Survey: 55% of transplant nephrologists report job satisfaction

Prince M Anand, MD, FACP, FASN, FAST

Kidney transplant is the optimal treatment for kidney failure. Kidney transplant improves quality and quantity of life in patients with advanced kidney disease. Care of kidney transplant patients is complex and spans multiple subspecialties. Transplant nephrologists are the central players who manage patients pre, peri and post-transplant. Per the American Society of Transplantation, there is a limited number of transplant nephrologists (approximately 800) available for the increasing number of transplant patients. In 2021, a record 18,699 deceased donor kidneys transplants were performed. This is about 2,000 more than in 2020. The aim of 2019 Advancing American Kidney Health Initiative is to double the number of kidney transplants by 2030. This will further increase the stress on transplant centers and transplant nephrologists to provide care of these very complex patients.

The recent paper by Singh and colleagues looks at the compensation and job satisfaction of transplant nephrologists across the country. The paper was based on a survey conducted among transplant nephrologists practicing in the U.S. The survey was sent to 809 physicians and responses were received from 365. The survey participants were from across the U.S., and practice in wide array of settings, including academic institutions, private practice groups and private hospitals. Only 260 responses were used as these respondents practiced in the U.S. and provided information about their compensation.

Mean salary for transplant nephrologist is $274,460 and range between $75,000 and $575,000. More than 60% of the respondents were paid based on their wRVUs and 11% were paid for non-billable work. Some participants had target RVUs (mean target of 4765). Half of the medical directors were paid for administrative work. In addition, 55% of the respondents were satisfied with their salaries and 43% complained of burnout.

This paper is important as it discusses non-clinical RVUs. A significant portion of the work done by transplant nephrologists falls under this category. The role of transplant nephrologists during the years has morphed into taking care of patients, pre and post-transplant lab reviews and talking to referring nephrologists. Although some of the afore mentioned activities do not generate RVUs, these are important in managing the patients and getting referrals for transplant. Transplant programs also generate large downstream revenue for hospitals from radiology, pharmacy, labs and cardiology services.

The number of new internal medicine residency graduates choosing nephrology, and subsequently transplant nephrology, is steadily decreasing. One major factor is the imbalance of work/life balance. Transplant nephrology has long hours but low compensation. Many current transplant nephrologists do not understand how their salaries are structured. Academic institutions view transplant nephrology as a money losing division due to the current RVU structure and hence pay low salaries to transplant nephrologists. The trend is better in private institutions or transplant centers where nephrologists are not held to RVU standards. Like our colleagues in general nephrology, CMS needs to provide a monthly lump sum amount to the hospital/transplant centers for taking care of complex transplant patients. This money will help pay the salary of support staff like social workers and coordinators as well. The improved salary and job satisfaction will hopefully increase interest in the field and enhance the long-term care of transplant patients.