Ask the Doctor
Questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask Dr. Spry.
Kim Zuber, PA–C, MSPS
A quick overview of the data we have collected from our Advanced Practitioners in Nephrology Salary and Benefits Survey leaves the Executive Committee really excited. We have had an excellent response and, judging from the preliminary data, will be able to provide nephrology APs with a wealth of information.
The preliminary results show that most of you are either between 30–40 (30%) or 50–60 (35%) years old, 86% are female, 88% are white and there is an even split between PAs and NPs (46% to 52%). Eighty percent have a Master’s degree, 88% work full time, and 57% have been in your present job one year, although most of you have 5–10 years of experience as an AP. More than half of you work for a single specialty physician practice but you are all over the place!!
Thirty percent of you are at an inpatient unit, 47% work in an office and 70% work in a dialysis unit. Forty percent of you do some hospital work, while 84% do HD rounds (usually the 3rd of 4 visits), 42% manage PD (boy…we will need to increase our PD education at 2011 Spring Clinical Meetings in Vegas), 12% do IR work, 23% are in research with most working as the sub–investigator (81%)! You teach (56%), you do office visits (78%) and you manage others in your groups (25%).
Now for the really interesting info: Most of you are paid $70–80K/yr (29%) with 4% reporting being paid more than $104K/yr. Your average CME budget is $1,000–1,500/yr with 86% getting the CME days paid for. Ninety two percent are covered under your employers’ malpractice. More than 50% received a raise last year, even with the lousy economy. Most of you have a 401K with a 2–3% employer match. Twenty six percent participate in profit–sharing. You have either 16–20 days (20%) or >25 (24%) days off each year. The most common benefits are car mileage, lab coats and business cards. Only 34% of you have your names on the doors and only 8% have your name on the office stationery (this is my pet project—to convince everyone that you need to be treated as the professional you are! A new doctor would not accept not being listed on the office stationery!).
And the satisfaction section…it is fascinating! Eighty three percent of you look forward to going to work in each day and 89% feel you can count on your physician to back you up. Eighty nine percent feel that your group is practicing excellent medicine. Eighty four percent understand exactly what is expected of you in your job and 67% would do exactly what you are doing if offered a chance (WOW, I wonder what that data is for other types of work??!!).
The five most important things to you are being valued at work (66%), having a good working relationship with your doctor (63%), counting on your doctor for back–up (51%), enjoying what you are doing (48%) and being free to practice medicine how you wish (35%).
So, you can see what wonderful data will be coming out of the survey. The final data will be published and presented at meetings this summer, in addition to being posted on the CAP website.
Early in 2010, the NKF launched “Your Treatment, Your Choice,” a comprehensive, unbiased Stage 4 CKD patient education program. The content is designed specifically to satisfy Medicare’s requirements for reimbursement outlined by the Medicare Improvements for Patients and Professionals Act of 2008 (MIPPA) Kidney Disease Education Benefit.
According to Barry Straube, MD, CMS Chief Medical Officer and Director of the Agency’s Office of Clinical Standards & Quality, “The new Medicare benefit is an important step forward in assuring that patients with CKD have the information they need to live active, healthy lives as they make informed treatment decisions and manage the effects of their disease. We are pleased to be working with the NKF to spread awareness of this important new Medicare education benefit through a national network of trained kidney health professionals.”
“Your Treatment, Your Choice” includes six upbeat, hopeful, patient–friendly, engaging and action–oriented workshops:
It includes almost 60 different patient teaching/learning tools that were developed using a scientific foundation to maximize learning. The program outlines desired outcome goals for each topic, and includes measurement tools and strategies for evaluating patient learning, as well as professional documentation tools.
The program was developed with community input from, and review by, clinicians as well as patients. Two of the comments from patients are:
“Shows that life can still be good even with treatment”
“When I started with CKD 18 years ago, this would have been so helpful!”
NKF believes that MIPPA offers the promise of improving patient outcomes for Medicare beneficiaries, and, after significantly influencing the passage of the Kidney Disease Education Benefit for over 7 years, wants to ensure that eligible patients receive the maximum benefit and that as many beneficiaries as possible avail themselves of this coverage.
For more information, and to order, visit the “Your Treatment, Your Choice” web page. You can also visit the NKF’s CME web page for currently available free NKF CME/CE activities. A webcast, offering CME/CE credit, highlighting the MIPPA benefit and “Your Treatment, Your Choice” as a model for implementation will be available on the site beginning July 2010.
2010 marks the first year achievement awards were given by the Council of Advanced Practitioners. The Tim Poole Award was accepted by Lynn Poole, FNP–BC, at the CAP luncheon, where she was given a standing ovation by her fellow CAP members for her long-standing dedication to the advancement of programs related to chronic kidney disease. Lynn spoke of her dedication to the progress of advanced practitioners in nephrology and her ardent interest in legislation that affects both the care for CKD patients and advanced practitioners. She made a plea to her fellow CAP members to be informed about legislation affecting our group.
An added honor A brief statement made by Dr. Robert D. Toto, who was Tim Poole’s collaborating physician, was an added honor. He spoke eloquently about the dedication of Tim to his patients, his CKD clinic, his community and his family. He spoke of the tragedy of Tim dying young as he had been so very dedicated to the education of the medical community about CKD.
The Nostradamus Award was accepted by Senator Blanche Lincoln (D–AR), who introduced the MIPPA education bill which has altered CKD education forever. The award was presented in her Washington office on World Kidney Day (March 11). She was tearful when accepting the award as it showed great awareness that positive things can happen at the end of a day in Congress! She taped a video message which spoke of her support for stopping the progression of CKD and promoted the mission of the National Kidney Foundation.
CAP is calling for Award nominations for 2011. For more information on how to nominate a person or organization for these awards, go to the CAP website. Nominations will close September 15.
Thank You for Tim Poole Memorial Award By Lynn Poole, FNP-BC
I want to express my sincere thank you and appreciation to the Executive Committee for honoring me with the Tim Poole Memorial Award. To be recognized by one’s peers is unparalleled by any other experience one can have in their professional life. Even though we share a name in common, I did not know Tim and according to those who knew him, he embodied what it means to excel and contribute to the care of those entrusted to him. We should all look to emulate his example as we conduct our professional and personal lives.
Through my years as an AP in nephrology, sometimes it was a lonely place to be. There were few of us and often we struggled with where we fit best into the nephrology community and delivery system. It is so gratifying for me to now have the CAP where I know I belong and have peers with likeminded focuses and goals. I see only great things for APs in nephrology as the changes in healthcare evolve and unfold over the coming years and months.
So to all of you, thank you for the award but more importantly for all you do to better the health and quality of life for those we serve.
Two Sydney the Kidneys arrived at the Orlando NKF Spring 2010 Clinical Meetings. Sydney had a minor makeover during Spring break. A new Sydney was created by several of the staff at a quilt shop in Greensboro, NC to resemble the old Sydney, but was given a few modifications in order to increase his durability as he travels around the country. The owner of the quilt shop, a dialysis patient, generously provided the resources for Sydney’s new look.
Once Sydney arrived in Orlando, he made the rounds meeting CAP members, attending the CAP reception and luncheon, schmoozing with the NKF Board of Directors and making everyone smile wherever he went.
Both Sydneys debuted at the CAP luncheon and Advanced Practitioners were introduced to CAP’s goal of using Sydney as a vehicle for increasing kidney health awareness in many venues with all ages. Many volunteers signed up for this opportunity to use Sydney and he is booked for the next several months. If you are interested in having Sydney visit your practice or place of work, please contact Deb Hain, his travel agent to be put on the waiting list. CAP members who take Sydney are asked to write a paragraph or two on the Sydney’s kidney activities and to send it with a picture(s) of Sydney’s visit to CAP’s Publications Chair, Jane Davis.
Syd’s travels are posted on the NKF web site. CAP is working to develop an interactive map so that when you click on the state/location, it brings up Syd’s activities in that location. So far, Sydney has been to Texas, Virginia, Washington D.C., North Carolina and Florida. When last seen, Sydney was leaving Orlando with Floyd Johnson, NP, to head to Minneapolis and then on to Elkhart Lake, Wisconsin, where he will stay with Linda Doeckel, PA–C.
Indiana and Haiti are as far apart as any two places can be. Mishawaka, IN, is a town of 46,600, located in the North Central U.S., while Haiti is a tropical island in the Caribbean. Donna Woodward, NP–C, moves easily between these two worlds. For the past three years, she has been one of a group of 15 who spend approximately 5 days in the country treating 1200–1300 patients in less than four days. By herself, Donna sees 80–100 patients daily (no paperwork). Their clinic is in Belledere approximately 60 miles northeast of Port–au–Prince, a 4–6 hour bumpy journey by jeep and SUV. Actually, according to Donna, to call their location a clinic is a misnomer. There is a building and tables. All the equipment and supplies are brought by the team.
Donna says the team (usually a surgeon, 3–4 physicians and advanced practitioners, 4–5 nurses and other non medical personnel) sees everything from heartburn to malaria to typhoid fever to worms. Hypertension is rampant and because the team provides their own supplies, they do not treat blood pressures under 160/90.
In 2008, she visited one of Mother Teresa’s orphanages and saw real malnutrition firsthand. Until then, Donna says, she had no idea the children in magazines and on TV only had mild malnutrition. Donna says people often ask her why she goes to another country when there are so many needs here. While she recognizes our problems and the situations many of our citizens face, she knows the stark contrast between the needs of the poor in the United States and Haiti. “Even the homeless in our country can walk into a public bathroom and have access to clean water and a toilet which is way better than it is for a Haitian,” she says. Her future plans include a return trip to Haiti where she will possibly take her children (ages 6 and 17) along.
It was exciting to see the seven CAP members who received travel grants to attend the 2010 NKF Spring Clinical Meetings (SCM10). They each received $500 plus free registration for the Clinical Meetings. The recipients were Sandra Abrahamson, Elaine Go, Jason Tiede, Valerie Pompey, Linda Doeckel, Lynn Poole and Catherine Groeger.
The recipients are required to write a brief article on their experience at the meetings. So we can all reflect on the experience, the essays have been condensed. For most of the awardees, it was the first or second NKF Spring Clinical Meetings they had attended. All left enriched by the experience and somewhat overwhelmed by the variety of topics and presentations.
Linda Doeckel, PA–C, from Wisconsin, attended the Management of Diabetes Workshop—Cases. She was particularly impressed with the emphasis on making the patients managers of their health care and helping them manage the complexities of multiple medications.
Jason Tiede, PA–C, MHS, from Missouri, brings to his practice a new understanding of masses and cysts found on the kidneys and the best ways to handle patients with masses and cysts. He has been able to take back the information from this conference to his practice and improve the care of his patients.
Cathy Groeger, MN, NP–C, of Lousiana, appreciated the range of topics offered. She has a new appreciation for the GI effects of many of commonly–used treatments. She also sampled a range of offerings from basic to complex. Like many other attendees, she was impressed by the camaraderie among the advanced practitioners.
Knowing how to talk to patients is the key to compliance. Elaine Go, RN, NP, MSN, CNN, of California, is incorporating more “patient friendly” teaching into her practice by involving the patients in their care. She finds taking the time to explore why patients eat what we think they should not or drink more than we think they should pays off with big dividends in more compliance. She also brought back the value of reaching out to the non-renal community and has talked to nutritionist groups about CKD.
Valerie Pompey, MS, ANP–BC, from Indiana, began the conference with Nephrology 201 and used that as a springboard to attend other sessions which delved more deeply into the topics covered in 201. This was her first conference but between the activities and the networking, she is convinced it will not be her last.
Travel awards will be offered again for the 2011 NKF Spring Clinical Meetings. Priority will be given to applicants who are first time attendees, and the deadline is December 1. An email announcement will be sent to CAP members when the application is available in the fall.
As our numbers have grown, so has our Executive Committee. We are pleased to welcome Amma Sewaah-Bonsu, MSN, NP–C, DNP, Continuing Education Co–Chairperson and Marty Bergman, MS, RD, PA–C, Member–at–Large. We also welcome volunteers Beth Wilkening, NP, as Research Co–Chairperson; Lynn Poole, FNP–BC, as Public Policy Chair; Laura MacGregor, NP–C, as Cybernephrology Chair; and Tricia Howard, PA, as Member–at–Large. They are expanding the scope to the Executive Committee to meet our growing membership needs.
Executive Committee Member Spotlight:
Marty Bergman, MS, RD, PA–C
I have worked as a Nephrology PA with Carolina Kidney Associates for 15 years since graduating from the Wake Forest University PA Program. My practice has eight physicians, four PAs and one NP and covers eight dialysis centers, a hemodialysis population of 800 and one primary hospital.
Prior to my career change, I worked in a small rural North Carolina hospital/Skilled Nursing Facility as a Director of Dietetic Services. During that time, I also had two daughters and developed and became Director of the Hospital Day Care. I still do part time nutritional consulting at the same hospital, but the girls are now grown up. Jamie is teaching first grade in Charlotte and Lindsey will be graduating as a chemical engineer from Georgia Tech this coming May. I live with my partner, Vivian and our 13 year old rescue greyhound and 7 year old rescue terrier mutt. They help me keep life in perspective.
Over the years, I’ve been very involved in church leadership and teaching Sunday school. I’m learning to quilt and enjoy playing word games, dominos and Blokus. During above freezing weather, you can find me in my yard playing in the dirt. My motto is “you can never have too many books or flowers.” My favorite getaway place is Cape Lookout, the southern most tip of the Outer Banks. I’m looking forward to working with the CAP and am excited about bringing the big and little Syd projects to fruition.
Introducing the Chair of Public Policy:
Lynn Poole, FNP–BC
CAP members have expressed an interest in more information and involvement in issues related to public policy and their possible effect on Advanced Practitioners (APs), whether in nephrology or other areas of health care delivery. With national health care reform now a reality, there is heightened interest and awareness of the contributions APs have and will make to address the complex health care issues that are emerging and evolving on a daily basis. To help provide information and facilitate discussion, the Executive Committee has appointed a Chair of Public Policy to lead those efforts. The first person to hold that position is Lynn Poole, FNP–BC. Lynn has experience in understanding issues and contributing to discussions related to public policy on a federal, regulatory and state basis.
Recent discussions on the listserv have shown an interest in better understanding the complexities of billings and collections for services rendered. There is a rich experience and wisdom among members of the CAP so we are looking forward to a lively exchange of information and ideas. And as we are expecting the final rule for the bundling of payment for dialysis services to be published later in the summer, it will be important for members of the CAP to be ahead of the curve on understanding the rules and implications on their practice before they are implemented in early 2011. So watch for updates and discussions regarding public policy on the listserv and in the quarterly newsletter.