Official 2014-2015 Nephrology Fellowship Application Cycle

[fmg h1b 2014.]

anyone heard from cleveland, john hopkins...??

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[nephro007]

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[SemperJeff]

Both are huge with wanting their fellows to go into academics following training. The program director from UW came from UCSF, so he tries to model the UW program after UCSF. If you interview, you must give every impression that you will be research heavy and want academics. Merely giving them the impression that you may want to do community private practice is a big red flag for either of those two. Between picking the two, choose which city you like better and who you thought was nice on interview day......other than that.....both huge on academic careers possibly more than anywhere else except for the Harvard program. They both have their share of snotty academic types, but that may be your thing. In addition both programs have academic research heavy tracks or a physician educator track, which is also academic in nature.

Thanks very much for your input. It was looking like I had to choose between interviewing at one or the other.

 

[Karati]

I applied early this week ( late )?. Img community hospital. h1b visa. Ok to change to j1.
Usmle triple 99. 245-258-240. 2 poster presentation. Resident and teacher of year twice. 4 strong lor's. Strong mspe from the dean .
I don't know what is my chance. Any answer.

 

[pH74]

I applied early this week ( late )?. Img community hospital. h1b visa. Ok to change to j1.
Usmle triple 99. 245-258-240. 2 poster presentation. Resident and teacher of year twice. 4 strong lor's. Strong mspe from the dean .
I don't know what is my chance. Any answer.

Good chances . Make sure you interview well at top 5 places of your choice

 

[bludragon03]

Interview invites have slowed down this week..

 

[bmarow2k]

Tufts and Ochsner today

 

[bludragon03]

University of Arizona

 

[SemperJeff]

With the applicant numbers decreasing below the number of positions in recent years, are more Nephrology programs offering pre-match positions these days? Anyone hear of this type of thing going on?

I understand the NRMP changed their rules to require residencies to be all-in, but as I understood it, fellowships are not bound by the all-in rule.

 

[pH74]

With the applicant numbers decreasing below the number of positions in recent years, are more Nephrology programs offering pre-match positions these days? Anyone hear of this type of thing going on?

I understand the NRMP changed their rules to require residencies to be all-in, but as I understood it, fellowships are not bound by the all-in rule.

Few programs did give prematch last year as they were not sure they would be able to fill all their spots. I believe this year some of the low and middle tier programs will try to hand out prematch and secure candidates .

Talking to fellows in various programs , it seems number applications have further declined this year as compared to last year. I strongly recommend not to take a prematch and settle for a less competitive program. Most of the applicants will match in their top 3 choices. Save your time and program's time by interviewing at no more than 5 or 6 places.

 

[pH74]

Hi all. Was wondering if I could get some input regarding your opinions on the Nephrology programs at University of Washington (Seattle) and UCSF. What are their strenghts and weaknesses? If you could have your pick, which would you choose?

I would personally prefer UC

Same here..IV from UC davis

Hi all. Was wondering if I could get some input regarding your opinions on the Nephrology programs at University of Washington (Seattle) and UCSF. What are their strenghts and weaknesses? If you could have your pick, which would you choose?

Both are great academic programs on west coast

Other programs to consider in good locations : UCSD, OHSU, U Colorado

 

[Nephroexp]

I did my fellowship with great interest in Nephrology - Acid base/electrolyte/Acute dialysis stuff. Joined a private practice - get around 170 K. my day starts at 6 and ends at 5. run around 4 hospitals and 3 dialysis units.

Real life of nephrology

- Oversupply - tremendous oversupply - so employers dont really have any need to offer a fair deal

universities need bodies to do the scutwork - there is no need for these bodies outside an academic setting

many nephrologists end up as hospitalists -" saw this in fellowship itself - but still liked nephro- s0 did not quit"
- Smooch primary care and hospitalists for consults - They dont absolutely have to refer,unless patient needs dialysis - No patient sues them for non dialysis requiring AKI

what do you treat ATN with anyway ???


- Dialysis patient compensation is awful and they expect you to sort out all their medical/social problems for which you dont get paid nor do u have the time.


- Dialysis rounding can easily replaced by a NP.

- Income in dialysis goes to davita/fresenius - they pretty much own everything across the country now


Nephrology is not what you see in residency - stay away from it. Dont waste 2 -3 years of your valuable life to become slave to either a dialysis company or a private group for the rest of your life with 1/2 - 2/3 income of a hospitalist


Do nephrology for right reason - It does not have income, does not have a lifestyle and does not have the charm that u see in residency

 

[Nephroexp]

if you applied - you will get a spot - quit your interviews now and save yourself from a lifetime of misery

 

[Nephroexp]

forgot to add - NOBODY retires from nephrology as they can do the work with nurse practitioners or slaves like one of you when you make it out of fellowship.

 

[Nephroexp]

There is no growth in ESRD Population either

 

[nephro007]

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[Nephroexp]

Olden Days

Few nephrology Positions
Growing ESRD population
Physicians owned their own dialysis units(facility charges are far greater than physician visit charges)
they could visit dialysis patients as many times as needed clinically(of course open to abuse)
Hospitalists were rare and Primary care physicians needed help more often + they understood the need to have a nephrology support structure - more referrals
consult codes were different and paid higher
Office made some money on Epo Injections



Transition
Davita/Fresenius bought dialysis units - Old nephrologists made a killing by selling their units
Older guys now stay on as directors/part share in the unit



Current

False projections about increasing ESRD+ Totally false articles about a shortage of nephrologists (ASN has to say so to keep it's source of income)
No growth in ESRD population
Explosion in nephrology fellowship positions - even small community programs have fellowships
You can do no more than 4 visits per month
you only need one director for clinic and one person can be director at 2 places - most of them are occupied by nephrologists who see few patients but own big groups
Takes you ages to become a partner and top guy keeps hiring new slaves to keep the money flowing to him while he does little work.
Non compete clauses enforced by these guys who dont retire
No difference between consult codes and internal med codes - with no procedures or limited procedures to do - hardly any different billing than IM
Hospitalists took over - less likely to refer, as under pressure to get patients out to keep stay minimum+ Hospitalists have a tendency to resent specialists, some of whom can be jerks. With an oversupply of nephrologists now hospitalists have the say who they refer to - smooching matters not your patient skills. Makes one wonder if they refer because they believe that this physician provides good care or because they can go out to a fancy restaurant /have drinks funded by the consultant
Epo is restricted with indications

Primary care docs sold their practices to hospitals and are least bothered by what happens to their patients any more - they dont care where their patients end up.





Please read what I posted carefully - This speciality is on it's rapid course to bottom of the pit - Join at your own peril .

 

[Nephroexp]

Noone gave me an honest input when i applied - I wish someone did.

 

[pH74]

Olden Days

Few nephrology Positions
Growing ESRD population
Physicians owned their own dialysis units(facility charges are far greater than physician visit charges)
they could visit dialysis patients as many times as needed clinically(of course open to abuse)
Hospitalists were rare and Primary care physicians needed help more often + they understood the need to have a nephrology support structure - more referrals
consult codes were different and paid higher
Office made some money on Epo Injections



Transition
Davita/Fresenius bought dialysis units - Old nephrologists made a killing by selling their units
Older guys now stay on as directors/part share in the unit



Current

False projections about increasing ESRD+ Totally false articles about a shortage of nephrologists (ASN has to say so to keep it's source of income)
No growth in ESRD population
Explosion in nephrology fellowship positions - even small community programs have fellowships
You can do no more than 4 visits per month
you only need one director for clinic and one person can be director at 2 places - most of them are occupied by nephrologists who see few patients but own big groups
Takes you ages to become a partner and top guy keeps hiring new slaves to keep the money flowing to him while he does little work.
Non compete clauses enforced by these guys who dont retire
No difference between consult codes and internal med codes - with no procedures or limited procedures to do - hardly any different billing than IM
Hospitalists took over - less likely to refer, as under pressure to get patients out to keep stay minimum+ Hospitalists have a tendency to resent specialists, some of whom can be jerks. With an oversupply of nephrologists now hospitalists have the say who they refer to - smooching matters not your patient skills. Makes one wonder if they refer because they believe that this physician provides good care or because they can go out to a fancy restaurant /have drinks funded by the consultant
Epo is restricted with indications

Primary care docs sold their practices to hospitals and are least bothered by what happens to their patients any more - they dont care where their patients end up.





Please read what I posted carefully - This speciality is on it's rapid course to bottom of the pit - Join at your own peril .

The only reason I joined is because I don't plan on working in USA . I have job lined up in south east Asia where nephrology still pays decent enough to live a good life

 

[pH74]

Noone gave me an honest input when i applied - I wish someone did.

You should have checked application thread from last year.

If you join please finish it. Don't quit because (a) you may be banned from NRMP for next 2 years and will look bad on your application again (b) when you leave your colleagues are overburdened (c) its a pain for program to find new fellow in middle of the cycle

If you are not sure you want to finish, my advise is don't interview and waste your time

 

[Nephroexp]

I finished my fellowship a year ago. I liked my training , but would not do it now that I know the reality of nephrology in community .


Quit in middle only of u do not intend to apply again


Posting to spread info about the scam being perpetrated by nephrology programs and ASN.

There are no jobs


Even the jobs that are there will involve twice the work and half the pay of Hospitalist.

 

[nephro007]

edit

 

[Nephroexp]

Good luck and keep this dialysis companies out of your country

 

[pH74]

I finished my fellowship a year ago. I liked my training , but would not do it now that I know the reality of nephrology in community .


Quit in middle only of u do not intend to apply again


Posting to spread info about the scam being perpetrated by nephrology programs and ASN.

There are no jobs


Even the jobs that are there will involve twice the work and half the pay of Hospitalist.

wow, didn't know job market was this bad that practicing nephrologists are warning new applicants on a forum

I knew fellows are not getting jobs at their desired locations but didn't realize lifestyle is so bad as compared to hospitalists (less pay, twice amount of work !)

But the irony is most of the nephrology fellows in my program and most other programs of similar tier are former hospitalists who got burned out and wanted to do "some" fellowship -doesn't make any sense to me

Why would hospitalist leave his or her job, do nephrology fellowship and rejoin hospitalist job?

 

[Nephroexp]

Hospitalist job - no patient will call you their doctor, every consultant esp surgical will give u an attitude of the consultant can afford to, hospital will push you around - yes burn out is a factor

Doing nephrology to escape ) nothing more suicidal than that.

Misery loves company - FYI I was one of those idiots who did Hospitalist job too

 

[nephro007]

edit

 

[Nephroexp]

Cards- no one else can do angio, read echos
Gi - no one else can scope
Heme onc - no one else can order chemo- new drugs every year/ infusion charges
Rheumatology - biological only they can order
Pulmonary - bronch/ read PFTS / sleep study reading - singing for computer generated stuff and get paid !!


Let's talk about Nephro

Acute renal failure - u can ignore till dialysis- what therapy do u provide !!



Is there a single drug that changes meaningful and tangible outcome in nephrology.
Year after year we get studies disproving what we believe was beneficial. Epo is a classic example.


Even worse, very few dialysis are grateful for this life sustaining procedure of dialysis.

If cardiologists can exclusively read echos, why did nephrologists let go of renal us/ dopplers - why did we even let radiology take over interventional stuff - why couldn't we keep an exclusive access. Shouldn't interventional be part of every training ?
Renal US is done frequently enough , interventional nephrology needs huge patient numbers which are not there !!

Find a speciality where no one else other than you can do a procedure( a procedure that is needed a lot in numbers and paid per procedure)

If you don't put a needle or a scope in a patient ( dialysis doesn't count) ur pay is down.


Currently a Botox injection is valued more than ur complex acid base problem solving





Procedure is the king


Do nephrology if u like seeing ATN all day with no therapy in site, see dialysis patients who hate their own life saving procedure, ready to suck upto all PMD/ Hospitalist / generate revenue for ur senior partner till he dies.


I like GN/RTA/ CVVH/ acid base/ electrolyte and all the exciting parts but it constitutes a tiny fraction of real practice.



IF nephrology has to be competitive

Regain control of dialysis units
Regain control of renal imaging / procedures
Get better pay for our dialysis visits
Bring back consult codes

None of these r going to happen - for me I will accept it as I can't do anything other than Nephro - hubris of a specialist

 

[Nephroexp]

Programs fill the spots with IMGs


Reason IMGs have a fascination with sub specialization and desire some subspecialty training , if they ever return to their home country.

Programs cash in on this to get bodies to do scutwork for fellowship, knowing very well that there are no jobs for their trainees.( can't think of another speciality that does on this scale )

It's high time IMG's get away from this warped thinking.

Try to get a specialty that is worth the time and effort.

If not stay on as internist or Hospitalist - at least a better pay and lifestyle


Don't delude yourself thinking you made it to a stellar program in nephrology because of your talent. You make it because no American grad wants it and you fool yourself thinking you made it!!


IMGs get IM easily because AMG's choose the better specialities.
Nephrology fellowship is not desired even by most IMG's and you chose it!!

Nephrology is like the scum
of the scum of all the specialities as of now

 

[RUJ01]

how many total number of interviews for everyone this season, so far ?!

 

[Nephroexp]

If you are an AMG and applying for nephrology - admire your love for nephrology.

 

[ashhospitalist]

IVs today from albert Einstein Phili, wayne state/DMC, Indiana University and University of Kentucky.

 

[ashhospitalist]

how many total number of interviews for everyone this season, so far ?!

18 ..cancelled two so far.. will be cancelling more.

 

[Nephroexp]

Go to places which you really want to go. You will match in your top 1 if not top 3.

Attending > 10 interviews = no reality check + too much money to throw away on flights.

Cancel all your small places and go to the biggies at least, if you like Nephro so much.

 

[Jooj86]

JHC

 

[bludragon03]

JHC.. is this johns hopkins?

 

[Felipethesnail21]

Medscape Compensation Report is worth noting, I think. Average salary 243k. It's true that most Nephrologists would choose a different specialty, but so would 40% of cardiologists and GI docs. Neph is not as good as it seems in residency, nor as bad as it seems on this forum, I would say.

 

[Nephroexp]

Medscape compensation reflects data from yester years before the obamacare kick in and nephrology program massive expansion leading to oversupply. Every single fellow who joined from my program/all the new fellows in the area that I joined make 130-170 .

Which one would i believe - My paycheck/My freinds paychecks that they share or an old medscape report which is lagging behind reality

" nor as bad as it seems on this forum" - Let people learn the hard way.

There has been no justification to increase number of programs - ESRD growth was a flat line.
Just search number of jobs on NEJM and davita source - u can c the numbers.
Please do not mislead the residents

 

[pH74]

Medscape compensation reflects data from yester years before the obamacare kick in and nephrology program massive expansion leading to oversupply. Every single fellow who joined from my program/all the new fellows in the area that I joined make 130-170 .

Which one would i believe - My paycheck/My freinds paychecks that they share or an old medscape report which is lagging behind reality

" nor as bad as it seems on this forum" - Let people learn the hard way.

There has been no justification to increase number of programs - ESRD growth was a flat line.
Just search number of jobs on NEJM and davita source - u can c the numbers.
Please do not mislead the residents

This information is almost correct . I talked to headhunter last week who said that salary in big cities is 140-160 K , smaller cities in mid west is 150-170 k and in not desired locations like small town in North Dakota or Minnesota would be 200 k . Irrespective of this new job seekers will need to learn to compromise on call schedule , holiday coverage , etc as supply far exceeds demand . Employers clearly have upper hand and they will use you as needed.

He mentioned only way fellows will get better jobs is if they match nephrology fellowship positions to number of jobs which can happen if they cut nephrology fellowships positions by 50 % or so

Also disturbing trend is that more and more nephrology groups are hiring PA and NP to do dialysis rounds and even to see new consults so they can cut the costs. NP and PA are filling some of the jobs which should ideally go to graduating fellows.

 

[Nephroexp]

I am not suggesting that people stop doing nephrology. But do it after knowing the following

1. Nephrology you see in residency and what you practice are very different
2. You will be lucky if you find a job
3. You will put in twice the time and get half-2/3 pay of a Hospitalist
4. You will be panhandling for consults for the rest of your life
5. You will be a social worker for very sick group
6. Programs need bodies so that the attending a don't have to wake up or come in in the middle of the night.
7. Other than dialysis there is no single rx in bread and butter nephrology (GN too infrequent in clinical practice)
8. It does not matter where you train if you do private practice . Universities are worse than private practice for job opportunities or pay

After knowing the above If you still join Nephro - pay the price with your career for your love of nephrology.


Pay may continue to decrease to ?? 100k

Let's is see how far these programs will push nephrology into the ditch by keeping current number of training programs


IMGs stay away from this trap called nephrology- it's not worth the effort you guys put in to make it here.

 

[pH74]

I am not suggesting that people stop doing nephrology. But do it after knowing the following

1. Nephrology you see in residency and what you practice are very different
2. You will be lucky if you find a job
3. You will put in twice the time and get half-2/3 pay of a Hospitalist
4. You will be panhandling for consults for the rest of your life
5. You will be a social worker for very sick group
6. Programs need bodies so that the attending a don't have to wake up or come in in the middle of the night.
7. Other than dialysis there is no single rx in bread and butter nephrology (GN too infrequent in clinical practice)
8. It does not matter where you train if you do private practice . Universities are worse than private practice for job opportunities or pay

After knowing the above If you still join Nephro - pay the price with your career for your love of nephrology.


Pay may continue to decrease to ?? 100k

Let's is see how far these programs will push nephrology into the ditch by keeping current number of training programs


IMGs stay away from this trap called nephrology- it's not worth the effort you guys put in to make it here.

I am not suggesting that people stop doing nephrology. But do it after knowing the following

1. Nephrology you see in residency and what you practice are very different
2. You will be lucky if you find a job
3. You will put in twice the time and get half-2/3 pay of a Hospitalist
4. You will be panhandling for consults for the rest of your life
5. You will be a social worker for very sick group
6. Programs need bodies so that the attending a don't have to wake up or come in in the middle of the night.
7. Other than dialysis there is no single rx in bread and butter nephrology (GN too infrequent in clinical practice)
8. It does not matter where you train if you do private practice . Universities are worse than private practice for job opportunities or pay

After knowing the above If you still join Nephro - pay the price with your career for your love of nephrology.


Pay may continue to decrease to ?? 100k

Let's is see how far these programs will push nephrology into the ditch by keeping current number of training programs


IMGs stay away from this trap called nephrology- it's not worth the effort you guys put in to make it here.

If everything you said is true then no sane person would join nephrology

Why would someone spend extra 2 or 3 years doing something which will keep you twice busy and pay you less? How to pay back loans without decent job?

Are you sure situation is this bad as 350 people did join nephrology last year assuming 15% didn't join after matching or quit after joining ?

 

[Nephroexp]

"No sane person would join nephrology"

A few know the situation and join hopeful that situation will improve

Most do not know how horrid the situation is - They will know for sure when they get out.

They are not unemployed - they are underpaid and overworked ie. if they get a job, as supply >>> demand. Older nephrologists who own groups employ with ridiculous contracts and they have no reason to want the new person to become a partner as long as bodies keep coming of these factories called nephrology programs.

Ego comes in way to many in admitting what the real situation is which specialist wants to go and say " I was foolish to waste 2 years of my life in getting trained slaving it out in fellowship to come out and realize - I can be replaced by a nurse practitioner!!!"


350 souls due to face reality every year - Practices in future might offer them same as a nephrology nurse practitioner.


No program will cut their numbers as they need willing slaves and they care the least what happens to them once they are done. You see the patients and your attending cosigns - hospital gets the money paying you peanuts (As attendings r mostly employed except in some programs where fellowship is run by private groups). It is more expensive to employ a PA than a fellow esp with all weekends/nights involved.

Keep it rolling. At least I did what no one did for me before I joined in atleast trying to post the reality as it is.


I do not need to prove it to any one - Go join and slave it out for 2-3 years and after that if your ego does not come in the way - come join me on the forum to prevent more from suffering the same fate

Posting with humility - " I went in with hope/fascination/curiosity and ended up with frustration clinically/intellectually/financially"

 

[nephappl]

Funny people complaining when we have been warning this situation for several years. More frequent visits and in particular listening to what we say here @ SDN would have relieved some pain.
I agree with almost everything said so far.
I am lucky enough to work in a big practice with an established trajectory and reputation and a defined partnership track but jobs like this are very rare nowadays; that being said starting salary is well below hospital medicine or primary care but you see a light at the end of the tunnel. We hired our last MD a couple of years ago and we still do not know if we should have done it. No plans to hire in the medium term despite multiple requests every week.
Our competition hires quite often and is the trend I have seen in several places; he brings a couple of guys , uses them up for two or three years and then they give up as no partnership is seen in the horizon ; when they leave they can not stay in the area as they have non competition clauses so they have to start all over again; he then bring another couple of suckers for the next couple of years and so on. How he can get away with this??? Lots of supply so replacing a doctor is not difficult and you do not have to offer too much for people to take it.
In primary care or hospital medicine is harder to do so ; you have to offer something decent otherwise people will go somewhere else. Nephrology docs do not have that option.
Do not blame practices for hiring PAs or NPs; unfortunately workforce policy is dictated by academics that have no idea how a business is run. For us to survive we have to maximize productivity and use of resources. In academic medicine your main financial worry is to get a paycheck; we have to pay benefits, employees, generate payroll , pay taxes, comply with hundreds and hundreds of regulations with lower reimbursement.
It is funny; my program is a big advocate of the "nephrologist shortage theory" so they needed nephrologists and they replaced them with NPs however they do not take call or work on weekends. Solution? The hospital sponsored 2 more fellowship positions with its own money as fellows are cheaper than NPs or PAs with no limit on how much you can work them up.
Do you have to be crazy going into nephrology these days? Yes you have to but lack of common sense and being prone to make irrational decisions is a very common human behavior. Do whatever you want; at the end is your problem dealing with your own frustrations. Here @ SDN we told you so.

 

[Nephroexp]

I wish I visited sdn more often and listened to people like nephappl.

Paying the price right now with a career that is going nowhere - thx to my stupidity and irresponsible expansion of nephrology numbers by nephrology programs.

If you still make it to interviews, atleast ask the program directors what happened to their prev fellows?

Not sure you will be told the truth.

 

[Nephroexp]

"Funny people complaining"

Sadly it's not funny it hurts like hell.

It hurts to do Nephro and thought of quitting some thing that you aspired for from medschool days hurts more.

 

[LoudBark]

If you still make it to interviews, atleast ask the program directors what happened to their prev fellows?

Not sure you will be told the truth.

They will lie. Not kidding.
I asked during my interviews. I was told the usual lies that they all got great jobs in great locations.
Only later on I found out that two ended up going the hospitalist route. One because he was completely frustrated and disillusioned after doing the fellowship and one because he couldn't find a decent nephrology job in a major city. The other fellow took a crappy job in the boonies working like a slave making less than the local hospitalists.

Trying to get an honest answer out of a program director on interview day? Are you kidding?

 

[Jooj86]

Sometimes people make the wrong career decisions. This is obviously true in life in general and clearly at least in part on this forum. I have to make the best decision for myself based on what I know, want, and feel when I'm making that decision. It definitely helps to hear about the downsides of going in to nephrology but at this point you're sounding like the crazy ex-girlfriend and further and longer posts about the same thing will not be helpful to anyone.

 

[Nephroexp]

Thank you for reorienting me - did like Nephro like a girlfriend and will continue an unhappy marriage
Good luck to all you for your fellowship.
My job is done and will stay offline

 

[nephro007]

edit

 

[pH74]

I wish I visited sdn more often and listened to people like nephappl.

Paying the price right now with a career that is going nowhere - thx to my stupidity and irresponsible expansion of nephrology numbers by nephrology programs.

If you still make it to interviews, atleast ask the program directors what happened to their prev fellows?

Not sure you will be told the truth.

I am so confused now. I called my mentor who is nephrologist in academic setting.

Per him only people on J1 visa or from small community programs are having trouble finding jobs, other fellows are getting decent job offers

He also said do 1 more year of transplant or interventional nephrology and your chances of securing a job will increase.

He said this slowdown in nephrology job is only for 1 or 2 years as CMS is confused about dialysis payments and it will pick soon.

What do you guys think? How accurate is this information? After reading all this I don't know if I can trust anyone

 

[pH74]

Funny people complaining when we have been warning this situation for several years. More frequent visits and in particular listening to what we say here @ SDN would have relieved some pain.
I agree with almost everything said so far.
I am lucky enough to work in a big practice with an established trajectory and reputation and a defined partnership track but jobs like this are very rare nowadays; that being said starting salary is well below hospital medicine or primary care but you see a light at the end of the tunnel. We hired our last MD a couple of years ago and we still do not know if we should have done it. No plans to hire in the medium term despite multiple requests every week.
Our competition hires quite often and is the trend I have seen in several places; he brings a couple of guys , uses them up for two or three years and then they give up as no partnership is seen in the horizon ; when they leave they can not stay in the area as they have non competition clauses so they have to start all over again; he then bring another couple of suckers for the next couple of years and so on. How he can get away with this??? Lots of supply so replacing a doctor is not difficult and you do not have to offer too much for people to take it.
In primary care or hospital medicine is harder to do so ; you have to offer something decent otherwise people will go somewhere else. Nephrology docs do not have that option.
Do not blame practices for hiring PAs or NPs; unfortunately workforce policy is dictated by academics that have no idea how a business is run. For us to survive we have to maximize productivity and use of resources. In academic medicine your main financial worry is to get a paycheck; we have to pay benefits, employees, generate payroll , pay taxes, comply with hundreds and hundreds of regulations with lower reimbursement.
It is funny; my program is a big advocate of the "nephrologist shortage theory" so they needed nephrologists and they replaced them with NPs however they do not take call or work on weekends. Solution? The hospital sponsored 2 more fellowship positions with its own money as fellows are cheaper than NPs or PAs with no limit on how much you can work them up.
Do you have to be crazy going into nephrology these days? Yes you have to but lack of common sense and being prone to make irrational decisions is a very common human behavior. Do whatever you want; at the end is your problem dealing with your own frustrations. Here @ SDN we told you so.

Funny people complaining when we have been warning this situation for several years. More frequent visits and in particular listening to what we say here @ SDN would have relieved some pain.
I agree with almost everything said so far.
I am lucky enough to work in a big practice with an established trajectory and reputation and a defined partnership track but jobs like this are very rare nowadays; that being said starting salary is well below hospital medicine or primary care but you see a light at the end of the tunnel. We hired our last MD a couple of years ago and we still do not know if we should have done it. No plans to hire in the medium term despite multiple requests every week.
Our competition hires quite often and is the trend I have seen in several places; he brings a couple of guys , uses them up for two or three years and then they give up as no partnership is seen in the horizon ; when they leave they can not stay in the area as they have non competition clauses so they have to start all over again; he then bring another couple of suckers for the next couple of years and so on. How he can get away with this??? Lots of supply so replacing a doctor is not difficult and you do not have to offer too much for people to take it.
In primary care or hospital medicine is harder to do so ; you have to offer something decent otherwise people will go somewhere else. Nephrology docs do not have that option.
Do not blame practices for hiring PAs or NPs; unfortunately workforce policy is dictated by academics that have no idea how a business is run. For us to survive we have to maximize productivity and use of resources. In academic medicine your main financial worry is to get a paycheck; we have to pay benefits, employees, generate payroll , pay taxes, comply with hundreds and hundreds of regulations with lower reimbursement.
It is funny; my program is a big advocate of the "nephrologist shortage theory" so they needed nephrologists and they replaced them with NPs however they do not take call or work on weekends. Solution? The hospital sponsored 2 more fellowship positions with its own money as fellows are cheaper than NPs or PAs with no limit on how much you can work them up.
Do you have to be crazy going into nephrology these days? Yes you have to but lack of common sense and being prone to make irrational decisions is a very common human behavior. Do whatever you want; at the end is your problem dealing with your own frustrations. Here @ SDN we told you so.

A friend of mine read your posts last year and didn't sign ROL after doing his interviews . He reapplied to CCM this year , got few interviews and seems like he dodged the bullet