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January 30, 2015

Is the Grass Truly Greener?

10 Comments to “Is the Grass Truly Greener?”

  1. isaac gorbaty said,

    January 30, 2015 @ 9:59 am

    when I trained in Nephrology in 1977-79 I went to the ASN and a speaker announced that they had trained all the
    Nephrologists needed for the next 20 years. We have already trained 3 times the number needed. I am shocked that it took 30 years for the doctors in training to wise up

  2. Robert Provenzano, MD said,

    February 5, 2015 @ 4:30 pm

    Isaac – I was at that meeting, I think Wadi Suki gave the presentation. I agree, sometimes we can be our own worse enemies.

  3. stephen graham, m.d. said,

    January 30, 2015 @ 1:19 pm

    I believe the days of private practice are numbered. As Medicare proceeds to a P4P system the needs of IT and clinical support will overwhelm even medium sized practices. I am a member of a 7-man Nephrology group and we serve as medical directors of two Davita units. Currently are only option is to align with a major tertiary care center. What plans does Davita have to align with groups such as mine.

  4. Robert Provenzano, MD said,

    February 5, 2015 @ 4:31 pm

    Dr. Graham,

    Partnerships are becoming a necessity in health care and hospitals are doing it every day. DaVita Kidney Care, through Nephrology Practice Solutions (NPS – ), is currently developing practice partnerships and would be happy to discuss directly with you. If you will be at PLM we could chat.


  5. M maksy said,

    January 30, 2015 @ 1:53 pm

    What do you think of incorporating conservative(palliative) care in nephrology practice?

  6. Robert Provenzano, MD said,

    February 5, 2015 @ 4:29 pm

    Absolutely necessary part of the equation; there is strong data to support it use.

  7. Bruce Bartlow said,

    January 30, 2015 @ 2:39 pm

    Dear Bob,

    always love your missals.

    What I’m impressed here in the rural THC-growing capital of California, is that as we lose 80% of our primaries, 80% of specialists who will see “Partnership,” others and even Medicare, we’re flooded and drowning. We’re doing great financially. But patients are waiting 8 months to be seen (as opposed to your 2 days), and recruiting doesn’t happen.

    As you love thinking out of the box, how about this: create an outpatient nephrology fellowship, board certified, to let year 2-3 fellows take 1-12 months in our offices seeing office patients, getting a feel for the profession, not hospital privileged but able to round with us (we’re also all CC-Neph-Pulm certified) and advance their understanding of office/HD/inpatient practice without pretending to do research?

    We desperately need the help. You need the interested bodies.

    I’d love to work with you on this. 3 of our 4 nephrologists are over 65. But our credentials are impressive. We’d take some young guys to train in a minute.


  8. Robert Provenzano, MD said,

    February 5, 2015 @ 4:29 pm

    Thanks Bruce, you are spot on! Currently there are opportunities for fellows in training to do “out rotations” in rural communities. Unfortunately few avail themselves of this opportunity.

    Other solutions include Telemedicine, which we are currently trialing & physician extenders. Sadly, there will always be under-served areas of the country but noodling on solutions is the correct first step.

    Look forward to seeing you at PLM!


  9. Hector rodriguez said,

    January 31, 2015 @ 2:15 pm

    Bob: you articulate a very compelling argument for Nephrologists-dialysis providers partenrships and for Nephrologists thinking to evolve with the changing market forces. The “independent practitioner” and “individual entrepreneurship” views still prevail in the minds of many young Nephrologists. I find the analogy of the flip phone vs. smartphone very relevant. We should hear this talk at PLM.

  10. Robert Provenzano, MD said,

    February 5, 2015 @ 4:28 pm

    Thanks Hector – Keeping our focus on patients, developing meaningful partnerships and maintaining an open mind will all be necessary moving forward. See you at PLM!

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