Debunking Myths About Nephrology and Nephrologists

A s a discipline, nephrology is burdened by commonly held but incorrect perceptions.Unfortunately, these myths can make nephrology less appealing as a career option for medical students, residents, and future researchers and scientists; decrease how health systems value the specialty; and make it more difficult for ASN to advocate on behalf of the more than 850 million people worldwide living with kidney diseases.Identifying the most insidious myths, presenting evidence to prove these misconceptions false, and providing a more realistic explanation will help change how nephrology and nephrologists are viewed.In Meditations, Roman emperor Marcus Aurelius expressed the Stoic perspective, "All things fade and quickly turn to myth: quickly too utter oblivion drowns them" (1).Rather than accept misperceptions that threaten the field, ASN and the rest of the kidney community must continue to strive to present facts and truth.Myth: Nephrologists earn among the lowest compensation of all internal medicine specialties.No one contends that nephrologists are compensated fairly.In most cases, nephrologists work harder-and longer hours, especially when considering the "windshield time" required to drive between dialysis units or transplant outreach clinics-to generate a reasonable wage.Additionally, payors fail to differentiate among the different types of nephrologists."Nephrology is cognitive and procedural, has a primary care component focused on identifying patients and slowing progression of kidney diseases, and includes the need to manage comorbidities," ASN Past President Anupam Agarwal, MD, FASN, and I observed in 2020 (2)."Nephrologists also provide 24-hour coverage-often for dialysis services for [patients who are critically ill]-an important service to health systems."Among the 13 internal medicine specialties, nephrology ranks sixth for average compensation (3).Physician work relative value units (wRVUs), accounting for the time, effort and technical skill, judgment and mental energy, and stress to provide a service (2), are misvalued and unfairly favor procedure-based specialties (4).Unfortunately, wRVUs do not reflect changes in technology, which have vastly increased the efficiency of many procedures, thus allowing some physicians to generate more RVUs per hour than specialties requiring actual face time with complex patients, such as in nephrology (4).