Dr. Edgar Vera has worked for more than 20 years assisting patients with kidney problems.
With his team of four nephrologists, they visit four High Desert clinics – including Hesperia, Apple Valley and Victorville – to treat more than 1,000 patients.
Of these, about 60% need dialysis, a process by which toxins and excess water are removed from the blood after the kidneys stop fulfilling this function.
Vera, who is the medical director of the DaVita dialysis clinics in the High Desert, is adamantly opposed to Proposition 23 as he says it will affect the shortage not only of general practitioners, but also of nephrologists – medical experts in kidney diseases.
The motion, funded by the Service Employees International Union-United Healthcare West Union (SEIU-UWD) has four provisions: report infections, do not discriminate against patients, obtain government permission to close a clinic, and that dialysis clinics have a doctor on site at all times.
Opponents of Proposition 23 say this latest provision will have a serious impact.
In principle because the proposal does not specify what type of doctor must be present in dialysis centers. That is, it may well be a nutritionist or a cardiologist and not necessarily a kidney specialist.
On the other hand, in California there are about 600 dialysis clinics and Vera assures that the proposal was not developed by medical personnel but rather by the SEIU-UHW, whose objective is to increase its membership.
The doctor explains that if the few nephrologists that exist are sent to dialysis clinics, where they are not so essential, there would be more shortages in places where patients need them, such as hospitals and doctor’s offices.
“Every year, the number of doctors [and nephrologists] who stay in the US is decreasing,” said Dr. Vera.
He added that new generations of doctors are interested in areas that are less complicated and where they earn more money, such as plastic surgery. As a result, it is difficult to find enough kidney doctors to cover multiple dialysis clinics.
“We will not be able to find doctors who remain seated in a dialysis center, 12 hours in a row, without any reason,” he said and asserted that it is the technicians who know how to use the dialysis machines and not the doctors. Having them doctors in the clinic would not help them check the machines.
“Part of our work is in the dialysis centers, but we don’t stay there all the time since we can’t attend to other areas of our work,” says Vera.
This doctor visits each dialysis clinic once a week, reviews cases and talks with patients, responds to their concerns and adjusts their treatments. This job is rotated among the four doctors to care for the hundreds of patients.
“That is what the government, the Medical Services Center, requires, that doctors visit patients at least once a week,” said Vera. “It is what the vast majority of family doctors, kidney doctors in the United States do. There is no value in being there every day.”