The role of physician assistants in improving renal care.

Currently, nephrology PAs remain a small group. According to 2003 census data from The American Academy of Nephrology Physician Assistants, only 98 of 20,646 survey respondents identified themselves as practicing in nephrology. The future of PAs or nurse practitioners in nephrology is not only very bright, but is also an absolute necessity. We have known for many years that the number of individuals with kidney disease in the United States is increasing at a rate that outpaces our ability to develop and train nephrologists. This has resulted in an ever-increasing ratio of patients to clinical nephrologists. The workload for management of dialysis patients on a daily basis is becoming exhaustive and will not improve. The fastest growing segment of dialysis patients is now people in their 70s and 80s, and they bring with them multiple chronic health problems that are affected by dialysis and the treatment of their renal disease. The result is the need for closer monitoring, not less. The role of physician extenders can have a very positive impact for this patient population. Being the eyes, ears, nose, and fingers of our nephrologists can help in avoiding potential major problems in the outpatient arena. There is not a magic formula in caring for this patient population; it is a matter of spending time and becoming familiar with our patients, a premium most nephrologists do not have at present. It is not a matter of willingness; it is a matter of capability, of being in more than one place, and of having time to make the patient assessments. I think there is a great opportunity for nephrologists to create a new segment of providers to assist them in these endeavors. They can sponsor PAs as preceptors before graduation so that the students can have the opportunity to see what it takes to care for this population, the level of medicine they need to learn, and the responsibility they will need to accept. The nephrologist will benefit from working with a PA that has a good foundation of medical education that the nephrologist can tailor to his or her own method of practice in order to become comfortable in the relationship long-term. The future of care for our end-stage renal disease population needs all our efforts to succeed.