Leading a Dialysis Organization: Role and Responsibilities of the Chief Medical Officer (Nephrologist Leadership in a Dialysis Provider Organization).

The early beginning of the end-stage kidney disease program with the introduction of the Medicare Act of 1973 was marked by nephrologist entrepreneurs pioneering dialysis centers to deliver dialysis addressing the clinical needs of patients in a collaborative effort between physicians and nurses. As the number of patients grew, a system reliably providing dialysis treatments for many more patients than was ever anticipated was required to enable the demands of the increased scale. Solutions appropriate to respond to the growing needs of out-patient dialysis centers were developed combining emerging technology, clinical advances, and operational efficiency. With the consolidation of dialysis centers into large, midsize, and smaller dialysis providers a new landscape evolved, where nephrologists largely focused on their role as clinicians prescribing and overseeing the care of their patients, as well as taking on responsibility as medical directors of dialysis centers. Dialysis organizations eager to provide high-quality care to more than 500,000 patients in a program that was once anticipated to serve up to 35,000 patients answered to the need for physician leadership with the role of a chief medical officer. This role equates to that of the chief of medical staff function in hospital settings and so leads the quality improvement program, collaborates with the nephrologists, advances the clinical strategy and vision of the organization, and supports business decision-making. This article reviews the roles, responsibilities, and opportunities of the position as established in a midsize nonprofit dialysis provider.