Dr. Ian de Boer on signs of a crisis in nephrology

By ASN Staff

In an article by Manisha Jha of The Daily student publication at the University of Washington, Dr. de Boer speaks personally about his recent CJASN articles based on burnout in nephrology.

"'We wanted to highlight that to the community that this is something that many people are experiencing and open a dialogue,” de Boer said.

According to “Burnout in Nephrology,” one of the three main articles de Boer and his colleagues wrote, “44 percent of United States adult nephrology fellows were ‘somewhat, slightly, or not at all satisfied’ with their career choice.” Much of this dissatisfaction stemmed from a lack of job opportunities, difficult hours, and poor teaching or mentoring. According to the accompanying “Transforming Nephrology,” one study that examined four medical specialties (but did not include nephrology) found that “clinicians spend only 27 percent of their total time on direct clinical care and 49.2 percent of their time on [electronic medical record-keeping] and clerical work, with much of this time occurring after hours during personal time.” 

“That’s depressing!” de Boer said. “I can guarantee that’s not why any of us went into nephrology or medicine.”

Authors of the article suggest that this issue of overburdening clinicians with documentation is worse for nephrologists because they often attend to several different clinics. 

“Dialysis patients have 12-14 treatments a month,” de Boer said. “They don’t want to make an additional visit to come to a doctor’s office.”

To accommodate this, doctors often visit their patients at their dialysis centers. “Which is the right, patient-friendly approach to serving them,” de Boer said. The result, however, is that a lot of nephrologists then spend hours of time commuting from different dialysis units to clinics, research labs, and hospitals.

The number of medical students entering nephrology has also dropped over the last decade, which could negatively impact advances in kidney treatment.

“We’ve examined why promising new doctors aren’t going into the field of nephrology,” de Boer said. “People who are finishing their medical residencies and selecting subspecialties kind of saw some of these issues before coming in.”

But while the specialty of nephrology and the field of medicine itself is experiencing growing pains, de Boer believes that these issues that can be resolved as more of medicine’s leaders work to improve the age-old discipline.

“Medicine and nephrology both have gone through a lot of changes in the past few decades,” de Boer said. “Change is always hard, at least for people who have seen what it’s like before. I still think medicine and nephrology are great professions; I still love my job. Taking care of patients with kidney disease is a real honor and a privilege.”

For his students and for the future of nephrology, de Boer hopes to revive his beloved field."

Please visit The Daily for the full article.

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In an article by Manisha Jha of The Daily student publication at the University of Washington, Dr. de Boer speaks personally about his recent CJASN articles based on burnout in nephrology.

"'We wanted to highlight that to the community that this is something that many people are experiencing and open a dialogue,” de Boer said.

According to “Burnout in Nephrology,” one of the three main articles de Boer and his colleagues wrote, “44 percent of United States adult nephrology fellows were ‘somewhat, slightly, or not at all satisfied’ with their career choice.” Much of this dissatisfaction stemmed from a lack of job opportunities, difficult hours, and poor teaching or mentoring. According to the accompanying “Transforming Nephrology,” one study that examined four medical specialties (but did not include nephrology) found that “clinicians spend only 27 percent of their total time on direct clinical care and 49.2 percent of their time on [electronic medical record-keeping] and clerical work, with much of this time occurring after hours during personal time.” 

“That’s depressing!” de Boer said. “I can guarantee that’s not why any of us went into nephrology or medicine.”

Authors of the article suggest that this issue of overburdening clinicians with documentation is worse for nephrologists because they often attend to several different clinics. 

“Dialysis patients have 12-14 treatments a month,” de Boer said. “They don’t want to make an additional visit to come to a doctor’s office.”

To accommodate this, doctors often visit their patients at their dialysis centers. “Which is the right, patient-friendly approach to serving them,” de Boer said. The result, however, is that a lot of nephrologists then spend hours of time commuting from different dialysis units to clinics, research labs, and hospitals.

The number of medical students entering nephrology has also dropped over the last decade, which could negatively impact advances in kidney treatment.

“We’ve examined why promising new doctors aren’t going into the field of nephrology,” de Boer said. “People who are finishing their medical residencies and selecting subspecialties kind of saw some of these issues before coming in.”

But while the specialty of nephrology and the field of medicine itself is experiencing growing pains, de Boer believes that these issues that can be resolved as more of medicine’s leaders work to improve the age-old discipline.

“Medicine and nephrology both have gone through a lot of changes in the past few decades,” de Boer said. “Change is always hard, at least for people who have seen what it’s like before. I still think medicine and nephrology are great professions; I still love my job. Taking care of patients with kidney disease is a real honor and a privilege.”

For his students and for the future of nephrology, de Boer hopes to revive his beloved field."

Please visit The Daily for the full article.

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Thursday, February 15, 2018