Has Nephrology Resigned Itself to the Great Resignation

  • 1 Kathleen Mallett, MSN, APRN, FNP-C, CNN-NP, FNKF, is with Nephrology/Dialysis and Transplant, Children's Mercy Kansas City, Kansas City, MO. Sofia Thomas, DNP, MHA, AAPRN, FNP-C, CNN-NP, FNKF, FCDC, is with KidneyCare Solutions, LLC, West Palm Beach, FL.
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The COVID-19 pandemic has been a catalyst for burnout in a strained health care workforce, especially in the emergency medicine and critical care sectors (1). The Association of American Medical Colleges projects a shortage of up to 139,000 physicians by 2033 (2). Burnout has contributed significantly to the “Great Resignation,” with a tremendous short-term impact on the US health care system, prompting the US Surgeon General to prioritize this crisis (2). It is difficult, however, to understand the long-term implications of this exodus (3), especially in nephrology.

Nephrologist burnout

Multiple factors have

The COVID-19 pandemic has been a catalyst for burnout in a strained health care workforce, especially in the emergency medicine and critical care sectors (1). The Association of American Medical Colleges projects a shortage of up to 139,000 physicians by 2033 (2). Burnout has contributed significantly to the “Great Resignation,” with a tremendous short-term impact on the US health care system, prompting the US Surgeon General to prioritize this crisis (2). It is difficult, however, to understand the long-term implications of this exodus (3), especially in nephrology.

Nephrologist burnout

Multiple factors have contributed to burnout across specialties and roles (Figure 1). Before the pandemic, a 2019 survey revealed that approximately 1 in 4 (23%) nephrologists experienced burnout (4). Bureaucratic tasks, poor work-life balance, and feeling devalued by colleagues/employers are the top three reported obstacles to a fulfilling nephrology career (4). Furthermore, a decline in fellow recruitment has been observed (5), although the pandemic did not have a significant negative impact on professional development (6). Natural attrition and the uncertain impact of the Great Resignation have many professionals in the field expressing concern for patient care and the continued growth and diversity of nephrology.

Figure 1
Figure 1

Factors associated with health worker burnout

Citation: Kidney News 14, 9

Patient care suffers

Health care workers fear poor patient care due to burnout because of demands from multiple sectors (7). Effects include limited time with patients, increased medical errors, and hospital-acquired infections (2). Shortages are already felt in rural areas and in the primary care field (8). The burnout crisis may restrict access to care, increase costs, impair response to the next public health emergency, and exacerbate health disparities (2). Caring for patients with advanced kidney diseases is likely to worsen in all settings, and long-term management of one of the most prevalent health issues facing the United States is becoming more complicated as a result.

Build community

Burnout negatively impacts trust and camaraderie among health care teams, but this can be mitigated by building a diverse role set (2). During the pandemic, approximately one-third of nephrology fellows expressed an increased sense of community and improved relationships with mentors (6). Furthermore, the nephrology community has been integrating advanced practice providers (APPs)—nurse practitioners and physician assistants—into its teams since 2004 (9). Although data are scarce, it appears that nephrology APPs have not experienced burnout to the same extent as their colleagues. However, 6% (n = 293) of participants from the 2022 National Kidney Foundation/Council of Advanced Practice Providers survey noted that they were furloughed, had reduced pay, and lost bonuses or retirement contributions during the pandemic. In addition, many reported a heavier workload and busier practice (10). If these scenarios continue unchanged, then we would expect to see a shortage of APPs soon as well.

Although challenges exist, the nephrology community should continue to be innovative and collaborative in its efforts to advocate for change on behalf of ourselves and our colleagues and patients. We must not resign.

References

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