S1E15 The Nephrologist Who Left the System to Save Her Patients—and Herself. With Marilia Campos, MD

Podcast Episode Summary In this episode of The New Healthcare, Dr. Adama Diarra interviews Dr. Marilia Campos, a nephrologist and founder of Optima Kidney Care in Oregon. Dr. Campos shares her journey from employed nephrology practice to opening her own independent clinic after realizing she needed more autonomy, more control over her schedule, and more time with patients, especially after becoming a mother. A major theme of the conversation is how traditional healthcare schedules often force specialists to see too many patients too quickly, leaving little time for education, shared decision-making, or prevention. Dr. Campos explains that in her new practice, she schedules one hour for new patients and 30 minutes for follow-ups, which allows her to better explain kidney disease, reduce patient anxiety, and practice more thoughtfully. Clinically, Dr. Campos emphasizes that primary care clinicians should pay closer attention not only to eGFR, but also to urine albumin-to-creatinine ratio or protein-to-creatinine ratio, especially in patients with hypertension, diabetes, obesity, cardiovascular disease, or early CKD. She suggests referral to nephrology when patients reach approximately CKD stage 3B, eGFR 45 or below, or when proteinuria is 300 mg/g or higher, though she notes that earlier collaboration can be helpful. The episode also covers the importance of aggressive prevention in CKD, including managing proteinuria, using ACE inhibitors or ARBs, considering SGLT2 inhibitors, and recognizing the growing role of GLP-1 medications in slowing CKD progression, especially in patients with diabetes and cardiometabolic risk. On the business side, Dr. Campos shares practical insights for physicians considering independent practice. She discusses credentialing delays, insurance reimbursement realities, overhead planning, referral relationships, community visibility, and the emotional leap of starting a practice. Her advice to burned-out physicians is simple: talk to doctors who have done it, do the math, use available resources, and realize that private practice is possible. At its core, this episode is about reclaiming time, restoring the patient-physician relationship, and building a medical practice around real life instead of burning out inside a broken system.