Dialysis Investigation Draws Attention to Nephrologist Shortage

HealthLeaders Media Staff, November 15, 2010

In a damning series of investigative reports, ProPublica, in collaboration with The Atlantic, probed the question: Why does the U.S. spend more than almost any other country per dialysis patient and still have one of the highest mortality rates?

The question has dominated health headlines for days as the healthcare industry parses data from the ongoing investigation and subsequent news stories identifying serious failings at dialysis centers. One result of the report is that it highlights concerns about larger nephrology-related issues.

Physicians should recognize how important it is to institute measures to make widespread improvements in quality of care, Sharon Anderson, MD, president, American Society of Nephrology, said in an interview. ASN is currently working with CMS on a system of validated quality indicators designed to improve patient care, measure improvements, and provide consistent standards, she says.

Workforce issues may also play a role. "Many physicians will see this as further evidence of the crisis in the nephrology workforce: We do not have enough physicians trained in nephrology, and this shortage is projected to get much worse," she says.

An estimated 26 million people, 13 percent of the U.S. population, are living with chronic kidney disease, and this number continues to grow. If current trends continue, there won't be enough nephrologists, according to ASN data.

"Attracting more doctors to nephrology will go a long way toward improving care for all kidney patients. We hope one of the take-away messages is that kidney professionals need to encourage and mentor young people, to interest them in nephrology as a career," says Anderson.

So, was Anderson surprised at the results of the investigation? "Yes and no," she says. "With 26 million Americans suffering from kidney disease, it is a challenge to make sure all patients receive optimal care."

The ProPublica report offers a brief history of how dialysis is treated in the U.S. In 1972, Congress granted comprehensive coverage under Medicare to virtually anyone diagnosed with kidney failure. As a result, taxpayers spend more than $20 billion a year to care for those on dialysis—about $77,000 per patient, the report notes.  

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