I was a dialysis technician and trainer, working in acute care and chronic dialysis for 15 years before getting in medical school, and while I haven't worked since the first quarter of my first year (I'm in third year now) I can tell you that, like other specialties, and Doctors in general, the trend in nephrology is towards a growing shortage of physicians. The problem is, with the increase in diabetes AND an increase in lifespan, there has been an explosion of dialysis patients in the last decades. When I started in *cough* 1987, there were a couple dozen dialysis facilities in my state. Now there are closer to 100!
The dialysis business isn't going away, it just got gobbled up by bigger companies like Fresenius and Gambro (international giants). Dialysis, however, represents less than 25% of a nephrologist's patients. Most of your clientelle will be pre-renal and acutes you are trying to keep OFF dialysis. The nephrologists I know carry a patient load of from 200 - 400 patients! PA's and Nurse Practicioners have taken some of the load, but there will continue to be a shortage in the heaviest dialysis patient population areas - which are sadly wherever you find reservations, and "minorities". Blacks and hispanics have a higher than whites burden of hypertension and diabetes.
Nephrologists have a pretty competetive salary, but dialysis itself has essentially been socialized medicine since the early seventies when the government agreed to pay for dialysis for anyone who couldn't. There is also a high on-call need since acute dialysis often happens around the clock in bigger cities.
If you like the idea of a patient base you follow for years and years... and are technology oriented, I say go for it. Dialysis was very rewarding for me, and naturally I plan to specialize in Nephro when I get past IM.
