ASN President's Column April 2016

By Raymond C. Harris, MD, FASN

“It is one of the strengths and the appeals of our profession that we encompass so many aspects of medical science in our care of our patients and in our study of the mechanisms of kidney function and diseases.”
Dr. Harris

Fifty years ago this year, a group of illustrious Nephrologists and prominent Internists met to form the American Society of Nephrology. Nephrology as a subspecialty had arisen both from studies of renal physiology and from studies and clinical activities related to metabolic and hemodynamic alterations related to kidney failure. As a field, it had clinical roots in cardiology. Indeed, the first renal society in the United States was the Renal Section of the Circulation Council of the American Heart Association. Although Nephrology was already an accepted subspecialty, the formation of the ASN signaled that in the United States, nephrology would no longer be considered only a branch or an offshoot of cardiology.

Now in 2016, our discipline is so varied and so complex that it is difficult to think of us as only related to cardiology (we all know that the major role of the heart is to pump blood to the kidney, anyway). Nephrologists are as much physiologists, endocrinologists, immunologists, rheumatologists, and microbiologists as we are “cardiologists.” It is one of the strengths and the appeals of our profession that we encompass so many aspects of medical science in our care of our patients and in our study of the mechanisms of kidney function and diseases.

Currently, there seems to be a pervasive feeling of gloom and doom about Nephrology as a profession, and it easy to pinpoint many of the reasons for this malaise: decreased interest in Nephrology careers by trainees, a perceived lack of job opportunities and a sense that Nephrologists may work too hard for too little pay, inadequate funding by NIH and other funding agencies and increasing federal regulation on the one hand and encroachment of Nephrology’s turf by other subspecialties on the other hand.

All of these challenges are real and cannot be minimized. However, not everything is so dreary. Surveys indicate that the majority of nephrologists in practice enjoy their work and are engaged and fulfilled; similarly, a majority of our trainees are happy that they chose Nephrology as a profession. Although funding for kidney research still remains inadequate, we have seen some significant breakthroughs in our understanding of the causes of many kidney diseases, while venture capital and industry are increasingly viewing kidney disease as a new frontier, so we can hope to have new treatments for our patients in the near future.

Challenges always provide opportunities, and the difficulties facing Nephrology also give us the chance to have a dialogue about what is important about our profession and what we should support and encourage. We can re-evaluate what it means to be a nephrologist and what should be the scope of practice. We can re-evaluate what are the important research questions and how we should address them. During this year of my presidency, of ASN’s 50th anniversary, I want to use this column to help shape this dialogue in order for ASN to help in “reinventing Nephrology.”

What do you consider the area of most opportunity for nephrologists? Send your feedback to Dr. Harris at info@kidneynews.org (subject line: Feedback for Dr. Harris)

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Raymond C. Harris, MD, FASN
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“It is one of the strengths and the appeals of our profession that we encompass so many aspects of medical science in our care of our patients and in our study of the mechanisms of kidney function and diseases.”
Dr. Harris

Fifty years ago this year, a group of illustrious Nephrologists and prominent Internists met to form the American Society of Nephrology. Nephrology as a subspecialty had arisen both from studies of renal physiology and from studies and clinical activities related to metabolic and hemodynamic alterations related to kidney failure. As a field, it had clinical roots in cardiology. Indeed, the first renal society in the United States was the Renal Section of the Circulation Council of the American Heart Association. Although Nephrology was already an accepted subspecialty, the formation of the ASN signaled that in the United States, nephrology would no longer be considered only a branch or an offshoot of cardiology.

Now in 2016, our discipline is so varied and so complex that it is difficult to think of us as only related to cardiology (we all know that the major role of the heart is to pump blood to the kidney, anyway). Nephrologists are as much physiologists, endocrinologists, immunologists, rheumatologists, and microbiologists as we are “cardiologists.” It is one of the strengths and the appeals of our profession that we encompass so many aspects of medical science in our care of our patients and in our study of the mechanisms of kidney function and diseases.

Currently, there seems to be a pervasive feeling of gloom and doom about Nephrology as a profession, and it easy to pinpoint many of the reasons for this malaise: decreased interest in Nephrology careers by trainees, a perceived lack of job opportunities and a sense that Nephrologists may work too hard for too little pay, inadequate funding by NIH and other funding agencies and increasing federal regulation on the one hand and encroachment of Nephrology’s turf by other subspecialties on the other hand.

All of these challenges are real and cannot be minimized. However, not everything is so dreary. Surveys indicate that the majority of nephrologists in practice enjoy their work and are engaged and fulfilled; similarly, a majority of our trainees are happy that they chose Nephrology as a profession. Although funding for kidney research still remains inadequate, we have seen some significant breakthroughs in our understanding of the causes of many kidney diseases, while venture capital and industry are increasingly viewing kidney disease as a new frontier, so we can hope to have new treatments for our patients in the near future.

Challenges always provide opportunities, and the difficulties facing Nephrology also give us the chance to have a dialogue about what is important about our profession and what we should support and encourage. We can re-evaluate what it means to be a nephrologist and what should be the scope of practice. We can re-evaluate what are the important research questions and how we should address them. During this year of my presidency, of ASN’s 50th anniversary, I want to use this column to help shape this dialogue in order for ASN to help in “reinventing Nephrology.”

What do you consider the area of most opportunity for nephrologists? Send your feedback to Dr. Harris at info@kidneynews.org (subject line: Feedback for Dr. Harris)