Recruiting the Best Nephrologists

Reported and written by Leigh Page

When a nephrology practice is growing, the partners must work harder and at the same time recruit new practitioners to take up the slack. But before adding staff, nephrologists should consider the options carefully, because new staff will shape the practice’s future direction, says Martin H. Osinski, president of Nephrology USA^®, a recruiting and consulting firm in Miami.

Practices have several options, says Osinski, who has 20 years of experience in nephrology recruiting. They can hire a young nephrologist out of fellowship training, a seasoned nephrologist, or a midlevel practitioner, such as a physician assistant or nurse practitioner. This third option is becoming increasingly popular.

A growing number of nephrology practices are turning to midlevel practitioners, rather than hiring a new physician. With supervision, midlevel practitioners can assume some of the work that physicians would do otherwise, such as primary care, following up on office visits, and working with dialysis patients. They also staff chronic kidney disease clinics and vascular access centers.

Finding a Match
It’s time to start planning for recruitment when each nephrologist in a practice is seeing more than 75 dialysis patients, Osinski says. And, that number should be lower if the doctors have significant travel time to dialysis centers and hospitals.

Hiring a young nephrologist from a renal fellowship program can be difficult since the demand for nephrologists has been growing and supply from training programs cannot keep up. The number of open positions for nephrologists far exceeds that of renal fellows entering practice.

The United States Renal Data Systems, in Minneapolis, reports that the prevalence of patients with end-stage renal disease is expected to increase to 650,000 by 2010, meaning there will be 160 or more ESRD patients for each practicing nephrologist within four years.

Meanwhile, Osinski reports that the supply of fellows is limited by funding for nephrology fellowship positions. In addition, more graduating fellows are specializing in interventional nephrology and transplantation than they were in the past, he adds. While many practices in desirable locations may have little problem finding nephrologists, practices in less desirable cities and towns are struggling to find new hires, he says. And, all practices will feel the shortage soon, he adds.

Upward Mobility
Another problem is that many new hires no longer wish to stay in one place, Osinski says. “There’s a tendency for doctors to look at opportunities more as jobs than as careers,” he comments. “They’re apt to see a better opportunity elsewhere and move on.”

Since physicians are willing to move, more seasoned nephrologists may be available for recruitment, Osinski says. About half the nephrologists he places are mid-career physicians looking for a new practice, and unlike new doctors, they tend to know exactly what they want. They focus on higher compensation, opportunity to become a partner, more vacation time, reasonable call schedules, clinical work limited to nephrology, adequate support staff, and short travel times to dialysis centers. Seasoned nephrologists also are interested in lifestyle considerations.

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