Nephrology is Dead - stay away

[Tenesmus83]

I think you bring out important points to to consider. Applicants are in the dark on many of these issues that are not being talked about. Someone needs speak the truth!

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[blue.jay]

Like these posters
@Renal_Prometheus @Tenesmus83 have told us, there is no shortage of nephrology supply though the match rate is low. It appears like nephrology supply will eventually be low and demand will be higher decades later due to many unfilled spots but that doesn't seem to be the case based on this ASN data.

 

[Renal_Prometheus]

There's tremendous oversupply of neph graduates, and most will eventually end up back as hospitalist once they figure it out. Like the OP of this original of thread stated 4 years ago, employers don't need to take you seriously. They just keep churning new grads without really needing to make you partner. There is plenty of fresh meat out their to exploit, especially IMGs with visa issues. With declining reimbursement, even some of the more reputable groups are getting into this action. Trust me, they love IMGs with visa problems. It means you can't leave the practice or you have to leave the country. When the starting salary for nephrology is around 200K/year, driving to 4-5 places per day, taking night calls Q4. They love you guys. And you know what else. Fellowship programs love you guys too. They are willing to take anyone who applies. Even people without a residnency. EXPLOITATION EVERYWHERE!!
Why do people not learn their lessons years ago. This thread was published in 2016. They fall for the same trap over and over again. It's because the specialty is easy to get into and people are looking for an escape from reality. But reality always comes back to bite you in the end.

 

[Renal_Prometheus]

View attachment 329328
Like these posters
@Renal_Prometheus @Tenesmus83 have told us, there is no shortage of nephrology supply though the match rate is low. It appears like nephrology supply will eventually be low and demand will be higher decades later due to many unfilled spots but that doesn't seem to be the case based on this ASN data.

you are starting to figure out the trap.

 

[Renal_Prometheus]

In my experience with academic nephrologists, they are really afraid. They are afraid that if their fellows find out neph is a dead end, they would drop out and the attending will have to pick up the slack. They are already underpaid and are only doing it for the lifestyle. They are afraid of their own fellows.

 

[Renal_Prometheus]

other people are welcome to post their experiences on this thread as well. I don't want to dominate the discussion.

 

[FutureDO1992]

other people are welcome to post their experiences on this thread as well. I don't want to dominate the discussion.

I believe everything you have been saying since I have heard others with similar Nephro stories.

I am curious though where the salaries come from that Medscape comes out with every year because I believe it is typically in the >300K range which is definitely higher than IM.

Are these the more established Nephros who are reporting these salaries?

 

[Renal_Prometheus]

I believe everything you have been saying since I have heard others with similar Nephro stores.

I am curious though where the salaries come from that Medscape comes out with every year because I believe it is typically in the >300K range which is definitely higher than IM.

Are these the more established Nephros who are reporting these salaries?

Simple answer is you are correct, these are measures of established nephrologists who are practicing nephrology. What it doesn't take into account are those who have quit nephrology(maybe 1/3 of recent graduates) because it was not financially worthwile to keep doing nephrology. Their salaries are not being factored in, so there is a sample bias. But honestly, a hospitalist working 7 on 7 off usually can make 250K base + 50K performance bonus, so you are already at 300K/yr. So it's not that much difference to begin with.

 

[sloh]

Simple answer is you are correct, these are measures of established nephrologists who are practicing nephrology. What it doesn't take into account are those who have quit nephrology(maybe 1/3 of recent graduates) because it was not financially worthwile to keep doing nephrology. Their salaries are not being factored in, so there is a sample bias. But honestly, a hospitalist working 7 on 7 off usually can make 250K base + 50K performance bonus, so you are already at 300K/yr. So it's not that much difference to begin with.

Thanks for your contributions to SDN. I’m PM&R but have found your posts on Nephrology very eye opening. There’s something to take away for other specialties as well since job market and income are largely dictated by similar factors.

 

[Tenesmus83]

Thanks for your contributions to SDN. I’m PM&R but have found your posts on Nephrology very eye opening. There’s something to take away for other specialties as well since job market and income are largely dictated by similar factors.

yes, thank you @Renal_Prometheus for your contribution to SDN. It's something that I always knew about nephrology, but you are the only one who came on and spoke the truth.

 

[Renal_Prometheus]

You are all welcome! somehow the mods here think of me as more of nuisance than a net positive. Anyhow, y'all be care out there! I can now ride off into the sunset.

 

[FutureDO1992]

You are all welcome! somehow the mods here think of me as more of nuisance than a net positive. Anyhow, y'all be care out there! I can now ride off into the sunset.

What's your take on interventional nephro? Just a last ditched effort to revive the field?

Is there any circumstance you would recommend a nephrology fellowship to anyone?

 

[Renal_Prometheus]

What's your take on interventional nephro? Just a last ditched effort to revive the field?

Is there any circumstance you would recommend a nephrology fellowship to anyone?

you can read on this thread my take on interventional nephro.

Interventional nephrology

Hello guys, What I know about interventional nephrology is that you can be certified via training or practice pathway. Anyone knows if practice pathway can be done through practicing under the supervision of interventional radiologists or vascular surgeon rather than interventional nephrologist?

forums.studentdoctor.net

Would I recommend nephrology? No. But it's your life. If you absolutely love the subject matter, and don't care about reimbursement/lifestyle, then go for it. Maybe you will get lucky and land in a good spot, who knows? It's not betrayal if you go into something not expecting high outcomes to begin with. I just don't like how some of these academic nephrologists mislead applicants on how great this specialty is, and then when they go into private practice get completely clobbered. That hurts more.

 

[blue.jay]

There are other fun subfellowships to consider as well...
Like ..

Advanced Dialysis Fellowship​

University of Washington - An advanced 1-year fellowship devoted to technical aspects of dialysis

 

[somedoc1595]

you can read on this thread my take on interventional nephro.

Interventional nephrology

Hello guys, What I know about interventional nephrology is that you can be certified via training or practice pathway. Anyone knows if practice pathway can be done through practicing under the supervision of interventional radiologists or vascular surgeon rather than interventional nephrologist?

forums.studentdoctor.net

Would I recommend nephrology? No. But it's your life. If you absolutely love the subject matter, and don't care about reimbursement/lifestyle, then go for it. Maybe you will get lucky and land in a good spot, who knows? It's not betrayal if you go into something not expecting high outcomes to begin with. I just don't like how some of these academic nephrologists mislead applicants on how great this specialty is, and then when they go into private practice get completely clobbered. That hurts more.

Are you a practicing Nephrologist?

 

[Renal_Prometheus]

Are you a practicing Nephrologist?

what do you think?

 

[somedoc1595]

what do you think?

I think you haven’t ever answered the question though it’s been asked before, and I’m wondering why since you are one of like 3 people who regularly post regarding Nephrology. I think everyone should question anonymous internet sources before taking their advice.

 

[Test Boy]

I think you haven’t ever answered the question though it’s been asked before, and I’m wondering why since you are one of like 3 people who regularly post regarding Nephrology. I think everyone should question anonymous internet sources before taking their advice.

He probably was or is a practicing nephrologist. If such a huge percentage of fellowship spots go unmatched every year, there’s probably some truth (or a lot) to what he said.

 

[Scope guy]

I think you haven’t ever answered the question though it’s been asked before, and I’m wondering why since you are one of like 3 people who regularly post regarding Nephrology. I think everyone should question anonymous internet sources before taking their advice.

whatever @Renal_Prometheus has posted are absolute gold dust info that noone tells applicants. there is a reason why nephrology fellowships dont fill and take mostly imgs.

 

[Renal_Prometheus]

whatever @Renal_Prometheus has posted are absolute gold dust info that noone tells applicants. there is a reason why nephrology fellowships dont fill and take mostly imgs.

thank you all for the praise. I'm just trying to help the little guys.

 

[georgestone]

Nephrology is going thru a depressing time , low applicants , least competitive jobs , lack of innovation, worst work to income ratio and more have devastated the land scape , half of nephrologist switch to hospitalist in less than 10 years of completing their fellowship , this is a alarming number

Many programs are still clinging to old glory days which are long gone and discourage their fellows if they wish to pursue critical care accusing them of using neph as backdoor or launching pad, I had friends from good North east and midwest/texas Neph programs suffer from hostility because their pursuit of CCM & offended the Neph program

 

[georgestone]

thank you all for the praise. I'm just trying to help the little guys.

I agree with you that Neph programs blatantly lie and create fake impressions , I did Neph from a well known Neph program and found the inner workings depressing , they had no respect amongst other departments , were frustrated bc of their low wage , kept talking about amazing innovation in Neph which no one sees etc , had extremely low applicant numbers and were begging candidates to join

its a dead field , apart from lack of fellowship applicants , programs have a hard time even recruiting the midlevel's since even they know to stay away from it

 

[georgestone]

Also I would like to warn Nephro ccm candidates to discard this notion that nephrology training prepares you for ccm , unfortunately this is incorrect , Neph training programs are way behind and treat their fellows as Note writing jockeys or for night calls . Neph training doesnt prepare you to do POCUS , , intubations , mechanical ventilation and other procedures , so for any one who is doing one yr ccm , its very tough to get good at ccm skills, this is what I witnessed during my Interview trail that for one yr program generally wants a well groomed candidate , several faculty members from many ccm programs expressed frustration and conveyed that Neph fellows undergoing CCM training were out of their depth

so be ware , and ID CCM combo is even worse ,

I have completed my CCM training after doing Nephro and I knew this fact going into ccm and have come across other candidates who are clueless about it .

 

[Scope guy]

Also I would like to warn Nephro ccm candidates to discard this notion that nephrology training prepares you for ccm , unfortunately this is incorrect , Neph training programs are way behind and treat their fellows as Note writing jockeys or for night calls . Neph training doesnt prepare you to do POCUS , , intubations , mechanical ventilation and other procedures , so for any one who is doing one yr ccm , its very tough to get good at ccm skills, this is what I witnessed during my Interview trail that for one yr program generally wants a well groomed candidate , several faculty members from many ccm programs expressed frustration and conveyed that Neph fellows undergoing CCM training were out of their depth

so be ware , and ID CCM combo is even worse ,

I have completed my CCM training after doing Nephro and I knew this fact going into ccm and have come across other candidates who are clueless about it .

If someone wants to do CCM, then why waste 2 years in nephro? Why cant just directly do 2 years CCM?

 

[CCM-MD]

If someone wants to do CCM, then why waste 2 years in nephro? Why cant just directly do 2 years CCM?

Can't get in maybe. Potentially false belief that doing a nephrology fellowship might help them get in, because there are already few pure CCM programs and even fewer 1-year spots.

 

[georgestone]

Can't get in maybe. Potentially false belief that doing a nephrology fellowship might help them get in, because there are already few pure CCM programs and even fewer 1-year spots.

there are only 35-38 Pure CCM programs and the competition is intense , sometimes more than 100 applicants per spot or even more , this competition hasnt become big news since Pure CCM programs arent a part of Match so data doesnt get published by NRMP as in case of cardio, GI etc

 

[georgestone]

If someone wants to do CCM, then why waste 2 years in nephro? Why cant just directly do 2 years CCM?

unfortunately , given there are less than 40 Pure CCM programs , alot of candidates are using Nephro and ID as back door for CCM since pure CCM is incredibly competitive , and for many Nephro programs offering Nephro CCM track has become the sole attraction for candidates , since they cant find cadidates otherwise

several Nephro programs in Midwest and now in Northeast coudnt even hire a Nephro fellow for several years and then started offering neph-CCM and suddenly there is influx of people

but doing ID-CCM or Neph CCM without honing on CCM skills ( 1 yr isnt enough ) would produce alot off CCM docs with less than average skills unfortunately

 

[Renal_Prometheus]

I agree with you that Neph programs blatantly lie and create fake impressions , I did Neph from a well known Neph program and found the inner workings depressing , they had no respect amongst other departments , were frustrated bc of their low wage , kept talking about amazing innovation in Neph which no one sees etc , had extremely low applicant numbers and were begging candidates to join

its a dead field , apart from lack of fellowship applicants , programs have a hard time even recruiting the midlevel's since even they know to stay away from it

thank you for coming on and sharing your experiences. I wish more nephrologists would come on and share their experiences. I think many are embarassed, and it's somewhat taboo to admit that it was a stupid mistake to go into it in the very beginning. Some of these applicants think I am engaging in hyperbole when I am actually telling them the truth. Truth is a bitter pill to swallow unfortunately.

 

[georgestone]

thank you for coming on and sharing your experiences. I wish more nephrologists would come on and share their experiences. I think many are embarassed, and it's somewhat taboo to admit that it was a stupid mistake to go into it in the very beginning. Some of these applicants think I am engaging in hyperbole when I am actually telling them the truth. Truth is a bitter pill to swallow unfortunately.

I agree , the behavior of academic nephrologists is a combo of frustration and embarrassment , they have little recognition, they make little money and the plight of nephrology is well known, fellows are treated poorly in general

During Neph fellowship I used to write 20-25 notes daily and used to be on call from 7am till 5 pm next day and on weekends had to do lengthy sign-outs , and in CCM fellowship I really felt like a junior attending with freedom and didn't have to worry about Scut work and actually was way more productive and happy despite being insanely busy .

The entire Nephrology division was cluless about Ultrasound and simply rejected the idea when ever it was presented .

ASN is a failing organization and has little traction , Nephrology spots should not only be reduced but should follow demand and supply

 

[emergentmd]

From the EM standpoint, most EM docs dislike taking care of Nephro pts. They are typically train wrecks, complicated, multi organ pathology, and noncompliant.

I could not imaging taking care of such complicated pathology all the time who are ticking time bombs.

 

[Renal_Prometheus]

I agree , the behavior of academic nephrologists is a combo of frustration and embarrassment , they have little recognition, they make little money and the plight of nephrology is well known, fellows are treated poorly in general

During Neph fellowship I used to write 20-25 notes daily and used to be on call from 7am till 5 pm next day and on weekends had to do lengthy sign-outs , and in CCM fellowship I really felt like a junior attending with freedom and didn't have to worry about Scut work and actually was way more productive and happy despite being insanely busy .

The entire Nephrology division was cluless about Ultrasound and simply rejected the idea when ever it was presented .

ASN is a failing organization and has little traction , Nephrology spots should not only be reduced but should follow demand and supply

Unfortunately, programs are not going to reduce spots because they need the scut work. It’s just not going to happen because everyone benefits(ASN, fellowships) except you. They can always count on a desperate IMG, unable to get anything else, to sign up for nephrology. What’s really sad is that IMG gets exploited in fellowship, then graduate to let their senior partners exploit them some more, and then eventually they realize the work/income ratio is so horrible they are just better off back as a hospitalist. And the cycle repeats itself and people just don’t learn because the system was incentived to give you false hope.

 

[georgestone]

From the EM standpoint, most EM docs dislike taking care of Nephro pts. They are typically train wrecks, complicated, multi organ pathology, and noncompliant.

I could not imaging taking care of such complicated pathology all the time who are ticking time bombs.

Well taking care of hemodialysis patient or advanced CKD patient with multiple comorbids is challenging and is not expected from our ER colleagues to have that depth understandably

 

[georgestone]

Unfortunately, programs are not going to reduce spots because they need the scut work. It’s just not going to happen because everyone benefits(ASN, fellowships) except you. They can always count on a desperate IMG, unable to get anything else, to sign up for nephrology. What’s really sad is that IMG gets exploited in fellowship, then graduate to let their senior partners exploit them some more, and then eventually they realize the work/income ratio is so horrible they are just better off back as a hospitalist. And the cycle repeats itself and people just don’t learn because the system was incentived to give you false hope.

I agree , I have noticed increasing trend that alot of Nephrology programs are taking IMG's who were unable to get residency spots and are being used for scut work , not only these candidates lack a formal prior training but subjecting them to the horrific call schedule should be discouraged and banned

 

[Renal_Prometheus]

I agree , I have noticed increasing trend that alot of Nephrology programs are taking IMG's who were unable to get residency spots and are being used for scut work , not only these candidates lack a formal prior training but subjecting them to the horrific call schedule should be discouraged and banned

I wish applicants for neph fellowship come here and read this before signing up. There are some very unethical practices happening in neph fellowships, not to mention the crazy stuff that happens in private practice. Anyone listening??? But you know what, people are still gonna go into it because it's easy to get into. That's it. People want to specialize in something. Psychologically, I almost want to say that they want to be lied to so that they can keep their hopes alive. Anything to escape their current situation, whatever that may be. This specialty has a way of preying on the vulnerable and desperate.

 

[georgestone]

please share your experience of Nephrology , private practice or academia

 

[Costco]

I wish applicants for neph fellowship come here and read this before signing up. There are some very unethical practices happening in neph fellowships, not to mention the crazy stuff that happens in private practice. Anyone listening??? But you know what, people are still gonna go into it because it's easy to get into. That's it. People want to specialize in something. Psychologically, I almost want to say that they want to be lied to so that they can keep their hopes alive. Anything to escape their current situation, whatever that may be. This specialty has a way of preying on the vulnerable and desperate.

I agree , I have noticed increasing trend that alot of Nephrology programs are taking IMG's who were unable to get residency spots and are being used for scut work , not only these candidates lack a formal prior training but subjecting them to the horrific call schedule should be discouraged and banned

Interesting thread. It serves as a great PSA.

I pointed this thread out to a co-resident. He said that he has seen this thread, is ignoring what you guys are saying because "it's just SDN", and going all in within nephro still.

I have personally witnessed with my own 2 eyes IMGs who do a nephro fellowship but no residency get screwed over. This IMG from a mid tier nephrology program applied to our medicine residency program because his own medicine department wouldn't take him. Interestingly, both the resident and I interviewed the nephro fellow. You would think that this would behoove the resident to see the exploitation in the field of nephro.

Also, another nephrologist is working as a hospitalist at my institute, which will not hire him as a nephrologist. This same nephrologist is telling me how nephro is dead and makes no money.

The resident sees all of this before his very eyes, and is still choosing to do nephro. It will be interesting to see how things work out for the resident in a few years. I wish him no ill and the best of luck.

With that being said, nephro is a very interesting field with complex medical management, interesting cases, cool physiology, and has personally touched the lives of my loved ones. But it is hard as an AMG to go into this field with all of the warning signs with all of the subtly of Las Vegas signs so clearly flashing in my face.

 

[Test Boy]

Interesting thread. It serves as a great PSA.

I pointed this thread out to a co-resident. He said that he has seen this thread, is ignoring what you guys are saying because "it's just SDN", and going all in within nephro still.

I have personally witnessed with my own 2 eyes IMGs who do a nephro fellowship but no residency get screwed over. This IMG from a mid tier nephrology program applied to our medicine residency program because his own medicine department wouldn't take him. Interestingly, both the resident and I interviewed the nephro fellow. You would think that this would behoove the resident to see the exploitation in the field of nephro.

Also, another nephrologist is working as a hospitalist at my institute, which will not hire him as a nephrologist. This same nephrologist is telling me how nephro is dead and makes no money.

The resident sees all of this before his very eyes, and is still choosing to do nephro. It will be interesting to see how things work out for the resident in a few years. I wish him no ill and the best of luck.

With that being said, nephro is a very interesting field with complex medical management, interesting cases, cool physiology, and has personally touched the lives of my loved ones. But it is hard as an AMG to go into this field with all of the warning signs with all of the subtly of Las Vegas signs so clearly flashing in my face.

Just curious, how can you be accepted into a nephrology fellowship without doing a medicine residency??

 

[Costco]

Just curious, how can you be accepted into a nephrology fellowship without doing a medicine residency??

My understanding is that as long as you went to med school, you can do a fellowship in anything and see patients using an attending's/institutional license. I could be wrong.

I am not sure if you could sit for the nephro board if you do the nephro fellowship before the medicine residency. But, I thought it would have been rude to ask the very kind nephro fellow this during his residency interview, since I didn't want it to come off or be construed as a commentary on the utility of the 2 years he spent in fellowship.

Maybe @Renal_Prometheus and/or @georgestone could provide some insight, since nephro isn't my field.

 

[Scope guy]

My understanding is that as long as you went to med school, you can do a fellowship in anything and see patients using an attending's/institutional license. I could be wrong.

I am not sure if you could sit for the nephro board if you do the nephro fellowship before the medicine residency. But, I thought it would have been rude to ask the very kind nephro fellow this during his residency interview, since I didn't want it to come off or be construed as a commentary on the utility of the 2 years he spent in fellowship.

Maybe @Renal_Prometheus and/or @georgestone could provide some insight, since nephro isn't my field.

some IMGs who did IM residency in home country are hired to do nephrology here. I don't see anything wrong with it , as long as the IMG does not intend to stay back after fellowship to work here - basically finish training and go back to home country. However many use this as an opportunity to get IM residency after fellowship so they can be boarded to work in US

 

[Test Boy]

some IMGs who did IM residency in home country are hired to do nephrology here. I don't see anything wrong with it , as long as the IMG does not intend to stay back after fellowship to work here - basically finish training and go back to home country. However many use this as an opportunity to get IM residency after fellowship so they can be boarded to work in US

Interesting. Never knew you can do a US nephrology fellowship without doing a US IM residency.

 

[Renal_Prometheus]

If you guys think some of these practices in nephrology fellowship is shady, just wait until you get into private practice. Exploitation at all new levels that you will cry yourself to sleep every night. I've seen it happen to many of my neph friends and it's like horror movie happening over and over again. The issue lies in that starting salary is 200k/year, and your working really hard with no guarantees that you will be given partnership after x number of years. A lot of groups take advantage of that and it's even more common today because practice revenue is declining overall. Senior partners don't want to share. Or you would be given partnership, but then the senior partners don't share the JV and medical directorship money, so you might as be a hospitalist anyways. Graduating fellows walk into a trap, get exploited for couple of years, quit nephrology to take a hospitalist job. Classic example.

 

[Costco]

If you guys think some of these practices in nephrology fellowship is shady, just wait until you get into private practice. Exploitation at all new levels that you will cry yourself to sleep every night. I've seen it happen to many of my neph friends and it's like horror movie happening over and over again. The issue lies in that starting salary is 200k/year, and your working really hard with no guarantees that you will be given partnership after x number of years. A lot of groups take advantage of that and it's even more common today because practice revenue is declining overall. Senior partners don't want to share. Or you would be given partnership, but then the senior partners don't share the JV and medical directorship money, so you might as be a hospitalist anyways. Graduating fellows walk into a trap, get exploited for couple of years, quit nephrology to take a hospitalist job. Classic example.

So can you sit for the nephro boards if you do nephro fellowship first and then medicine residency? Or would you have to repeat the nephro boards after residency to sit for the nephro boards?

 

[Costco]

I have classmates who didn’t match this cycle and still looking for spots

Can they get into these nephrology fellowships? I mean, it’s something to pay off the loans right?

I would cold call community programs with mostly IMGs since the program may get desperate and need coverage when the IMGs have visa issues due to COVID.

 

[rokshana]

So can you sit for the nephro boards if you do nephro fellowship first and then medicine residency? Or would you have to repeat the nephro boards after residency to sit for the nephro boards?

No, you have to be BC in the core specialty to sit for the sub specialty boards.

 

[Prehealth1011]

No, you have to be BC in the core specialty to sit for the sub specialty boards.

I’m too lazy to Google this

So every 10 years, do you have to recertify both IM and your speciality boards?

 

[rokshana]

I’m too lazy to Google this

So every 10 years, do you have to recertify both IM and your speciality boards?

No, once you get initial certification in the sub specialty, core specialty certification isn’t required for recertification… depends on where you work though… academic places may want you to maintain both

 

[Costco]

No, you have to be BC in the core specialty to sit for the sub specialty boards.

Geez. Well, I feel terrible for the nephro fellow. He explicitly joined with the hopes of getting a medicine spot at that program. After working, he had the rug pulled right from under him. I hope everything works out for him bc he is genuinely a nice guy.

 

[Renal_Prometheus]

No, once you get initial certification in the sub specialty, core specialty certification isn’t required for recertification… depends on where you work though… academic places may want you to maintain both

Hey Rokshana. I am highly praised on this thread because I'm informing people of the exploitation going on in nephrology. I hope you see me as a net positive for the SDN community.

 

[bronx43]

Hey Rokshana. I am highly praised on this thread because I'm informing people of the exploitation going on in nephrology. I hope you see me as a net positive for the SDN community.

Lol why do you even care what a rando on SDN thinks? You keep posting and informing the youngblood about the neph market and they clearly appreciate it.

 

[rokshana]

Hey Rokshana. I am highly praised on this thread because I'm informing people of the exploitation going on in nephrology. I hope you see me as a net positive for the SDN community.

I agree that you have good information to give and overall have good intentions…but sometimes you perseverate on the bad to the poi t that you make it sound like people haven’t done their due diligence when they have Decided to apply to nephrology…and there are time that you do seem to take things personally…you have a couple of other posters that seem to get under your skin mostly because they disagree with you.