As a nephrologist there are various career paths that you can take after completing fellowship. Within each of these options are key factors that motivate individuals to choose one path or another. Some of those key factors might include your professional interests (i.e. research, direct patient care, teaching), as well as compensation and lifestyle. Let’s take a closer look at those options.
- Private Practice is the most common choice in post-fellowship plans, with nearly 50% of graduating fellows choosing this career path in 20151. As a private practitioner you may decide to join a single specialty practice with other nephrologists or start a practice on your own. Another option is to join a multispecialty group. As a private practitioner you are more likely to have the autonomy to make decisions on how you want to schedule your day, manage patient care, and run your business. Generally, private practices are self-governed by the physicians and they are ultimately the decision maker, negotiator, and human resources managers for their practice. Additional training like an MBA, MPH or MHSA are highly beneficial in the private practice setting.
- Employment is the second most common option by graduating fellows. In 2015, almost 25% of the graduating fellows accepted an employed position with a hospital1. Disappointingly, most were not employed as nephrologists. Hospitals, The U.S. Department of Veterans Affairs (VA), Health-maintenance organizations (HMO’s) and Dialysis Companies all offer employment opportunities for physicians.
- Hospitals employ physicians under various circumstances. Some hire to support a local practice that cannot afford to hire a physician directly. Others hire to support a cardiac program or to support a rural area where there is no full-time nephrologist dedicated to the area. The hospital can offer a high salary guarantee for one year with the expectation that the physician will be able to transition into their market on their own after they have built up a patient base. Often there are conditions to the employment or incentives that require a guaranteed length of service to the area. Hospitals will hire nephrologists to perform hospitalist work or a hybrid mix. It is important to remember that the initial salary may be high but they tend plateau early on with little room for professional growth.
- The VA offers a predictable schedule and the ability to work in any VA hospital without obtaining individual state licensures. The VA has a pay scale that varies based on experience, board certification, academic appointments and so on. Merit-based increases are subject to professional and academic accomplishments. There are several benefits that come with working for the VA including health insurance, retirement plans, sick time, vacation time and the opportunity to teach. The VA is very supportive of student and resident instruction, along with research.
- HMO’s act as liaisons with healthcare providers on a prepaid basis to provide or arrange managed care plans for health insurance providers, self-funded healthcare benefit plans, individuals and other entities within the United States. Some Healthcare providers are more tightly aligned and you work, get paid by and refer into the HMO network. Others are more loosely structured as a group of private physicians working collectively, and patients are seen for a set fee.
- Dialysis Companies are now looking to directly employ nephrologists in a private practice-like setting. Administrative burdens are placed on the employer and physicians make the clinical decisions. Dialysis companies typically provide salaries and benefits that are based on fair market valuations and may include bonuses based on several factors to include productivity and qualities measures.
- Academia – Academia is a choice that nearly 11% of nephrologists made in 2015, with opportunities for teaching (educator), patient care (clinician), research (scientist) or a combination of these. A few things to consider about academic physicians include:
- Salaries are typically lower than for private practice or employed physicians
- Generally time is split between patients and research
- Patients are often more complex in an academic hospital
- Physicians may need to seek research grants to help supplement their income
For more detailed information on each of these career options, feel free to reach out to the DaVita SOURCE team at firstname.lastname@example.org.
1 DaVita SOURCE 2015 Post Nephrology Fellowship Data Tracker