Manu Varma

So glad to have dinner with this group of physicians who are all organ transplant recipients! #docswithtransplants #ATC2022Boston

@ramit That just sounds like YNAB rule 1: every dollar has a job

This is how a lot of Americans define "living paycheck to paycheck"

@AndrewJSauer @anish_koka His daughter had a liver transplant…

As a transplant program builder and previous medical director and as a transplant physician, I can assure you we indeed run into cases of rejection because patients run into insurance barriers, lapse in coverage, or other challenges paying for meds (I’ve seen patients cut their calcineurin inhibitors in half to save money by dragging out their pills available and then they end up with rejection). Are you living under a rock? Oh I know, you just are talking out of your lane and maybe should just STFU.

Willing to bet no one in the USA has had an organ transplant rejection because their transplant medications were not approved by an insurance company. And the U.S. does a lot more organ transplants / year than our Medicare for All Canadian neighbor.

🔥 “The influx of these patients to the medical services was resisted by the medical residents and interns. On June 30th, 1981, the entire medical training program signed a resolution denouncing liver transplantation as an unrealistic objective and an “unethical pursuit.” Starzl shrugged, and from that point on admitted all these patients to his own surgical service, which at the time consisted of two surgical residents and two attendings.”

@AcademicTruther Not speaking on this specific case, but many such cases. We just don’t talk about it openly. Whispers in the hallways instead, 🤷‍♂️

Best thing you will read today. Just b/c a physician works in a prestigious institution doesn't mean they are the best at patient care.

Eminence ≠ expertise ≠ good clinical judgment.

@hswapnil @Maximal_Change I haven’t seen anyone promoting @roondoctors who isn’t paid by them, which says all I need to know about the value proposition

@Maximal_Change not for non-US doctors sadly and i honestly think the fragmentation had gone too far the kids are on insta - and they ain’t coming to any other platform unless its fun

I'm excited to shift my nephrology professional circle to Roon - Twitter has changed dramatically and I've been inactive because of the noise. BlueSky never really took off for me. Hope to see many of my nephrology friends, colleagues, and mentors on Roon to re-connect!

One thought for #Match2026 applicants making their residency rank lists: Given that residency lasts 3-7 years, many residents will experience a major life event during that time, like having a baby or a personal/family illness. And one thing that really differs between residencies—more than their tracks or their elective opportunities or the things that tend to get featured in interview day PowerPoints—is how they accommodate residents navigating those major life events. Some programs will go above and beyond to ensure residents are able to take time off, reorganize their schedules, and generally get the support they need without extending residency. Other programs will not. It’s important to choose a program that meaningfully supports residents through major life events, not only because you’re likely to experience one during your training, but also because knowing your program would support you if you did offers peace of mind. Additionally, I suspect having this kind of support is important for long-term professional success, because it reduces the likelihood of one of these events permanently derailing your career. So when making a rank list, I’d recommend talking to current residents about this, and prioritizing programs that offer meaningful support (even if these programs have fewer shiny buildings or less exciting electives).

@ISMMSKidney @DOMSinaiNYC @IcahnMountSinai One of them was a very impressive (diligent, kind) senior resident when I was admitted to this service. Congratulations to all!

Thrilled to have matched 7 outstanding #nephrology fellows! Welcome to @DOMSinaiNYC @IcahnMountSinai! #SinaiStrong

Like him or not, that Cheney lived to 84 years old is a powerful testament to modern cardiovascular medicine. He was vasculopath: First heart attack at age 37, third heart attack by 47, requiring quadruple bypass surgery, 4th heart attack at 50, severe heart failure requiring defibrillator at 60, surgical repair of arterial aneurysms in both legs at 64, LVAD at 69, Heart Transplant at 71. Truly amazing! npr.org/2025/11/04/123…

How I consult on cardiorenal syndrome: • Bump furosemide from 20 to 60 mg bid IV • Consider rapid resumption of sacubitril/valsartan and empagliflozin. Let's not treat these life saving medications as nephrotoxins

@SVRaoMD @PinakShahMD There are Tregs in all the heart transplant biopsies he does. How could they forget to add him?

I’m sorry to say that the Nobel committee has once again passed over @PinakShahMD Next year my friend.

@bdweis @AliZaidiMD @ABIMcert @abp I was interested as a medical student and gung ho as a resident. It was in the middle of cardiology fellowship (and the middle of COVID) that the enthusiasm wore out. It’s too much of an ask after all those years. And you know as well as anyone how precious the years of life are.

@AliZaidiMD @ABIMcert @abp If you are a medical student, please consider becoming an ACHD specialist. Our patient population is terribly under-served. Appointments require long travel and wait times. GP'S and IC's don't know what to do with us. Signed, CHD patient.

The #ACHD work force remains a major issue. #ACHD fellowship training, with concomitant issues like physician reimbursement and the job market are in some ways intertwined. Not an easy conundrum to solve where the pipeline is limited and stems from both @ABIMcert @ABP @WGACHDChair @ISACHD @ACCinTouch

@AliZaidiMD @ABIMcert @abp Sadly, it’s just too much of an ask of young physicians. Most of us have only one specialty, and all of us have only one life to live. Too many better options. But the ACHD patients are the ones who suffer from this system dysfunction.

@CMichaelGibson Maybe not equal, but disparities of 2-3x are too much, and then there are the subspecialties that earn *less* than primary specialties.

Do you agree with pay cuts to highly trained specialists who spend many additional years in training and pay increases to primary care doctors? Why or why not ?

Imagine you're covering neurosurgery call. You're out trying to enjoy a nice family dinner, or maybe it's the middle of the night. Suddenly, you're called away for an acute traumatic subdural hematoma. You get there, the patient is herniating. You rush to the OR and stabilize the patient. You have a long conversation with the family, giving the broad range of possible outcomes, from death to full recovery. It's physically and emotionally taxing. Then you go back home and switch back to family mode, or maybe get a little more sleep. Then, the next business day, you're hit with the email below. This is why there is a physician shortage. We are fed up with this and are heading for the exits as quick as we can.

Dear Incoming PGY-1, "Remember—You are entering a TRAINING program—not a PERFORMANCE program. We expect you to have a lot to learn & that you will contribute to the group! If you knew all you were supposed to know, what would you do for 3 yrs?" — @AimeeZaas #InsideTheMatch

Congratulations to John Magee @UMich on his election as #HRSA #OPTN Board President - his leadership and vision will help all children and adults going through the transplant journey. @StarzlT @AST_LICOP @UNOSNews @HRSAgov @SPLIT_TTS