Early Career Nephrologists: Results of a 2017 Survey
Prepared for The American Society of Nephrology
By The George Washington University Health Workforce Institute
Among early practice nephrologists, practice setting—those in academic practice compared to those in a group practice—is a major factor influencing educational pathways, current practice characteristics and satisfaction.
- Similarly, USMGs among the early practice nephrologists are more likely to practice in academic settings than group practice (50.8% to 43.5%) while IMG early practice nephrologists are less likely to practice in academic settings and more likely to practice in groups (43.8% to 50.4%).
- Academic practitioners are far more likely to have had 3 or more years of nephrology fellowship training than group practice nephrologists (48.4% to 14%). Academic physicians are more likely to have had additional training in clinical research (37.4% vs. 16.3%); basic science research (19.8% vs. 14%); and transplant nephrology (31.9% vs. 20.9%). Group practice nephrologists were more likely to have had training in interventional nephrology (20.9% to 4.4%) and palliative care (9.3% to 4.4%).
- Both academic and group practice nephrologists were generally satisfied with their education and training with only 3.3% of each group expressing any dissatisfaction.
- Not surprising, academic nephrologists were far more likely to focus on transplant than group practice nephrologists (21.3% to 3.3%). The majority of nephrologists practice general nephrology only: 85.2% of the group practice nephrologists and 65.6% of the academic nephrologists.
- By far the most common job responsibilities were care of hospitalized patients (96.1% of respondents), care of patients in the clinic (93.8%) and care of patients in an outpatient dialysis unit (78.7%). Those in academic practices were more likely than those in group practices to have responsibility for kidney biopsies (48.4% vs. 9.1%), dialysis catheter placement (34.4% vs. 19.8%) and clinical research (57.4% vs. 8.3%), while those in group practices were more likely than those in academic practices to have responsibility for care of patients in an outpatient dialysis unit (90.1% vs. 69.7%) or in a nursing home or rehabilitation unit (34.8% vs. 22.5%) or to hold a medical directorship with a dialysis provider (33.9% vs. 15.6%).
- As would be expected, the vast majority of group practice nephrologists have a path to partnership (77%), while this is rare for those in academic practice (5.7%).
- Group practice nephrologists work far more patient care hours per week than academic nephrologists: 57.4% of group nephrologists provided 50 or more hours of patient care per week compared to 16.5% of academic nephrologists. Academic nephrologists provided more hours per week on research than group practice nephrologists.
- In general, nephrologists working in group practices received more incentives to join their current practice compared to academic nephrologists including: sign-on bonuses (28% to 5.1%); income guarantees (33.1% to 16.9%); relocation allowance (34.7% to 20.3%); support for MOC preparation (53.4% to 40.7%); and J-1 visa waivers (6.6% to 3.4%). On the other hand, academic physicians were more likely to receive support for career development opportunities (37.3% to 16.9%); H-1 Visa sponsorships (18.6% to 13.6%); and on-call payments (5.9% to 2.5%).
- Group practice nephrologists have far more evening and weekend call responsibilities: 60.6% of group practice nephrologists had weekend call 13 times or more in a year while only 24.1% of academic nephrologists had 13 or more; and 39.1% of group practice nephrologists had night call 26 or more weeks compared to 18.1% of academic nephrologists.
- While nephrologists generally provide a set of core services regardless of setting, there are some notable differences in regard to specific procedures. For example, 61.1% of academic nephrologists provided CRRT to 5 or more patients per month, yet, only 31% of group practice nephrologists provided that level of procedures. Only 12.3% of group physicians performed any kidney biopsies in a typical month compared to 60.9% of the academic nephrologists. Only 35.7% of group nephrologists performed any temporary dialysis catheter placement in a month compared to 61.4% of the academic nephrologists; and academic nephrologists were more than 4 times as likely to perform a renal ultrasound in a month as group nephrologists (16.7% vs. 3.5%).
- There was a significant difference in income by setting, with group practice nephrologists earning an annual mean income $30,000 higher than academic physicians (mean incomes $207,176 vs. $176,438). The difference was greatest for males, with male group practice nephrologists making nearly $40,000 more per year than male academic nephrologists ($220,479 vs. $180,952). The difference for females was a little more than $9,000.
- When viewed by gender, males were making nearly $31,000 more than females (mean incomes $206,043 vs. $176,152). The difference was far greater in group practice ($41,050; $220,479 for males vs. $179,429 for females) than in academic positions ($10,629; $180,952 vs. $170,323).
- IMGs in group practices reported earning $6,500 more than USMGs in group practices ($210,000 vs $203,404). However, USMGs in academic settings make nearly $20,000 more than IMGs in that setting ($189,483 vs $168,000)
- Despite the great variation between the incomes of nephrologists in group practice and academic institutions, their satisfaction with their income is similar. Overall, a quarter of nephrologists were dissatisfied with their income.
- Both group practice and academic nephrologists were satisfied or very satisfied with the intellectual challenges (92.6% and 93.3% respectively) and with their relationships with patients (91% and 94.5% respectively). These were clearly some of the key reasons for selecting the specialty and undoubtedly contributed to the general satisfaction with their current position.
Leo Quigley, MPH George Washington University Health Workforce Institute and School of Nursing
Edward Salsberg, MPA, FAAN George Washington University Health Workforce Institute and School of Nursing
Ashté Collins, MD George Washington University School of Medicine
The views and findings in this report reflect the work of the GW Health Workforce Institute (GW-HWI) and do not necessarily reflect the views of ASN or GW University. The GW-HWI and ASN welcome comments and feedback on this report.
Suggested Citation: Quigley L, Salsberg E, Collins A. Report on a Survey of Nephrologists in Early Years of Practice. Washington, DC: American Society of Nephrology; 2018.
Since 2014 the George Washington University Health Workforce Institute (GW-HWI) in collaboration with the American Society of Nephrology (ASN) has surveyed nephrology fellows, tracking their transition to practice and their experience in the job market. In 2017, GW-HWI surveyed recent fellowship graduates to explore the practices, satisfaction and view of the specialty of early career nephrologists. GW-HWI surveyed nephrologists who had completed their nephrology training between 2011 and 2016. There were 270 valid responses (an 11% response rate). While this response rate is low, a comparison with ACGME data on recent nephrology fellows indicates that the characteristics of respondents are generally consistent with the characteristics of recent graduates. The responses provide a good picture of the early career nephrologist.
After reviewing the results by gender, location/type of education (US medical graduates [USMGs] vs international medical graduates [IMGs]), length of time since graduation and practice setting, it appears that practice setting—those in academic practice compared to those in a group practice—is a major factor influencing educational pathways, current practice characteristics and satisfaction. The following are key findings related to the differences between nephrologists in academic practice and those in group practice. *An equal number of respondents were working in group practices and academic settings. Early practice female nephrologists are more likely to practice in academic settings than group practice settings (53.8% to 38.7%). Early practice male nephrologists, on the other hand, are less likely to practice in academic settings and more likely to practice in group settings (42.4% to 52.9%).
Exhibit A1: Setting of Primary Nephrology Job by Gender
Exhibit A2: Setting of Primary Nephrology Job by Total Years Training Completed, Academic and Group Practice Only
Exhibit A3: Responsibilities in Primary Nephrology Job by Group or Academic Practice Setting
Exhibit A4: Time Spent in Patient Care by Group or Academic Practice Setting
Exhibit A5: Number of Weekends on Call Annually by Group or Academic Practice Setting
Exhibit A6: Number of Weeks with Night Calls Annually by Group or Academic Practice Setting
Exhibit A7: Frequency Common Procedures Were Performed by Group or Academic Practice Setting
Exhibit A8: Mean Base Salary by Sex and Setting of Primary Nephrology Job