Nephrology Fellows Perceive Job Market as Mixed, Challenging in 2015

Nephrologists entering practice in 2015 encountered a mixed job market, according to the latest report authored by George Washington University (GWU) and published by the American Society of Nephrology. GWU’s analysis of the 2015 Nephrology Fellows Survey noted job search experiences continued to differ substantially between US medical graduates (USMGs) and international medical graduates (IMGs), the latter comprising the majority of physicians choosing the specialty (1).

“The 2015 survey of nephrology fellows found the job market continues to be challenging, especially so in communities near training programs and for IMGs, many of whom are seeking positions in designated underserved areas,” said GWU’s Edward Salsberg.

Now in its second year, the annual fellows survey is an important component of ASN’s ongoing collaboration with GWU to analyze the nephrology workforce. Data garnered in the survey can provide advanced indicators for future physician supply and uncover potential trends for regional and national demand for kidney care. “Workforce data collection and analysis are key to informing ASN’s efforts to ensure Americans with kidney diseases receive the specialized care only a nephrologist can provide,” said ASN President Raymond C. Harris, MD, FASN.

A mixed employment outlook in 2015

The overall survey response rate in 2015 (38.1%) was a slight improvement over last year (35.8%). Respondents’ demographic characteristics closely mirrored those of all nephrology fellows according to the most recently available data from the Accreditation Council for Graduate Medical Education (ACGME), the definitive source. Both the survey participants and the total ACGME nephrology fellow population were mostly male and IMG (60.4 percent and 64.8 percent, respectively).

Overall, IMGs tended to be older and have less educational debt than USMGs. While USMG respondents were evenly split between the sexes, women only accounted for a third of IMG fellows.

Of the 91 respondents entering the workforce, most planned to join a group practice (60.6 percent) followed by academic practice (20.2 percent). Contrary to anecdotal evidence, only 8 fellows planned to work as a hospitalist (9 percent); only 1 respondent (1 percent) indicated planning to work for a dedicated dialysis provider. Starting salaries in 2015 were flat compared to 2014, with expected median income ranging between $175,000 and $199,999.

The percentage of fellows having difficulty finding a satisfactory position rose slightly in 2015, both overall and by educational status. Despite applying for more positions than USMGs, IMGs were more likely to report changing their practice plans this year, most likely due to visa issues.

“The overall job market picture for nephrology fellows remained mixed in 2015. Most fellows saw the nationwide job market as stronger than their local job markets, and IMG fellows seemed to have an especially difficult time finding satisfactory positions,” said lead author Leah Masselink, PhD.

Quality of life issues remained key determinants when fellows assessed employment opportunities. As in 2014, a job in a desired location continued to be of importance, as well as the volume of weekend duties and frequency of overnight call (Figure 1).

Figure 1. Factors influencing job selection

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Abbreviations: Imp = important. N/A = not applicable.

“The bottom line is that there are good jobs for nephrologists but they may be in areas and settings that are not the first choice of graduates,” said Salsberg.

Recommending nephrology as a career

Despite a challenging employment environment, a majority of respondents (71.8 percent) would recommend nephrology to students and residents. “Most fellows—both IMGs and USMGs—were glad they chose to be nephrologists because of the variety and intellectual challenge the specialty offers,” said Masselink.

Among the reasons to recommend nephrology, fellows indicated the opportunity to build long-term patient relationships and apply learned knowledge, as well as the balance and breadth of procedures and work environments. Those who wouldn’t recommend nephrology often cited a poor work-life balance, lower compensation than other specialties, and a lack of jobs in desired locations.

Future GWU research

GWU investigators will continue monitoring trends for both the current workforce (through analysis of AMA Masterfile data) and the future workforce (through the Nephrology Fellows Survey). In particular, Salsberg, Masselink, and their colleagues will focus on supply and demand issues in 2016. GWU will model potential supply scenarios in collaboration with UNC Sheps Center for Health Services Research. They will also conduct an analysis of Medicare claims data and examine new kidney care delivery models to determine their effects on future demand for nephrologists.

Reference

1. 

Masselink L, et al. Report on the 2015 Survey of Nephrology Fellows. Washington, DC: American Society of Nephrology; 2016. Available at https://www.asn-online.org/education/training/workforce/Nephrology_Fellow_Survey_Report_2015.pdf.