Thank you for the special section, The Kidney Care Team, in the September issue of Kidney News, highlighting the collaborations among physicians, physician assistants (PAs), advanced practice registered nurses (APRNs), and pharmacists. The special section included numerous well-written articles that focused on the education, training, and responsibilities of the PA, APRN, and pharmacist team members, highlighting data that showed optimization of care for the nephrology patient through a team concept.
However, the article, “Use of Non-Physician Providers in the Nephrology Workforce Needs Careful Consideration and Urgent Attention,” by Christin Giordano McAuliffe, lacked evidence-based data and gave conflicting recommendations regarding the role of the advanced practice provider (APP). The author noted the included figure and table were her opinion; however, the suggested utilization of APPs neither reflects current practice nor the Centers for Medicare & Medicaid Services' standard billing allowances. Furthermore, the suggestion of “under direct supervision” is contrary to standard practice in any setting and counters most state and federal laws regarding APP practice.
The shortage of nephrologists is a driving force behind the increased utilization of APPs within nephrology. These APPs are trained and educated in a manner that allows, and encourages, collaboration with board-certified nephrologists. Research demonstrates their inclusion increases access to care and provides high-quality care to the increasing number of patients with chronic kidney disease and end stage kidney disease (1–4).
References
- 1.↑
Roberts JP, et al. A design thinking framework for healthcare management and innovation. Healthc (Amst) 2016; 4:11–14. doi: 10.1016/j.hjdsi.2015.12.002
- 2.
Agency for Healthcare Research and Quality (AHRQ). Designing and implementing Medicaid disease and care management programs. Created March 2008; last reviewed October 2014. https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/index.html
- 3.
United States Renal Data System (USRDS). 2021 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2021. https://adr.usrds.org/2021/introduction
- 4.↑
Kalantar-Zadeh K. The rise of advanced practitioners in nephrology and urology. Renal & Urology News, September 26, 2022. https://www.renalandurologynews.com/home/departments/commentary/the-rise-of-advanced-practitioners-in-nephrology-and-urology/
