Don’t Rule Out A Smaller Town When Considering Your Future

As you embark on your nephrology career, choosing where you want to live and practice is a particularly impactful decision. Where and how you begin practicing nephrology can impact your initial earning potential, shape your work environment expectations, and dictate the professional growth opportunities available to you. In order to identify the practice that suits you best, consider the following.

The Suburbs vs. The City

There’s no denying that big cities are exciting places, but those city lights don’t come without their own challenges. Every location has pros and cons, so it’s important to consider all your options when deciding where you want to practice. You may be surprised to find that many nephrologists choose to skip the major cities in favor of smaller areas for a number of different reasons.

Both small cities and suburban areas often offer access to nearby amenities. Even in the most walkable U.S. cities, it’s unlikely that you can walk to your gym or the grocery store..  While those living in a city may be physically closer to the places they run errands, when traffic is taken into account, they often take just as long to get to.

It’s not uncommon for suburban areas to have.excellent public schools. Even if you don’t have children now, it’s important to consider that great public schools can save you the significant cost of finding a good private school in the area.  A slower pace of life, local parks and activities, and lower crime rates can also make suburbia very attractive. Suburbs often offer larger homes, more space, and lower prices than metro area  options.  

When thinking about what to do for recreation, the “in-between” nature of small cities and suburban areas is a huge advantage.For many, the perfect residence is nestled between the vibrant downtown nightlife and the tranquil parks and bike trails. You could be dining at a fancy restaurant one weekend, and the next, hiking or swimming at a nearby nature preserve. This kind of balance makes for a nice quality of life overall. 

Consider your geographic preferences

Some people have a very specific place in mind when they think of where they want to live. Others are happy to follow the best career opportunity presented to them. This is an important question because even the best job will quickly become unsatisfactory if you hate cold winters and find yourself in Minneapolis. Are you happiest on a beach? In the mountains? Do you want to live somewhere with distinct seasons or would you prefer to stay in shorts all year round?

We spoke with Hawaii Kidney Specialists Executive Director Charlotte Dixon about what it’s like being a nephrologist in Hawaii. As you would expect, the unique location of the clinic plays a huge role in why people come and work there. “[Our physicians] all enjoy what all the islands have to offer,” says Executive Director Dixon. “For example, I go snorkeling every single weekend in one of the most beautiful bays in the world. One of my doctors takes his kids bodyboarding every weekend, another hikes every weekend with their family. And several of them are very involved in the outreach projects of their kid’s schools.”

Another consideration may be how close you want to live to your family.  In our experience, we find most physicians who switch jobs do so primarily for family-oriented reasons. With that in mind, start your search for a long-term practice there. Decide what your acceptable traveling  distance is to your family, then do some research into what areas are within that time limit.This method of marking a radius on a map is an effective strategy to streamline your career search and pave the way for long-term success.

What do you want in a community?

In some regions of the country, the population is fairly uniform, while in others, it’s a captivating blend of various cultures. It’s a common belief that larger markets tend to have more diversity compared to smaller ones, but this isn’t always true. Suburban areas can also exhibit a rich diversity. 

As a physician, this can also offer you some unique opportunities. In another recent interview, we spoke with Dr. Poonaiah Mohan, Renal Associates of North Texas in Arlington, Texas. He explained how the diversity there was a major professional draw.  “Arlington has a big African American and Hispanic community. It’s more diverse than most people realize.  These are also the same communities that are sometimes hesitant to seek medical care. I get the honor of sitting with them and explaining everything we’re doing and how to better take care of their conditions, which ultimately leads to better outcomes. I’m able to personally have a big impact on the quality of people’s lives…and that is a big goal of mine.”

If you’re considering an opportunity in a smaller city, be sure to do some research into what the local communities are like there. You may be surprised at the amount of diversity you find.

The benefit of serving a smaller community

Practices in smaller areas may see lower volumes and have fewer physicians, which means you get to see the same patients more often. In addition to the climate and natural beauty, Dixon also mentioned that the personal level of care is a major draw for the nephrologists practicing in Hawaii.  “The population in Hawaii is very different from anywhere else in the world. There is the native Hawaiian population as well as a large East Asian population — Indian, Malaysian, Filipino, Japanese, etc. Every unique ethnic population has its unique medical concerns specific to it. And practicing medicine in a remote place brings its own unique challenges. It is an underserved area so you get to really feel and see the difference you make and how much it is appreciated.” 

Dr. Ahmad Mian, Mohawk Valley Nephrology Associates in New Hartford, New York echoed what Dixon said, emphasizing the importance of personal care and building meaningful relationships in his work. “In our small town, we receive referrals from patients. I was visiting a patient in the hospital with a family friend in the room. The visitor reminded me that I had cared for her husband years ago in the ICU and I told my friend to be sure they got Dr. Mian to care them, too,” Dr. Mian added, “Her voice cracked when she said that…it was a humbling gesture that you only find in a close-knit community like ours.”  

Whether working in Hawaii or New York, serving a need in a smaller community can allow you to easily create these kinds of ties to the people you serve. You will see your patients and families while out in the community, at children’s events, worship, volunteering, and more. For many physicians, this kind of connection to the community is vital in feeling fulfilled and happy with the impact they are making in the lives of others.

How much do you want to shape your practice?

At the onset of your career, it might seem challenging to envision the opportunity you have to shape the practice you work in, especially in a large practice.   But in a smaller practice, that couldhappen a lot sooner. Dr. Mian had this exact experience and was excited to share his journey. “Personally, I had a certain way I wanted to practice and I knew what I wanted wasn’t compatible with how a lot of large practices operate. I wanted to grow my practice and mold it to make it more patient centric.”

“That extends to my team as well,” Dr. Mian continued, “any major decisions, like practice management decisions, we always involve the doctors. We tend to involve the nurse practitioners as well if it pertains to them. For example, we recently made a decision to change the call schedule structure. That would affect a new practitioner coming in so we would talk to them before we made any changes, no matter how long they had been on the team.”

At a smaller practice, you may be able to quickly influence decision-making and adjust processes to match your standards for patient care and efficiency. Smaller practices naturally have smaller teams, with fewer senior leaders making the vital decisions of the practice. Ascending to a position of influence is always a process, but in larger practices, the ladder may have more steps.

There’s a lot to consider when choosing a practice to begin your career, but hopefully this gives you a good place to start. If you have any questions, don’t hesitate to reach out to the U.S. Renal Link teamWe are here to assist you in finding your ideal location and practice to call home.