Bri (00:02):
Let’s talk about kidneys takes a deep dive into the chronic kidney disease patient journey. We’re here to inspire meaningful conversations and to help people living with CKD gain a full understanding of their disease. DNA began in 1971 with two providers and 10 employees. Today, we have over 25 locations in DFW, more than a hundred providers, and over 300 dedicated employees join us as Dr. Rubin Valez reflects on our growth and what it means to provide 50 years of excellence in kidney care.
Bri (00:35):
Dr. Valez thank you so much for taking the time to chat with us today because you have to unique story as a part of the DNA journey. So you joined Dallas nephrology associates from what I understand in 1983. So you’ve been with them 38 years at this point. And this year they’re celebrating their 50th anniversary, which is huge. And DNA started from what I understand, with two doctors and about 10 staff members, and now DNA has over a hundred providers and 300 staff members. I can’t imagine the changes that you’ve seen over the years, but what’s your perspective on how things have changed over the last 50 years?
Dr. Valez (01:18):
Well, I joined DNA when I was 12 years old. It was a different time. It was a different era. It was different healthcare at that time, but Dr. Allen hall and Dr. Ron Prty started DNA in 1971. Then they had several more people join DNA. I was number 13 when I joined DNA.
Bri (01:46):
Number 13, lucky!
Dr. Valez (01:47):
And so lucky 13, and at that time it was considered one of the largest groups in the nation of kidney specialists.
Dr. Valez (01:55):
They, they started the first dialysis program in town. Started most of the nephrology sections at different hospitals in town that are now well known. But the beauty of this is, it’s been a wild ride. How it continues to grow for the need because it’s sad, but there’s many patients with kidney disease in Texas and many patients that need dialysis dialysis was approved by Congress back in 1972. Okay. So, so DNA started in 71. Dialysis was started in 72 and dialysis centers were opened up between 72 to 73. So the first dialysis center in the area, but like you well said, the growth has been amazing.
Dr. Valez (02:56):
DNA has been involved locally with every single hospital leadership programs. DNA has been involved with the state especially organizations with the state with the network DNA started, and was part of the people that, that opened the first organ transplant program. And especially the organ bank was one of the DNA leaders. And and on top of that the network, which involves the whole state in the dialysis population nationwide, we been involved in almost every single nephrology organizations. So it’s been a very wild ride and now we’re only a hundred, you know, physicians and and it continues to grow. So it’s been fun.
Bri (03:54):
You know, when you mentioned that at the time, just with 13 physicians, that it was one of the largest collective of nephrology physicians, you said in the country, if correct. So at that point, you know, I think it sounds like if nothing else the need always existed, but it’s just, you’ve been able to expand the level of care to where people understand where they can go.
Dr. Valez (04:16):
That is correct. The need was there. It’s sad, but the need was there and we needed to be prepared. You mentioned something that is correct. One of our nurses that is gonna retire by the end of this year, after 50 years, it tells you that one of the contributions of a great leader, like DNA has had many has been so rounded by the people that really make changes. The that’s very important for a leader.
Bri (04:55):
Well, I love that you said that, because I would love to ask from your perspective, you’ve hold held multiple leadership roles. Within the organization over the years, what’s one of your first or earliest memories with DNA.
Dr. Valez (05:08):
Well, the, initially it was hard work. Everybody was working very hard, long hours. You did not measure, you just did what needed to be done and everybody was doing the, the same thing. And so you did not have time to think about what am I gonna do tomorrow.
Bri (05:29):
That sounds about like entrepreneurship. It is
Dr. Valez (05:32):
It’s. And remember at that time there was no cell phones. I mean, how did we exist without cell phones? But we did, there was nothing different. And so I think the memories are more out there working at, at different places, different clinics and different hospitals.
Bri (05:51):
When I think about your earliest memories with DNA, I can imagine if we look flashback to that point, you know, how has the, the type of care changed during your tenure?
Dr. Valez (06:02):
The dialysis was very limited at that time. And in fact there were some areas in the nation that had what was, what it was called, the death panels. Panels at hospital, would decide who will receive dialysis. And the person that they decided would be on the death panel wouldn’t survive long. That I’m glad to say disappeared, but it was, they do strictly the shortage of availability.
Dr. Valez (06:32):
Exactly. So there were more dialysis equipment made. There was a lot of patients doing dialysis at home. We think that home dialysis is something new. Absolutely not. But you know, I would remember 40 years ago, I mean, there was a lot of patients on dialysis at home, different ways. Technically dialysis is much better. What we did before. Healthcare has improved the care of patients, the delivery of care, the availability of care. And, and also the training has, has improved tremendously. So patients have a significant improvement from what we had before family always were very involved in, in the care. And and there was limitations of what they could do today. We have more availability.
Bri (07:30):
Being able to educate them on, what they can do and empowering them. Correct. A little bit more. Well, I’d love to hear about you’ve. Do you have any idea, many patients you’ve seen throughout your career? Like if we’re throwing out a number, I not sure where to start.
Dr. Valez (07:48):
I would not know how many.
Bri (07:52):
I can imagine, but well, is there, you know, I’d love to hear about a story. Maybe there’s a memorable moment. If you’re open to sharing
Dr. Valez (08:03):
There are many specific stories and, and some of them being sad, which I will not mention, but, but at the end of the day as a physician, you’re walking into the live of a patient. So we, the art of medicine, and is being able to have that door, open that window open so that you can get into their lives and learn from them. It’s not just them learning from me, but I learn from them because every patient is a different world. So with, that said, I’ve been in ball games with patients. I been with patients also on the sat aside, on funeral that, the family has invited me to be there. And you understand that you made a difference in the family. So, so your patients suddenly become your family dialysis side.
Dr. Valez (09:01):
There’s, there’s nothing in medicine, in any practice of medicine where you have contact with your patient on a weekly basis. Those are the patients that are on the kidney machine. You have a contact with them on a weekly basis. There’s nowhere in medicine. You do that. So as you know, if you get ill, then you go and see your doctor. Otherwise you see them once a year. Well, that’s not true in dialysis. So, so you develop a bond. So my patients will tell me if I’m gaining weight, my patients will tell me if I need a haircut and they will tell me, yes, I have gone to make rounds with with hulu skirt and coconut bras. I there’s pictures of me you know, making rounds at the clinic like that, but a smile or a laugh out of a patient. That’s the best medicine there is.
Bri (09:54):
Absolutely. Well, so you bring the humor and I think it’s so important, you know, that we focus on the authentic and human element of the healthcare that you all bring. And from everyone that I’ve spoken with from meeting so many of the physicians and the nurses that are, you know, involved in the clinical staff and seeing patients on, on such a regular base, like you said, you can tell that there’s a level of care and you said, welcome. You’re learning from them. And I can imagine, you know, as a doctor, you’re being able to even understand chronic kidney disease, EV you know, even better, every single patient that you talk to because you’re understanding patterns and things like that, that you’re seeing
Dr. Valez (10:40):
The time you learn that the definition of a good physician is not he or she who knows the most, but he or she, that cares the most. So I may not have answers to your problems or your questions, but we will find out let’s, go and dig and find out. And that’s really the true nature of what we do. So I think that like I was meeting a new patient yesterday, and I said, if you’re looking for a professional, you came to the wrong place. Now, if you’re looking for somebody that will, let’s walk together and, and try to find answers, we, we will do it. So I think every in every patient, as I said, is a different world. So I, you learn a lot from your patients. So it’s been fun. It’s been wild and healthcare is changing quite a bit. That’s the bottom line.
Bri (11:38):
Yes, absolutely. You know, and that’s, I’m glad that you mentioned that because I’m curious as to how Dallas nephrology associates has contributed overall and influenced the field of nephrology, because if you’ve been a leader from 19 71 72 to today, how, you know, how do you feel like that influence has been felt, you know, across as the country, maybe even feel worldwide?
Dr. Valez (11:59):
We have you know, I would say happily, we have been involved with research for a long time, but research, not only on dialysis machines, but on medications and things that are now available we created some early dialysis software systems that, that now have been used. And now we have superior software systems. So, so it’s been fun to see the growth and also things the direction is taken at times. And I believe that we’re in an era of healthcare that we just don’t comprehend how big this is gonna be. Augmented intelligence artificial intelligence is gonna, or change healthcare quite a bit. And it’s good because there’s no way the human mind can keep up with all the advancement on a weekly basis. So you’re gonna need I tend to forget my wife’s name at times. So that means my computer.
Bri (13:13):
We can all use a prompt, that’s right
Dr. Valez (13:16):
But healthcare is changing and we want to be sure is, is used the right way. That’s the bottom line.
Bri (13:23):
You know, I got to sit down with ed, the director of it with DNA and him and Ben who’s in finance also talked about just the emergence of telemedicine, you know, something that had been discussed, obviously, maybe available before 20, 20, but also not something that was you know, as used as prevalently as it is today. What, what are your thoughts in terms of telemedicine? You mentioned artificial intelligence. So I’m just curious of that element of medicine.
Dr. Valez (13:54):
It has open areas that was difficult for us to, to do what we needed to do. I’m cautious in what I’m telling you in, in the sense of a good tool used the wrong way becomes a bad tool.
Bri (14:11):
Yes.
Dr. Valez (14:12):
Telemedicine is one of those tools that is fantastic, but you, we have to learn to use it appropriately. So telemedicine was not made for me to have breakfast at home in shorts by telemedicine. So at the same time, you can reach out areas that you can reach out because of, you know limitations let’s say, and you can talk to patients, you can see patients, you can have a small assessment of a patient. We DNA for over, I would say, 30 years, we’ve had offices in Puerto Rico. So I can listen to your heart and your lungs in Dallas through telemedicine and assess the patient in one of our clinics there that we couldn’t do before.
Bri (15:10):
So having a, a doctor that’s on site in Puerto Rico, but then you’re being able to be the, the nephrology, you know, physician correct. Specializing in aiding a primary care physician, correct.
Bri (15:23):
What you said probably could not be you know, restated enough that a bad tool, or, you know, a tool can be in the wrong way can imagine that if we’re looking at any you know, physicians going through their training, you know, this has to be a new level of training around how to identify so many things, because you can lose quite a bit from a screen. So there’s gotta be a lot of contextual clues. I can imagine that have to be looking for it.
Dr. Valez (15:51):
You have to because telemedicine being one that can easily be abused and, and, and I don’t think would help patients on the other hand. You see how it’s so nice that if you come from work and you’re not feeling well and maybe coughing, and you can get somebody by telemedicine when you get home at six in the evening, that could be helpful telemedicine wasn’t made to assess somebody that is having chest pain.
Bri (16:25):
Yeah.
Dr. Valez (16:26):
So, I think we have to learn the limitations of telemedicine also.
Bri (16:30):
Absolutely well, and I I’ve had a chance to also talk with David in HR from, from DNA. And we got to talk a lot about community involvement and just the level of volunteering that, you know, all of the employees are involved in and you know, the different organizations that, that have been involved. So I’d love to hear your perspective of, you know, maybe the growth of, of that involvement over the years.
Dr. Valez (16:55):
DNA has been involved in with the Dallas county medical society, for example, and has been in the multiple leadership levels of the Dallas county. And, and I’ll give you an example. There was a project that lasted for about 10, 12 years called Project Access that would help patients in the community that have no insurance and limitations. And, and we would support them and have, we would have clinics where one of us would go to visit and see those patients that couldn’t go to a doctor. And, it was very nice. You helped the community that way we’ve been involved with the national kidney foundation especially in north Texas, where we have done clinics to evaluate and assess patients that are having kidney problems, but they were not aware they were having kidney problems. So, and the national kidney foundation has been wonderful in doing this, this type of clinics. And sometimes we would assess a hundred patients in four hours. So it’s been a way to give back to the community what the community needs and that’s important.
Bri (18:19):
The better together aspect. And I know you personally have been involved in a lot of those associations, you know, at a, at a leadership level. Why do you feel like Dallas might be a hub? Do you feel like it just is something that, you know, DNA started and then it’s just continued to grow from there, or, you know, Dallas in comparison to the rest of the country you know, how are they leading in terms of nephrology?
Dr. Valez (18:43):
It’s an interesting question. And in the nephrology world for many years everybody said, well, how, why is Dallas doing this? How is Dallas dealing with this problem? So for some reason, this, this was out there saying, and, and, and there’s many nephrologists in different states that would pick up the phone and call and say, you know, life is about relationships. So, so, you know, pick up the phone and say, we’re having this problem. What are you guys doing there compare? And we all learn. We learn from them, they learn from us. And that’s the way that I think we all get better because the, at the end of the day, you want to deliver better care for the patient. So it was you know, think we all learned that there’s different ways of doing it. It’s not working harder, it’s working more intelligently, it’s be more efficient. We also especially DNA, we we’ve been involved with multiple projects with the federal government, with CMS, with Medicare. Mm. And we’re currently involved in one, and we’ll be involved in several other ones. So again, it’s to learn the efficiency of how to deliver better care and what we now call value care.
Dr. Valez (20:10):
And we’re all learning together this, so you, you want to be at the table or if not, you’re gonna be part of the menu.
Bri (20:18):
Yeah. Well, and you mentioned it before, I think a strong foundation of research and being able to be a, a, a resource for that, that others can, can learn from. And that’s where you can base so much off of correct. So, oh, over the last 50 years, what do you feel like, or, or maybe I should say over the last 38 years of you practicing, what do you feel like are some of the most common questions that chronic kidney disease patients and, or their families are asking you, and you just saw a new patient, for example. So, you know, what do you feel like are some common themes that are coming up?
Dr. Valez (20:52):
One of the most common statements made is they told me my kidneys are not working, but they don’t hurt. They’re not hurting me. That’s the first common question. If they don’t hurt, then they’re fine. I said, no, that’s not true. Number one, kidneys don’t hurt. That is rare when they hurt, but number two, you can have significant kidney damage and not have any symptoms. So that’s a, that’s a common area. The, the the other thing is the assessment that personal physicians will do. The primary care physicians will do nine out of 10 times. They can assess if there’s a potential kidney problem. So that’s where I first tell the patients, that’s your main, your primary care physician and be sure that you get a simple, what we call urinalysis, a urine test and a simple blood test, though. You don’t require anything else initially, and you can assess us and find significant problems.
Bri (22:02):
You know, I’m one of those patients where I’m like, just run all of the tests, let’s find it out. Like I run the screenings, we’re on the tests, let’s know about it, but that’s easier said than done in a lot of cases.
Dr. Valez (22:14):
It is, especially in the COVID era, you know, it’s not that easy anymore. So,
Bri (22:19):
Absolutely. Well, I would love to leave us on this note, you know, you you’ve served in, in several different medical leadership roles throughout your career. What do you want your legacy or, or that of DNA to be
Dr. Valez (22:33):
The DNA one has been we’ve been there from day one. Hopefully we’ll be there forever or till the end of the story and we will continue to evolve just like healthcare is. We will continue you to evolve and see how we can manage and do things better. On my end has been contribution to the system having fun understanding that this is work, but you can have fun having, you know, doing all of this. And most of it, patients, you know patients have had respect for you have filled a bond with you. That’s, that’s the best of the worlds. So I feel sad when I cannot deliver what the patient needs. And it’s difficult. I hope in the future, we will be able to cure if not delay patients getting on dialysis. That would be the beauty of this. Not letting anybody getting on dialysis and hopefully transplantation has helped, but we also need improvement in transplantations.
Bri (23:56):
Do you have any projection of what, you know, are we 50 years away from it, or is it much like trying to find a cure for cancer at this point?
Dr. Valez (24:02):
I think in the next five to 10 years, we’ll know more about what people think is available artificial kidneys we’ll know a lot more about that. Will we be able to use kidneys from animals, maybe? That’s a possibility and you know, and I think transplantation is looking at that, that potential of being able to transplant without having to use any of the medications that we use today. Would that be a possibility? That’s a possibility there’s all this is all work in progress. Yeah. And that would be a beauty to, would be. I think when you see a patient that suffers during their kidney treatments gets transplanted and has almost as close a normal life as that’s, that’s what you say, that’s, that’s what I want to get everybody to possible.
Bri (25:03):
That is fascinating. And I think so important, you said it best value based care. And I think, you know, anybody who’s met you, I have I’ve heard your legacy before I actually met you. So you definitely have made a lasting mark on you know, your patients, your coworkers, and your colleagues, and, you know, but I do think that value based care is absolutely something that I’ve seen as a theme from everyone that I’ve spoken with it DNA. And it definitely seems to be what they’re serving. So I’m so glad you got to take some time. Thank share a little bit about your experience, you know, over these last three decades of, of being part of the team. I know they’re grateful for you.
Dr. Valez (25:39):
It’s been fun. And I hope it continues to be fun.
Bri (25:42):
Absolutely!
Dr. Valez (25:43):
Never, you know, and that’s the other thing you never look back and say, I made a mistake in what you know, on my decision. Absolutely not. You there’s no, no day in my life that I looked back and says, what did I do 40 years ago? No, not true.
Bri (26:00):
When all, when all those hard days, that’s when you throw on the Hulu scooters, right.
Dr. Valez (26:04):
That’s right, you got it!
Bri (26:06):
Thank you so much for your time.
Dr. Valez (26:09):
Thank you. It’s been a pleasure!
Bri (26:10):
Absolutely. Thanks for tuning in today. Learn more about Dallas nephrology associates@wwwdotdf.com. That’s D N E P h.com. And if you found the information valuable, be sure to share with those also impacted by chronic kidney disease.