Nephrology is Dead - stay away

[NewYorkDoctors]

Nephrology is akin to gambling. There will always be the few that hit it big, but the majority will end with a loss and destroyed hopes. The casinos/neph programs will only advertise the winners; never the losers.

its more like wall street and politics. A few (that are well connected) will win big. Most will be struggling to get by living paycheck to paycheck and sharing a Lincoln Towncar, burning all your money on fancy, and going to big fancy steak houses every night under peer pressure. not a good way to build sustainable savings long term.

this is hyperbole of course as a nephrologist is not starving for money and living paycheck to paycheck

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[Renal_Prometheus]

The specialty attracts the desperate. Older IMG hospitalists who can’t get anything else and is looking for an escape. Or the IMG who can’t match IM residency, hoping to find a way into the us medical system. Or the IMG who wants cards/GI but can’t match, who took an offer during the scramble because there is cultural prestige to being a specialist. The people who are in their 40s who really cannot afford to gamble the last good years of their working career on a speculative investment, are ironically the ones who make up majority of neph fellows. It just goes to show you that desperation and human emotions always overtake logic and common sense.

 

[Renal_Prometheus]

And it’s cruel to give false hope to desperate people. Because you know they will bite on it and end up hurting their careers even more. I hope these academics who are trying to “sale” this specialty to applicants sleep well at night.

 

[NewYorkDoctors]

And it’s cruel to give false hope to desperate people. Because you know they will bite on it and end up hurting their careers even more. I hope these academics who are trying to “sale” this specialty to applicants sleep well at night.

they most certainly do lol

 

[Renal_Prometheus]

wow 200K views on the thread! I hope we have reached a lot of people who were curious about the state of nephrology.

 

[NewYorkDoctors]

wow 200K views on the thread! I hope we have reached a lot of people who were curious about the state of nephrology.

that was the whole point. I can only hope somewhere out there we have saved the careers of some doctors.

The goal was never to "get rid of nephrology." That would be asinine. The goal was to help all residents or other applicants know what they may be getting themselves into. If they read the whole thread and still love nephrology, then more power to them and I wish them the best.
But those on the fence need to know what the real deal is like. Moreover, no one who failed to match cardiology or PCCM should EVER take a nephrology scramble spot. EVER.

In any event I am certain this thread has provided countless hours of entertainment to all forum members.

I wonder what the OP NephExp is doing. I hope he/she is proud!

I wonder what mediocremed is doing now?

yes on PAPER that private practice PARTENRSHIP track SOUNDS great on PAPER... but such naivete...

Analogy:

"Hey if you join wall street, you start out as a paper pusher and pretender with your pay check to paycheck rental apartment and expensive suit and shasring lincoln towncars and blowing all of your money on fancy steak dinners at night. But hey if you stick it through you can become a big head honcho on wall street like the wolf of wall street and be roling in teh dough, doing lines of *****, banging *******, and being like Jordan Belfort. sweet!"

only difference is there is NO GUARANTEE you will make partner as nephrology as the revenue is HIGHLY DEPEND on a SCARCE resource of hemodialysis patients.

In other IM subspecialties in which you do not need to rely on a very specific population of patients for procedural volume (every patient needs CRC screening, everyone can get an echo and stress test, lotsa cancer patients need chemo, every lung patient can do a PFT, etc...) and can generate the revenue easily.

In renal PP, the office consults are the same as IM and you need to fight tooth and nail to get HD patients... plus don't forget the moral hazard of NOT treating CKD patients optimally because doing all that extra (uncompensated effort) means the patient will not end up on the machine to make money for you

 

[Renal_Prometheus]

I think neph applicants underestimate how much control they are giving up when joining this specialty. When you are you forced to take low salaries for 2-4 years, worked very hard, with only the promise of partnership, you are at the whim of someone else. There is plenty of horror stories of broken promises to pass around. But fundamentally senior partners are experiencing revenue decline across the board and they are looking at new hires as exploitable workers in order to maintain their standard of living. A lot of nephrologists go hospital employed or academics because they have been abused like this before. Yet I bet none of the academics will tell you this during your fellowship interview.

 

[sloh]

Delete

 

[Renal_Prometheus]

If all Neph grads(or even most) make 500k/yr post-partner, why do fellowship spots don’t fill? Wouldn’t you expect match rate to be higher? What’s the disconnect? Why are so many choosing to go back to hospitalist medicine if such great opportunities exist? Unless there’s a more sinister answer that nobody wants to tell you.

 

[Renal_Prometheus]

People need to have some common sense. The market needs to match career expectations. You can’t expect to go into an extremely non-competitive specialty and expects to make a lot of money after making partner. I don’t care what kind of BS fellowship programs try to sell you, you have to have the common sense to see through the conflict of interest. Reality needs to match market expectations. Market is never wrong; only people get it wrong.

 

[NewYorkDoctors]

One success story out of 99 failures (hyperbole I do not have exact numbers as it's not like the nephrologists who made partner due to family connections are advertising how much they make) does not make it worthwhile to pursue for money reasons

do nephrology if you are content with the subspecialty and the lifestyle (academics has the combo of good intellectual stimulation and good lifestyle as attending. it does not have the money though but that's not what its about)

 

[CRRT]

Many community nephrologists aren’t really comfortable with managing things out of the box. They do regular AKI, CKD, HD , MBD well but will throw up their hands and transfer to university hospital whenever something out of the ordinary comes up.
In a private practice where you are scurrying around you don’t have time to read up and be up to date with latest stuff.
But with more hospital employed jobs there will be more expectation by hospitals to keep these patients in house.

 

[NewYorkDoctors]

Many community nephrologists aren’t really comfortable with managing things out of the box. They do regular AKI, CKD, HD , MBD well but will throw up their hands and transfer to university hospital whenever something out of the ordinary comes up.
In a private practice where you are scurrying around you don’t have time to read up and be up to date with latest stuff.
But with more hospital employed jobs there will be more expectation by hospitals to keep these patients in house.

im sure they are comfortable enough

the real issue is time spent on things and not getting paid more for harder cases.
how do you make money? quick office visits and doing procedures
in neprhology how is that done? turfing harder GN cases, cystic kidney disease, etc... anything that requires a lot of talking, a lot of prior auths, a lot of patient navigation, and a lot of patient education. telling CKD patients to "yeah follow up endocrine, cardiology, PCP get that sugar and BP under control and try to lose some weight."

why?

to be fair, there is not much the nephrologist can do besides recommend SGLT2 inhibitors, aldosterone blocker, xanthine oxidase inhibitors and titration RAAs agents perhaps and finding a right balance for diuretics.

but on the other hand, why go all out when the real money is in waiting for the patient to go onto HD?

there is a lot of moral hazard in play here and that's one reason why I do not practice any dialysis (the other being its way too political to get HD privileges. you need to "pay tribute" to the senior nephrologists like paying a feudal lord or something)

 

[deleted1164820]

Career Opportunities – NephMD Recruitment what does anyone here this about this job opportunities posted on this website. Lot of empty promises?

 

[Renal_Prometheus]

Career Opportunities – NephMD Recruitment what does anyone here this about this job opportunities posted on this website. Lot of empty promises?

Lots of buzz words that don’t mean anything. Competitive starting salary?(ie 220k/yr). Earning potential of 500k/yr as a partner? Sure, any internist can hit the same number working as hard as you will be working. All the desirable locations are no go. Florida nephrologists get payed very little so it’s not realistic. California cost of living is too high. I recognize one group on this site where my friend recently left due to poor compensation as partner! But that’s not stopping them from advertising great compensation, JV opportunities, great package.

 

[NewYorkDoctors]

when most community doctors (nephrolgo yor otherwise) cannot be ****ing bothered to send any prior workup to me for a consultation (i don't need your *****y office note. I need the blood work, the echo result, the imaging result, etc....) and send patients in blind and empty, then it's not a stretch to think that most community doctors turf the high effort / revenue patient cases to the university setting.

for the record I spend $600 a month on efaxes send my consultation notes out and all of my pretty procedure reports in color.
i spend another $200 in efaxes a month to send out referrals to other specialists with my office note/ assessment, reason for referral and relevant workup.

 

[CRRT]

the real issue is time spent on things and not getting paid more for harder cases.
how do you make money? quick office visits and doing procedures
in neprhology how is that done? turfing harder GN cases, cystic kidney disease, etc... anything that requires a lot of talking, a lot of prior auths, a lot of patient navigation, and a lot of patient education. telling CKD patients to "yeah follow up endocrine, cardiology, PCP get that sugar and BP under control and try to lose some weight."

You do make good money and clear > 1 million and that is by working hard and keeping up to date. For goal directed hard-workers nephro+/- critical care not a bad option.
For lazy hospitalists looking for an outlet this is not a way out. You don’t get anything in life easy.

 

[georgestone]

more than a million ?
Thats a new one
LOL

 

[NewYorkDoctors]

more than a million ?
Thats a new one
LOL

some of the nephrologists in NYC PP do clear over 1M but that's do a unique set of circumstances that combines

1) very good IPA negotiated rates
2) also doing PCP/GIM as well
3) overstuffing the waiting rooms quadruple booking. to hell with the patient reviews. they're gonna keep coming anyway.
4) turfing all hard cases out
5) chasing ATNs like and ambulance chasing lawyer and stuffing the HD panel stat sheets
6) smooching wining and dining cardiologists, PCPs, and hospitalists

that's way too much effort honestly. but not every single doctor can get #1 done. plus this relies on doing #2 quite a bit.
I would not feel good at all with #3. i am always on time, rarely late (unless the patient before is late and it affects the on time patient)
I have too much pride for #4,5, and 6.

heck as it stands, I get sent all the hard cases in pulmonary. The hardest case to date is Sjogrens related PAH NYHA Class 3 who also happens to have CKD3 due to chronic tubulointerstitial nephritis and Type 1 RTA due to Sjogrens as well as likely hypoperfusion from a cardiac index of 1.8 from his PAH (amazing case!). He also has MGUS likely due to the sjogrens but without clear evidence of MGRS (subnephrotic proteinuria about 0.5g and no major discrepancy between the UACR and UPC) This patient belongs in a tertiary care center but the patient is literally too breathless to get there so I cannot even physically turf that patient over! im doing yeomans work and his 6MWT, VO2max, and Cr (bettet renal perfusion from the low cardiac index) is improving slowly with ambrisentan and tadalafil. but if he needs IV prostacyclin then im laying the hammer on the patient saying off you go to the academic center of excellence. but i do not have an army of support people like an academic center has yet im getting this work done.
the only reason why this case is acceptable from a business standpoint despite the very high effort is because I did a lot of in office procedures for him and that events out the effort / revenue ratio.

thoracic surgeons and cardiologists wine and dine me (i have declined their offers because I have little kids to take care of at night)

i dont chase any patients in the hospital. they all get referred to me post discharge by the hospitalists.

 

[Renal_Prometheus]

The neph PDs are playing stupid. They are smart enough to know that if a specialty has this hard of time attracting fellows, there are serious problems in private practice. They can put 2 and 2 together. They are playing dumb. It’s too late for them to change careers and private practice is not very appealing. So they keep selling hopium to desperate applicants in the hopes of at least having a comfortable lifestyle. It’s just an act.

 

[NewYorkDoctors]

The neph PDs are playing stupid. They are smart enough to know that if a specialty has this hard of time attracting fellows, there are serious problems in private practice. They can put 2 and 2 together. They are playing dumb. It’s too late for them to change careers and private practice is not very appealing. So they keep selling hopium to desperate applicants in the hopes of at least having a comfortable lifestyle. It’s just an act.

yep. academic nephrology without fellows would be BRUTAL

i have some colleagues who are in community hospitals. usually the community hospital will contract out to a private practice renal group. anyway their group comes in for all the urgent HDs. granted not as many as in an academic medical center but enough. 65-70 and still coming in the middle of the night. whatever it takes i guess. at least they ask the internal medicine residents (smaller hospital has a residency just no renal fellowship) to do the HD consent , confirm HD access is present first and they call in the nurse and come later in the night. that's not as bad as the fellow doing all those steps and coming in BEFORE the HD nurse gets in

 

[CRRT]

some of the nephrologists in NYC PP do clear over 1M but that's do a unique set of circumstances that combines

1) very good IPA negotiated rates
2) also doing PCP/GIM as well
3) overstuffing the waiting rooms quadruple booking. to hell with the patient reviews. they're gonna keep coming anyway.
4) turfing all hard cases out
5) chasing ATNs like and ambulance chasing lawyer and stuffing the HD panel stat sheets
6) smooching wining and dining cardiologists, PCPs, and hospitalists

that's way too much effort honestly. but not every single doctor can get #1 done. plus this relies on doing #2 quite a bit.
I would not feel good at all with #3. i am always on time, rarely late (unless the patient before is late and it affects the on time patient)
I have too much pride for #4,5, and 6.

heck as it stands, I get sent all the hard cases in pulmonary. The hardest case to date is Sjogrens related PAH NYHA Class 3 who also happens to have CKD3 due to chronic tubulointerstitial nephritis and Type 1 RTA due to Sjogrens as well as likely hypoperfusion from a cardiac index of 1.8 from his PAH (amazing case!). He also has MGUS likely due to the sjogrens but without clear evidence of MGRS (subnephrotic proteinuria about 0.5g and no major discrepancy between the UACR and UPC) This patient belongs in a tertiary care center but the patient is literally too breathless to get there so I cannot even physically turf that patient over! im doing yeomans work and his 6MWT, VO2max, and Cr (bettet renal perfusion from the low cardiac index) is improving slowly with ambrisentan and tadalafil. but if he needs IV prostacyclin then im laying the hammer on the patient saying off you go to the academic center of excellence. but i do not have an army of support people like an academic center has yet im getting this work done.
the only reason why this case is acceptable from a business standpoint despite the very high effort is because I did a lot of in office procedures for him and that events out the effort / revenue ratio.

thoracic surgeons and cardiologists wine and dine me (i have declined their offers because I have little kids to take care of at night)

i dont chase any patients in the hospital. they all get referred to me post discharge by the hospitalists.

There is room for nephrologists in the community(preferably hospital employed) who use their brains and can deal with complicated stuff) instead of being like the mechanized robots in the HD industry.

 

[NewYorkDoctors]

There is room for nephrologists in the community(preferably hospital employed) who use their brains and can deal with complicated stuff) instead of being like the mechanized robots in the HD industry.

while that is a true statement, that kind of work does not lead to big money. that kind of work leads to burnout.

 

[Renal_Prometheus]

The specialty needs to establish some barrier to entry for applicants. When anyone with a pulse can walk in, it doesn’t project any confidence that investing in this specialty will lead to anything worthwhile.

 

[georgestone]

some of the nephrologists in NYC PP do clear over 1M but that's do a unique set of circumstances that combines

1) very good IPA negotiated rates
2) also doing PCP/GIM as well
3) overstuffing the waiting rooms quadruple booking. to hell with the patient reviews. they're gonna keep coming anyway.
4) turfing all hard cases out
5) chasing ATNs like and ambulance chasing lawyer and stuffing the HD panel stat sheets
6) smooching wining and dining cardiologists, PCPs, and hospitalists

that's way too much effort honestly. but not every single doctor can get #1 done. plus this relies on doing #2 quite a bit.
I would not feel good at all with #3. i am always on time, rarely late (unless the patient before is late and it affects the on time patient)
I have too much pride for #4,5, and 6.

heck as it stands, I get sent all the hard cases in pulmonary. The hardest case to date is Sjogrens related PAH NYHA Class 3 who also happens to have CKD3 due to chronic tubulointerstitial nephritis and Type 1 RTA due to Sjogrens as well as likely hypoperfusion from a cardiac index of 1.8 from his PAH (amazing case!). He also has MGUS likely due to the sjogrens but without clear evidence of MGRS (subnephrotic proteinuria about 0.5g and no major discrepancy between the UACR and UPC) This patient belongs in a tertiary care center but the patient is literally too breathless to get there so I cannot even physically turf that patient over! im doing yeomans work and his 6MWT, VO2max, and Cr (bettet renal perfusion from the low cardiac index) is improving slowly with ambrisentan and tadalafil. but if he needs IV prostacyclin then im laying the hammer on the patient saying off you go to the academic center of excellence. but i do not have an army of support people like an academic center has yet im getting this work done.
the only reason why this case is acceptable from a business standpoint despite the very high effort is because I did a lot of in office procedures for him and that events out the effort / revenue ratio.

thoracic surgeons and cardiologists wine and dine me (i have declined their offers because I have little kids to take care of at night)

i dont chase any patients in the hospital. they all get referred to me post discharge by the hospitalists.

This boils down to Work to income ratio
any MD after 90 a hr a week or above mentioned rigorous schedule can generate a Million , but frankly is this common? or sustainable , we can all come up with some anecdotal example of an individual who is just killing it , but this aint common at all

I have seen Hospitalist taking only 2 months off a year and making more than 700 k but then their shelf life gets shorter and quality gets compromised
same is with Nephrology , running around to diff HD units , inpatient and outpatient , HD unit directorship and then calls on top of that !! any nephrologist can generate more than 4-500 k but then there is no life style and this becomes unsustainable

 

[Renal_Prometheus]

The other issue that applicants fail to consider is how difficult it is to switch jobs. If you are coming out of an unfair partnership, you are looking at giving another group 2-4 yrs of your life getting payed low 200ks for the chance that this new group will treat your better. Too many unknowns as to what they will share with you post-partner and what the buy in is for their JVs. Plus JVs are not that lucrative now a days. So that’s why you see so many nephrologists looking at hospitalist, academic Neph, or hospital employed positions. In theory, pp nephrology has the highest financial ceiling, but usually there is a catch that new grads fail to consider that will haunt them. At least half of my cofellows are not even practicing nephrology at this point. And of the ones I know who are still practicing Neph, many are with their 2nd Neph job. So the specialty is not for the faint of heart and you really need to know what you are getting into. But of course applicants don’t listen and will apply to Neph because it’s easy to get in and they don’t want to be a hospitalist.

 

[NewYorkDoctors]

Unclear why one would prefer not to be a hospitalist half the year and enjoy life but rather wants the masochism of PP nephrology .

One approach is many FMG want to stay in big cities near their culture like LA and NYC and big city hospitalist jobs are essentially full time job 21 shifts a month for laughable pay . So I see that perspective. If I’m gonna work hard anyway I’ll do so as a specialist

 

[CRRT]

I have seen Hospitalist taking only 2 months off a year and making more than 700 k but then their shelf life gets shorter and quality gets compromised
same is with Nephrology , running around to diff HD units , inpatient and outpatient , HD unit directorship and then calls on top of that !! any nephrologist can generate more than 4-500 k but then there is no life style and this becomes unsustainable

The nephrologist I know making >600 K is hospital employed. He didn’t have to slog for years to become partner. He is though busy with clinic and goes to 2 HD units.
I think if you are not location limited there are ways to have a life and make money in nephrology. Currently quite a bit of need and academic jobs also available for those who want that direction.

 

[NewYorkDoctors]

M

The nephrologist I know making >600 K is hospital employed. He didn’t have to slog for years to become partner. He is though busy with clinic and goes to 2 HD units.
I think if you are not location limited there are ways to have a life and make money in nephrology. Currently quite a bit of need and academic jobs also available for those who want that direction.

The same logic applies to all other subspecialties of IM .

Go rural and you have a better chance to get a foot hold . But don’t forget most individuals who are wrapping their minds about nephrology are FMG and FMG prefer to be in big cities unless a rural location happens to have a community of their own country people .

AMG nephrologists can become top academics easily

 

[Renal_Prometheus]

The whole system has misaligned incentives. Fellowship programs act like sharks in the water, circling their prey, waiting to snatch someone(anyone really) up to be used for cheap labor. Private practice groups are looking at new hires as people they can screw over and not make partners because revenue is down. Suckers for this specialty pay the price year after year, seamingly ignorant to what has happened, with no lessons learned from the hoarde of Nephrologists who are currently not practicing in their own specialty. Why put yourself in that kind of position, to be taken advantage of?

 

[Renal_Prometheus]

I think if you are not location limited there are ways to have a life and make money in nephrology. Currently quite a bit of need and academic jobs also available for those who want that direction.

So you want applicants to ignore the macroeconomics of this specialty, that dialysis unit profit margins are declining drastically, and one of the biggest sources of revenue for a nephrologist. It’s another one of those close your eyes and hope for the best scenarios? And if it doesn’t work out, you can always do hospitalist, but you can’t have those years back?

 

[CRRT]

So you want applicants to ignore the macroeconomics of this specialty, that dialysis unit profit margins are declining drastically, and one of the biggest sources of revenue for a nephrologist. It’s another one of those close your eyes and hope for the best scenarios? And if it doesn’t work out, you can always do hospitalist, but you can’t have those years back?

I think if the goal is only to make money/not use brains then nephrology is not the field for you. Instead try to go to GI or other procedural specialty. Actually medicine is probably not the field for you likely get more reward working in financial sector/Wall Street etc.
If you want to be a good internist and practice good medicine then there are jobs now available although can’t be location limited.

 

[Renal_Prometheus]

I think if the goal is only to make money/not use brains then nephrology is not the field for you. Instead try to go to GI or other procedural specialty. Actually medicine is probably not the field for you likely get more reward working in financial sector/Wall Street etc.
If you want to be a good internist and practice good medicine then there are jobs now available although can’t be location limited.

Yet you didn’t practice nephrology out of fellowship, but instead went into critical care for presumably higher salary/job prospects. So is this a case of do as I say, not as I do?

 

[NewYorkDoctors]

I think if the goal is only to make money/not use brains then nephrology is not the field for you. Instead try to go to GI or other procedural specialty. Actually medicine is probably not the field for you likely get more reward working in financial sector/Wall Street etc.
If you want to be a good internist and practice good medicine then there are jobs now available although can’t be location limited.

Other subspecialists also use their brains not just nephrology. that's a very arrogant statement

yes community GI doctors, interventional cardiologists and general cardiologists don't have to use too much brain power...

but CHF subspecialists, EP, advanced GI, hepatology, rheumatology, endocrinology, pulmonary, ID would like to have a word ... just to name a few

"the nephrologists are the smartest doctors in the room".... only holds true in the pre-UpToDate era and also if the room is comprised of interns and med students only.

 

[CRRT]

Other subspecialists also use their brains not just nephrology. that's a very arrogant statement

yes community GI doctors, interventional cardiologists and general cardiologists don't have to use too much brain power...

but CHF subspecialists, EP, advanced GI, hepatology, rheumatology, endocrinology, pulmonary, ID would like to have a word ... just to name a few

"the nephrologists are the smartest doctors in the room".... only holds true in the pre-UpToDate era and also if the room is comprised of interns and med students only.

I did not mean to say all doctors don’t use brains only the interventional specialities don’t use brains.

Academic nephrologists use brain power but community nephrologists like to focus solely on creatinine and electrolytes. Sadly many community nephrologists and cardiologists do not even focus on volume status or HTN. They leave that management to the hospitalists /intensivists.

Anyway in 2nd year of nephrology I felt like I was only focusing on creatinine and lytes and was not caring about rest of the patient. I lost interest my inservice scores tanked and I just felt like I needed an outlet.

So I bade nephrology goodbye and took an outlet into CC. 10 years later after making money I now realize that much of CC is just palliative care and there are many patients that no matter how hard I try I can’t make a difference for.

So now time for another fellowship maybe do a transplant + ECMO fellowship maybe.

 

[CRRT]

Yet you didn’t practice nephrology out of fellowship, but instead went into critical care for presumably higher salary/job prospects. So is this a case of do as I say, not as I do?

Partially for job / salary. Partially because I didn’t like what type of doctor I was becoming being a community nephrologist.

 

[NewYorkDoctors]

Partially for job / salary. Partially because I didn’t like what type of doctor I was becoming being a community nephrologist.

I hear you.

that reinforces the argument I have been making though


Academic Nephrology = a pretty good career. those who like nephrology should aspire to do so without hesitation.

Anything else Nephrology... if you're not making the big money why go through the sludge like that?

If anyone wants the "best of both worlds" then do another subspecialty.

 

[sloh]

So now time for another fellowship maybe do a transplant + ECMO fellowship maybe.

Haha thought this was sarcasm

 

[CRRT]

Haha thought this was sarcasm

Maybe not ECMO but maybe transplant. I am not the first person thinking of going back to nephrology after spending 8 - 9 years in CC. We had a nephrology fellow in our fellowship who had previously done CC and was practicing for 5-6 years as intensivist. He got tired of CC and wanted a fall back. He did a neph fellowship and then for a while was working 2 weeks a month as an inpt nephrologist in a university owned community hospital along with 1 week of ICU nocturnist in the big mothership. He has now gone back to the country he originally came from but occasionally comes back to do locums in USA.

 

[CRRT]

It actually makes sense to have some extra training in transplant if eventual plan is to go back to home country. In other countries its more common to get a living related kidney transplant than to do traditional in center HD. If someone wants to go back to their home country important to learn transplant and home PD.

 

[Renal_Prometheus]

It actually makes sense to have some extra training in transplant if eventual plan is to go back to home country

I’ve heard so many distorted explanations that IMGs say to justify doing nephrology. One of the more common is that they need to specialize in something to go back to their home country. In the end, all of them stay in the US and none went back to their home countries. They are all coping with their bad decision making and can’t admit to themselves it’s a mistake.

 

[Renal_Prometheus]

30 yrs ago, when nephrology was very lucrative, it was one of the most competitive sub-specialties. You had to be cream of the crop to get in. I bet those applicants claimed they were in it for the passion for renal physiology and mental stimulation of acid/base balance. Where are these people now when specialty has gone down the drain? Programs need to lie through their teeth to get sucker to come take their night calls for them. The market always knows what is going on and people always go where the money is. So when a specialty can’t fill spots year after year, it’s illogical to run towards it and expect to make bank down the road. I know these programs will sell you on how well their grads have done, but you need to have the common sense to recognize that theirs is a conflict of interest in what they say and yes, they will lie. The reality is always more brutal.

 

[NewYorkDoctors]

before screening colonoscopes became standard in the 90s, GI was not a popular field. Who wanted to deal with IBD, IBS patients all day long?
but boom after that everyone wanted to scope for dollars. sure the academic GI and hepatologists are using big brain power to deal with cirrhosis, IBD, and other more systemic GI issues, but most GI docs in the community just want to scope for the dollars. it leads to community GI doctors cutting corners left and right and getting these kind of google reviews lol:

 

[Renal_Prometheus]

I am currently doing interviews for Nephrology/critical care combined programs. There is only less than 20 programs that offer combined programs in the country. I am wondering if the field can transform, like Pulmonology getting attached to critical care and it has been attracting more candidates than nephrology. Most of places where I do interview there is so much interest for combined programs among candidates and not a lot of people want to do just General Nephrology. I think combining would make the speciality a little competetive. I am not sure if a Pulmonologist would make as much money as Nephrologist if they don't have the critical care part. As far as I know no body would want to do just pulmonology without the critical care that's how bad it is. Pure Pulmonology is a terrible speciality to choose. I beleive general Nephrology needs an upgrade.

Do you expect pulmonology to lie there doing nothing and let you take their cash cow? Basically, applicant interest is not about the subject matter, but where the money is. Nephrology needs to work on being more lucrative and stop these indentured servitude partnership tracks that end nowhere.

 

[NewYorkDoctors]

pulmonology makes more than nephrology without critical care
trust me

while it is true that the "employed salaried" pulmonologist/intensivist who works for the health system does not get the facility fees for the procedures, the PP pulmonologist as so many office procedures that it's the same as the PP general cardiologist. the benefit is none of the pulmonary office procedures needs prior auth other than sleep studies portable or in lab (and a few like UHC medicare need no PA for home sleep study)

gotta compare apples to apples. if you're gonna compare PP nephrologist with one hundred HD patients then i counter that the PP pulmonologist can see and do so many more office based procedures and is more comfortable and does not travel anywhere but the hospital for bronchs

 

[Renal_Prometheus]

In theory, you can make decent money in nephrology if you move to a semi-rural area where there’s a lot of CKD pts and no competition. You can build a HD panel and leverage it into a JV or MDA with one of the dialysis companies. It will take you many years and your spouse may not be able to put up with the location. In reality, such locations don’t exist and you are forced to join a neph group and accept their terms for partnership which often times favor those who wrote it. Large cities is a no go. Competing with multiple groups for consults, driving to 6-7 locations per day, kissing up to the hospitalist for consults, not making much money even if you make partner. If you are gonna live in a large city, you are better off being a hospitalist.

 

[CRRT]

before screening colonoscopes became standard in the 90s, GI was not a popular field. Who wanted to deal with IBD, IBS patients all day long?
but boom after that everyone wanted to scope for dollars. sure the academic GI and hepatologists are using big brain power to deal with cirrhosis, IBD, and other more systemic GI issues, but most GI docs in the community just want to scope for the dollars. it leads to community GI doctors cutting corners left and right and getting these kind of google reviews lol:

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Many outpatient GIs just run an endoscopy practice and make bank off ASC facility fees and path fees. I went to a gastroenterologist because of abdominal pain and even before seeing me he first scheduled me for a EGD/C Scope and after the scope he diagnosed be with esophagitis/gastritis. Thats their favorite dx I didn’t even know if it was a real diagnosis or just made up.
As time goes on many of these guys become scope monkeys and not doctors anymore.

 

[NewYorkDoctors]

Many outpatient GIs just run an endoscopy practice and make bank off ASC facility fees and path fees. I went to a gastroenterologist because of abdominal pain and even before seeing me he first scheduled me for a EGD/C Scope and after the scope he diagnosed be with esophagitis/gastritis. Thats their favorite dx I didn’t even know if it was a real diagnosis or just made up.
As time goes on many of these guys become scope monkeys and not doctors anymore.

yeah these GI docs never even have even a PA or NP talk to the patient about the "boring stuff."


anyway the original point is nephrology is indeed very brain power intensive
that does not always translate to money
these things are not mutually exclusive persay... but one should go into nephrology due to love of the field and should keep money at the lower priority

If one wants to go into research and be intellectually oriented, then do academic nephrology
if one enters private practice (regardless of field) it should be to make as much money as possible. nephrology cannot guarantee that

while there are forms of intermediate kind of jobs, my take on things in life is if you want the "best of both worlds," you usually get neither.

 

[Test Boy]

Many outpatient GIs just run an endoscopy practice and make bank off ASC facility fees and path fees. I went to a gastroenterologist because of abdominal pain and even before seeing me he first scheduled me for a EGD/C Scope and after the scope he diagnosed be with esophagitis/gastritis. Thats their favorite dx I didn’t even know if it was a real diagnosis or just made up.
As time goes on many of these guys become scope monkeys and not doctors anymore.

The default dx for EGD is gastritis and for a colonoscopy, it’s hemorrhoids. They always put that down as a minimum (even it’s all normal), presumably for insurance purposes.

 

[CRRT]

The default dx for EGD is gastritis and for a colonoscopy, it’s hemorrhoids. They always put that down as a minimum (even it’s all normal), presumably for insurance purposes.

That’s because they have to show that they did something. If they found nothing the patient and the insurance would question why the EGD / C Scope was done in the first place.
In Canada screening for colorectal CA is with FOBT. If that suddenly became the standard in USA there would suddenly be a lot of endoscopy centers going bankrupt. Actually that would improve care as we would have more luck getting GI to come in to scope our bleeders who really need a scope.