A case for nephrology


In recent times, physician burnout has rightfully surfaced as a social concern for the medical fraternity. Physician burnout is a thing, and lately, I was thinking about it related to nephrology.

Many national physician organizations and local hospital systems are developing strategies to reduce work-life stress and improve the engagement of the workforce. In November 2018, I represented the Renal Physician Association at the interim meeting of the American Medical Association House of Delegates, where physician burnout was a topic of heavy discussion. After spending the past five years of my life immersed in nephrology, I found myself elbow-to-elbow with young physicians of every specialty as Dr. Michael Tutty started discussing the AMA initiatives on burnout.

As Dr. Tutty described that an estimated 30  to 40 percent of physicians experience burnout, I reflected on my own well-being as a physician, as a leader, and as an individual. Psychology Today states that “Mindfulness is a state of active, open attention on the present. When we are mindful, we carefully observe our thoughts and feelings without judging them as good or bad.”

Sitting in the room, I reflected on the past months and years of my life.

As the wife of a physician, mother of toddlers, educator, clinician, and administrator, I have subconsciously developed a habit of listing my desired accomplishments for each day on my drive into work. A great deal of time, I accomplished only a percentage of what I had hoped, and my drive home was clouded with anger, resentment, and a sense of failure. Was I angry with workload or the fact I had unaccomplished goals? Did physicians in other specialties feel this too?

I’ve always been an enthusiastic person. In fellowship, I aspired to publish and write as a clinical educator, which paved the way for a career in academia. I got my dream job at a major academic center — teaching during ward rotations, rounding at dialysis units, and seeing patients in the clinic. It’s easy to forget how much work and frustration came along with the achievements. At every stage of education has come a new set of duties and responsibilities — this is a privilege but also a challenge.

To the public, and to the new generation of medical trainees, a nephrologist is neither physician physiologist nor adventurous inventor, but rather the steady traveler who ran and staffed the outpatient unit and cared for patients both there and in the hospital.

Since 2008, there has been declining interest in our field as the perception of “underpaid and overworked” emerged. Even within the medical field, our role is poorly understood, and we often have to explain and validate our profession.

As a panelist at the medical student showcase at a recent AMA meeting, I fielded questions about work-life balance, compensation, and my job profile as a nephrologist. I was reminded of Homer Smith’s musing that “superficially, it might be said that the function of kidneys is to make urine; but in a considered view, one can say that the kidney makes the stuff of philosophy itself.”

Just as the nephron is a complex and elegant unit of discrete and interconnected elements, a career as a nephrologist is one of many facets. We are physiologists; we are internists. We manage dialysis units. We are teachers, learners, and leaders of teams. We can be entrepreneurs, writers, community organizers, and advocates.

We choose roles that interest us, suit our lifestyle, and achieve our goals, and we evolve within those paths. Professional societies, academicians and private practitioners have joined forces to reincarnate the impression. On multiple occasions, many of us have explained or somewhat clarified our job profile to other colleagues in the medical fraternity.

I hope that with good mentorship and vocal enthusiasm, nephrologists can turn the tide of decreased popularity that has plagued our field of late. For me, nephrology has been the source of great joy and scholarship, and I hope to share my passion with generations of doctors to come.

Nupur Gupta is a nephrologist.

Image credit: Shutterstock.com


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