Abstract
Remuneration issues are a substantial threat to the long-term stability of the pediatric nephrology workforce. It is uncertain whether the pediatric nephrology workforce will meet the growing needs of children with kidney disease without a substantial overhaul of the current reimbursement policies. In contrast to adult nephrology, the majority of pediatric nephrologists practice in an academic setting affiliated with a university and/or children's hospital. The pediatric nephrology service line is crucial to maintaining the financial health and wellness of a comprehensive children's hospital. However, in the current fee-for-service system, the clinical care for children with kidney disease is neither sufficiently valued, nor appropriately compensated. Current compensation models derived from the relative value unit (RVU) system contribute to the structural biases inherent in the current inequitable payment system. The perceived negative financial compensation is a significant driver of waning trainee interest in the field which is one of the least attractive specialties for students, with a significant proportion of training spots going unfilled each year and relatively stagnant growth rate as compared to the other pediatric subspecialties. This article reviews the current state of financial compensation issues plaguing the pediatric nephrology subspecialty. We further outline strategies for pediatric nephrologists, hospital administrators, and policy-makers to improve the landscape of financial reimbursement to pediatric subspecialists. A physician compensation model is proposed which aligns clinical activity with alternate metrics for current non-RVU producing activities that harmonizes hospital and personal mission statements.
Highlights
The American Board of Pediatrics certified pediatric nephrology as a subspecialty in 1974
We are at a crossroads moment that will determine the sustainability of our pediatric nephrology workforce
Solutions will likely require concerted efforts to bring about a culture change in health care delivery and reimbursement models to pave the way toward improved valuation of the unique services provided by a pediatric nephrologist
Summary
The American Board of Pediatrics certified pediatric nephrology as a subspecialty in 1974. Patient volumes in the field continue to rise, with significant growth over the last several decades due to improved survival of primary renal diseases as well as Compensation Pediatric Nephrology other non-renal conditions including congenital heart disease, childhood cancer, prematurity, and sepsis Survival of these childhood illnesses is associated with increased incidence of chronic kidney disease (CKD) and/or hypertension in adolescence and young adulthood. A major opportunity to reduce this burden of illness and cost over the several decades exists in early prevention of progressive kidney disease This can only occur with skilled identification, treatment, and education of children at risk for kidney disease or with early kidney disease, all of which are best accomplished by the pediatric nephrologist.
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