Thoughts From the NKF Spring Clinical Meetings

At this year’s National Kidney Foundation (NKF) Spring Clinical Meetings, I talked a resident out of applying to a nephrology fellowship program and discouraged a kidney professional from joining Twitter (now known as X).

Weird times.

All Who Wander Are Not Lost

I met a resident from a strong internal medicine residency program. They are a rising PGY3 and think nephrology is for them. But they are also burnt out. The romp through the pandemic-stained medical school/residency doubleheader wrung them out. They have lost balance. They have been living too much on the work side of the lifestyle teeter-totter.

They were deciding whether to apply for a fellowship and push through another 3 or 4 years (transplant is a potential destination) or complete a residency, snag a locum tenens position for a year, and take time to recharge while applying for fellowship.

I sided with team recharge.

We need to view medical education as a rewarding journey, not just a destination, and taking time to reflect on the journey is an important part of enjoying the trip.

While nephrology has been panicking about decreased interest in our field, perhaps we are undervaluing the upside of accepting people who wander rather than sprint into nephrology.

The counterargument is for the resident to put their head down and grind their way to the end. But what then? Is the end of a fellowship a good time to take some time off? The opportunity cost of wandering is higher. Every year the gravity of spousal or family responsibilities grows larger. They may not be in a position to get off the medical train ever again.

However, there is a real risk that the 1-year pause becomes 2 years, then 3, then forever. Circumstances change, and the dream of becoming a nephrologist fades. I have heard stories of residents taking hospitalist positions with plans to return to fellowship only to find their expenses balloon with their salaries. They become trapped by small luxuries.

I wish this particular resident luck in their journey and hope they take the time to enjoy it.

MedTwitter Is Over … Or Is It?

I never thought I would discourage people from joining #NephTwitter.

For most of my career I have been the #NephTwitter advocate. My first recommendation to anyone poking around nephrology was to join Twitter. #NephTwitter offered the fastest, most reliable way to find your tribe in medicine. It was the best way to connect with people and model a career in nephrology. #NephTwitter is populated with people from private practice, basic science, medical education, epidemiology, transplant, stones, interventional, palliative, and dozens of other nephrology flavors from every part of the world. It was the perfect nephrology stew. Ladle yourself a bowl; it isn’t too hot, and we welcome your unique perspective.

Amazingly, despite all the changes that have been thrust on Twitter/X, the community stands. We have lost some people for certain, and likely more every day, but a lot of people remain. Look at the numbers for the NKF Spring Clinical Meetings (#NKFClinicals). Almost 500 people posted using the meeting hashtag. There were more than 2000 tweets over 4 days. #NephTwitter lives but has suffered a real wound at the hands of the algorithm. Much more of your experience is determined by the algorithm, and less of it is determined by personal decisions of who to follow or interact with. It is harder than ever to filter out what you don’t want and bring in what you do.

The changes that Elon Musk has brought prevent users from building a wall against the darkness. My timeline is filled with politics that are not my own. My replies are filled with comely young women promising pictures if I just follow the link in their bio. My direct messages contain daily enticements to crypto riches. Twitter always had a seedy underbelly, but under Musk, this underbelly is being surfaced and pushed into users’ feeds in a more visible way. I tolerate it. For me, the value of the platform rises above the politics, filth, and anger that populates my feed. But I don’t feel comfortable suggesting it to others. The downsides are real, and I no longer make it a blanket recommendation.

Today we are left in limbo. I no longer confidently recommend Twitter to others, but it still provides enough value that I don’t want to leave. And it’s possible being anchored to Twitter blocks alternative social media sites from rising up and providing a better home for our online community.

Dr. Topf posts on X as @kidney_boy. You can also find Nephrology Times there, @Neph_Times.