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10 Questions with
Stuart L. Linas, MD, FASN Stuart L. Linas, MD, FASN, is the Nephrology Training
Program Director
at the University of Colorado Health Sciences Center. He has made
significant contributions to the area of Angiotensin II Receptor
Physiology and Cell and Molecular Biology, and was one of the first
individuals to identify an important role for inflammatory factors in
the initiation and maintenance phases of acute renal failure (which is
now known as acute kidney injury).A former President of the Association of Specialty Professors (ASP), Dr. Linas has served as chair of the ASN Training Program Directors Executive Committee. He is currently chair of the ASN Hypertension Advisory Group, the past education editor of the American Journal of Kidney Diseases, and current Chair of the Nephrology Board of the American Board of Internal Medicine (ABIM). He recently took a break from his busy schedule to answer a few questions for this edition of Renal Express. You are the current chair of the ASN Hypertension Advisory Group (HAG). What are the advisory group’s goals in 2008? HAG has three goals for this year. Our first goal is to develop a database of ASN investigators who are interested in participating in clinical studies. In addition, we hope to prepare either a course or a Toolkit for younger investigators on how to become involved and to conduct clinical studies. Finally, we hope to initiate a series of brief position statements on various aspects of hypertension and kidney disease. An ASN-created clinical trials website has been discussed for some time by both HAG and the ASN Clinical Science Committee (CSC). Can you explain this initiative? There are a large number of ASN members with expertise and interest in participating in clinical trials. At present there is no way to identify ASN members with expertise or pharmaceutical companies with need for clinical trial sites. Our two committees, the HAG and the CSC, hope to develop a database of investigators who could participate as sites or serve on advisory boards for clinical trials. What do you see as the most important challenges facing nephrology? I have been a nephrologist for more years than I will confess. The field of Nephrology is, if anything, more exciting now than when I began my faculty appointment. The number of diverse opportunities in clinical nephrology, education, or research is spectacular. The two biggest challenges that I foresee are: a) revitalizing the physician scientist and b) expanding the number of nephrology trainees. With regard to the physician scientist, the number of fellow applicants with interest in either basic or clinical research has decreased dramatically. In addition, we continue to lose junior faculty to funding concerns and job satisfaction. The recently published approach from the Alliance for Academic Internal Medicine to revitalizing the physician-scientist workforce is a model that I believe ASN should take on and utilize to increase the number of nephrology scientists. With regard to the workforce issue, the number of patients with chronic kidney disease and end-stage renal disease (ESRD) has increased significantly during the last decade and does not seem to be stabilizing. We need to have an approach from the fellowship training program perspective to keep pace with these very challenging numbers. ASP was founded by an ASN member (Eric G. Neilson, MD) in 1994. You recently served as ASP President. How is the relationship between ASN and ASP mutually beneficial? Dr. Neilson’s vision of ASP proved to be right on. ASP serves as the representative for all subspecialties of internal medicine. Through the years, ASP has had a great deal of success in advocating for the subspecialties. For example, ASP has provided many benefits to ASN, including the ASN-ASP Junior Development Grant in Geriatric Nephrology, the recent fellowship match in nephrology, and representation of ASN (and all of the subspecialties) to the Accreditation Council for Graduate Medical Education. ASN has brought leadership as well as a strong subspecialty vision and support for research and education to ASP. Can you explain ABIM's interest in recognizing 'focused practice"? ABIM is exploring a new pathway to recognize areas of “focused practice” through its Maintenance of Certification (MOC) program in internal medicine. Unlike subspecialties that require additional training through fellowship, these focused practice pathways recognize skills that develop over time in practice. Hospital medicine is the first area to be considered for focused practice recognition; over time, ABIM will consider other areas that meet criteria it has developed to identify major, emerging areas of practice focus within internal medicine. How has ABIM changed during the past five years? The major development in the last five years has been the inclusion of practice performance assessment in the MOC Program. ABIM's Practice Improvement Modules (PIM's) are multi-pronged, web-based tools that help physicians evaluate the care they provide patients and use data to take action to improve care. The numbers of PIMs available to diplomates continue to grow. For example, in our field, there is a hypertension and osteoporosis PIM. In addition, data many of us are already collecting, either for the Clinical Performance Measures Project (CPM), ESRD-Consumer Assessment of Healthcare Providers and Systems, Dialysis Facility Compare, or the ESRD Disease Management Demonstration Project can be used to complete the ABIM self-directed PIM. In the future, ABIM hopes that ASN will develop additional PIMs that are most-relevant and helpful to the Society’s members. You have worked with Robert W. Schrier, MD, and Tomas Berl, MD, for a long time. Can you describe a few "pearls" you have learned from them? Indeed, I have been very fortunate to have worked both with Dr. Schrier and Dr. Berl. They are both mentors but good friends as well. From Dr. Schrier, I learned the meaning of the word “persistence”. I learned to believe in myself and in my work even when research granting agencies saw things a bit differently. From Dr. Berl, I learned to see the best in everyone. Tom has never seen a weak student, resident, , fellow, or faculty member. He can find the best in everyone. I also had the good fortune of being mentored by Allan C. Alfrey, MD, who recently passed away. Dr. Alfrey taught all of us the meaning of the word humility. Please tell about your most memorable training experience or most influential mentor. That’s easy, and it is another story about Dr. Schrier. The first paper I ever wrote as a fellow was rejected outright by the New England Journal of Medicine. I came to see Dr. Schrier with my head hanging and my shoulders drooping. He took one look at me and was concerned that something awful had happened to me or my family. When I told him about the paper being summarily rejected, he was visibly relieved. After looking at the review, he picked up the phone and gently but persistently worked his way through to the editor and then explained what an awful mistake the editor had made by rejecting this paper and went on to tell the editor "you just don’t get it, let me explain". The bottom line is that I watched as Dr. Schrier wore the editor down and, I believe, the paper was accepted just to get Dr. Schrier off of the phone. Thirty years later, I still remember this conversation. Persistence and belief in one’s work and one’s self is a hallmark of Dr. Schrier’s mentoring that I appreciate to this day. Why did you decide to become a Nephrologist? I went to Tufts University School of Medicine and was fortunate to be exposed early on to Maurice B. Strauss, MD, William B. Schwartz, MD, Jerome P. Kassirer, MD, William Madden, MD, and Theodore I. Steinman, MD. As a renal division, even as young faculty, they were master educators, clinicians, and researchers. In addition, their analytic approach to medicine and insistence on evidence-based medicine, even before the term was in vogue, greatly influenced my decision to become a nephrologist. Renal Express has learned that you have a personal connection to the Baltimore Orioles. What’s the story? That’s another side of my life from the distant past! I grew up in Baltimore, MD, and my sister’s best friend’s father was about a one-third owner of the Baltimore Orioles. I had lots of exposure to baseball and really wanted to play and some how thought that it would be possible to be a professional baseball player. There was, however, this little problem: I was short, slow, wore glasses, and couldn’t even stand in to hit a curve ball. So, instead of playing baseball, I went to medical school. |
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 Congress Passes Medicare Bill The Senate passed HR 6331, the “Medicare Improvements for Patients and Providers Act of 2008,” Wednesday, July 9. Several Republican Senators joined Senate Democrats to form a veto-proof majority. The House of Representatives passed the Medicare bill by a bipartisan vote of 355-59. President George W. Bush has vetoed the bill Tuesday, July 15, 2008, despite the veto-proof margins in both chambers of Congress. The House and Senate are expected to vote on overriding the veto as early as this week. The passage of this bill is significant for at least two reasons. First, the legislation reverses a proposed physician pay cut. The bill replaces the 10.6% physician payment cut that went into effect Tuesday, July 1, 2008, with a 0.5% update extension through December 31, 2008. For calendar year 2009, the update will be 1.1%. Second, the bill contains reform measures to Medicare payment for end-stage renal disease (ESRD) that have been long-sought after by the renal community. The ESRD reform measures establish education and prevention initiatives for chronic kidney disease, expand the current bundle for purposes of reimbursement, require the Government Accountability Office to report on bundling 12 to 18 months after the beginning of the program, link quality performance to payment, and provide a mechanism for inflationary updates. A more complete summary of the ESRD reform measures and the actual bill language is available on the Policy & Public Affairs section on the ASN Web site. While this is truly a significant victory for the renal community, there is still a lot of work ahead as the community attempts to implement the bill’s ESRD reform measures. ASN looks forward to working with the entire renal community during this important next stage. The ASN Public Policy Board would also like to take this opportunity to acknowledge the critical contribution of the Kidney Care Partners (KCP) consulting team (which includes Linda Keegan, John Jonas, Kathy Lester, Susan Murdock, and John Schmidt). Match Day for Nephrology The first match in nephrology took place Wednesday, June 18, 2008. The National Resident Matching Program (NRMP) Specialties Matching Service (SMS) provides an impartial venue for matching the preferences of training programs and applicants. According to NRMP, 142 nephrology fellowship programs participated in SMS. Nearly 90% (127 programs) are filled to capacity, with 95% (348 of a possible 367) of positions filled. In spring 2007, nephrology fellowship training program directors voted to participate in the NRMP SMS for fellowship positions that begin in July 2009. The available fellowship positions were split into four separate tracks: research (general), basic science research, clinical research, and clinical (with no formal research year). The NRMP SMS statistics by the four tracks are as follows:
The next table illustrates the type of medical school graduates that applied for nephrology fellowships through SMS. They included US medical graduates (USMGs), international medical graduates (IMGs), international medical graduates who are US citizens (USIMGs), graduates of osteopathic medical schools (DOs), and other graduates.
For more information about NRMP SMS or the nephrology match, please contact ASN Training Program Directors Executive Chair, Donald E. Kohan, MD, PhD, FASN, at donald.kohan@hsc.utah.edu or ASN Senior Policy Coordinator Susan E. Owens at 202-416-0668 or sowens@asn-online.org. |
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 The ASN Acute Kidney
Injury (AKI) Advisory
Group is charged with informing the Society of the various issues of
importance to the AKI community and ensuring that ASN takes proactive
steps—via advocacy, education, and research—to support clinicians and
investigators dedicated to AKI treatment and research.AKI plans to advance an agenda in the next year that addresses the needs of the AKI community in a multitude of areas. AKI, in collaboration with the Dialysis Advisory Group, plans to consider ways for ASN to partner with established aid organizations that seek to provide patients with appropriate care, including dialysis treatment, in the wake of a natural disaster. The advisory group has also proposed creating a curriculum on intensive care unit nephrology, including continuous renal replacement therapy, for practicing nephrologists and trainees. In addition, the advisory group has initiated discussion with the organizers of World Kidney Day to increase awareness of AKI as an important contributor to chronic kidney disease and end-stage renal disease. AKI will continue to advance its research agenda through collaboration with the pharmaceutical industry; federal drug agencies, including the US Food and Drug Administration; and related organizations such as the Acute Kidney Injury Network. The committee recognizes the importance of supporting investigators as they maneuver through the pipeline and hopes to consider ways to improve career development of junior investigators interested in AKI research. Lastly, AKI recently assisted the Society in a joint effort with the National Kidney Foundation, Renal Physicians Association, and International Society of Nephrology. The advisory group helped draft a letter to the National Center for Health Statistics (NCHS) regarding ICD-9-CM coding for acute renal failure. In particular, the letter incorporates AKI in the nomenclature. The next NCHS meeting is scheduled for September 2008, and the new nomenclature may be effective as early as October 1, 2008. Mark D. Okusa, MD University of Virginia School of Medicine Chair, AKI Advisory Group |
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 Looking for that Perfect Fit? The ASN Career Center is now open and available to members. Featuring robust candidate and recruiter account modules, the ASN Career Center allows ASN members to easily search jobs, post resumes, review candidates, and apply for positions—all from one site. No matter where ASN members are in their careers, the ASN Career Center has the tools to help all of its members to move to the next level. Employers and recruiters now have the ability to browse resumes, post jobs, and use the tiered pricing system to find the recruitment package that is right for any sized budget. For information about placing classified advertising in ASN publications, please contact Tammy Zafiros at tammyz@scherago.com. The candidate section of the ASN Career Center is open to ASN members only, which makes it a premiere benefit of membership. Job seekers can post anonymous resumes for employer review, search the latest job postings in their field or area of interest, and create personalized job agents that will seek out an notify them of job postings based on the selected criteria. Try it today! |
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