By Jill C. Winter
Are you focusing on finishing your fellowship, or are you starting to experience anxiety about finding employment? If it’s the latter, surprisingly you are not alone. In the past, healthcare and education have been two industries that are immune to recessions. However, with national unemployment levels over 9 percent, and numerous policy and reimbursement changes this year, nephrology practices have been reluctant to hire additional physicians, although the need for nephrologists has not decreased.
To emphasize how many nephrology fellows are affected by unemployment, as of May 1 of this year, 104 out of 324 nephrology graduate fellows are still actively looking for jobs. Typically, most graduate fellows have signed a contract by January and are in the process of getting state license and hospital privileges by July.
If you are a nephrologist still looking for a position, you may have to be flexible and get more creative to find work. This article should help you through your decision-making process, and will list the pros and cons of each approach. For those graduates still looking, many have specific locations or states that they are focusing on, due to family ties or a spouse’s job location. The following are eight job options: fellowship, faculty, part-time positions, join the less optimal group, locum tenens, hospitalist, startup practice, or reconsider the geographic location
1. Fellowship—To avoid unemployment or to meet visa requirements, a fellowship is the easiest avenue to pursue, especially if you are seeking employment in the city where you are currently training. Due to budget constraints, the difficulty is the limited number of slots available. Many nephrology fellows have already pursued this avenue this year. In fact, 41 nephrology fellows have committed to another year of training. According to FREIDA (Fellowship and Residency Electronic Database), in 2008 only 27 fellows pursued additional training.
2. Faculty—A faculty position within your program is an option, although many academic institutions have made budget cuts this year. In general, the available faculty positions have been for clinical jobs, and the majority of them have already been filled for this year.
3. Part-time positions—If you have a particular group that you are targeting, but it is not adding any more physicians this year, how about offering to work part-time with the possibility of going full-time at a later date? When a group adds a full-time nephrologist to its practice, it takes about two years for the group to break even on its investment in the new physician. This approach decreases the initial investment, and if you are willing to network to grow your referral base the break-even point would occur sooner. Even though you would work on a part-time basis, it is standard to take full-time call. Actually, taking full-time call is very beneficial because you will get more unassigned patients. The drawback in hiring a part-time physician for the group would be if it has to hire additional staff, or needs more space to accommodate a part-time physician.
4. Less optimal practice—Some practices seem to have difficulty in retaining new physician employees or members. There are several reasons this can happen, and as a job candidate you may want to speak with previously employed or affiliated physicians to find out the reason for their departure. For example, a physician with a disagreeable personality trait will make it hard for other physicians to practice in that environment. However, if the physician left the practice due to an undesirable salary, even a less attractive practice may be worth considering—a low salary is better than no salary. The opportunity will also introduce you to other nephrologists in the area, and they will get to know your qualities and practice style. When signing an employment contract, make sure that the non-compete clause does not exclude you from practicing in other parts of the city. If you intend to be in the city for only a short period of time, then the non-compete may not be a factor.
5. Locum Tenens—If you are interested in practicing as a locum—temporarily filling in for another physician—first approach the groups in your desired location. See if you can negotiate a contract, where you assist with weekend call coverage and vacation coverage. Next, contact the dialysis providers to see if they know of anyone needing temporary coverage. Make sure you also contact the locum tenens firms. They may not have many nephrology locum assignments, but they can supplement your income with internal medicine and hospitalist assignments. The advantage of dealing with locum firms versus dealing directly with the group is that they will take care of your malpractice insurance, assist with state licensure, and assist with travel arrangements. The downside is that it costs the nephrology group more money, which decreases the number of assignments the firm receives. In order to create a steady stream of income you should pursue all three of these strategies.
6. Hospitalist positions—Taking a hospitalist position may not seem like the right choice at first, but it can be an excellent opportunity for future growth. Hospitalist positions have beginning salaries that are normally higher than most beginning salaries for nephrologists. Usually you will be offered a fixed work schedule. Most positions are structured as employment with no partnership track. Hospitalist programs are generally accustomed to a high turnover rate. During your time as a hospitalist, you will get to know the nephrologists in the community and their practice style. The groups will also have a chance to get to know you, both personally and professionally.
