Ipracticed nephrology in eastern North Carolina for nearly 25 years. Like many of my colleagues, I went into medicine to give my patients the best care possible, helping them live longer, healthier lives.

But over time, the system began to chip away at my ability to fulfill that purpose. Growing administrative demands, declining reimbursement, the pressure to see more patients in a day, and a fragmented care delivery structure left little time for the kind of patient relationships and long-term impact that inspired many of us to enter the field.

That kind of longitudinal, patient-centered care simply isn’t supported by today’s dominant payment model. Most physicians practice in fee-for-service (FFS) environments that reward volume over value. The model is geared toward episodic care, inc

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