A Nephrologist's Experience Transitioning From Fellowship

Dr. Silvi Simon

Dallas Renal Group, Dallas, TX

“Only six months left, and I can’t wait to be on my own and rid myself of these time-consuming rounds!” I said, as a second-year fellow during my nephrology training. Fast forward to six years as a private practice nephrologist, I realize I should have cultivated those last 6 months of fellowship to better equip myself to build a successful nephrology practice from the onset.

Typical of any career change, my first year of private practice had the biggest learning curve. In what seemed like an instant, not only did I become the sole medical decision maker, but I was expected to excel in the business practice of nephrology, which I was not taught during my 30-hour call days as a fellow. To embrace the title of ‘renal expert,’ I had to get used to not having dedicated weekly lectures or carved out study time. I continue to refresh, and expand my knowledge base through my real-time patients and found the mobile UpToDate app to be a game changer. Ultimately, it has been the timely management and the quality of care delivered to my patients which have become the true display of my knowledge and the catalyst for recurrent consults.

Speaking of consults: they are no longer the bane of my existence (especially the five o’clock p.m. ER ones). On the contrary, they are the means to my nephrology practice existence. I am no longer in the mindset to deny consults but instead, I welcome them. Some of the strongest bonds that I build are with my patients and my patient referral sources. Along the way, I have also learned the art of billing: a foreign concept to the average fellow in training. However, it’s not just about sorting through and submitting the numerous ICDs and CPTs (don’t worry, there’s an app for that!), but understanding the different payer mixes, giving importance to the new number of patients seen, and being concerned with RVUs (relative value units).

Speaking of consults: they are no longer the bane of my existence

Silvi Simon, MD, practicing nephrologist with Dallas Renal Group

In contrast to the other stages of my medical training career, which were looked at as short-term tasks, transitioning from fellowship to private practice made me reassess my life and goals for the long haul. Similar to acquiring successful real estate, location does matter when establishing your private practice. Personally, I was starting a family at the beginning of my private practice. I had to consider available working opportunities for my spouse as well as the environment where I would raise my children, because at the end of the day, life does go on. It was no longer a 1-3-year window but a minimum of 10-15 years where I would establish my roots, become known in my community, and in return, strengthen my patient and referral source base.

In order to fulfill my long-term career goals, I have valued the importance of establishing a mentorship, being patient and persistent in achieving my goals, and being given opportunities for investment and partnership. In doing so, I have focused less on vacation time and on-call schedules. In fact, it has been a pleasant surprise that on-call weeks and weekends are nowhere near as brutal compared to as my experience as a fellow. I have wondered many times why the treating staff is not calling me! The private practice world has taught me that sowing strong work on the front end can reap the benefits of financial growth and work-life balance for a fulfilling career.