Are American Nephrologists Dialysis Money Sucking Leaches?

By Peter Laird, MD

In a recent post on HemoDoc, (here) I evaluated calls by some in nephrology to increase payment for their services. There is no doubt that many American physicians truly earn their pay and I have no doubt that my colleagues in nephrology do likewise work hard. However, at least one person took exception to my essay and categorically stated that nephrologists are not "dialysis money sucking leaches." However, the unfortunate historical record of American dialysis care does not corroborate that statement. (here)

While we can look to multifactorial improvement in cardiovascular outcomes not simply from revascularization alone as correctly pointed out in the above comment, but instead by a combination of advances in the pharmacologic interventions of myocardial infarction and improvements in revascularization techniques as well which I duly noted in my post; sadly I cannot state the same about dialysis outcomes in the US.

The point of comparison is the measurable advances we see in the treatment of cardiovascular disease in the general population vs. the stagnation of dialysis outcomes in the United States in particular.  When I see the median longevity on dialysis of 36-38 months, (here) which has not improved substantially for decades despite a concerted effort by many to promote optimal dialysis techniques, I must question the American nephrologist individually and collectively who are the only doctors legally able to prescribe dialysis treatments.

Indeed, what technological advances can we point to in the standard in-center treatment of the majority of American dialysis patients that has relieved pain and suffering of our patients in as dramatic a fashion as in many other areas of medicine?

As a dialysis patient myself, I do not take lightly the denial of individualized care I have seen in many units personally. I have been subject to cattle call dialysis sessions where I was yelled at for coming 25 minutes early instead of 30 minutes and suffered inadequate clearances simply because that unit refused my standard treatment at my home center. (here) To deny the existence of money sucking leaches in the field of nephrology is to remain in denial of the truth of the for-profit dialysis industry of the last 40 years.

Clinics Pad Kidney Dialysis Costs

By Jack Anderson

"Washington - Of all the corporate Scrooges in the world, none is lower than one that would squeeze profits form the sick and debilitated."

Today, the American nephrologist cannot stand up and proclaim significant improvements in the treatment of ESRD in the same manner that you can for a broad segment of other high tech specialties. 2012 was supposed to be a year when we saw new dialysis technologies approved by the FDA but 2012 has come and gone and we are not doing any better today than we did in 2011.

I could easily have cited improvements in the treatment of childhood leukemia or peptic ulcer disease or a myriad of other conditions but only used improvements in cardiovascular outcomes as one ready example. Focusing on my one example renders no justice at all to the deficiencies of dialysis care in America that lie entombed in stagnation and an intransigent resolution to not change the system whatsoever. In the meantime, patients on hemodialysis in America have a worse prognosis than AIDS patients and many cancer patients. Shall we gain any benefit by criticizing those who stand up and ask simply why cannot we do better today than we did yesterday?

This remains a uniquely American debate since the rest of the developed world has long since embraced the basic tenants of optimal dialysis. America remains paralyzed by an industry that is one of the most profitable in the US, (here) that is unless you are one of the unfortunate patients beginning dialysis today that only has 36-38 months of median life expectancy remaining. I believe that the American nephrologists have much that they need to account. We could do better and we should do better but shall we do better is the unanswered question.  There remain many champions of dialysis improvement in America, but sadly in my own venture as a dialysis patient, they appear to be few in number collectively. What then do we call the many American nephrologists who do not advocate for documented improvements in basic dialysis outcomes in America?

Comments

[alexi acevedo]

Nephrologists are simply slaves due to politics and healthcare...