I know. I was kind of shock when she said that. She is still at this job. I guess they will be dragging their feet before giving her that green card.lol you could get that job in LA…
I know. I was kind of shock when she said that. She is still at this job. I guess they will be dragging their feet before giving her that green card.lol you could get that job in LA…
well when you dont have any procedures or H&P/discharge summaries to do, guess you gotta do something right lol?What do you mean?
I think the subject matter is fascinating.
Nephrologists in my hospital seem to be the only IM subspecialty who remember a lot of things about IM not related that much with nephro
Fundamentally the reason this specialty can’t attract fellows is simple: it’s a bad specialty. These PDs try to spin the narrative that it’s a misunderstood specialty, just makes it more fake and insincere when people have already voted with their feet. I would be more open to joining a program if PD came out and said I can’t offer you anything except to satisfy your itch of being a specialist.
you mad ?You have posted hundreds of very similar messages in this very thread. I don't doubt your point. But this obsession is super weird. Hope you are all right.
you mad ?
He is trying to warn med students and residents. There is nothing wrong with that. What I have noticed in medicine is that we tend to buy whatever BS academia is selling.Hope you are all right too. I see you have posted hundreds of very similar messages as well. Peace out
stay mad bruh.Hope you are all right too. I see you have posted hundreds of very similar messages as well. Peace out
They can always become hospitalists. The 2-yr opportunity cost is not outrageous. I only make a little bit over 1 mil in the 2.5 years as a hospitalist since I left residency.I’ve just had too many friends and cofellows who really screwed themselves by going into nephrology. Hard to turn back the clock when you have invested this many years. When we went into the specialty, there was darth of info on what was really happening in private practice , and so academics lied thru their teeth to get fellow to stick around. I don’t want the same fate for newer generations as they are the ones taking all the career risks here.
Are they IMG or FMG? There is a difference.These threads are necessary. I don't think there's a strong IMG presence here on SDN, and everyone who matches into nephrology from my IM program is an IMG. I doubt they know half of what's posted here.
stay mad bruh.
They can always become hospitalists. The 2-yr opportunity cost is not outrageous. I only make a little bit over 1 mil in the 2.5 years as a hospitalist since I left residency.
Varies significantly with location and size of the dialysis unit. 100k/yr is fair for an average unit. The problem with these medical directorship agreement(MDA) fees is that many Neph groups have it in their contract that existing MDA fees are not shared with new partners. As an example, I know one group where the founding partner keeps all the MDA fees(4 units) and the other physicians just keep what they bill. Many Neph groups will have something along the lines that existing MDA fees are not shared with new partners, but if a new unit opens up, he can take that one. More of an empty promise because it may never happen.Curious, How much does being Medical director of a dialysis center pay on an average ?
That is a pretty nice gig. No wonder these nephrologists here are freaking rich.Varies significantly with location and size of the dialysis unit. 100k/yr is fair for an average unit. The problem with these medical directorship agreement(MDA) fees is that many Neph groups have it in their contract that existing MDA fees are not shared with new partners. As an example, I know one group where the founding partner keeps all the MDA fees(4 units) and the other physicians just keep what they bill. Many Neph groups will have something along the lines that existing MDA fees are not shared with new partners, but if a new unit opens up, he can take that one. More of an empty promise because it may never happen.
Partnership contracts are written by partners to favor them. New grads are too green to pick up these sleight of hand changes and naively think there is endless growth of dialysis units when the ESRD population is actually shrinking in this country.
lol i dunno. doing dialysis rounds is supposed to be just focus on the HD , ESRD, AV access, BP, nutrition, transplant, etc...That is a pretty nice gig. No wonder these nephrologists here are freaking rich.
How many chairs an average unit might have?
I think the big caveat here is with the assumption that the private practice group will treat them fairly. In my experience, at least half of Neph grads will enter exploitative groups where there is unequal split in ancillary income post-partner and they may not make more money than a hospitalist. Unfortunately, most new grads are not sophisticated enough to “figure out the trap” when they sign their employment contracts.If the candidate join a good private practice, they can recover their losses overtime.
They refuse to address the problem because they are the stakeholders in the game. They benefit from the ignorance of neph applicants who continue to supply the slave labor needed to churn the wheels of academic programs and private practice groups, while the benefits only flow to the top.Frequently, those in the room are main contributor to the problem. And they refuse to address elephant in the room.
I train nephrology fellows. I help educate them about business. only one in 6 private group contracts is OK and I advice against joining the rest. I made one of the nephrology groups in town mad because I told a recruiter that I will never send fellows to then as they exploit new employees. Another group has a scaled up partnership over 7 years.
Do you still recommend that people apply for nephrology? And if yes, please tell me if Academic Nephrologists are trying to find solutions to make sure new grads don't go into these predatory Private practices. Also, IMGs who are US citizens, do they have any better chance of finding good private practices or have a chance to have a satisfactory career?I train nephrology fellows. I help educate them about business. only one in 6 private group contracts is OK and I advice against joining the rest. I made one of the nephrology groups in town mad because I told a recruiter that I will never send fellows to then as they exploit new employees. Another group has a scaled up partnership over 7 years. Division chiefs and Dept chairs have their big salaries and they would keep fellows if they can. Now it is more common to hire from the inside than outside.
Here is the big one: Nephrology is now a BROWN specialty and most of new fellows are IMGs. This is a vulnerable population due to the VISA need (it takes some of them 9-14 years to get a green card through the H1 and labor cert route, yes we do not get fellows from Liechtenstein who has very short wait from green card). However, because almost all IMGs do not have medical school loans and >80% are 2 physician family, lower pay with low work load is not only acceptable, but desirable.
I’ve never met an academic nephrologist not recommend nephrology to an applicant. Have you ever met a realtor who says it’s not a good time to buy a house?Do you still recommend that people apply for nephrology?
It would be naive to think academic nephrologists or even ASN, can do anything to change how private practice groups operate.And if yes, please tell me if Academic Nephrologists are trying to find solutions to make sure new grads don't go into these predatory Private practices.
Yes, you have slightly higher chance of not falling into job pitfalls that an IMG needing visa waiver will typically have to take. But I know plenty of nephrologists who are US citizens who are not practicing nephrology right now.Also, IMGs who are US citizens, do they have any better chance of finding good private practices or have a chance to have a satisfactory career?
That’s pretty good money for 7 on/14 off. You will certainly have to work a lot harder as a private practice nephrologist. Believe it or not, I actually encourage you to chase your dream. But make sure it really is your dream. And also go into it with the mentality if it doesn’t work out down the road, you are emotionally strong enough to stomach that outcome.For context, I am an IMG practicing Hospitalist Medicine 7 ON 14 OFF (nights only) making $280K,
I know! I have a decent gig. It is a good lifestyle with the potential to make more money since more than half of the year I'm OFF. However, I don't like Hospitalist work. I have moved from days to nights, which is much better—less administration BS. However, covering multiple day teams at night has its issues. But I enjoy managing patients at night and doing a lot of POCUS. I tell my co-workers and friends that this gig is like a "Roller-coaster." At the end of my WEEK ON, this is the best job ever. However, my last three days of OFF are when I get so depressed and lurk around these forums. I can do this right now (12 hours shift in a week = 84 hours) given I'm young, I don't know if I would be able to do the same after 10 years. I can never do a DAYS Hospitalist job, though. That is what makes me think that if there is anything I should do, now is the time. I do like how @NewYorkDoctors has set up his practice. However, if I do Nephrology, I would like to do Nephrology only (ideally). I've noticed money doesn't drive me. Not that I'm saying that it doesn't matter. Of course, I also enjoy finer things in life, plus I have a family to feed. My friends keep picking up more shifts on their days off. Meanwhile, I would get depressed even if I had to pick one more shift in a month.I’ve never met an academic nephrologist not recommend nephrology to an applicant. Have you ever met a realtor who says it’s not a good time to buy a house?
It would be naive to think academic nephrologists or even ASN, can do anything to change how private practice groups operate.
Yes, you have slightly higher chance of not falling into job pitfalls that an IMG needing visa waiver will typically have to take. But I know plenty of nephrologists who are US citizens who are not practicing nephrology right now.
That’s pretty good money for 7 on/14 off. You will certainly have to work a lot harder as a private practice nephrologist. Believe it or not, I actually encourage you to chase your dream. But make sure it really is your dream. And also go into it with the mentality if it doesn’t work out down the road, you are emotionally strong enough to stomach that outcome.
If anything in nephrology can be fixed, it would not be languishing as a bottom rung specialty for a decade now. What amazes me though, that neph fellows are still unaware of what’s happening in the real world.I still don't understand how a supply : demand mismatch is not working well for nephrology.
And my second question is, how to fix this.
I enjoy the topic of Nephrology more than Allergy, Rheum, and Endocrine. But those are good options in terms of money and lifestyle.You can also consider allergy, rheum, and endocrine.
It could if you subtract the chronic HD part of things. this is only feasible if you open up your own private practice.I'm even ok NOT making Heme/Onc money in Nephrology as long as my quality of work improves compared to Hospitalist and I get to spend enough time with my family; I think I'll be happy. However, sounds like Nephrology doesn't even offer that.
I don't have a problem with what you are saying. Every one of your scenarios is possible. I'm not saying it's likely or probable.Find a good group which is collaborative, full partnership in 2 years.
Every private Nephrology group hides their "dirty laundry".
I interviewed with a group who were excited about recently joining some national group Panoramic Health. At first, it sounded exhilarating.
On more probing, about my projected income after becoming a partner, I learned that they expect their projected income to plunge by 100k annually after joining Panoramic Health. I couldn't comprehend the reason for practice to join Panoramic Health. Later, local Nephrologist educated me, it appears that the group received $$$$ upfront to join. There is no upside for a graduating fellow to join such a group. If it was not for a "slip of tongue" moment during dinner among senior partners, I would have not know this. For me, this was RUN RUN RUN.
If anyone has more information about good groups to Join? Prefer warmer weather.
I take it you haven’t interviewed at a lot of neph programs. Hopium get sold all the time, especially when they can’t find anyone to take their fellowship positions.From my limited experience, I have never met a nephrologist who encourages residents to apply to nephrology. They are always approachable if you should interest, and they will not sell you hopium.
im not sure that's the right analogy. Cypher took the blue pill. to him it was real and he had a nice steak.Would you rather take the red pill or blue pill?
You will not get interviewed unless you applied.I take it you haven’t interviewed at a lot of neph programs. Hopium get sold all the time, especially when they can’t find anyone to take their fellowship positions.
the top tier programs who have real education, the full braedth of nephrology services, good careers for fellows (whether in academia, return to their own countries, or a decent PP set up) do not have to pander and grovel. They just offer how good their program is and the fellows will comeYou will not get interviewed unless you applied.
You wouldn't apply unless you are interested.
My point is, not all PD's and nephrologists promote their specialty or try to actively recruit applicants. They didn't even promise good money.