Nephrologists have been challenged in recent years to attract young physicians to the specialty. Many attribute this difficulty to the field’s complexity, the younger generation’s focus on work–life balance, the vulnerability of the patients nephrologists serve, and limited exposure to the field during medical school and residency. Now that kidney disease has been thrust into the limelight by COVID-19, some observers are asking whether the specialty might be more attractive to young physicians in the future.
Such a change would be welcome. In 2019, only 62% of nephrology resident positions were filled during the annual match. That’s a slight increase
To mitigate the risk of COVID-19 infection, a recent white paper released by the Kidney Health Initiative (KHI) Board of Directors urges KHI stakeholders to accelerate the development of home-based technologies for people with kidney failure (1).
“The COVID-19 pandemic is unmasking the shortcomings of in-center hemodialysis for people with kidney failure,” the paper states, noting that people who rely on in-center dialysis do not have “the luxury of social distancing during a pandemic,” exposing them and those working in dialysis centers to potential infection.
“The global medical device development community needs to collaborate and overcome barriers to
Quality measures can be powerful tools for leveraging performance improvement, but only if they are based on reliable evidence, feasible to implement, and attributable to the providers being measured. Quality measures should also capture clinically relevant outcomes and other aspects of care that matter to patients.
Since the introduction of value-based care, quality measures have multiplied, but far too frequently, they fall short of these standards. This deficiency undermines the value of quality measurement, and not just for kidney care. In 2018, the American College of Physicians (ACP) Performance Measurement Committee determined that only 37% of the national measures being
Extraordinary times call for extraordinary measures, and at least as far as kidney care is concerned, the federal government is rising to the challenge. In the past month, the Centers for Medicare & Medicaid Services (CMS) has issued an unprecedented set of waivers to facilitate care delivery during the COVID-19 pandemic. The sweeping interim final rule the agency published March 30, 2020, provides a remarkable degree of flexibility in how providers may deliver care to patients insured through Medicare and Medicaid during the current public health emergency (1).
Equally extraordinary, nearly every one of the requests ASN put
Throughout the COVID-19 pandemic, nephrologists have made adjustments to best care for patients. Now they are taking stock of how kidney care has changed and considering which of those changes might stick moving forward.
The challenges of delivering kidney care during the pandemic underscored the need for innovation. The experience of meeting those challenges also showed nephrologists that some improvements are well within reach and that emergency protocols adopted during the pandemic may become a new normal.
“I’ve stopped thinking that this is temporary,” says Jeffrey Perl, MD, SM, FRCP, associate professor of medicine at the University of Toronto and
Although widely thought of as a respiratory ailment, COVID-19 has demonstrated its ability to impact multiple organs. For those with existing kidney disease, the dangers of the SARS-CoV-2 coronavirus are especially stark. Researchers at New York City’s Montefiore Medical Center reported that recipients of kidney transplants who contract COVID-19 appear to be at exceptionally high risk of severe illness. Additionally, a study of electronic health record data by CarePort Health found that people with chronic kidney disease were 2.5 times more likely to die than other hospitalized COVID-19 patients. Even patients without prior kidney disease are proving susceptible to acute kidney injury (AKI) associated with the virus.
The statistics are startling. As of April 20, African Americans were far more likely than whites to become infected with SARS-CoV-2 and die from COVID-19. More recent data paint a similarly bleak picture of COVID-19’s impact in Hispanic and Native-American communities.
Every physician is critical in the battle against COVID-19, but some may soon find themselves sidelined—not by the illness but by the complexities of a U.S. visa process, which can leave applicants in limbo as they transition from one legal status to another.
In a March 2020 letter, ASN asked congressional leaders to encourage the administration to enact policies to make sure no law-abiding physician or medical resident who wants to come to or remain in the United States is prevented from doing so. The letter called for:
When a novel coronavirus emerged in late 2019, everyone risked infection, but kidney patients found themselves especially vulnerable. People with kidney disease have compromised immune systems and the vast majority of these individuals—roughly half a million people—must visit dialysis centers several times a week, exposing themselves to contact with staff and other patients when they should ideally be isolated at home.