Urban renal disease: reflections of an urban nephrologist

On completion of a Nephrology fellowship, I went back to the inner city community where I was raised to begin my practice. Filled with idealism, I believed that, by returning, I could slow the devastation that hypertension was imparting on the black community, and in doing so, prevent end-stage renal disease (ESRD). It was soon obvious that this view was naive. Although the government is willing to spend $60,000 per dialysis patient per year, there is no adequate system for, nor funding of, prevention. Social factors impact on prevention as well. Black physicians are often not readily accepted on staffs of hospitals in their own communities. The community itself often values medical care more highly from others not of their own race. Medical schools, located in inner city neighborhoods, rarely encourage their graduates to practice in the local communities. Economic issues result in varying access to care, with the poorest, who often have the highest needs, receiving the least. Effective change will occur only when there is a concerted multidisciplinary approach, led by respected leaders in the black community (nurses, physicians, preachers, social workers, teachers, and politicians) to create an atmosphere of empowerment within the community residents.