Physician assistants (PAs) are licensed clinicians, trained in the medical model, who practice medicine in every specialty, setting, and state. They are dedicated to expanding access to care and transforming health through patient-centered, team-based medical practice, and as such, nephrology is a perfect home. In 1997, a cohort of nephrology PAs, under the auspices of the American Academy of Physician Associates, created a specialty organization—American Academy of Nephrology PAs (AANPA)—for all facets of nephrology PAs (e.g., office, dialysis, transplant, and intensive care unit). In 2020, of <148,000 PAs in the United States working in 70 medical and surgical subspecialties, only 0.4% claimed nephrology as their practice specialty (1, 2) (Figure 1).

NCCPA PA medical practice specialty report 2020: Number of PAs practicing in each area
Citation: Kidney News 14, 9

NCCPA PA medical practice specialty report 2020: Number of PAs practicing in each area
Citation: Kidney News 14, 9
NCCPA PA medical practice specialty report 2020: Number of PAs practicing in each area
Citation: Kidney News 14, 9
With such limited representation and a shortage of both nephrologists and nephrology PAs, AANPA initiated outreach to its referring practitioners to decrease concerns with referrals, such as missing data, inappropriate timing, and/or missed diagnoses. Outreach was two-pronged and included oral continuing medical education (CME) 1 presentations and journal articles.
Offering kidney-based lectures to state and national PA organizations, with expert speakers supplied by AANPA, has been extremely popular. This has morphed into AANPA members teaching the nephrology section for multiple PA programs across the United States. The organization has found that its speakers make nephrology more accessible to students, and because the speakers are excited about the topic, it is more interesting to the students. The goal of AANPA is to increase student interest in nephrology rotations, because nephrology is an elective in all PA schools.
The second outreach that the organization implemented was in a written format, called Nephrology Nuggets, a case-based CME program offered to all PAs and nurse practitioners (NPs) at a very low cost (<$1/CME credit). “Nuggets” is a collection of patient cases that have been managed by AANPA members (3). Nephrology may not include large numbers of practitioners, but it does provide interesting stories.
AANPA's first nephrology-focused article, “Medication dosing in patients with chronic kidney disease” (4), published in the Journal of the American Academy of Physician Associates in 2013, was awarded Clinical Article of the Year. AANPA members followed kidney medication dosing with articles highlighting chronic kidney disease, acute kidney injury (AKI), hypertension (HTN), education for patients with kidney diseases, organ transplant, diabetes management, the new estimated glomerular filtration rate calculator, as well as other kidney-related topics.
Nephrology NPs saw the positive response to outreach by the PAs and also published articles in multiple NP journals on topics that ranged from autosomal-dominant polycystic kidney disease to pain management of the nephrology patient to AKI, HTN, and hepatitis.
PAs were joined by NPs, medical doctors, and pharmacists in information distribution, because the care, treatment, and management of a patient with kidney diseases embody a multi-disciplinary endeavor.
References
- 1.↑
National Commission on Certification of Physician Assistants. Statistical Profile of Certified PAs by State. Annual Report. 2020. Accessed June 22, 2022. https://www.nccpa.net/wp-content/uploads/2022/04/2020-State-Report-4_1_22-FINAL.pdf
- 2.↑
National Commission on Certification of Physician Assistants. 2020 Statistical Profile of Certified Physician Assistants by Specialty. Annual Report. 2021. Accessed June 15, 2022. https://www.nccpa.net/wp-content/uploads/2021/12/2020-Specialty-report-Final.pdf
- 3.↑
American Academy of Nephrology PAs. A CME project for the non-nephrology PA. Nephrology Nuggets II. January 15, 2022–December 31, 2024. Accessed May 15, 2022. http://aanpa.org/nephrologynuggets.html
- 4.↑
Zuber K, et al. Medication dosing in patients with chronic kidney disease. JAAPA 2013; 26: 19–25. doi: 10.1097/01.JAA.0000435257.26357.a8