Nephrology is the only specialty that can help someone live and have a reasonable quality of life after a major organ fails and stops working. As such, Nephrologists get to offer patients extra years of life and experience the reward of watching them enjoy their families because of the treatments and technology they make accessible.
Dr. Charuhas Thakar is a leading kidney care specialist currently working as the Director of the Division of Nephrology and Hypertension at the University of Cincinnati Medical Center and as the Chief of the Section of Nephrology at the Cincinnati VA Medical Center for the Department of Veterans Affairs. His journey of becoming a physician and his focus on Nephrology was highly influenced by the teachers and mentors that he had as a student and his own competitive nature and perseverance.
Dr. Thakar began his training to become a physician with studies in his home country of India, where his father practices as an Internist and Cardiologist. His training in India included medical school and a one-year internship. He graduated top of his class of 120 students each year of medical school. In order to apply to practice medicine in the United States he was required to take the United States Medical Licensing Examination, which he took in Bangkok, Thailand. He passed the two-test series of the USMLE in 1995 and 1996 which qualified him for post-graduate training in the United States.
The first time he traveled to the United States he spent three and half months interviewing for 14 different positions across 26 states. He knew very few people and travelled throughout the country during winter, which was the first time he had seen snow. From the interviews he completed during that first trip, Dr. Thakar received several invitations to Internal Medicine Residency programs. He was matched with an Internal Medicine Residency at Bridgeport Hospital, Yale New Haven Health, in Connecticut, which he completed in June of 2000. He began his Nephrology Fellowship in July of 2000 at The Cleveland Clinic Foundation in Cleveland, Ohio.
From there he was given the opportunity to join as an Assistant Professor of Medicine at the University of Cincinnati and began work as a Staff Physician at the Veterans Affairs Medical Center in Cincinnati, Ohio. Within one year he was appointed as the Chief of the Section of Nephrology at the VA Medical Center, a title he maintains alongside the position of the Director of the Division of Nephrology and Hypertension at the University of Cincinnati Medical Center.
A Day in the Life . . .
With his two leadership titles his schedule requires him to work 65-90 hours per week leaving free time in the evenings and over the weekends to be with his wife and two dogs. He also enjoys hobbies of photography, hiking and spending time in the outdoors. He travels once or twice a year to a National Park where he can spend time hiking and backpacking and considers himself an amateur ornithologist.
Dr. Thakar’s day-to-day schedule varies depending on which role he is required to fill. Most days he wakes up around 6:30am and spends about an hour at home where he watches some news, lets his dogs out and drinks tea before he starts a 40-minute commute to work. On days when he has clinic he is at the VA Hospital by 8 am. There, he supervises and teaches six kidney specialists in training who see 35 to 40 patients between 8 am and noon. At 12:30 the aspiring kidney specialists have an hour-long teaching conference that is part of their training. During this time one of the trainees will present a case and a discussion will take place to facilitate student knowledge and understanding. During several months of the year Dr. Thakar does inpatient care and will spend the second half of his day doing rounds. After rounds he completes documentation and is home around 6:30 or 7 pm. On the days he is not doing hospital work he fulfills his role as Director, which consists of attending meetings, meeting faculty members and trainees, meeting with his staff or superiors, etc. He also spends time doing research which involves weekly meetings with his research teams both at the VA clinic and the hospital. He may also have collaboration phone calls scheduled throughout the week with doctors working at different locations. While he was working on his recently published text book Perioperative Kidney Injury: Principles of Risk Assessment, Diagnosis and Treatment, he also had weekly calls with his editor and partner to discuss the project.
Seeing patients, teaching and the research aspects of his position are the most enjoyable and interesting to him, though he admits that he did not expect to be in his position at this point in his career. He explains, “I think a lot depends on the mentors that you meet when you are training and role models that you come across as well as the opportunities that make you happy or successful or both. Then you follow that path.”
Dr. Thakar’s choice of Nephrology was highly influence by doctors he came in contact with during his training in the United States. He had noticed that Nephrologists had a lot of knowledge and were often “the smartest doctors in the room,” which inspired him. While Dr. Thakar was at Yale University a Nephrologist he worked with as a student told him during an evaluation that the way he approached medical problems would make him a good Nephrologist. At that time he didn’t have a lot of experience with the specialty so the doctor invited him to come work with him at the West Haven VA Hospital. The doctor and the experience at the VA hospital were instrumental in shaping Dr. Thakar’s decision to specialize in Nephrology.
As a teacher now, Dr. Thakar tries to offer the same inspiration and influence to the students he gets to work with. His position allows him to impart knowledge as a teacher, mentor, and researcher as well as published author. “Its very exciting that I get to contribute new knowledge and new information,” says Dr. Thakar. As a teacher, he looks for students that are critical thinkers, meticulous and have a thorough attention to detail. “You have to be very patient,” says Dr. Thakar, “It’s not a specialty that involves a lot of sudden action . . . There is a lot of deliberation, thinking and solving problems . . . If you like internal medicine, if you like physiology, if you like to think and you like numbers than you have the right skillset to be a good Nephrologist.”
Tips for Success
Dr. Thakar recommends that students interested in succeeding in Nephrology should maintain a focus on physiology during medical school, which will help their practice in the long run. In addition, second year medical students should find a mentor who is a Nephrologist sooner rather than later and try to spend a day or week with them in order to understand better what they do and what is required of the specialty. Students who are given the opportunity to do research or be involved with other Nephrology-influenced projects will find the experience very helpful to their overall career.
In addition, the American Society of Nephrology and the National Kidney Foundation offer travel grants and networking opportunities to those who are interested in Nephrology as a sub-specialty. These grants can be used to attend either of the two, annual meetings which happen in the fall and spring each year. Students who sign-up for the conferences are able to meet other students, interact with trainees and can be placed in small groups with role models and mentors who may be accessible after the conference. These introductions can increase their connections with hospitals and clinics throughout the United States. Conference attendance also shows a dedication and interest to the field which can be beneficial when applying for further training or positions.
Currently, the field of Nephrology is at a crossroads as the epidemic of kidney disease increases in the United States and fewer students are choosing Nephrology as a specialty. The American Society of Nephrology reports that falling interest is partially do to the challenge of physiology, studied the second year of medical school, which can turn students away because of its complexity. In addition, other specialties may offer shift-style work with higher pay, which can be desirable to new graduates with high student loans. Dr. Thakar offers that students who wish to increase their income as a Nephrologist can pair their training with a third year study in transplantation, critical care, or another dual certification which will increase both job prospects and salary.
Advancing the Field
Over the course of his career, Dr. Thakar has been able to experience advancements in Nephrology that are improving patient care, quality of life, and accessibility to treatment. The most exciting recent developments in Nephrology include advances in managing patients with transplants and the development of therapies that allow patients to keep their new organ longer. Exciting knowledge about genetics and the application of genetics to patients with kidney disease are also underway, which could make a significant mark on the field.
Aspiring Nephrologists could be involved in further advancements and discoveries within the field. Making new organs available for transplant, created by technology, would further increase patient quality of life. Breakthroughs in new drugs and therapies that treat acute renal failure or kidney injury would be significant. Expanding beyond the field, process improvements that would decrease the injury that kidneys experience because of other procedures and treatments could also advance the field and would be a good focus of research and testing.
Dr. Thakar has climbed both the professional and academic ladder as a leading Nephrologist with perseverance and hard work as well as sacrifice on his part and his family’s. He says that there are no regrets and that he would do it all again, enjoying every aspect of the journey he has been on since 1995. His advice to those interested in specializing in Nephrology, pursuing academia or even medical administration includes the following:
Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score to predict acute renal failure after cardiac surgery. (J Am Soc Nephrol, 2005, 16(1), 162-8) (Citations: 197; Impact Factor:7.24; Editorial)
Thakar, CV, Christianson, A, Himmelfarb J, Leonard A. Acute kidney injury episodes and chronic kidney disease in diabetes mellitus. (CJASN 6: (11) 2567-2572, Nov 2011) (Citations 1, Impact Factor 4.8; Editorial)
Thakar, CV. Peri-operative Acute kidney injury. (Adv in Chr Kidney Dis, 20(1): 67-75; Jan 2013).