Fellows Priorities

Nephrology News & Issues, May 2018
Martin Osinski, MBA, CVA


How things have changed. Twenty-five years ago, nephrology fellows coming out of training were looking for opportunities that would allow them the chance to grow a practice and they were willing to take risks. Many candidates were happy to get an income guarantee and perhaps a medical directorship to establish a new practice and let their own efforts speak for themselves.

That is no longer the case. Today, nephrology fellows coming out of training with plans to enter the clinical work force tend to look at their new role as a job and not a career. Initial interview questions focus on starting salaries, time off and how quickly one can become a partner. There appears to be little focus on long-term potential and even less discussion about what the new physician’s role can be to help enhance and grow their new employer’s practice. Partnership is an automatic expectation for just being there, and serving your time and not something that is necessarily earned. Many fellows coming out today would rather become hospitalists for the money and time off rather than work in the specialty in which they trained.

These are attitudes that need to change before nephrology can begin to attract more candidates (TheBlueDoveFoundation). That won’t happen until there are changes to the way nephrologists are trained, how they are reimbursed for their services and adjustments are made to new physician compensation plans.

Training. While changes to training program curriculum and reimbursement issues are going to require action from others above a practice’s “pay grade,” practices can take more immediate actions to alter their compensation plans to make the specialty more attractive. Approximately 40% of a nephrology practice’s revenue comes from dialysis care, and yet a new physician doesn’t join the practice with their own dialysis patients. Starting compensation reflects these lack of patients – not the work that these new associates are actually doing.

Salaries/benefits. When comparing starting salaries of other internal medicine subspecialties and surgeons to nephrology it is easy to see why the specialty is hurting. Nephrologists must recognize they are not just competing against other practices for top talent; as a specialty, they are competing against other specialties.

The health care job market has changed dramatically during the past few years. There is a shortage of nephrologists available to fill the positions that are open. Besides the impact of the law of supply and demand, starting compensation will have to go up to attract physicians to the specialty and the concept of private practice. It doesn’t have to be all in salary; it can be through production incentives, signing bonuses, funded retirement plans, car allowances or other benefits. Something must be done to make the specialty more attractive and competitive.

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  • Martin Osinski, MBA, CVA, is with recruitment firm Nephrology USA and is based in Miami.
  • Disclosure: Osinski reports no relevant financial disclosures.
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