Half a century ago, nephrology was considered by many the pinnacle of internal medicine. Nephrologists – often referred to as the “internists’ internists” – were commonly among the most celebrated figures in academic medicine, frequently serving as highly respected Deans, Department Chairs, Editors-in-Chief of major journals, and Chiefs of Staff of major hospitals and nascent health systems. Advances in molecular biology, biochemistry, and other basic and translational science, including those directly addressing, or adjacent to, clinical medicine, were deployed to a far lesser degree than in other fields; expansion of Medicare coverage for dialysis services and financial incentives tempted nephrologists to expend disproportionate time and effort on the care of patients receiving dialysis.