Official 2013-2014 Nephrology fellowship application cycle

[Boyka]

Dialysis companies recruiters from davita or fresenius or whatever will always tell you there are jobs and give you a bright picture since these companies live off nephrologists, without nephrologists they will be out of business since we are the only specialty that can fuel their dialysis units. And they are not lying there some jobs out there, but you have to look at the locations, 99% of these jobs are in undesired locations, the starting pay is between 160-180, you will have to keep in mind that you have to round at 3-4 hospitals and 4-5 dialysis units plus clinic, and you will be lucky if you got 4-6 days off a month. And with all that they ask you how do you intend to market yourself !!!!! Since they expect you to go kiss every *** In the community to get more consults, in addition most practices want you to do some internal medicine on the side. That's what the recruiter and dialysis company won't tell you.

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[pH74]

what is your advice to fellows who are just starting? two of the people I know from interview trail have decided not to join fellowship and have taken hospitalist jobs

 

[nephappl]

If you absolutely love nephrology and do not see yourself doing anything else; if you do not mind not finding a job in the US or being under-employed or working as a hospitalist or in primary care after fellowship or if you are planning to practice in another country just go and enjoy your fellowship time.
If you can live without it (which I think applies to the majority of people here) there are certainly much better options than wasting 2 years of your life and your family for almost nothing.
Good luck
N/A

 

[Boyka]

It all depends on how much you are willing to sacrifice, as mentioned prior after the 2 years you will most likely not find your dream job, and even if you did it will probably not even closely comparable to what a hospitalist job has to offer in terms of time off and money, all of the nephrology jobs in the good locations are not advertised and are usually already assigned to someone who knows someone in the group, you need also to realize that nephrology fellowship is a no walk in the park, first year is worse than internship and you will be doing pure service as it is the busiest service in any academic program and that is why programs hire you, if you don't mind wasting 2 years of hard work and no pay for learning something new that you might not do in the future then go for it, it is definitely an interesting field. When i started my fellowship i wasn't aware of how the job market was and i didn't seek advice prior to starting, i did it because i liked it during residency, but it wasn't until 2nd year when i started job searching that i realized how bad the market was, if time would go back i would not do it again, and so would most of the fellows in my program, believe me we spent the first 6 months of my 2nd year talking first year fellows not to leave although i can not blame them if they did so.
People say that the market might change in the future, but even if it did it will only mean an opportunity in a nicer location, but the work load and pay would not change, and with the way medicare is targeting dialysis the financial drive for nephrology that existed 10-20 years ago is no longer there, the way i think about it now is i would have tried hospitalist first, if i would not have liked it then i would have sought fellowship, and believe me plenty of people did that and are now regretting it.

 

[Nephro critical care]

Agree . I did nephrology but after looking at the job market and work hours in my 2nd year (and also my own interest ) I went on to a critical care fellowship . And I never regretted it . In critical care my lifestyle , the salaries , the job market and the work itself are totally awesome !

 

[Boyka]

That is actually a good exit, going for an extra year critical care definitely gets you out of the nephrology trap, the problem for me though after those 2 years i am so tired to do an extra year, i have no clue how some people go for 3rd year in transplant, to waste another year after already wasting two, quite the mystery.

 

[nephappl]

Yeah, I do not understand it either.
I have a cofellow who got an OK job in a not so bad location. Told him to take it but he instead decided to waste an extra year in transplant.
He just called the other day looking for a job in our area hopefully in transplant (he is like the 3rd of 4th txp person calling for transplant or even general nephrology jobs of which we have none).
I remember him telling me he wanted to pursue an "academic job"
LOL

 

[pH74]

how to go about finding critical care fellowship after nephrology? Is it pretty competitive?

Should I do nephrology and then CC or directly do CC ?

 

[Boyka]

I don't know the answer to your question, if it was me and time goes back i would probably just do plane critical care, i did not look into the possibility of doing a critical care fellowship after nephrology simply because i just got tired of fellowship. If you want to explore that possibility you probably want to look at the market first, what i realized this year during my job search that politics play a huge role when you are looking for a job, you have to look at the potential market, private pulmonary critical care groups have no use of your nephrology background so they will not be hiring you, and hospitals might think twice before hiring you because having an intensivist with nephrology background in the ICU will upset the local private nephrologist who are getting consults at that ICU which will create a problem with the hospital. I would say if you want to do critical care just go for it without wasting time in nephrology since i believe it will make you less marketable.

 

[nephappl]

Funny question
Doing one fellowship to end up doing another for which you do not need the first one.
Do not do Nephrology and go straight to CCM. At least you are more likely to find a job with a better lifestyle.

 

[Boyka]

I totally agree, you have a better chance finding a job as an astronaut than finding something decent in Nephrology, the job market is that pathetic.

 

[Nephro critical care]

It's a good combo ; you get a very good grasp of all aspects of medicine and critical care and become a very complete physician. but there are problems though. There are very few private nephrology critical care groups and it will be hard to find a nephro-critical care job. Your best bet would be a hospital employed job. One of my seniors did this combo and now does 2 weeks nephro and 1 week of critical care and make a very decent figure. It's also hard to do critical care fellowship in a year especially if you have less experience with procedures as u will get exposed easily .

 

[pH74]

My program didn't fill in match. They ended up taking 2 hospitalists (who didn't match in PCCM) through post match and unfortunately one of them already resigned. Is any other program facing similar situation? I heard rumor that 5-10 % of nephrology fellows who matched this year or post matched are planning to resign.

 

[LoudBark]

My program didn't fill in match. They ended up taking 2 hospitalists (who didn't match in PCCM) through post match and unfortunately one of them already resigned. Is any other program facing similar situation? I heard rumor that 5-10 % of nephrology fellows who matched this year or post matched are planning to resign.

Yes, your program is not alone. Mine too. People quit to become hospitalists or become hospitalists even after finishing fellowship. Not surprising at all.
And agree with another poster on the other thread who said that nurse practitioners will be hired in the future to write dialysis orders.

 

[IM2GI]

My program didn't fill in match. They ended up taking 2 hospitalists (who didn't match in PCCM) through post match and unfortunately one of them already resigned. Is any other program facing similar situation? I heard rumor that 5-10 % of nephrology fellows who matched this year or post matched are planning to resign.

Brutal. Residents are wising up though, why work 3 more years at a fellow pay grade and lifestyle, to work worse hours and make less money than a hospitalist? That is if you can even find a job. Add to that the frankly boring practice of CKD and depression of dialysis, the future looks bleak.

Nephro is in bad shape.

 

[pH74]

I think nephrology organizations/programs need to urgently intervene and cut down number of fellowship positions by at least 50 %
This way fellows will find at least some job when they graduate. What's the point of creating so many Nephrologists every year (>400 per year) when there are handful of decent jobs?

 

[Nephroexp]

Advocate atleast the program directors you know to stop hiring people on false premises. Confront them in interview with the harsh reality

Nephrologists and nephrology as a specialty is becoming a laughing stock in private care due to oversupply, leading to intense competition with groups begging for consults or stealing each others patients.


Pathetic situation for an Intellectual specialty

 

[PlutoBoy]

Brutal. Residents are wising up though, why work 3 more years at a fellow pay grade and lifestyle, to work worse hours and make less money than a hospitalist? That is if you can even find a job. Add to that the frankly boring practice of CKD and depression of dialysis, the future looks bleak.

Nephro is in bad shape.

lol

Hey, you should write a novel or something. You certainly know how to best use words for dramatic effect.

 

[PermaCath]

Hi all, thinking about quitting nephrology fellowship in one of big University program. Just started fellowship this July. Didn't like the lifestyle, work load and future prospects. How soon can i quit ? Is there any specific timeline for that. The only regret I am going to have is the amount of work load other co-fellows are going to have. So can any one guide what the right way, should i just quit all of sudden or give them few weeks prior to leaving ?

Never be so indecisive in my life.

 

[nephappl]

As a fellow you are considered an employee of the hospital / university. As an employee all you have to do is to submit your resignation whenever you feel you should. Do not feel guilty for other people, you should do what you consider is best for you as everyone does; as an example your PD is going to try hard to keep you with all kind of reasons because is in his / her best interest to keep you as a worker; when you go for a fellowship in particular nephrology these days you know that someone can quit anytime like people do in residency and you can be screwed up; it happens all the time. Talk to your PD, human resources; you should be OK.
Want a different fellowship through the match and all these things I really do not know.

 

[PermaCath]

I think nephrology organizations/programs need to urgently intervene and cut down number of fellowship positions by at least 50 %
This way fellows will find at least some job when they graduate. What's the point of creating so many Nephrologists every year (>400 per year) when there are handful of decent jobs?

Did you started nephrology fellowship and then quit ? Or you never started fellowship ?

 

[LoudBark]

Hi all, thinking about quitting nephrology fellowship in one of big University program. Just started fellowship this July. Didn't like the lifestyle, work load and future prospects. How soon can i quit ? Is there any specific timeline for that. The only regret I am going to have is the amount of work load other co-fellows are going to have. So can any one guide what the right way, should i just quit all of sudden or give them few weeks prior to leaving ?

Never be so indecisive in my life.

Don't stay because you feel bad for your program director or other fellows.

This is your life! You have to do what is best for you. Don't throw away 2 years of your life. You are losing lots of lost income and lots of lifestyle and free time on something that could be a career dead end for you.

Keep in mind people do quit fellowships. You are far from the first person to ever do so.

Will your program director be mad? Yes. Will the department chair person be mad? Yes. But in the end, who really cares.
They will get over it! You may never get over it if you stay to complete this fellowship with a dead end career path.
Get out now while you still can! A year from now you won't regret leaving. If you stay, a year from now you will regret staying.

The best thing to do is to type out a letter of resignation and send it to your program director and maybe cc it to the department chair person. You have to put it in writing. Don't go in to too much detail why you want to quit. Just say something along the lines that you have firmly decided that nephrology is not the career you ultimately want to go into. You may say it is nothing against their program, but more a personal decision to do what is best for yourself and your career and then thank them for the opportunity they gave you, but you have decided to leave.

 

[Nephroexp]

Agree with loudbark. All that programs care about is scutwork by a fellow (half the pay of an NP). Call it training !! They do not care what happens to you afterwards

If one has to do IM or Hospitalist in the end, quit ASAP and spare yourself of two wasted years or few more wasted years as nephrologist if u ever find a job.

 

[pH74]

Did you started nephrology fellowship and then quit ? Or you never started fellowship ?

Hi all, thinking about quitting nephrology fellowship in one of big University program. Just started fellowship this July. Didn't like the lifestyle, work load and future prospects. How soon can i quit ? Is there any specific timeline for that. The only regret I am going to have is the amount of work load other co-fellows are going to have. So can any one guide what the right way, should i just quit all of sudden or give them few weeks prior to leaving ?

Never be so indecisive in my life.

Check with fellows in other program. You may not be the only one planning to quit.

 

[pH74]

Also depends upon if you have student loans, family to support(wife, kids, dependents) , your age and potential years of earning.

If you are AMG or US FMG in your mid 30s with 200 K in student loans, you can't afford to gamble 2 or 3 years of your life when you can potentially work hard and make good money as hospitalist.

 

[neph fellow 07]

I am a second year nephrology fellow at a big university program.

an update for all the prospective applicants. after going through this demanding nephro fellowship,job market sucks. I am permanent resident, even then , no good jobs in metros/suburbs.its not just the low pay which I kind of know before hand, but , just the lack of jobs.Spoke to few people last few weeks, not encouraging.

One recruiter tells me that job market for nephrology is not good and offers me a job I am not interested.Other employer tells me they want only all american trained,including medical school, nephrology grads.each rare decent job is getting flooded with several applicants so that they can literally cherry pick .

I hope the situation changes and my 2 year hard work comes to something.

Does not really understand how come nephrology fellows had to face this hard situation .

 

[nephappl]

 

[nephappl]

Neph Fellow 07:
How nephrology fellows ended facing this situation ? Easy.
Graph above might explain it (from CJASN Sept 2014)
Look first year fellows number and the number of nephrologist over time from below 7000 to almost 8500 in short 5 years (ending 2010)!!!! not counting 2011 to 2014 around 400 new grads per year +/- 1400 - 1600 more.
Thanks academia!!!!

 

[CptNemo]

I just noticed that the ASN published a recent workforce analysis.
http://www.asn-online.org/workforce
They have an executive summary and full report.

I only read the executive summary, but it looks like they are finally admitting that there is a soft job market overall (and absolutely horrid for IMGs) and that there may be too many training program positions. Plus, the largest cohort of nephrologists is in the 35-44 y/o age group, so it's not like a bunch of ppl are going to retire soon. They didn't mention low salaries... which we know about empirically and make things worse. They also didn't mention how many nephrology fellows actually end up practicing nephrology vs. doing something else (I've heard from recruiters that ~25% of nephrology fellows do hospital medicine, but I'm not sure how accurate that number is; though, it does correlate with what I've seen).

Interesting read.

 

[pH74]

I am a second year nephrology fellow at a big university program.

an update for all the prospective applicants. after going through this demanding nephro fellowship,job market sucks. I am permanent resident, even then , no good jobs in metros/suburbs.its not just the low pay which I kind of know before hand, but , just the lack of jobs.Spoke to few people last few weeks, not encouraging.

One recruiter tells me that job market for nephrology is not good and offers me a job I am not interested.Other employer tells me they want only all american trained,including medical school, nephrology grads.each rare decent job is getting flooded with several applicants so that they can literally cherry pick .

I hope the situation changes and my 2 year hard work comes to something.

Does not really understand how come nephrology fellows had to face this hard situation .

Situation will not change. It will worsen with each passing year. Most of the practices are hiring PA and NP as they are unable to afford physicians.

Your best bet is to quickly take a good hospitalist job before they run dry.

 

[pH74]

Situation will not change. It will worsen with each passing year. Most of the practices are hiring PA and NP as they are unable to afford physicians.

Your best bet is to quickly take a good hospitalist job before they run dry.

It is unfortunate that your hard work during nephrology fellowship is worthless now. People like loudbark and nephappl have been warning fellows for years but no one believed them . Now pay the price

 

[nephappl]

No joke!!!!
In one of the hospitals I work we now have 2 nephro-hospitalists.
Besides killing us with their parallel management of the patients leading to late consults is sad looking at them with no renal jobs and not many choices left after spending training years. Asked by one of them for advise only thing I could say is go far away from here as we are not hiring now not even in years.
Do not understand; people do stuff and then start thinking what are they going to do after doing the first thing and its consequences without serious evaluation in the first place.
Went to ASN this year; there was talk about the future of nephrology (bad at least for new grads) and one of the fellows on a visa (very uninformed by the way) was asking ASN to do something to facilitate people with visas to find jobs (people forget ASN is a professional association not an immigration agency and of course they can not help with it or create more jobs out of nothing as they honestly pointed out).
Dr Berns from UPenn who co-wrote the paper in CJASN I mentioned recently was mad with the society and academia for having created this mess by increasing the supply of new grads too fast ,too much and for too long. At least the ASN is honest saying they do not know what they can do as the guys that got us into this mess are now trying to get us out.
Like in many diseases the best cure is prevention; want to avoid all these headaches (?) then DO NOT DO THIS FELLOWSHIP
Can not be more obvious