Nephrology is Dead - stay away

[NewYorkDoctors]

getting off topic. but agreed to all points above.

my original point is people in general follow where the money is at.

not everyone is about the money. if you love nephrology and dont care about the money, then do academic nephrology and have no regrets with your career.

there is no logical reason why anyone would do private practice nephrology unless this individual has an arrangement to try to make money

most PP nephrology jobs do not pay more than hospitalist when accounting for hours worked and days worked

the argument seems to be - if you can go to the rural areas you might get a good foothold in nephrology.
the counterargument is if you go to the rural areas, you could find a hospitalist job that works half the year and pays at a better rate than said nephrology job.

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[CRRT]

getting off topic. but agreed to all points above.

my original point is people in general follow where the money is at.

not everyone is about the money. if you love nephrology and dont care about the money, then do academic nephrology and have no regrets with your career.

there is no logical reason why anyone would do private practice nephrology unless this individual has an arrangement to try to make money

most PP nephrology jobs do not pay more than hospitalist when accounting for hours worked and days worked

the argument seems to be - if you can go to the rural areas you might get a good foothold in nephrology.
the counterargument is if you go to the rural areas, you could find a hospitalist job that works half the year and pays at a better rate than said nephrology job.

I think in a rural place if you are hospital employed you may get lucky in practicing real nephrology and not getting abused by a PP group. In bigger cities most tough cases get referred to the the university center and PP groups focus on AKI and HD running to 7 hospitals on a weekend and to see 3-4 pts at each hospital.

 

[CRRT]

But yeah working in a rural place is hard if you have little kids. They will definitely suffer from not getting the best schools.
You may make more money but will pay in other ways.

 

[Renal_Prometheus]

Nephrology is not for the faint of heart. Like NYD have said, you have to go into it with a specific goal looking for a specific niche. If you are just going into it because you are desperate and want to gamble on doing specialty, those are the people who fail down the road when they realize they are working harder for less money than a hospitalist. There are too many nephrologists not practicing in their primary specialty for the applicant to be unaware that this is a possible outcome.

 

[Renal_Prometheus]

I think in a rural place if you are hospital employed you may get lucky in practicing real nephrology and not getting abused by a PP group. In bigger cities most tough cases get referred to the the university center and PP groups focus on AKI and HD running to 7 hospitals on a weekend and to see 3-4 pts at each hospital.

That’s why I say you have to get lucky to do well in private practice. Most people get abused or get disappointed with their partner incomes. So as a general rule, you should not recommend applicants to go into nephrology if you believe in “first, do no harm”.

 

[NewYorkDoctors]

That’s why I say you have to get lucky to do well in private practice. Most people get abused or get disappointed with their partner incomes. So as a general rule, you should not recommend applicants to go into nephrology if you believe in “first, do no harm”.P

Primum no nocere applies to patient care . Hence I’m sure these academics feel it does not apply to fellows

 

[CRRT]

That’s why I say you have to get lucky to do well in private practice. Most people get abused or get disappointed with their partner incomes. So as a general rule, you should not recommend applicants to go into nephrology if you believe in “first, do no harm”.

The truth in life is nothing comes easy. I had a friend who wanted to do GI. He was working as a hospitalist for 4 years and did GI research for 3-4 years while getting his green card. Busted his ass every other week while working 7 on 7 off as a hospitalist. Had 4 basic science publications ; had 3 or 4 interviews but did not match. He then decided to do nephrology and was a very good nephrology fellow. However he joined one of these groups that just ran him into the ground working 3 weekends out of 4 and going to 7 hospitals on weekends. Making just 170 K. He got burned out and went back to be a hospitalist.

I know of two hospitalists who wanted to do cards and did multiple ancillary fellowships and research years. One was offered a nephrology fellowship with option to do CC afterwards. He didn’t take it. Both then matched into cards but it took them 7-8 yrs hard work post residency.

 

[CRRT]

The truth in life is nothing comes easy. I had a friend who wanted to do GI. He was working as a hospitalist for 4 years and did GI research for 3-4 years while getting his green card. Busted his ass every other week while working 7 on 7 off as a hospitalist. Had 4 basic science publications ; had 3 or 4 interviews but did not match. He then decided to do nephrology and was a very good nephrology fellow. However he joined one of these groups that just ran him into the ground working 3 weekends out of 4 and going to 7 hospitals on weekends. Making just 170 K. He got burned out and went back to be a hospitalist.

I know of two hospitalists who wanted to do cards and did multiple ancillary fellowships and research years. One was offered a nephrology fellowship with option to do CC afterwards. He didn’t take it. Both then matched into cards but it took them 7-8 yrs hard work post residency.

None of these guys took the straightest path and although 2 got into the fellowship they wanted they did waste 8-10 years of their life. If they had thought things out well prior to starting out on their endeavors they would have had to flail less.

 

[CRRT]

One guy I know did neph / CC and then went to Mayo. He made ECMO his niche and is now head of ECMO for that Mayo site. Mayo doesn’t pay too bad and his location is a desirable location. He though had his career path well thought out from the beginning.

 

[Renal_Prometheus]

The truth in life is nothing comes easy. I had a friend who wanted to do GI. He was working as a hospitalist for 4 years and did GI research for 3-4 years while getting his green card. Busted his ass every other week while working 7 on 7 off as a hospitalist. Had 4 basic science publications ; had 3 or 4 interviews but did not match. He then decided to do nephrology and was a very good nephrology fellow. However he joined one of these groups that just ran him into the ground working 3 weekends out of 4 and going to 7 hospitals on weekends. Making just 170 K. He got burned out and went back to be a hospitalist.

Isn’t this more evidence to not do Nephrology. You can get nephrology, but it doesn’t get you anywhere then what’s the point of doing it in the beginning?

 

[CRRT]

Isn’t this more evidence to not do Nephrology. You can get nephrology, but it doesn’t get you anywhere then what’s the point of doing it in the beginning?

I was speaking with another nephrologist from Kentucky yesterday. He told me market is better and salary potentials are 500 to 600 K. But starting is 220 - 230 K with 2 years partnership track. They were looking for a partner. He said that though with the advent of SGLT2 inhibitors ESRD incidence may fall further and that may bring another dip in nephrology market.
In the last 10 years there was nephrology market was down some programs did not fill at all and many nephrology fellows went back to hospitalist medicine or did another fellowship like CC if they could.
Because of this there is a relative shortage of nephrologists at present at least in smaller cities. Obviously though this may change and another drop in demand may occur as HD compensation has not grown significantly.

 

[CRRT]

Actually with decrease in smoking rates there may be a dip in incidence of COPD and lung CA and which may decrease market for pulmonologists.

 

[Renal_Prometheus]

I was speaking with another nephrologist from Kentucky yesterday. He told me market is better and salary potentials are 500 to 600 K.

The key work is potential. Doesn’t mean it will happen. How many stories have we heard already of unfair partnerships, senior guys not sharing existing JVs, or junior guy was told he didn’t make partner after 2-3 yrs of low pay. Completely unfair for job ads to dangle these numbers in front of unsuspecting new grads. Once your first job was a failure, are you gonna try another group starting all over at 200k/yr. How many years do you have left before retirement?

 

[CRRT]

The key work is potential. Doesn’t mean it will happen. How many stories have we heard already of unfair partnerships or junior guy was told he didn’t make partner after 2-3 yrs of low pay. Once your first job was a failure, are you gonna try another group starting all over at 200k/yr. How many years do you have left?

It is up to the nephrology fellow not to get recruited to a predatory group. Be very clear from the start that you are not going to be abused.
I see most AMGs going after nephrology to the job of their choice. Certain no AMG would get abused by an IMG nephrologist. However often IMGs from subcontinent become prey to these groups.

 

[Renal_Prometheus]

Certain no AMG would get abused by an IMG nephrologist

You sure about that. Predatory groups don’t care if you are AMG or IMG. You can tell a group is predatory in the beginning? If that’s the case then nobody would fall for these predatory groups. The new grads I talk to are completely surprised that this is happening at prevalent level. They have miscalculated the risk they were taking and misled by their fellowship programs.

 

[NewYorkDoctors]

in general one goes into private practice to try to make as much money as possible
if one does not pursue money but wants to pursue intellectual pursuits, then one does academics or clinical/instructor type of role.

it is highly illogical to enter private practice nephrology if one did not want to make as much money as possible.
But then the roadblock is there are way too many barriers to making that money in private practice nephrology unless you have connections.

therefore logically one should not pursue nephrology to enter private practice. One should pursue another subspecialty if one's goals are to make money.
if one loves the intellectual stimulation of nephrology, then one should do academics.

any middle ground is just asking to be abused..

 

[Renal_Prometheus]

The truth in life is nothing comes easy. I had a friend who wanted to do GI. He was working as a hospitalist for 4 years and did GI research for 3-4 years while getting his green card. Busted his ass every other week while working 7 on 7 off as a hospitalist. Had 4 basic science publications ; had 3 or 4 interviews but did not match. He then decided to do nephrology and was a very good nephrology fellow. However he joined one of these groups that just ran him into the ground working 3 weekends out of 4 and going to 7 hospitals on weekends. Making just 170 K. He got burned out and went back to be a hospitalist.

This outcome is actually very common in nephrology. Many posters have documented similar outcomes among their friends on this thread. When I talk to new grads, they are completely surprised and was not given fair warning prior to joining fellowship. I bet their PD wouldn’t tell them this when they are trying to sway a sucker to take their night calls. Who else, except me, has the balls to come on here and tell an applicant this is the type of risk you are taking when applying to Nephrology. Yet this information can save an applicant wasting years of their lives chasing a failing specialty. Because of a conflict of interest, no academic is gonna tell them what I’m telling them. As hard of a pill as it is to swallow, applicants need to be aware of all the risks of a specialty prior to throwing their lives away chasing the hope of doing well.

 

[NewYorkDoctors]

this thread has gained quite a reputation on reddit. this thread is reaching it out there for sure.

again I hope to outline that the goal of this thread is not "die nephrology die."

we need great intelligent motivated nephrologists to further this field in academia.

we don't need on the fence doctors getting hoodwinked to be a warm body for a fellowship for 2 years and then have their careers ruined to empty promises.

 

[NewYorkDoctors]

speaking of reddit:



This poor individual. I can only say if you love renal stick with it. You will get better with time as you become more efficient and begin to realize you just need to "know about" the non nephrology parts of their care and how it relates to the kidney but you are NOT the internist/primary team and do not have to figure out all of the non-renal issues

But on the other hand, this is the reality of "academic nephrology." There are only so many "cool cases" and the faculty group has to pay the bills and their salaries by seeing these "creatinine stable c/w lasix" follow ups. The fellow is the cheap labor in this case.

I will also say if a private nephrologist did this many follow ups that nephrologist will be making some serious bank.
but that all entails having the right referral base and set up though. easier said than done

 

[Renal_Prometheus]

I keep saying that most neph applicants have no idea what they are signing up for. By the time they figure it out, you have already wasted 2 years of your life and now you are scrambling to get into critical care to avoid horror of private practice nephrology. All these posters who went into critical care(NYD, CRRT, Georgestone) figured out the trap towards the end of fellowship. We need applicants to figure out the trap before they apply to nephrology.

 

[deleted1164820]

The problem is there is not enough combined (Nephro+crit) positions right now. Its roughly around 20 today. 5 years ago there was only less than 5.

 

[NewYorkDoctors]

The problem is there is not enough combined (Nephro+crit) positions right now. Its roughly around 20 today. 5 years ago there was only less than 5.

true but one just has to get creative and "get good" to get that CCM spot
the only issue is "Getting good" for CCM requires being in touch with PCCM physicians to get lettters of rec.
that is easier to be done as a IM resident of course

here's a thought. do CCM or PCCM first then very easily get your top academic 2 year nephrology fellowship lol

 

[NewYorkDoctors]

so today is Saturday. my admin day. i have to pay bills, do payroll, write my PFT/CPET reports, check inbox, return patinet message/emails...

I get an urgent call from a PCP for a patient I see for CHF for CHF (yes I help the local general cardiologists with diuretic and volume balance when they run into issues with sodium or BUN/Cr and also do PFTs and CPETs to help distinguish cardiac/pulmonary dyspnea and prognosticate their CHF with peak VO2) who had no prior renal issues.
suddenly has AKI from baseline 0.7 to 2.2 and AST ALT 100/90 normal TBili in the span of one month

I say sure come on over patient. let's get you the care you need quickly to try to avoid an unnecessary hospitalization or to justify a necessary hospitalization.

this is laborious work took me one hour + as my support staff are not in today only secretaries. While the secretaries can us ethe machines to measure vitals for me, I'm doing phlebotomy urine collection and ISTAT Lab test running myself today.

I painstakingly went through a history to detail out time frame / time line of symptoms, signs, new medications
Went through all of her bottles to confirm what an when what was swallowed
Called pharmacy to get a list to see what other doctors might have prescribed and then have to confirm with the patient if swallowing or not (cephalexin and celecoxib recently prescribed)
The patient had a fall off of bed onto the ground for about 30 minutes or more

physical exam was painstakingly detailed. yes no edema clear lungs no new rashes, no periorbital edema.
on asking her to walk up the step stool she had proximal muscle weakness. I ask her to pretend to comb her hair and was unable to
rhabdo versus inflammatory myositis suggested
skin exam no apparent stigmata of dermatomyositis
no apparent temporal pain for PMR.

I do point of care ultrasound for volume status and euvolemia suggested.
no hydronephrosis or large bladder volumes
i had remote BP monitoring set up from before and average BP 130/80s without hypotension noted recently

point of care ISTAT VBG shows BUN is improving a bit, Na, K, HCO3 and pH are normal so i was less inclined to just send to the hospital (she did not want to go anyway) . I did explain how IV fluids may be required for rhabdo. the patient wanted outpatient labs to see just how dangerous it is before going to the
point of care U/A dipstick shows large protein and large blood

wholesale medication adjustments made and reviewed with lists printed out and Xs marked onto bottles

I have repeat labs with a rhabdo and limited glomerular work up being done now. Lab to stat tell me what CPK is

if CPK is high I willl tell patient you have to go to hospital for IV fluids of course


this encoutner took 1 hour... and the extra time to document note... and to call PCP.... and to inform lab of STAT labs

im biling 99215, 36415, 81002, 82803... and then I get to check labs on my day off tomorrow and ask patient to go into the hospital perhaps....

next week I have a stable lupus nephritis Class 3/5 patient on CS + MMF who is currently in remission year 2 right now. that patient will be check labs and talk a bit like a primary care doctor and bill 99213 + 36415. no real difference from PCP honestly from a revenue perspective.

yes I used my brain and I would LIKE to think I have helped this patient out (hopefully potentially avoiding a hospitalization though I would tell her to go if the CPK is very high) but
this subspecialty is totally not worth it from a revenue / effort standpoint IMO unless one has a large HD panel. That large HD panel is very protected politically and senior doctors do NOT allow the junior ones to establish a foot hold easily without paying tribute. Don Vito Corleone will not let you ascend. You are not Michael Corleone


I use my brain plenty when working up interstitial lung diseases. I have a somewhat unique perspective in that I can say for certain the workup thought process and logic of working up interstitial lung disease and glomerular disease is analogous. It's not apples to apples but analogous.
The difference is I have more office procedures to make money with for pulmonary patients that I do not have for GN patients.

Again I do not want to make it seem like I am a mercenary who only wants money (after all I used my day off to see my patient urgently), but I am just highlighting that nephrology is a "high maintenance" subspecialty that does not reward such high effort to the same degree as other subspecialties.

 

[Renal_Prometheus]

The problem is there is not enough combined (Nephro+crit) positions right now. Its roughly around 20 today. 5 years ago there was only less than 5.

If general nephrology was as good as the fellowship programs claim to be, they don’t need to act this desperate to get a fellow.

 

[RustBeltOnc]

This thread is my favorite of all the medical discourse on the internet.

 

[NewYorkDoctors]

This thread is my favorite of all the medical discourse on the internet.

i appreciate all the non-nephrologists who view this thread and help contribute to keep it active. everyone loves to slow down and watch a car wreck on the highway. this visibility is what is keeping this thread up and going for all potential nephrology candidates to read


think of this thread as the litmus test for renal applicants. if they read through all this and are still dedicated, then that is one good fellow and future academic nephrologist

if not, then the academic faculty of a program can be spared the headaches of a suboptimal fellow.

oh what you wanted a warm body who is ALSO a top candidate? you can't have the best of both worlds unless you're Columbia, UCSF, BWH, etc.. you know?

 

[Renal_Prometheus]

Nephrology fellowships are saleing hopium and the mirage of a once lucrative specialty to mostly desperate applicants in order to extract cheap labor for its program. This is the reality of the situation today. People will always fall for this because it offers “hope” of escape from a dreary hospitalist career.

 

[NewYorkDoctors]

Happy thanksgiving everyone especially those renal fellows writing 50 notes today not including on HD notes

 

[Renal_Prometheus]

I have so many friends who are stairing down the possibility of looking for another Neph job or just go the hospitalist route. In my opinion, most first jobs out of residency don’t work out because new grads are too naiive to negotiate a good deal and cannot recognize the unfair distribution of ancillary income in their partnership agreements. They also misjudge the cunning intentions of their senior partners when wrapped in smiles and promises. So many don’t figure out they were taken for a ride until several years into practice when they get worned down by the workload but share none of its profits. Of course, jumping ship to another group means starting all over again at the bottom with low salaries with no guarantees that the outcome is any different. Many of my friends have made the comment that at least going hospitalist route you know what you are getting into. You knows the hrs, the salary, and only cover one hospital. None of this give me 3 years and we will see if we give you partner BS. Of course none of this was told to the neph fellows by their PD when they went for their interviews; instead it was bunch of hype and promises that would make a car salesmans blush in shame. It’a like crypto, bunch of hype and promises with no real world foundation in reality. Yes there are many established nephrologist who are doing well(which is why the specialty was competitive decades ago) but that doesn’t mean new grads will have the same opportunities(this concept was explained in detail from previous posts, and is why the specialty is non-competitive now). So in the end, it’s always the people at the bottom who get hurt; years of their lives wasted, opportunity cost of good income given away for the hope of being a specialist, their spouses and family getting dragged through the mud, IMGs approaching retirement and still earning less than a hospitalist. All for what, just so the academics can sleep well through night without getting paged.

 

[happymd2000]

I have so many friends who are stairing down the possibility of looking for another Neph job or just go the hospitalist route. In my opinion, most first jobs out of residency don’t work out because new grads are too naiive to negotiate a good deal and cannot recognize the unfair distribution of ancillary income in their partnership agreements. They also misjudge the cunning intentions of their senior partners when wrapped in smiles and promises. So many don’t figure out they were taken for a ride until several years into practice when they get worned down by the workload but share none of its profits. Of course, jumping ship to another group means starting all over again at the bottom with low salaries with no guarantees that the outcome is any different. Many of my friends have made the comment that at least going hospitalist route you know what you are getting into. You knows the hrs, the salary, and only cover one hospital. None of this give me 3 years and we will see if we give you partner BS. Of course none of this was told to the neph fellows by their PD when they went for their interviews; instead it was bunch of hype and promises that would make a car salesmans blush in shame. It’a like crypto, bunch of hype and promises with no real world foundation in reality. Yes there are many established nephrologist who are doing well(which is why the specialty was competitive decades ago) but that doesn’t mean new grads will have the same opportunities(this concept was explained in detail from previous posts, and is why the specialty is non-competitive now). So in the end, it’s always the people at the bottom who get hurt; years of their lives wasted, opportunity cost of good income given away for the hope of being a specialist, their spouses and family getting dragged through the mud, IMGs approaching retirement and still earning less than a hospitalist. All for what, just so the academics can sleep well through night without getting paged.

Honestly I really don't understand why people even bother with private practice after fellowship. It is SO obvious in fellowship that after fellowship there will be a lot of exploitation that it isn't even funny. I remember looking at job opportunities during fellowship. The classic private practice position was: Drive to 7 hospitals. Get paid 200 K to start and work like a dog for 2 years. "Partners make 500 - 600 K. After 2 years you can buy-in." I mean sure why not take a huge loan after 2 years when you already hardly got paid to work like crazy and are burned out to get the outlier dialysis units with barely any patients. I am not even kidding when I say I know people who after finishing fellowship were tasked with driving up to 45 minutes to dialysis units, sometimes for only ONE patient on that particular shift. I realize that as a hospitalist there are a lot of dumps that other services don't want. However, you get half the time off and the pay is still similar to working nephro the full year. With your time off, you can invest, learn, even work extra to make more money. I don't want to say being a hospitalist is amazing because I don't think it is but compared to nephro and having every mild hypoNa be your problem and running around to multiple dialysis units, I still think it is pretty good. It isn't unusual for nephrons in private practice to see 40 patients a day and write all the notes. I have never seen a hospitalist see 40 people a day lol. Bottom line is try to do something with at least some semblance of a work life balance. Otherwise your personal life will suffer a lot and it is not worth it.

 

[NewYorkDoctors]

One can write forty notes a day in private practice primary care and make far more than most nephros. Another plug for nephros to do PCP and leverage their renal knowledge to bolster their primary care acumen

Skip dialysis and don’t be a cog of the dialysis industrial complex

 

[Renal_Prometheus]

Honestly I really don't understand why people even bother with private practice after fellowship. It is SO obvious in fellowship that after fellowship there will be a lot of exploitation that it isn't even funny.

Sunken cost fallacy. Many feel since they spent 2 years in fellowship, they need to intrinsically justify their bad decision by gambling on a private practice group, giving away another 2-3 years, and figure out it was a scam and the senior partners were never going to share in ancillary income evenly. It's a repetitive process that's been ongoing for years, but fellowship programs try to keep it "hush hush", and hopium among the applicants to be a specialist is strong.

 

[NewYorkDoctors]

Again there’s no shame in graduating renal fellowship and doing GIM and leveraging your renal knowledge . You’ll be happier

addendum without making consecutive new posts

Why Nephrology?

Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. In this post, Dr. Ng shares why she chose the field of...

www.shemd.org

Prior to submitting a nephrology fellowship application, I heard mutterings of how unpopular the field had become. Online Student Doctor Network forums had toxic threads on nephrology:

​

“Do not go into nephrology, it is a DOOMED field”​

“You work hard but you are paid nuts”​

“Patients with kidney problems are difficult and complicated”​

As obstinate as I was, I closed the website, swore never to look at it again, and applied to nephrology. Later that year, I matched at my top choice while 40% of the nephrology fellowship programs were left unfilled. I began my fellowship training with a chasm of doubt, unclear if what I saw on the online forums were true. As time progressed, I learned that the negativities that plagued nephrology were misconceptions. Moreover, I witnessed the field evolving and changing its course in response to the needs of a new work force. My uncertainty vanished and I felt that I had chosen the right path.

Why did this nephrologist state SDN threads are toxic? because she did not agree with the sentiment? because her feelings were hurt by this thread? this thread was not meant for her just like how Brie Larson said a wrinkle in time was not meant for a 40 year old biological man.

our comments on these threads have been in the line of "buyer beware but if you love nephrology and are set in doing academics then go do it and you will have a good career" and "do not enter the private practice market unless you have a clear plan in place." we are not trying to make nephrology extinct (asinine to think so). we are trying to help those doctors who are desperate for something prevent making a serious career mistake if he/she is not fully bought into nephrology. we do not want those "on the fence" candidates to get exploited by predatory non-academic bottom barrel trash feeding programs that do not have true academic pedigree attached to them (i.e. med school, transplant, onconephrology, CRRT, PD, PLEX, etc...)


I googled her up (edit: deleted from this post. anyone interseted can google yourself)
good for her. she made it. she has a great career teaching fellows

but does does she give two cents (euphemism for what I really wanted to say) about all of those nephrologists who are UNABLE TO GET AN ACADEMIC FACULTY JOB and do not have as great of a position as she does?

"toxic" is just an excuse on social media for someone to try to discredit an opposing side's argument in the fashion of a strawperson (see how I went gender neutral for that one?) argument.

too bad someone like her cannot claim RP, others, and I are just a bunch of "-ists - phobes and incels" lol. toxic indeed.

 

[CRRT]

This thread has caused a lot of damage to private nephrology groups and corrected some of the over supply of nephrology fellows. I was meeting a private practice nephrologist last week and he was lamenting that nephrologists are in short supply at present.

 

[NewYorkDoctors]

they should hire mid levels like any other private doctor would.
oh you cant threaten a mid level with not making partner so they will quit ? lol.
you cant force a mid level to travel to multiple HD centers a day? cant make a mid level take night call and weekend call?
guess we now know what they really wanted

 

[CRRT]

they should hire mid levels like any other private doctor would.
oh you cant threaten a mid level with not making partner so they will quit ? lol.
you cant force a mid level to travel to multiple HD centers a day? cant make a mid level take night call and weekend call?
guess we now know what they really wanted

NPs are all Americans and they will not be abused. They will not travel to multiple hemodialysis centers a day, not take night and weekend call.
Most nephrologists are IMGs including many from the subcontinent, and they just treat their countrymen as people are treated in the subcontinent/Asia.
These scumbags purposely do not want to take American graduates or NPs as they are just looking for suckers to abuse for three or four years.

 

[CRRT]

I interviewed for a primary care spot fresh out of residency. I was on a H1 visa. The guy who was interviewing me told me straight up he was looking for a J1 who he wanted to go keep and abuse for five years.
That doctor was from a well politically connected family in the subcontinent. I of course did not join him.

 

[Renal_Prometheus]

This thread has caused a lot of damage to private nephrology groups and corrected some of the over supply of nephrology fellows.

I wish I can take credit for this. But if a specialty can be hurt this badly by a long running thread on SDN, it has deeper foundational issues that are not being addressed.

I was meeting a private practice nephrologist last week and he was lamenting that nephrologists are in short supply at present.

No kidding. People are not stupid. You are asking someone to do a 2 year fellowship, then give you another 3 years of cheap labor, then take out a loan to buy into a partnership with terms that favor the senior guys, assuming partnership is even granted in the first place. All while having a really bad lifestyle, driving to multiple locations per day, and no hope of JV into any new units as current dialysis units are saturated, and profitability declining year after year. No kidding bro. Before your nephrologist friend make a comment like that, he needs to some self reflection on how awful of a job he is offering. Talent always go where the money is, and people are voting with their feet.

 

[Renal_Prometheus]

I interviewed for a primary care spot fresh out of residency. I was on a H1 visa. The guy who was interviewing me told me straight up he was looking for a J1 who he wanted to go keep and abuse for five years.
That doctor was from a well politically connected family in the subcontinent. I of course did not join him.

Since you didn't go into nephrology private practice after finishing fellowship, you have no idea the type of horror my friends with J1 visas went through with their exploitative partners. They got out of their chains, and joined academic nephrology, but this was not their original first choice. I'm pretty sure they would have been better off just being a hospitalist. I have advocated many times applicants needing j1 waivers not go into nephrology due to low starting salaries and high concentration of exploitative senior partners ready to pounce, but they don't listen and make up a substantial pool of neph fellows.

 

[NewYorkDoctors]

at one of the hospitals I am affiliated with , it is a community hospital non-tertiary care.
the nephrologists for this hospital group have no fellows. they are a private practice group that is contracted by the hospital to run the renal service and run HD.
there is an IM residency though.
what do the renal attendings do overnight when called for something urgent?

on BiPAP them. intubate them. call MICU. kayexelate / veltassa. push bicarb. will set up HD first thing in the morning
lol

though for the acute new HDs (like the occassional urinary obstruction Cr 25 or something) or a pulmonary renal syndrome, they will get in the middle of the night for HD though they usually ask the MICU resident to place a femoral temporary HD catheter first.


if no fellows, that is the kind of management that will happen.
with fellows, the faculty can squeeze out some RVUs overnight

 

[NewYorkDoctors]

What are the reasons for the shortage of nephrologists in the United States? What are the difficulties associated with becoming a nephrol...

Answer: Nephrology is one of the most scientifically demanding subspecialties. And perhaps one with some of the saddest outcomes.

www.quora.com

He shortage of nephrologists in the United States can be attributed to several factors:

1. Growing Demand: As the population ages and the prevalence of chronic kidney disease (CKD) increases, there is a higher demand for nephrologists to provide specialized care and treatment.
2. High Patient Load: Nephrology often involves managing complex cases and a significant patient load, which can be challenging for healthcare professionals to sustain over time.
3. Lengthy Education and Training: Becoming a nephrologist requires extensive education and training, including a medical degree, residency, and fellowship in nephrology. The length of training can deter some individuals from pursuing this specialty.
4. Income Disparities: In comparison to some other medical specialties, nephrology may have lower earning potential, which can influence the career choice of medical professionals.
5. Work-Life Balance: The demanding nature of the specialty, including being on call and managing critical cases, can impact work-life balance, potentially dissuading individuals from choosing nephrology as a career.
6. Geographic Distribution: Nephrologist shortages can be more pronounced in rural or underserved areas, making it difficult to provide specialized care to all patients in need.

Regarding difficulties associated with becoming a nephrologist:

• Education and Training: The path to becoming a nephrologist involves a long and rigorous educational journey, including completing medical school, residency, and a nephrology fellowship.
• Specialized Skills and Knowledge: Nephrology requires a deep understanding of kidney function, diseases, dialysis, transplantation, and other related areas, necessitating continuous learning and keeping up with advancements.
• Patient Care Complexity: Nephrologists often deal with patients facing complex conditions, including those with end-stage renal disease (ESRD) or requiring renal replacement therapy, making the role mentally and emotionally demanding.

Regarding career prospects:

• Job Opportunities: Despite the shortage, nephrologists remain in demand due to the rising prevalence of kidney diseases and an aging population. Job opportunities are available in hospitals, clinics, academic institutions, research, and private practice.
• Advancements in the Field: Nephrology continues to evolve with advancements in technology, therapies, and research, offering opportunities for career growth and specialization.
• Collaborative Care Models: Integrated care models and team-based approaches are becoming more prevalent, providing a supportive environment for nephrologists to work collaboratively with other healthcare professionals.
• Public Health and Policy Roles: Nephrologists can also contribute to public health initiatives, policy development, and advocacy to improve kidney health at a broader level.

In summary, while there are challenges in becoming a nephrologist, including the demanding educational path and the demanding nature of the specialty, the field offers rewarding career prospects, especially in light of the increasing demand for specialized kidney care.

1-6 are all valid points. But it misses the point somewhat. Cardiology can arguably be considered to also have points 1-6 as well with the exception of not having the income disparity.

cardiologists get all the glory, fame, and pay. why would anyone want to work as hard as a cardiologist but get paid and mistreated like a nephrologist?

2 year fellowship is shorter than 3 and there are no shortages in PCCM, HemeOnc, cardiology, GI physicians

all subspecialties have specialized skills and knowledge. this is not a valid point

all subspecialties have complex patients. ESRD patients just have more psychosocial issues perhaps. But the sheer arrogance for nephrologists to think ESRD patients are the most complex is asinine

regarding career prospects - this line can probably be applied to every subspecialty honestly... this whole quora answer is just a fluff piece by a job recruiter i bet.

what did jerry maguire say?

 

[RustBeltOnc]

All joking aside, the thread is a real service to the medical community.

The truth is, there is a little bit of "nephro" in every discipline in medicine and young people would be advised to read these posts when contemplating a career.

In addition, every single person contemplating starting medical school over the age of 30 should be required to read this thread before writing the MCAT.

 

[NewYorkDoctors]

it's that time of year again
Congratulations to those renal fellows who matched into your top choices.

now let's dissect this corpse shall we?

7,700 Resident Physicians Placed into Fellowship Training Positions through the NRMP's Medicine and Pediatric Specialties Match

/PRNewswire/ -- The National Resident Matching Program® (NRMP®) has released results for the 2023 Medicine and Pediatric Specialties Match, its largest...

www.prnewswire.com

https://www.nrmp.org/wp-content/uploads/2023/11/2023-MPSM-Match-Results-Statistics-Report.pdf

nice it has dipped from 70% the last few years.


for all cardiology and PCCM candidates who failed to match, do NOT NOT NOT NOT scramble into Nephrology. You will regret this.

I know there is an empty hole in your heart right now. Do not be tempted by the Nephrology sirens. These remaining scramble programs are bottom barrel trash. Even if you suddenly loved the beans, you want to apply next year to the beans.
Logically, if you cared about nephrology you would have applied to a TOP nephrology program.

All of the residents whom failed to match cardio or PCCM whom I have given advice to did not accept renal and did more research and networking and ultimately made it into their primary subspecialty in one or two years.

Do not be fooled by that "heart lung kidney connection," the beans were not your first passion.

doing another fellowship does NOT make your resume look more competitive to reapply to cards or PCCM. This is not like med school where you need to stuff the stat sheet.
If you want to be a pulmonary renal person like me then finish PCCM then do renal after at a TOP ACADEMIC PROGRAM
If you want to be a cardionephrologist, do Cardio first then do renal at a TOP ACADEMIC PROGRAM and get that SCUF going for CHF patients.

 

[Renal_Prometheus]

All I can say right now is that I feel really bad for those IMG applicants without US residency. They would be heavily recruited to make up the manpower shortage. It just means more exploitation of vulnerable population for cheap labor. How many of these people can get a residency afterward fellowship is anyone’s guess.

 

[happymd2000]

All I can say right now is that I feel really bad for those IMG applicants without US residency. They would be heavily recruited to make up the manpower shortage. It just means more exploitation of vulnerable population for cheap labor. How many of these people can get a residency afterward fellowship is anyone’s guess.

These days some of them do transplant and go academic. Believe it or not they do hire transplant nephrologists even without a US residency in the academic setting due to a severe shortage of transplant physicians. They get an institutional license. Once again, if you think general nephro is bad then transplant is 10 X worse. Literally any of the patient's minor complaints become your problem but if you desperately want to work in the US it is possible.

 

[LoudBark]

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.

GI was actually an easy fellowship to match in to before screening colonoscopies were recommended in the early 1990's. The screening colonoscopy changed everything and GI became a very lucrative followed by a very popular and competitive field.
Nephrology on the other hand, does have screening for renal failure.......draw a BMP and check albuminuria in diabetics. Not exactly the cash cow for nephrologists that the screening colonoscopy is for GI doctors.

 

[NewYorkDoctors]

GI was actually an easy fellowship to match in to before screening colonoscopies were recommended in the early 1990's. The screening colonoscopy changed everything and GI became a very lucrative followed by a very popular and competitive field.
Nephrology on the other hand, does have screening for renal failure.......draw a BMP and check albuminuria in diabetics. Not exactly the cash cow for nephrologists that the screening colonoscopy is for GI doctors.

Pcps do the “screening” with labs .

All the more reason for non academic nephrologists to consider doing GIM with renal and dump the dialysis industrial complex

 

[CRRT]

it's that time of year again
Congratulations to those renal fellows who matched into your top choices.

now let's dissect this corpse shall we?

7,700 Resident Physicians Placed into Fellowship Training Positions through the NRMP's Medicine and Pediatric Specialties Match

/PRNewswire/ -- The National Resident Matching Program® (NRMP®) has released results for the 2023 Medicine and Pediatric Specialties Match, its largest...

www.prnewswire.com

https://www.nrmp.org/wp-content/uploads/2023/11/2023-MPSM-Match-Results-Statistics-Report.pdf

View attachment 379297

nice it has dipped from 70% the last few years.


for all cardiology and PCCM candidates who failed to match, do NOT NOT NOT NOT scramble into Nephrology. You will regret this.

I know there is an empty hole in your heart right now. Do not be tempted by the Nephrology sirens. These remaining scramble programs are bottom barrel trash. Even if you suddenly loved the beans, you want to apply next year to the beans.
Logically, if you cared about nephrology you would have applied to a TOP nephrology program.

All of the residents whom failed to match cardio or PCCM whom I have given advice to did not accept renal and did more research and networking and ultimately made it into their primary subspecialty in one or two years.

Do not be fooled by that "heart lung kidney connection," the beans were not your first passion.

doing another fellowship does NOT make your resume look more competitive to reapply to cards or PCCM. This is not like med school where you need to stuff the stat sheet.
If you want to be a pulmonary renal person like me then finish PCCM then do renal after at a TOP ACADEMIC PROGRAM
If you want to be a cardionephrologist, do Cardio first then do renal at a TOP ACADEMIC PROGRAM and get that SCUF going for CHF patients.

Well, at least the predatory private practice Nephrology groups won’t have any suckers to prey on for another two years.

 

[NewYorkDoctors]

for anyone who did not match to primary subspecialty choice and is getting renal offers, please take your time to read this ENTIRE THREAD in its entirety.

I know people are reading. last Thursday views for 204K. now it's 206K

 

[CRRT]

Apocalypse Nephrology

This summer I was really optimistic. I was riding a #Flozin high that was being further buoyed by the successes of finerenone. Long dormant fields were yielding fresh life. How long has it been sin…

pbfluids.com