Education in Dialysis Access

There are currently four to five training pathways to becoming a dialysis access provider—vascular surgery, transplant surgery, interventional radiology, and interventional nephrology; some with general surgery training only practice in this role as well. All pathways have their drawbacks—surgeons tend to have very rudimentary knowledge of dialysis itself, transplant and general surgeons may have little exposure to endovascular techniques, and (with a few exceptions) interventional radiologists and nephrologists cannot perform surgery in regulated settings. As discussed in the following chapter, the obvious answer to these drawbacks is to create a team of providers, who, as a unit considered together, can provide any and all needed services essentially in real time. When looked at in a more fundamental sense, however, the question arises as to whether a better training paradigm would be useful. The care of a patient on dialysis is perhaps the best example today of a true “organ system”—based practice. It is proposed that an integrated training program would be feasible, which would include dialysis-based nephrology and surgery, interventional training, systems based administrative training, and exposure to research and education in this field. As a straw man, 4 years would seem to be a good starting point. Barriers obviously include how these graduates would be certified and where they could practice, as well as program creation and funding (while the issue of grandfathering existing providers and whether conventionally trained providers can still practice in this field—of course—seem to be less of a barrier).