Organizing Nephrologists at the State Level

The Florida Experience

The Florida Society of Nephrology (FSN) was organized in 1966 by a small group of prescient nephrologists at a time when nephrology was in its infancy. Fast forward 56 years, and the FSN has evolved into a vibrant alliance of hundreds of academic and private practice nephrologists focused on education, advocacy, confronting the challenges of building a future nephrology workforce, and practice management improvement. Unlike other medical and surgical specialties, “organized” nephrology has operated mostly at the national level with strong organizations such as the American Society of Nephrology (ASN), Renal Physicians Association (RPA), and the National Kidney Foundation. This article summarizes the opportunities that were created in Florida by developing an independent and strong state-based grassroots nephrology organization working to improve the current and future practice of nephrology in our state and the care delivered to patients with kidney disease.

Internal Structure of the Organization

The successful execution of the myriad of FSN initiatives requires contracting with an effective and committed management organization that works closely with leadership. The FSN maintains a traditional leadership structure of President, Vice-President, Secretary, and Treasurer, each serving 2-year term appointments. They serve on the Executive Committee (EC) along with the Program Committee Chair, Chair of the Past Presidents Council, and eight directors-at-large who serve a maximum of three 2-year terms. Committees focused on Advocacy, Women in Nephrology, Educational Programming, Communications, Finance and Audit, and Past Presidents Council meet regularly and report to the EC. Membership in the organization is dues requiring with financial accommodation made for large groups and academic centers. The Society enjoys robust support from industry partners at the annual meeting, which empowers the organization to invest in its other important initiatives.

Educational Programs

An important mission of the FSN has always been the delivery of cutting-edge knowledge to our members. The centerpiece of the organization's education pillar is the annual meeting. Spread over a weekend at a family-friendly resort, four thought leaders from around the country plus two from academic centers in the state are invited to present state-of-the-art lectures in an intimate setting that encourages vibrant discussion and exchange of ideas. The FSN works closely with the Florida Renal Nurses Association to provide a parallel educational track for its members. Both continuing medical education (CME) and maintenance of certification credits are available for the participants. Another highlight is the Geronemus Fellows Competition that encourages trainees to submit their research for consideration. Two finalists are selected to deliver an oral presentation during the main session. This is an excellent opportunity for fellows to gain valuable experience presenting in front of a large group of physicians. The meeting also serves as a networking event where academic and community-based members can discuss issues of mutual importance and fellows can make contacts and interview for potential job opportunities.

Recognizing that many cannot attend the annual meeting and that we must bring quality educational opportunities into the communities where our members live and work, the FSN has developed a series of evening regional meetings featuring an invited out-of-state speaker. Additionally, another educational initiative involves a recent collaboration with our academic teaching centers whereby selected Nephrology Grand Rounds are available to FSN membership in real time over the Zoom platform.

Practice Management Support

One of the most effective ventures of the FSN has been to harness the purchasing power of a larger organization by acting as a buyer for multiple small groups. As an example, in 2013, the FSN collaborated with a risk-purchasing group for medical malpractice protection, which provides coverage at a 17%–55% discount from what a practitioner could independently obtain in the marketplace. Similarly, the FSN created a health insurance program that provides self-funded and level-funded health insurance benefits for its members and their employees. In addition, during the early months of the coronavirus disease pandemic, the FSN was able to purchase and make available to its membership personal protective equipment at a time when supplies were scarce and difficult to obtain for small practices.

The FSN recognizes that it also has a responsibility in advancing patient care. The organization has facilitated participant recruitment into clinical trials across Florida by listing centers that are actively enrolling patients on the FSN website. In addition, experience has taught us that during natural disasters, nephrologists are in the unique position of being responsible for providing life-sustaining care to displaced dialysis patients. Data suggest that living in a county affected by a hurricane increases the mortality of dialysis patients during the next 30 days by 13%.¹ As is the case with many coastal states, every county in Florida has the potential to be affected by a hurricane. The FSN works closely with the Florida Renal Administrators Association in advance of hurricane season to assist with the implementation of the emergency protocols that each local jurisdiction has in place and the emergency preparedness requirements that all dialysis facilities must follow. In addition, the FSN's network of nephrologists can quickly respond to emergency needs of their colleagues and provide a clearinghouse of information, availability, and best practices.

Building a Future Nephrology Workforce

There has been a sharp decline in the interest of medical students and internal medicine residents in nephrology as a career choice over the last decade.² Forty-seven percent of nephrology fellowship programs reported having at least one unfilled fellowship slot during the 2022 appointment year match.³ Studies have shown that up to two thirds of medical students develop an interest in their chosen specialty before or during medical school and cite mentorship as one of the important factors in their specialty choice.⁴ Recognizing this nephrology workforce challenge, the FSN launched an initiative in 2016 for the early engagement of medical students through an outreach effort to all Florida medical schools. As part of this initiative, the FSN provided educational grants to medical students to attend the annual meeting. During this weekend, the students interacted with FSN members and leadership in special sessions and developed mentor/mentee relationships in an effort to spark their interest in nephrology. The pre- and postmeeting survey of the medical students showed significant improvement in the negative perceptions of nephrology regarding work–life balance, procedural opportunities, and complexity of renal pathophysiology. We are aware of one student who has chosen nephrology as a career pathway. This FSN initiative has evolved into a long-term partnership with the National Institutes of Health–funded University of Miami Kidney Innovative and Interdisciplinary Medical Education in Research Activities (UM-KIIMERA) program. Ten first-year medical students are selected from the Florida medical schools to attend the UM-KIIMERA immersive summer mentored nephrology research program. The FSN follows this up with travel scholarships to these UM-KIIMERA medical students to attend the subsequent annual meeting and present their research projects. The FSN couples this with travel grants to chief nephrology fellows from Florida fellowship programs to attend the same meeting, thereby fostering the interaction of medical students and fellows. The KIIMERA students will continue to be tracked on their career decisions. This grassroots workforce effort can be a model for other state nephrology societies to supplement initiatives being taken at the national level by ASN.

Advocacy and Public Policy

It is imperative for the nephrology community to play an active role in political advocacy and public policy at the state level to safeguard the interests of both patients with kidney disease and our nephrology practices.⁵ FSN operates a bipartisan political action committee that meets with and financially supports pronephrology candidates. The Society also retains a contract lobbyist in the state capital to advocate for nephrology issues and keep membership aware of legislative initiatives as they move through the committee process. In addition, FSN leadership meets with the Florida Agency for Health Care Administration each year to discuss access to care issues for patients with kidney disease. Furthermore, FSN participates in Florida Kidney Day each year and meets personally with state legislators to encourage support of pronephrology legislation. In the past legislative session, the FSN successfully lobbied along with other organizations in opposition to a bill that proposed to change the structure of the Florida Organ Transplantation Advisory Committee that could have negatively affected kidney transplant programs in the state. Furthermore, FSN interfaces with both regional and national organizations. As an example, FSN leadership is actively involved in the Florida Medical Associations' annual advocacy meetings, and the FSN invites RPA representatives to the FSN annual meeting to update members about important RPA initiatives.

These advocacy efforts and collaborations with other medical organizations are critical to breaking down the barriers to providing high-quality care to patients with kidney diseases and protecting the interests of nephrologists.

Conclusion

With the vast availability of resources on the web and the conglomeration of physician practices, one may question the need for a nephrology organization at the state level. The success of the FSN demonstrates the inherent value of a strong state-based nephrology organization and the important space that it fills in the day-to-day life of nephrologists in Florida. By aligning the interests and efforts of academic and private sector nephrologists, the Society delivers quality educational content, advocacy in the state capital, and medical student programs that highlight the excitement of a career in nephrology. Important practice support initiatives for malpractice relief and affordable health care are also in place. The Society and its membership also represent a cohesive statewide network that is available for rapid mobilization to assist colleagues with patient care during public health emergencies, such as what has occurred after destructive hurricanes or early in the pandemic. Nephrologists in other states may find this model of grassroots nephrology to have value and could benefit from the more than 50 years of experience of the FSN.