Over the past 30 years, kidney transplantation has grown greatly, and there are now >200 Centers for Medicare & Medicaid Services (CMS)-approved kidney transplant centers. As a result, many transplant nephrologists are not faculty members at a medical school and do not attend at large teaching centers but instead work in private practice. Almost all private practice nephrologists see some kidney transplant recipients, typically patients who are at least several months posttransplant and relatively stable. Private practice transplant nephrologists, however, also care for transplant recipients during the immediate peri- and posttransplant periods and are on staff at kidney transplant centers.
Private practice transplant nephrology offers many potential rewards. Some transplant nephrologists prefer that private practice focuses on clinical care, without the necessity to perform research, publish scholarly articles, or teach trainees. Private practice usually allows transplant nephrologists to continue practicing general nephrology. Private practice may offer reimbursement opportunities, such as joint ventures with dialysis units, that are unavailable to academic transplant nephrologists. Private practices, by functioning outside the complex structures of academic medicine, may have minimal “red tape” and administrative hassles.
Compared to transplant nephrology at academic medical centers, private practice transplant nephrology also has some disadvantages. Many transplant nephrologists enjoy research, scholarship, and teaching, and these are not as easily possible in private practice. Some transplant nephrologists would prefer to focus solely on transplant medicine. However, such focus requires a larger transplantation volume, and many private practice transplant nephrologists are based at hospitals with lower transplantation volumes. Smaller private practices may lack the infrastructure to fully support the career development of their transplant nephrologists. Private practice transplant nephrologists may be fully employed by their private practices or partly employed or contracted to the hospital and transplant center; these arrangements can be complex. Finally, transplant nephrologists in private practice may find conflicts between the demands of their private practice and the transplant center. For example, the private practice may compete with other nephrology groups that refer patients to the transplant center.
Private practice transplant nephrology is a sometimes-overlooked segment of nephrology that should be considered by trainees. Given the current focus on increasing rates and numbers of kidney transplants, we will likely see a growing need for transplant nephrologists in the private practice setting.