.

EHRs: lagging too far behind available technology to be useful to patient care?

 

This article by Craig DeGarmo is the first in a series of perspectives from experts working to address disparities in faculty compensation, and improve approaches to faculty recruitment and retention.

Tax credits, Medicaid expansion, 5 principles outlined by the president -- Zach Cahill and David White keep you informed.

What's In; What's Out; What's Happening in Congress? ASN's Zach Cahill and David White provide this week's update.

Do physicians in Australia need more oversight?

Dr. Avnish Seth recommends building exchanges between cornea and organ donation systems in India to increase opportunities for transplants.

The Indian Society of Organ Transplantation is trying to standardize the cost of transplants.

Physician trainees and physicians experience higher-than-average levels of stress and depression. What can be done to expand support? Stethoscope - Copy.jpeg

The US Department of Health and Human Services has issued a report summarizing gaps in health data privacy and security. But is anything being done to close those gaps?

"As a physician, I can share the sense of loss that many feel as they mourn the passing of an era of independence....On the other hand, I celebrate the new direction toward more value and better outcomes for patients." 

Kidney News Online begins a series of interviews with nephrologists who trained in the United States as International Medical Graduates (IMGs). To launch this series, we turn to two brothers, Fahim and Naeem Rahim, nephrologists who have changed the landscape for kidney patients in southeastern Idaho.

Some institutions are beginning to enact programs designed to better support medical residents as they begin their training.

Will expanding requirements for IT infrastructure further reduce the number of independent practices?

Doctors and nurses employed by a health insurer -- is this model workable?

This perspective piece argues "the MACRA definition of interoperability is based on an aging IEEE statement from 1990 and that definition was never intended to describe the interoperability of health data records nor interoperation of EHR or HIT systems.”​

The new Editor-in-Chief of "Science" thinks scientists in the US are at risk of becoming just "another special interest group."

Do electronic communications and web portals benefit or challenge physician/patient communications? Or both?

"Laughter doesn't mean you're not depressed." Physicians have higher rates of stress, and sucide risk, than the general public. 

A closer look at the Health IT requirements associated with the MACRA final rule.

Well-known healthcare CIO offers insights on making MACRA work for your practice and your patients.

Physicians suffer higher-than-average rates of depression and suicide. Mayo Clinic study addresses what can be done from an organizational perspective to promote physician well being.

Leveraging digital technologies for research may limit participant diversity.

St. Louis Review article highlights work of Dr. Stuart Slavin and the SLU Medical School: making concrete changes to reduce depression rates and stress among medical students.

Also of interest:

Medical Students and Depression: Identifying the Causes

Health insurers say proposed mergers are an outcome of the Affordable Care Act. Opponents say the mergers will negatively impact quality and cost of care.

Nice summary of the MIPS benefits and pick-your-pace options from EMR and EHR.

KN Online MACRA resources here.

This survey of small practices in New Jersey indicates the small practice is not in danger of disappearing completely, especially for those who are embracing new technologies.

Some physicians vote to unionize, voicing a desire for more negotiating authority re patient care.

In celebration of ASN's 50th anniversary, a number of ASN leaders have taken the time to remember what it was like to attend their first ASN annual meeting. We will continue to update this section throughout the year, and encourage you to send in your recollections of your first ASN annual meeting (info@kidneynews.org). 

Match season is upon us. Take a look at the variety of careers in nephrology, and ASN's Match resources.

Dr. Lilia Maria Rizo Topete (Monterrey, Mexico) shares one of her memorable training experiences.

ASN President Raymond C. Harris, MD, FASN notes the profound contributions of nurses to advancing care of patients with kidney diseases.

The Office of Research Integrity will always face criticism, but right now a good measure seems to be coming from inside.

The Office of Research Integrity will always face criticism, but right now a good measure seems to be coming from inside.

It's been one year since Wales launched presumed consent for organ donation; results so far are positive.

Physician

Becker's Hospital Review published this article about physician burnout and suggest hospitals are incorrectly engaging with the issue.

Can doctors effectively assess a patient just by reviewing a file? Ontario's workers compensation board says yes.

Patients will help determine the future of kidney treatment. Kevin J. Fowler will present at 4:30 -- read his recent article on the patient voice in transplant care.

Shifts in health care requirements will also affect physician compensation. Learn more about compensation models and how they may be affected by changing policies regarding value-based care.

Do PHPs help physicians, or does the US need to develop and implement standards for these programs?

Terrific column by Christine Sinsky, MD on what is lost when physicians must spend so much time interacting with a computer screen.

"Even when residents recognize their stress and want to seek support or treatment, they may be discouraged by the professions's culture of stoicism...." This article from HopkinsMedicine discusses the challenges residents face, and potential approaches to better supporting trainees.

Survey says: Patients like their physicians, but are increasingly concerned about whether they can afford to see them.

There are almost 400,000 hemodialysis patients just in the US, with a mortality rate approaching 50% at three years from the start of hemodialysis. Pragmatic trials, conducted under real-world conditions, may help improve routine care for these vulnerable patients. 

Does "publish or perish" pressure undermine -- or encourage -- quality?

One doctor notes that exhaustion doesn't stem from the patient load, but from "external factors like increased paperwork, insurance hassles, and ever-increasing regulation."

Flawed tools, flawed research? Lack of reproducibility of some studies linked to custom-built antibodies.

Premier Brad Wall hopes to bring presumed consent to Saskatchewan, and believes the province should serve as a model for the rest of Canada.

The International Committee of Medical Journal Editors says study data should be shared within six months of publication. Is that the best approach?

doc ofc b w - Copy.jpg​"The way MACRA is structured now, the large practices will do well..."

Many clinics, including those without physicians leading them, are seeking "legitimacy by association." 

“For the first time we’ll have some regularity in research funding in Greece,” says Nektarios Tavernarakis, director of the FORTH Institute of Molecular Biology and Biotechnology (IMBB).

Employed physicians face sometimes interesting challenges balancing their individual approaches with organizational priorities.

Older researchers are applying more often than younger investigators. This Cell Stem Cell study addresses that among other factors influencing the aging of the average NIH funded independent investigator.

Nephrology program directors lead the best, and most dedicated, educators in medicine. This is an exciting time of year as applicants and programs begin the match process.

Are science and medicine on the verge of developing a two-tiered system of policies regarding private health information?

What can NRMP Match data tell us about specialty choice? ASN Data Science Officer Kurtis Pivert takes a look.


 

Kevin J Fowler, a recipient of a preemptive kidney transplant, discusses an FDA meeting focused on organ transplant recipients, and his insights regarding the value of the patient voice in improving care.

Dr. George Veletsianos, Canada Research Chair in Innovation and Technology, offers some practical advice regarding highlighting your research

A number of viral infections can result in glomerular damage, including a spectrum of lesions with differing pathogenetic mechanisms.

"Engagement hinges upon authenticity."

Security protections for  patient health information don't seem to be keeping up with the dissemination of PHI.

"Dialysis and transplantation represent extraordinary therapeutic milestones.... However, many fellows and trainees are looking for new therapies comparable to what they see taking place in other fields."

 

 

What opportunities, challenges and pressures will clinicians face under MACRA?

Doctoral degree but not a doctor -- interesting case from Canada highlighted in CMAJ.

"I believe all digital health tools that can improve the experience for patients must be deployed. They have a role, they add value, they improve the experience, and they make the healthcare seeking process more dignified. But I’d be kidding if I expect these tools today to give me the insights and clinical acumen that Dr. JK brought to bear during our consultation."

"When I was a medical student, I suffered an episode of depression and refused to seek treatment for weeks. My fears about licensing applications were a major reason I kept quiet."

True interoperability? Not here yet. Added physician burden? That's definitely here.
 

True interoperability? Not here yet. Added physician burden? That's definitely here.
 

During a discussion about the William and Sandra Bennett Clinical Scholars Program,  Dr. William Bennett asked Dr. Jane Schell,  the first recipient of the Bennett Scholars Grant, why she chose to go into nephrology. Their ensuing  discussion, including Dr. Bennett’s look back at very early dialysis care, is compelling and inspiring. 

 

Clinical decision support systems: hindrance, help -- both?

New payment models may require completely new approaches to data and outcomes management.

Don't miss Dr. Amit X. Garg, 2016 recipient of the ASN-AHA Young Investigator Award, presenting at Sunday's plenary (8:05 am W375C-E). Learn more about his research here.