Ian de Boer often found himself bringing home hours of work at night when the work day didn’t seem to end when he left the clinic or his kidney research lab. He drove hours between dialysis centers to meet with different patients, and while he remembered going into medicine for the ability to care for and interact with people, his long days seemed to consist of endless paperwork.
De Boer is a UW professor of medicine specializing in kidney research and also a UW Harborview Kidney Research Institute scientist, but lately he’s found himself asking why he chose this profession in the first place, something he never expected to have to ask himself.
Early last month, de Boer published an article addressing the issue of burnout in kidney research. He and his colleagues noticed an alarming trend in worker satisfaction in nephrology, the scientific name for kidney research.
“We wanted to highlight that to the community that this is something that many people are experiencing and open a dialogue,” de Boer said.
According to “Burnout in Nephrology,” one of the three main articles de Boer and his colleagues wrote, “44 percent of United States adult nephrology fellows were ‘somewhat, slightly, or not at all satisfied’ with their career choice.” Much of this dissatisfaction stemmed from a lack of job opportunities, difficult hours, and poor teaching or mentoring. According to the accompanying “Transforming Nephrology,” one study that examined four medical specialties (but did not include nephrology) found that “clinicians spend only 27 percent of their total time on direct clinical care and 49.2 percent of their time on [electronic medical record-keeping] and clerical work, with much of this time occurring after hours during personal time.”
“That’s depressing!” de Boer said. “I can guarantee that’s not why any of us went into nephrology or medicine.”
Authors of the article suggest that this issue of overburdening clinicians with documentation is worse for nephrologists because they often attend to several different clinics.
“Dialysis patients have 12-14 treatments a month,” de Boer said. “They don’t want to make an additional visit to come to a doctor’s office.”
To accommodate this, doctors often visit their patients at their dialysis centers. “Which is the right, patient-friendly approach to serving them,” de Boer said. The result, however, is that a lot of nephrologists then spend hours of time commuting from different dialysis units to clinics, research labs, and hospitals.
The number of medical students entering nephrology has also dropped over the last decade, which could negatively impact advances in kidney treatment.
“We’ve examined why promising new doctors aren’t going into the field of nephrology,” de Boer said. “People who are finishing their medical residencies and selecting subspecialties kind of saw some of these issues before coming in.”
De Boer and other nephrologists are particularly concerned with the shrinking pipeline into nephrology because chronic kidney disease is caused by chronic diseases — like diabetes and high blood pressure — that are increasing in prevalence, especially as the population ages.
“Who’s going to take care of these patients?” de Boer said. “We need good doctors to do it and it’s been very concerning that there’s been a downtrend in the field. That’s been part of the stimulus for us to ask, ‘What’s going on? What’s wrong with our wonderful field?’”
But de Boer has hope that introspection in the field will lead to possible solutions.
“I think most people are drawn to nephrology for the same reasons as me: It’s fascinating science, it’s a great population of patients to work with, great human interaction,” de Boer said. “We think it’s a fabulous place to be, but obviously there’s another side to it, and that’s the side that we want to try and shed some light on.”
But while the specialty of nephrology and the field of medicine itself is experiencing growing pains, de Boer believes that these issues that can be resolved as more of medicine’s leaders work to improve the age-old discipline.
“Medicine and nephrology both have gone through a lot of changes in the past few decades,” de Boer said. “Change is always hard, at least for people who have seen what it’s like before. I still think medicine and nephrology are great professions; I still love my job. Taking care of patients with kidney disease is a real honor and a privilege.”
For his students and for the future of nephrology, de Boer hopes to revive his beloved field.
Reach reporter Manisha Jha at firstname.lastname@example.org Twitter: @manishajha_