Martin Osinski

The results of the most recent ASN/Hopkins survey among nephrology fellows are not all that surprising. Like many industries in and out of health care dealing with the desires and demands of millennials coming into the workforce for the first time, nephrology is feeling the impact. Lifestyle, according to the survey, is the overall key factor in the decision-making process for this age group when looking for that first job. Based on the results of this survey, for example, limits on weekend and weekday call rotations is the most important factor to fellows coming out of training.

While this may be the case for the fellows who responded to the survey, it is also important to note that the results may be skewed by additional factors. The authors of the report did indicate a wide variance between international medical graduates (IMGs) with student loans ($0 median) and American medical graduates ($225,000 median) who responded to the survey. It would be reasonable to expect income and debt assistance to be a priority for the American medical graduates. A large percentage of IMGs must deal with visa assistance, either with J1 or H1b visas. With 64.5% of nephrology fellows being international medical graduates who responded to the survey and 45% of them requiring visa assistance, their main focus for finding a job is going to be different as well. IMGs who are on visas have to deal with finding positions in locations that are underserved for J1 visa requirements and meet specific requirements as H1b visa candidates. Their choice of geographic locations may have to be limited in order to meet those requirements. While call rotation may be the highest factor for all nephrology fellows, the realities of student debt and meeting visa requirements creates a differing focus for many IMGs.

Location was another major factor according to the survey in choosing an opportunity; 64% of fellows indicating there were “too few” or “far too few” opportunities within 50 miles of their programs. Some of the reasons for this dissatisfaction is a result of the majority of training programs being located in nine states. It should not be surprising that more than 50% of nephrologists out of fellowship are in those states (43% of fellows completing training chose to stay within the same state of their training program sites). But a key factor that may be limiting job opportunities in those states is that the populations are not growing as rapidly as they have in the past (New York, New Jersey, Pennsylvania, Illinois and Ohio are five of the nine states; they grew 1.3% or less in population during the last 8 years vs. a national average of 6%). These slowdowns in population growth combined with the increase in physicians wanting to remain in those states makes procuring a position difficult.

Another factor that plays into the unattractive position close to the training programs is that many of those schools are in metro areas, which are highly competitive for jobs and where tax rates and cost-of-living are high. These factors all impact salaries, which in these locations are not necessarily as competitive with national averages. Between the number of opportunities available and the inadequate compensation, it forces a number of nephrology fellows to accept hospitalists or internal medicine positions in the communities where they want to stay. As a hospitalist, their initial salaries will be substantially higher than those of a first-year nephrologist and the week-on/week-off schedules can be attractive. The downside is that you are not practicing nephrology (which is the reason for going through the fellowship) and there is limited long-term growth potential.

It should also be noted that more than 48% of the respondents in the survey are in their first year of training. There is a strong possibility that their attitudes and plans may change after fellowship. There is minimum exposure during training to how to go about looking for employment. As a result, as the fellows go through their interviews, they are exposed to factors they may not have considered in responding to a survey question a year in advance and may alter their priorities and responses.

In summation, while the survey provides insight into key factors fellows utilize in determining their post fellowship plans, the results can be misleading if the motivations of the respondents are not considered.

Martin Osinski, MBA, CVA
Nephrology USA-
division of American Medical Consultants Inc.
Palmetto Bay, Florida
Nephrology News & Issues Editorial Advisory Board member

Nephrology News & Issues, May 2018
Martin Osinski, MBA, CVA


How things have changed. Twenty-five years ago, nephrology fellows coming out of training were looking for opportunities that would allow them the chance to grow a practice and they were willing to take risks. Many candidates were happy to get an income guarantee and perhaps a medical directorship to establish a new practice and let their own efforts speak for themselves.

Martin Osinski. MBA, CVA

What can we expect — and what do we think we need — to handle the kidney disease population over the next 30 years?

Having helped nephrologists, young and old, find employment over the last 30+ years, it’s my view that the specialty is at a crossroads.

By Martin Osinski, MBA, AVA
from Nephrology News & Issues 

Nine years of your life. 

That is the minimum number of years a fellow needs to complete post-college training to become a nephrologist. For many of you, especially those that have done training in other countries, that time frame is substantially higher. But now that it is time to look for a job in what has been a difficult market, what are your options?

from ViewPoint, Nephrology News and Issues , March 2012

by Martin Osinski

“Doctors Going Broke,” read a CNN headline on Jan. 5. Similar stories appeared in The New York Times and other national publications. One cannot say that broke is the right term for an occupation that averages in excess of $200,000 (primary care) or more than $350,000 (specialty incomes) a year, four to seven times the per capita national average. However, you only need be in practice to recognize the difficulties physicians are dealing with financially.

from Nephrology News and Issues , April 2011
by Martin Osinski


These past 15 months have represented some of the most tumultuous and difficult periods of time for physicians in practice, especially nephrologists. The number of government and economic policy changes and their immediate impact has never been greater. This left many practices unsure of taking the best steps to move forward.

This article will review the various policies that have been implemented and their impact on the average nephrology practice.

Michelle Beaver
Renal Business Today

The numbers are daunting. Consider these statistics from the Association of American Medical Colleges graduate questionnaire and try not to glaze over and fall off your chair in a fit of depression:

Judie Bizzozero
Renal Business Today

Just like the rest of the workforce, nephrologists eventually have to hang up their stethoscopes someday and enjoy life after work. However, the recent recession and a rollercoaster stock market have to hurt potential retirees and cause a them to work beyond what they planned. That's why it is important to have a solid retirement plan in place as soon as possible. This is especially true as more young nephrologists enter the workforce.

Published by the Nephrology News & Issues., January 2009

by: Martin Osinski, MBA, AVA

Practices have different options for compensation packages; VACs also offer investment opportunities

Published by the HealthLeaders Magazine., January 2009

How involved should executives be in efforts to bring docs on board?

5 years from now, the U.S. Renal Data System predicts, we will nearly double the endstage renal disease population in the United States. With the ongoing struggle to increase organ donation, most of those 650,000 individuals will be on some form of dialysis.

Ninety percent of medical groups that participated in the Cejka Search and AMGA 2005 Physician Retention Survey reported having programs to track physician turnover. That number is up from the 73% that reported doing so in 2004. Additionally, 58% of groups have designated retention-improvement initiatives, up from 48% the previous year.

By Martin Osinski

In January NN&I reported on an announcement by the Council on Graduate Medical Education (COGME) that it is predicting a shortage of physicians in the near future. COGME says that by 2015, an increase of 3,000 U.S. medical graduates, a corresponding expansion in the number of resident positions, and a change in the distribution of residency positions to more closely mirror market demand are all needed, By 2020, there could be a shortage of 85,000 physicians, they said.

Lackluster Interest Among U.S. Fellows and Government Restrictions Could Spell Disaster for Nephrology Specialty

By Martin H. Osinski and Michael J. Kirschner

Conducting a comprehensive search is an extensive, time-consuming process when you are seeking a quality physician to fit your organizational goals. You should evaluate the situation carefully. Before you initiate a search, it is critical that you are methodical, organized and efficient since the process takes commitment and is costly. This article will explain 10 steps to identify quality physicians in a reasonable time frame.

By Martin H. Osinski and Michael J. Kirschner

One of the last stages in the physician recruitment process is presenting the contract to the qualified candidate. This step should be a formality and many organizations have mastered this stage. However, for some organizations, it becomes a major obstacle. If a top quality candidate is lost at this period of the process, it becomes demoralizing. A well-designed contract can save significant time, money and avoid massive frustrations.

This article provides suggestions in designing a successful physician employment contract.