Nephrology at a Crossroads

Increasing work demands, high rates of burnout, and declining interest in nephrology as a career—these are issues that touch the lives of nephrologists everywhere, threatening to reduce job satisfaction and impair delivery of high-quality care to patients with kidney diseases. In this issue of the Clinical Journal of the American Society of Nephrology, three perspectives by Rosner and Berns (¹), Williams (²), and Roberts (³) address the prevalence, causes, and consequences of these pervasive problems. The perspectives eloquently lay out the scope of challenges facing nephrologists today, including long work hours, multiple clinical practice sites, heavy burden of documentation, increasing regulatory intrusiveness, demanding payment models, and lower salaries relative to other subspecialties. Further dissected are the downstream consequences of these stressors, including cynicism, pessimism, emotional exhaustion, low sense of accomplishment, and deterrence of trainees choosing nephrology as a career. Remarkably, one half of nephrologists surveyed in 2017 reported burnout (², ³). It is apparent that the nephrology community is at a crossroads—either we accept this fate, or we take a new direction that restores job satisfaction and enables the highest quality of care for our patients.

The perspectives by Rosner and Berns (¹) , Williams (²), and Roberts (³) ask each of us to take a moment to think broadly about where we are and where we want to go as individuals and as a field. As Rosner and Berns state, “it is critical for us to take a step back, ask why we chose nephrology as our specialty, and consider how we can recapture joy and excitement in our practice of nephrology” (¹). Although it is clear that there are no quick or easy solutions to the issues that they delineate, Rosner and Berns (¹), Williams (²), and Roberts (³) outline a combination of fundamental issues and specific steps for the nephrology community to consider. The editorial team of the Clinical Journal of the American Society of Nephrology hopes that these perspectives will serve as a constructive platform to promote further meaningful discussion and concrete steps to improve the career of nephrology.

Disclosures

None.