The outlook for securing a job after nephrology training has become increasingly more difficult. A glance at the New England Journal of Medicine classifieds shows that the number of jobs advertised for nephrology trainees is decreasing. To assess the current job market for graduating nephrology fellows, we conducted an Internet-based, nine-question anonymous survey.
The survey was created online using SurveyMonkey.com, and a hyperlink was placed on popular nephrology fellow blogging sites such as the Renal Fellow Network (http://www.renalfellow.blogspot.com), Nephron Power (http://www.nephronpower.com), and Uremic Frost (http://www.uremicfrost.com) and the ASN Kidney News Facebook Fan page (http://www.facebook.com/ASNKidneyNews) from May 27 to June 25, 2010.
Data were collected anonymously and could only be completed once from a given Internet Protocol address. The respondents were asked about the region of the United States in which their training program was located; whether they were a U.S. citizen or green card holder; whether they were a United States–based university graduate; what their dream job was; whether they had a job position secured for July 2010; if yes, what type of job; and finally, whether they were glad they entered a nephrology training program.
Of the 72 respondents to the survey, 60 were graduating from their respective nephrology training programs (an estimated 17 percent of the total graduating fellow class) (1). Twenty-two (34.4 percent) of the respondents did not have job yet, and five (8.8 percent) were undergoing extra training in nephrology, supporting our hypothesis of the difficult job market. To determine whether or not the respondents were happy with their job selection, we first asked what they considered their dream job to be, then asked what job they were about to start. Interestingly, only two respondents (3.1 percent) initially felt that being a hospitalist was considered their dream job, but six respondents (12 percent) were planning on becoming a hospitalist after completing their training. On the other hand, 16 respondents (25 percent) felt that staying in academia was their dream job, whereas only six (16 percent) planned to stay in academia after completing their training. Twelve respondents (18.5 percent) were not glad that they chose nephrology as career. Table 1 summarizes the responses to the survey.
There are likely several factors contributing to this year’s decrease in job opportunities for graduating nephrology trainees. Private practices and academic nephrology groups alike have been affected by recent economic problems. Furthermore, the new bundled payment system that will begin this month and the numerous policy and reimbursement changes enacted this year have likely created some apprehension about hiring new nephrologists. Finally, many groups are opting to hire physician extenders instead of nephrologists in these difficult economic times.
A recent article in Renal Business Today reported a phone-based survey in which 104 of 324 graduating fellows indicated that they did not have a job as of May 2010 (2). Likewise, according to the Fellowship and Residency Electronic Database, since 2008 there has been a 50 percent increase in fellows pursuing extra training (2).
In conclusion, our survey results indicate that finding a job within the field of nephrology is difficult. Nephrology positions are available; however, finding the perfect fit for every graduating trainee might prove challenging. We are hopeful that the current job market will improve over the next several years after the economy recovers and the full impact of the bundled payment system plays out.
Several limitations are apparent from this survey. First, our survey was limited by the small sample size of graduating nephrology fellows who responded (60 [17 percent]). Second, the survey was collected anonymously and cumulatively rather than as individual data were available. Furthermore, several questions were not answered by some of the respondents. We were not able to exclude the 12 nongraduating fellows who responded to the survey, which is likely to confound our results. Finally, these results only show a snapshot of the current job market. We can only speculate how respondents would have answered in previous years.
Deepti Torri, MD, and Kellie Calderon, MD, are renal fellows at North Shore LIJ Health System. Matthew Sparks, MD, is a renal fellow at Duke University Medical Center. Hitesh Shaw, MD, is the program director for the North Shore/LIJ Health System nephrology fellowship. Kenar Jhaveri is an attending physician at the division of nephrology at North Shore/LIJ Health System.
Rosenberg ME. Adult nephrology fellowship training in the United States: trends and issues. J Am Soc Nephrol 2007; 18:1027–1033.