There are five reasons why I'm a pediatric nephrologist, but they might not all be the reasons you'd think. After all, my renal block in medical school was certainly not my favorite, and my clinical nephrology exposure was limited. I heard the stories—“To be a nephrologist, you have to be the smartest doctor in the hospital.”—and since I never saw myself as “the smartest,” I didn't think the field was for me. But by the end of my month on pediatric nephrology as a first-year resident, a confluence of inspiring events and the encouragement of supportive mentors had changed my life and altered my career path forever.
Now at Nationwide Children's Hospital, medical students and residents learn a new reason for my career choice each day of the week when I am the attending on our service. It's a fun way to encourage young learners to consider a career in pediatric nephrology, but it's also a wonderful reminder about what this dynamic subspecialty has to offer.
First, I am a nephrologist because of my mentors. As a first-year resident, I lacked confidence on rounds and struggled with “imposter syndrome” (1). A dedicated group of enthusiastic and supportive faculty mentors took the time to build my confidence and encourage me to be bolder in my medical decision-making. Comments like “Dr. Bignall, you're writing excellent notes,” from Dr. Bradley Dixon, and “I love your plan—that's exactly what I would have done,” from Dr. Stuart Goldstein, enabled me to dedicate less time to perseverating over the mechanics of inpatient rounds and more time to the development of robust differential diagnoses and plans of care. Their support was essential in prompting me to join the small but steadfast ranks of the roughly 1100 board-certified pediatric nephrologists in the United States (2), and such mentorship will be key to inspiring the next generation of pediatric nephrologists as well.
Second, I am a nephrologist today because of my patients; they inspire and teach me on a daily basis. No other profession affords such variety of pathologies, the ability to follow the traverse of electrolytes through the nephron, facilitate the gift of life through organ donation, bring balance to the forces of oncotic and hydrostatic pressures in nephrotic syndrome, and discover new genes that unlock the promise of new cures for disease. And for children with kidney disease, there is the added thrill of contributing to their growth and development for the rest of their life. With such a breadth of opportunities, pediatric nephrology is an easy sell.
Third, I learned that nephrologists get to go on field trips: we are needed in all facets and venues of child health! Our expertise is required in emergency departments and intensive care units. We direct chronic dialysis programs that give patients with kidney failure a lifeline of hope. We deliver life-saving acute dialysis in settings that range from the operating rooms of quaternary care academic children's hospitals to the humble abodes of remote villages around the world. We establish relationships with patients in the outpatient clinic and in our communities that result in lasting and powerful human connections. And we do all of this while delivering world-class care for some of the most complex diseases in the smallest of patients. What a gift!
Fourth, and speaking of gifts, we offer children the gift of life. There is no greater thrill than calling a parent to share the news of an available organ for their child's transplant or receiving a graduation invitation for a patient living (and thriving!) with glomerular disease. Pediatric nephrologists share in this gift through myriad medical, surgical, diagnostic, and therapeutic breakthroughs taking place across our field. Innovations in kidney genetics, neonatal nephrology, pediatric transplant, and acute dialysis are just some of the advances discussed in this issue, contributing to the culture of discovery that improves the lives of so many children and their families.
Finally, pediatric nephrology offers opportunities for service and advocacy. In no other field of medicine is one's physical health more closely connected to one's social, psychological, or environmental well-being, and advocating for healthcare justice is essential to our work. Children living with kidney disease face tremendous obstacles to health if they are also impacted by poverty, food insecurity, housing instability, environmental injustice, or systemic racism and discrimination. In this issue, you will read about pediatric nephrologists who are answering the call, leveraging our work as kidney health professionals to fight for justice and equity in medicine and society.
It is our hope that these pieces will propel you to consider not only the many advances in the field but also the incredible opportunities for this field to inspire the next generation of nephrologists.
Mullangi S, Jagsi R. Imposter syndrome: Treat the cause, not the symptom. JAMA 2019; 322:403–404. doi: 10.1001/jama.2019.9788
The American Board of Pediatrics. Pediatric subspecialists ever certified. ABP Certification Management System. March 2020. https://www.abp.org/content/pediatric-subspecialists-ever-certified