Fellows: Career Profile
Dr. Arnold Berns - The Nephrologist in Private Practice
My interest in nephrology began as a second year medical student but really began to consume me during my residency. I was fascinated by the subject matter and the fact that a thorough knowledge of renal physiology could inform clinical decision making in a rational and thoughtful way. However, I was even more taken by the staff nephrologists, who just seemed to be the smartest and most professional physicians that I had met up to that time. They seemed to understand and explain things that nobody else could. So even before I became a nephrologist, my mentors and role models had an enormous influence on me, an experience that I have honored throughout my career.
I remember with clarity one of my fellowship interviews in which I was asked "Why nephrology?" After talking non-stop for 30 minutes, the faculty member actually asked me to be quiet. He was overwhelmed by my enthusiasm. Even though I chose to train in a rigorous academic program, I knew that my true love was direct patient care. Therefore, I chose to trust my instincts and pursue a career as a practicing nephrologist.
I was fortunate in that I found a promising practice situation that would allow for a busy and well balanced practice experience and offered me the great privilege of teaching in a university affiliated community training program. I had always seen the three foundations of medicine as patient care, teaching and research and understood that my particular talents, my love of clinical medicine and my ability to communicate, would guide me to the pursuits of patient care and teaching. However, I quickly realized that the two endeavors were not parallel pathways but rather highly synergistic and complementary activities. Skill in direct patient care makes you a better teacher, and teaching makes you a better doctor.
Starting in practice, I had two major concerns. I had a young family, two children in diapers, and as they say, "mouths to feed." Would my career choice support my obligations? My second concern was life style. It is not easy being a practicing nephrologist. The work is stressful, the hours are long, and call can be brutal. Would I be able to balance the two great forces in my life, my chosen career and my family? Happily, I answer yes to both, but not without some trial and error, the development of highly efficient work habits, making sure that I never missed a recital or a school play, and plenty of vacation.
Much to my surprise and utter delight, my clinical career has thrived and has sustained my family and myself, but there are always unexpected twists and turns, unintended consequences. My local teaching efforts blossomed into national teaching opportunities and I have had the privilege of participating in the programs of the NKF as well as Renal Week. I was asked to chair the fledgling Midwest Renal Weekend Program and have now done so for several years. This experience allowed me to meet other practicing nephrologists who take their CME very seriously and almost painlessly keeps me about as current as a busy nephrologist can hope to be. As an authentic practicing doctor, I felt that I had a unique point of view and a real contribution to make, and therefore I became active in the American Society of Nephrology and its various committees and teaching activities. More recently, I have had the opportunity to participate in the Nephrology committee of the American Board of Internal Medicine, an extremely rewarding experience.
One of my greatest joys in my career, and a recapitulation of my formative experiences as a resident and fellow, has been the mentoring of residents in helping them launch their careers in nephrology. With great pride, I can point to dozens of practicing nephrologists who benefited from my influence and assistance in securing their fellowships and starting their own practice careers. I remember being told during fellowship that "we train the trainers" and we expect each one of you to leave your mark on the profession. I have never forgotten those words, the mission of commitment and the concept that you should leave things better than when you found them.
The decision to practice nephrology carries with it heavy obligations and great rewards. At no time have I felt that somehow I missed out by not spending my life in an academic medical center, teaching fellows and attending daily conferences. The rewards of practice include the pride of a job well done, giving every patient your one hundred per cent effort, watching the smiles of delight as trainees and attending staff come to understand what has confounded them, helping others launch their own careers, and generally leaving your patients and the specialty better off for your having passed through. In short, a mix of both actual and psychic income.
In this era of growing dissatisfaction with medicine, more and more regulation, mindless bureaucratic harassment, and contracting compensation, I am often asked as to what the future of nephrology practice is. I am the first to admit that I have no clear idea. However, I have learned that adjusting to change is critical to survival and success, and today’s problems are really tomorrow’s opportunities. I take great solace from my life long career journey, the never ending learning curve that we all have committed to, and the notion that professional achievement and excellence is a process and not a destination.