Nephrology ...give me an insight please

[salam]

I am interested in Nephrology as career and I really like itbut I am having mixed messages about the salary and life style that nephrologists have , please if someone can shed the light on this issue.....thanks

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[Atlas]

Renal medicine is hard to make a living nowadays. I'm on my second renal month and the days can be long and very stressful. The pay is ok, but considering what you have to do I'm having second thoughts about renal myself. The hours are long, people need emergent dialysis at 2am, the fellowship is very very busy. The fellow I'm with says that he lost 25 lbs his first year of fellowship because he didn't have time to eat. It's not as "cushy" as people lead it to be! The money is not there like it was. Dialysis would actually lose money now if it weren't for injectable meds like epo. And at the current rate of slashing payments, that's next too. Working hard, you MAYBE can hit 300-350k. And that's busting your butt!! I was heavily into renal, but now I'm considering other options...just keeping my options open! I definately think you honestly have to LOVE it because the money won't be there and the lifestyle can be hectic. Again, this is my second month of renal and it's busy, but a lot of docs are feeling worn down from being consulted for every creatinine above 1.5. You can still make a pretty good living, but that's changing. I hope this helps.

Atlas

 

[drsnh]

i am applying for renal this yr . it would be better if we start a thread upon this discussing various topics

 

[salam]

Renal medicine is hard to make a living nowadays. I'm on my second renal month and the days can be long and very stressful. The pay is ok, but considering what you have to do I'm having second thoughts about renal myself. The hours are long, people need emergent dialysis at 2am, the fellowship is very very busy. The fellow I'm with says that he lost 25 lbs his first year of fellowship because he didn't have time to eat. It's not as "cushy" as people lead it to be! The money is not there like it was. Dialysis would actually lose money now if it weren't for injectable meds like epo. And at the current rate of slashing payments, that's next too. Working hard, you MAYBE can hit 300-350k. And that's busting your butt!! I was heavily into renal, but now I'm considering other options...just keeping my options open! I definately think you honestly have to LOVE it because the money won't be there and the lifestyle can be hectic. Again, this is my second month of renal and it's busy, but a lot of docs are feeling worn down from being consulted for every creatinine above 1.5. You can still make a pretty good living, but that's changing. I hope this helps.

Atlas

Thank you for your comment ...wow ...I am more confused now ...it is amazing to see a drop in the dialysis payment while more people are expected to be on in the coming decads..there are 20 millions americans who have CRF and it is expected to rise specially with obesity DM, HTN..etc ..
That should creat better and stronger demands for nephrologist ...( I thought)

 

[Atlas]

If you go to the ASN website there is an editorial titled something like "if there is such a shortage of nephrologists where are all the jobs???". It is something to that effect. There are jobs out there but they aren't THAT great. My attending (a nephrologist) said that starting salaries in my area (Ohio) are around $150,000 and after you're established and WORKING REALLY REALLY HARD you can make $250,000. And that's working close to 80 hours a week. Anyways, I doubt there will be any significant INCREASES in pay/reimbursement...you'll just have to work harder and harder to make the same amount of money. Seriously, the financial picture is not looking so good. Granted, I don't have a crystal ball, but since dialysis is totally dependent on Medicare reimbursement, unfortunately, I don't see Uncle Sam increasing nephrologists pay. It's funny, but it's true that medicine is the only occupation where supply and demand don't equal more money. If it did, FP would be one of the highest paid!!

 

[maxpower75]

First a disclaimer, I am beginning my Renal fellowship in the future, so I may be a bit biased, However, I have spoken to several people in the field (private and Academic), and I am based in the southwest. Here, the academic nephrology attendings are starting around 160K, private practice (where some of the fellows go) are usually starting in the 190-220K range. According to some of the private practice nephrologist in the area (>5years working), they all tell me they make >350K (one told me he made close to 6).
Of course this is all based on what I have been told by the people in the area, however most surveys show the median salary btw 220-270, so I doubt most nephrologist are working 80+ hours to earn the median salary for their field.
I wouldn't base a decision to pursue a fellowship based on the posts above, talk to people in practice (academic vs private), there are definately differences based on location. Good luck

 

[Atlas]

First a disclaimer, I am beginning my Renal fellowship in the future, so I may be a bit biased, However, I have spoken to several people in the field (private and Academic), and I am based in the southwest. Here, the academic nephrology attendings are starting around 160K, private practice (where some of the fellows go) are usually starting in the 190-220K range. According to some of the private practice nephrologist in the area (>5years working), they all tell me they make >350K (one told me he made close to 6).
Of course this is all based on what I have been told by the people in the area, however most surveys show the median salary btw 220-270, so I doubt most nephrologist are working 80+ hours to earn the median salary for their field.
I wouldn't base a decision to pursue a fellowship based on the posts above, talk to people in practice (academic vs private), there are definately differences based on location. Good luck

I have nothing to gain or lose by posting here. I'm just posting what my attending and I talked about just the other day. I agree, talk to people especially your attendings. I know my posts above were from an academic attending that has been out about 3 years and he never disclosed how much he made, but said it was enough (but he had no loans). The number of hours depends TOTALLY on the group and your call schedule. I know several private practice attending that do really well, I'm assuming 350k+ but they DO put in their time. There are 8 docs in the group, so call is ok. But, when they are on call, they get killed! They are by far the busiest nephrologists I've seen. Their day is typically 12 hours long because they cover 5 hospitals and that includes weekend time. So, generally, I'd say they are around 60 hrs/wk off call and around 80 when on call. This is just one example from one group. Other groups are not this aggressive, but their salaries are not as impressive. The saying "the more you work, the more you make" is so true.

 

[salam]

I am very thankful for you to post an answer to my question...but....another question ...I am doing now a critical care fellowship and I am looking for nephrology fellowship....what is the advantage of having critical care board besides your nephrology board...??
thanks

 

[Renovar]

I have nothing to gain or lose by posting here. I'm just posting what my attending and I talked about just the other day. I agree, talk to people especially your attendings. I know my posts above were from an academic attending that has been out about 3 years and he never disclosed how much he made, but said it was enough (but he had no loans). The number of hours depends TOTALLY on the group and your call schedule. I know several private practice attending that do really well, I'm assuming 350k+ but they DO put in their time. There are 8 docs in the group, so call is ok. But, when they are on call, they get killed! They are by far the busiest nephrologists I've seen. Their day is typically 12 hours long because they cover 5 hospitals and that includes weekend time. So, generally, I'd say they are around 60 hrs/wk off call and around 80 when on call. This is just one example from one group. Other groups are not this aggressive, but their salaries are not as impressive. The saying "the more you work, the more you make" is so true.

I will be a nephrology fellow in ~gash~ 7 months and have talked to many people in the field from all spectrum of practice. And my feeling towards the topic about income/lifestyle is always as follows: any field in medicine is what you make of it. You can bust your butt in pp and make a $hitton but have no life, or take it relatively easy and make "average". It's the truth of almost any field, even if you go to primary care pp, you can expect to bust your chops 60-80/wk if you want to make a good amount. In the age of shrinking pie, every field (especially the fields that are currently lucrative) is going to eat a cut of some shape or form. Ultimately you gotta do what you enjoy doing. Overall nephrology is not a life-style oriented subspeciality - not the harshest but by no means cush at all. And as a fellow (especially first years), you do bust your chops almost regardless of where you train.

With that being said, I think in terms of longterm outlook, depending on area of the country, the jobs are more or less there. Just like every field, you will find more saturation in metro areas and more vacancies in the rural areas. Heck, even right now before I am even started, I am starting to have recruiters email/calling me promising me 20k signing bonus or loan repay if I sign on to join nephrology groups in rural midwest towns, many have pretty decent incentives too. Given the overall aging population, job security is very much there, unless they start allowing NP's to dialyse people which I dont think will ever happen. (At least so far) I do not regret commiting a career to nephrology in any way, and am overall optimistic about its general outlook.

 

[Atlas]

I will be a nephrology fellow in ~gash~ 7 months and have talked to many people in the field from all spectrum of practice. And my feeling towards the topic about income/lifestyle is always as follows: any field in medicine is what you make of it. You can bust your butt in pp and make a $hitton but have no life, or take it relatively easy and make "average". It's the truth of almost any field, even if you go to primary care pp, you can expect to bust your chops 60-80/wk if you want to make a good amount. In the age of shrinking pie, every field (especially the fields that are currently lucrative) is going to eat a cut of some shape or form. Ultimately you gotta do what you enjoy doing. Overall nephrology is not a life-style oriented subspeciality - not the harshest but by no means cush at all. And as a fellow (especially first years), you do bust your chops almost regardless of where you train.

With that being said, I think in terms of longterm outlook, depending on area of the country, the jobs are more or less there. Just like every field, you will find more saturation in metro areas and more vacancies in the rural areas. Heck, even right now before I am even started, I am starting to have recruiters email/calling me promising me 20k signing bonus or loan repay if I sign on to join nephrology groups in rural midwest towns, many have pretty decent incentives too. Given the overall aging population, job security is very much there, unless they start allowing NP's to dialyse people which I dont think will ever happen. (At least so far) I do not regret commiting a career to nephrology in any way, and am overall optimistic about its general outlook.

Very nicely put.

 

[salam]

thank you all for posting a responses, can anyone of you comment on interventional Nephrology ?
thanks

 

[kdstoor]

The starting pay for primary care is 160 + 15 bonus after new pay revision.
9to 5 , no weekends.
My friend nephrologist started off at 160 for atleast 2 years.
If you are in for the money [ which ultimately determines how competitive a subspeciality is , believe it or not ] , forger nephrology.
The AssProf of nephro said the other day by 2016 expect drastic changes in funding for dialysis.
Not many country give free dialysis to all its population.

 

[salam]

I am not doing renal for money ..but still ..a hospitalist can make more in this case than a nephrologist ???what is going on with this speciality....

 

[newdoc010]

OK, OK... All this worries me. I am just starting to interview and I am hearing such sad stories. I am in the midwest and the starting here is 250 K and partners make 300-350 K with ok work. My friend just joined a practice down south and starting 250 K with the youngest partner making 450 K. So I am not sure what all the frowning is about. The median salary is 250-350 K for nephrology and granted the more you work the more you make still holds. Primary hospitalists can make 160-200 K starting with 2 weeks on and 2 weeks off but they are putting in the same hours when calculated for the 2weeks of 8-8pm. So it is slightly better.

 

[ragred]

Iam interested in nephrology and would be going into it pretty soon. I applied to neph out of interest. I have a few Ex-fellows who are being paid 160k for 2 years.,and 60-80 hrs a week.
Now , few other friends of mine who joined as internists , guess what they are being paid.. 180K for 2 weeks on 2 weeks off . Do the math.. and the work hrs suck specially if you are working your butt off for 2 weeks but then you have the remaining 2 weeks vacation... AWESOME. you have all the time to spend that money .
Nephrology is a challenging field specially if you are in academics ,, which I would eventually want to ..
If in private practice the max you get is 250-350 depednding on location.
If you want to make money and enjoy life go for a hospitalist's job. you can make more than a nephrologists if you work that 3rd week also and take only one week off.
Let me know your thoughts on this

 

[hurdle2kross]

Hospitalists (2weeks on 2weeks off or one on one off) is very tough, don't even think about it. Nephrologist >>> than hospitalist, as far work and money is concerned.

 

[salam]

can anyone please provide me with the difference in Nephrologist salary depending on the geography ?
I mean like ..how much a nephrologist makes as an average in texas compared to the northeast ( NY, NJ)
thanks

 

[singh83]

I'm also interested in how much the average nephrologist makes in California - academic vs private vs. mixed?

 

[LanceArmstrong]

I know this sounds boorish but I heard that interventional nephrologists make big bucks - but I am confused as to what they do - I mean nephro is an IM subspecialty I dont see them putting in grafts, ciminos, etc. that to me is a vascular surgery job ...

 

[polaris1]

please don't go into nephrology if you are a money grubber. we don't need you. complaining about $350K? pathetic. go get your mba and get out of medicine. it will benefit all involved.

 

[maxpower75]

I am a final year Nephrology fellow, and I have begun the interviewing process for jobs in private practice. To clarify some issues, Interventional Nephrologist essentially place tunelled dialysis catheters as well as declot fistula's and grafts. I wouldn't say they make "big bucks," as they function as part of a nephrology group that starts its own vascular center. Essentially they increase the revenue for all the partners in the group. Most interventional Nephrologist do 50% intervention and 50% general Nephrology, groups that have started their own access center generally earn more money for the partners.
Generally the starting salary for nephrologist are about the same as Hospitalist, and sometimes less, you will also put in lots of hours, the main difference occurs once you become a partner in a group, and can share in the medical director income, access unit etc.
There is no question that there is going to be goverment changes in the reimbursment system for Nephrologist, however this will probably affect all aspects of medicine. Some will falter, others will thrive based on the new payment schemes.
Hope this was helpful

 

[msood99]

Im a canadian staff nephrologist and Im tired of reading all of the misinformation. Many of the low salaries in nephrology are strictly in the USA. In canada I started at 400k + at an academic centre! Nephrologists are mcuh, much better reimbursed in Canada vs USA and job opportunites are readily available. Our reimbursement has no connection with iv medication adminsitration.

 

[Atlas]

It helps to know someone. That's really key in getting a spot. Either know someone really well or do well in a residency program affiliated with a fellowship.

 

[spectrin]

i want to resurrect this old thread to see if there any any more insights in nephrology

 

[bigdog8829]

bump x2.

 

[Ash MD]

good luck everyone.

 

[Transition Consultants]

Im a canadian staff nephrologist and Im tired of reading all of the misinformation. Many of the low salaries in nephrology are strictly in the USA. In canada I started at 400k + at an academic centre! Nephrologists are mcuh, much better reimbursed in Canada vs USA and job opportunites are readily available. Our reimbursement has no connection with iv medication adminsitration.

Based on national salary data for nephrologists, your compensation is somewhere around the 90% percentile of what a nephrologist could obtain in the united states. Is this the norm in canada or is it reflective of higher tier compensation in that country?

 

[Nephro2012]

Hello Guys,

Just bumping the thread for the question unanswered- Nephrology + Critical care? How does the schedules work? Anyone with any opinions/comments/insight?
Tx in advance

 

[Kidney007]

I would be curious to know what is the current situation for nephrologists in USA. I'm a Canadian nephrologist working in a non academic centre and I make around 450k/year (after overhead expenses). The average salary for nephrologists in Canada is probably 300-400k/year, but some provinces are below average (e.g. Quebec) and some are above the national average (e.g. Alberta).

 

[Top Gun]

As someone who will be starting nephro fellowship in July, I will say this. Do not go into nephrology if your goal is to make a ton of money. Go into it because you enjoy it. Go into it because you're really interested in the pathophysiology and management of renal disorders. Now that payments for dialysis are being bundled, there will be less reimbursement for it in the future. If money were my primary goal, I would have taken a hospitalist job where I get every other week off and only work 7 to 7, and still make $250,000 a year..