Hello anyone interested in nephrology fellowship. Welcome!
The objective of this thread is to give a real insight into program so if you do consider it you know what you are getting. Also to provide you with the types of questions I wish I knew to ask on my fellowship interviews.
USC:
Pros:
There is a night float system that means you do not need to be on call as much as traditional call system.
Night float is a home call but see below.
There are some good attendings but see below.
The pathologist are wonderful and great teachers.
There are NPs/PAs but see below.
The transplant service support staff is amazing.
There is a good breadth of patients due to high volume.
The fellows work well together.
Cons:
Great attendings are leaving the program or being forced into retirement. The quality of teaching is going down. Teaching is getting pushed off onto the fellows, ie fellows teaching fellows.
Night float is a home call but in reality you will need to come in multiple times a night.
Night float also means that for the two week blocks of nights (1.5-2 months) you with routinely have more than 30 pages, and sometimes up to 10 consults between 3 hospitals and cross cover sometimes more than 100 patients. There is a Sunday night call that is 20 hours long. There is no help on night float.
Nephrology is primary on transplant patient which means surprise transplant middle of the night admissions, surprise transplants. The communication is poor and the fellow is often unaware of incoming transfers/admissions until they arrive at 3 AM. Night float is an extension of the transplant service in reality.
Fellow burn out scores were very high. There are wellness gestures (gifts, meals) but overall fellow wellness is poor.
There is no progressive autonomy. If you are a student that is returning from practice especially this will be extremely difficult. One such fellow quit in the last few years (he was a hospitalists and left during the first year).
There are multiple attendings that are not skilled clinicians and do not contribute to your growth or learning.
The NP/PAs are designed to help the fellows but get preferential treatment (as employees): more days off, less responsibility and readily transfer said responsibility to the fellows. Fellows have routinely had to cover the NP/PAs on days off, vacation, meetings from their lighter rotations.
The 2020 start year of 4 USC residents were interested in nephrology, none selected USC as their fellowship.
The 2020 start year also included 2 family members of a former fellow, neither selected USC as their fellowship.
Questions to ask of any program:
Have any fellows left the program in the last 2 years? If so why?
Have you retained any residents from the parent IM program in the last 2 years?
What is the call system like? What are the expectations of the person on call? Ie is there clear delineation of call being for emergency only or are you expected to see routine consults too? Are you expected to see ESRD face to face overnight? (In practice you would never see routine consults overnight.)
Who can consent the patient? (In practice the RN would consent the patient. Some fellowships force the fellow only to obtain consents which makes everything much more difficult.) Do ESRD patients need new consents? (They should not.)
What is fellow wellness like? Are there objective measures of wellness (ie burn out scores obtained routinely)?
What types of electives or learning enhancements are available? (Any program will have holes in education and you need to know how to you fill those gaps and if the program is supportive of you trying to learn more than it can provide meaning conferences and outside electives.)
Can I reach out to all the fellows to ask questions? (If a program only allows you to speak to a few select fellows be suspicious, especially if that is only the junior fellows. They are probably hiding something if they do not let you talk to every fellow if asked.)
Those should be some red flag questions to ask. Do not be afraid to ask them. Remember, they need you more than you need them. Two years can feel like eternity in the wrong program with a bad culture. Also trust your gut, if a place feels like everyone is miserable and putting on a good show to lure you in, they probably are. Also know that there are programs that are not toxic and nurturing; you just need to know how to find them.
Good luck and hopefully you have a great experience in fellowship!
The objective of this thread is to give a real insight into program so if you do consider it you know what you are getting. Also to provide you with the types of questions I wish I knew to ask on my fellowship interviews.
USC:
Pros:
There is a night float system that means you do not need to be on call as much as traditional call system.
Night float is a home call but see below.
There are some good attendings but see below.
The pathologist are wonderful and great teachers.
There are NPs/PAs but see below.
The transplant service support staff is amazing.
There is a good breadth of patients due to high volume.
The fellows work well together.
Cons:
Great attendings are leaving the program or being forced into retirement. The quality of teaching is going down. Teaching is getting pushed off onto the fellows, ie fellows teaching fellows.
Night float is a home call but in reality you will need to come in multiple times a night.
Night float also means that for the two week blocks of nights (1.5-2 months) you with routinely have more than 30 pages, and sometimes up to 10 consults between 3 hospitals and cross cover sometimes more than 100 patients. There is a Sunday night call that is 20 hours long. There is no help on night float.
Nephrology is primary on transplant patient which means surprise transplant middle of the night admissions, surprise transplants. The communication is poor and the fellow is often unaware of incoming transfers/admissions until they arrive at 3 AM. Night float is an extension of the transplant service in reality.
Fellow burn out scores were very high. There are wellness gestures (gifts, meals) but overall fellow wellness is poor.
There is no progressive autonomy. If you are a student that is returning from practice especially this will be extremely difficult. One such fellow quit in the last few years (he was a hospitalists and left during the first year).
There are multiple attendings that are not skilled clinicians and do not contribute to your growth or learning.
The NP/PAs are designed to help the fellows but get preferential treatment (as employees): more days off, less responsibility and readily transfer said responsibility to the fellows. Fellows have routinely had to cover the NP/PAs on days off, vacation, meetings from their lighter rotations.
The 2020 start year of 4 USC residents were interested in nephrology, none selected USC as their fellowship.
The 2020 start year also included 2 family members of a former fellow, neither selected USC as their fellowship.
Questions to ask of any program:
Have any fellows left the program in the last 2 years? If so why?
Have you retained any residents from the parent IM program in the last 2 years?
What is the call system like? What are the expectations of the person on call? Ie is there clear delineation of call being for emergency only or are you expected to see routine consults too? Are you expected to see ESRD face to face overnight? (In practice you would never see routine consults overnight.)
Who can consent the patient? (In practice the RN would consent the patient. Some fellowships force the fellow only to obtain consents which makes everything much more difficult.) Do ESRD patients need new consents? (They should not.)
What is fellow wellness like? Are there objective measures of wellness (ie burn out scores obtained routinely)?
What types of electives or learning enhancements are available? (Any program will have holes in education and you need to know how to you fill those gaps and if the program is supportive of you trying to learn more than it can provide meaning conferences and outside electives.)
Can I reach out to all the fellows to ask questions? (If a program only allows you to speak to a few select fellows be suspicious, especially if that is only the junior fellows. They are probably hiding something if they do not let you talk to every fellow if asked.)
Those should be some red flag questions to ask. Do not be afraid to ask them. Remember, they need you more than you need them. Two years can feel like eternity in the wrong program with a bad culture. Also trust your gut, if a place feels like everyone is miserable and putting on a good show to lure you in, they probably are. Also know that there are programs that are not toxic and nurturing; you just need to know how to find them.
Good luck and hopefully you have a great experience in fellowship!
