Following Fellowship: How to Approach a Career in Nephrology

We have had the pleasure of being nephrology training program directors, who both began as junior faculty with research appointments at the institution in which we were fellows. We have held several titles throughout our careers and pivoted from the laboratory to develop successful careers as clinical educators. Through this role, we discovered that trainees are unfamiliar with all that our field offers and struggle with making decisions regarding their career path: Balance of personal and professional satisfaction, intellectual stimulation, autonomy, and finances. We have also been lucky to work closely with fellows through our involvement with Nephrology Business Leadership University, a week-long program tailored to second-year fellows preparing to begin a career in nephrology. Each year, we see the excitement of attendees grow as they learn of the varied roles available to them, which will allow a fulfilling career. This article’s goal is to introduce a mindset by which nephrology trainees can approach their job search and develop a fulfilling career in nephrology.

The previous paradigm, dividing academic and private practice, is no longer applicable. Although still an early branch point, the individual components of a career (e.g., clinical practice, teaching, research, and practice leadership) exist in both (Figure). When looking at a job, trainees should look past the false dichotomy of “academic versus private practice,” and instead, consider the activities they want to be doing in their job. The first step in finding the “right” job starts well before the job search. The first year of fellowship is overwhelming, but we encourage trainees to explore not only diverse clinical settings but also roles in medical education, hospital committees, and internships, available through ASN and the like. Toward the end of their first year, fellows should take some time to reflect on what they want their work to encompass. Do they want to teach; if so, whom? In what setting do they want to see patients—inpatient, clinic, dialysis, transplant, or all the above? Are they interested in leadership; administration? Taking an honest inventory allows a more focused job search and a more fulfilling start to a career as a nephrologist. It is important for fellows to remember that seeking a job is different than applying for a trainee position; a job will be long term. They should feel empowered to do research into the practice, ask questions regarding the issues important to them, seek input from those familiar with the practice, and enlist those familiar with contract negotiations.

Once a fellow has entered the workforce, they will find that new opportunities will continue to present themselves as their career progresses. These opportunities from colleagues, industry, academia, and hospitals allow them to try out distinct roles to see what is a good “fit” and what is fulfilling. Each patient’s case, teaching event, and administrative role are chances to demonstrate their work ethic, innovative spirit, and commitment to the mission. It is said, “Be kind; you never know who is watching.” We should also be engaged, thoughtful, and thorough. A career will grow unexpected branches as a result.

By saying “yes” to countless opportunities, we have organized teaching conferences, directed services for the division, and carved out careers centered around education. Now as (near) senior faculty, we relish the opportunity to help guide those coming after us to carve their paths based on an honest introspection of their career interests. We hope this helps graduating fellows see the opportunities that exist as they complete their training and join us as nephrologists. A great reference for meetings and conferences that can help our new colleagues develop their career interests is maintained at the Renal Fellows Network.

Footnotes: The authors report no conflicts of interest.