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Fellows Learning the Business Aspects of Medicine

Rare is the occasion when business training intersects with medical education. Absent in most medical curricula and nearly taboo in academic residency and fellowship training, understanding the operational aspects of nephrology is imperative in preparing young fellows for practice. Too often, budding nephrologists are ensnared in complicated contracts, beguiled by partner promises, or seduced by transient gains. Unaware and unprepared, young and enthusiastic nephrologists often learn the business as they go, eager to see patients but often without the means or knowledge of how to achieve though we often tell ourselves, “just 4 years of medical school, just 3 years of residency, just 2 years of fellowship before the next step…,” entering the workplace becomes a lifetime commitment many are ill-equipped to make. Our focus on short-term goals quickly becomes apparent as we search for our next position. By focusing on salary, weekend calls, and working hours, young physicians often lose sight of long-term plans, potential for ten results in quick turnover of positions, loss of patient continuity, and overall dissatisfaction. In the end, we are often left with the same series of questions: What questions should I ask? What should I look for in a practice? How do I know this is a good fit?

A theme frequently voiced to fellows by many mentors in both academic and private practice is, “What I wish I had known when I was in your shoes.” Too often, young fellows are thrown into an arena equipped with medical knowledge, able to manage hypertension and proteinuria, but uneducated in the business of nephrology. Shielded throughout training, they enter practice encumbered by billing and coding, submerged in Quality Assurance and Performance Improvement (QAPI) and MACRA (Medicare Access and CHIP Reauthorization Act of 2015), and overwhelmed by insurance and investment. Although none would argue that the focus of nephrology education should be on economics, many practicing physicians say they were ill-equipped to handle the challenges thrust upon them in practice. To address these shortcomings, the Nephrology Business Leadership University (NBLU) was created from training to practice, with emphasis on providing the tools needed to interview, to find the right job, and
to grasp the economics of nephrology. I attended the conference not knowing what to expect. I left with a better understanding of how to analyze a practice, assess a market, and screen for red flags. I left with competence, now able to interview with assuredness, tailor my resume with expertise, and parse a contract with awareness. I left with the confidence needed to evaluate programs, screen for overhead, and question my fit in a practice. While there, I met with nephrologists working in traditional and nontraditional roles as presidents of hospitals, chief executive ocers of companies, fellowship program directors, basic science researchers, joint nephrology hospitalists, and consultant nocturnists of large multispecialty groups and solo rural practices.

Hearing their perspectives not only has provided me with a cabinet of mentors but also has encouraged me to break the traditional workplace stereotype and apply for more leadership roles in the field. Overall, I found the experience to be valuable, empowering, and eyeopening. Now more than ever, being a nephrologist requires more than just an understanding of medicine. With a decrease in the number of nephrologists, we must push ourselves further to improve the care of our patients. Before this experience, I was more eager to just find a job rather than try to find one that was the right fit. NBLU has condensed lifetimes of learning experiences and provided me with the tools necessary to make this leap and become an independent, satisfied physician. At the end of the conference, the energy, enthusiasm, and excitement about being a nephrologist were palpable, partly owing to a focus often lost in training programs. Education in the business aspects of nephrology is crucial in preparing the young fellow for future practice.

For more information regarding NBLU, please visit or @NBLUniv.
Sapna Shah is a second yearfellowatMt. Sinai inNewYork.

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