Official 2014-2015 Nephrology Fellowship Application Cycle

[interested_party]

I matched in a University program but just found out half of positions went unmatched. I am the only one out of 15 PGY-3 in my program who applied for nephrology. I feel I should have applied for GI or hem-onc. What should I do? Can I quit now? What kind of legal action will I face? If I reapply what are my chances to match in competitive fellowship next year? @nephappl please give me some advise. I am under lot of stress

Sorry to hear that but your reason for being concerned doesn't make sense to me. I don't understand why you want to bail out of your commitment. I'm assuming no one forced you into applying to nephrology, and that you had 4-6 months to interview and ask astute questions about: nephrology, job prospects, work load, the future of the field, etc. Finding out that 51% of programs did not fill is a very bad reason for you to bail on a specialty that, presumably, you were interested in (so interested that you applied, interviewed, and ranked programs).

Finding out that you are the only one of 15 PGY-3s who applied to nephrology is also a very bad reason to break your commitment. After all, I presume that you speak with your colleagues on a regular basis -- perhaps even socialize with them. Wouldn't you already know (before you began interviewing) that you were the only person in your program who was applying to nephrology.

If I'm missing something please correct me.

Tejas Desai, MD
Assistant Professor of Medicine
Director, Nephrology Fellowship Program
Division of Nephrology & Hypertension
East Carolina University
Greenville, NC
Founder and Editor-in-Chief
Nephrology On-Demand
On your iPhone @ http://goo.gl/tfSAQT
On the Web @http://www.myNOD.org
On Twitter @nephondemand

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[nephappl]

@juggernaut16
Do not do a fellowship you will not be happy with in particular if you regret it. It will be 2 more years of missery for you and your co-fellows.
You did not do your homework in the beginning and now you are in this situation.
This time please do it !! Leave the fellowship and match commitment in a way it will not hurt you and will allow you to move on with your life and your career.
I checked NRMP; looks like after 45 days commitment ends so you can leave safely.
Good luck

 

[Nephroexp]

Based upon this link, I can safely quit after 45 days. Is that correct? I don't want to be PCP/ Hospitalist. I will do locums and apply next year.

Nephrology job prospects have been discussed umpteen number of times.

It is not uncommon for candidates to dropout even after match.

Do it in a way that is not going to hurt you longterm - Please do your research at least now.

It took years for ASN to even acknowledge that there is a problem. It will take even more years for this glut to be sorted out it it happens.
If you join your fellowship, you solved the program's problem. Your training will make it harder for you to find a decent job for a long time. "Nephrohospitalist" is not easy at least for some.

It is unethical to recruit for a fellowship when a program knows very well, job prospects for their trainees are poor. It is not illegal though.

Think about yourself and do what is legal. Legal is not the same as ethical.

 

[LoudBark]

Sorry to hear that but your reason for being concerned doesn't make sense to me. I don't understand why you want to bail out of your commitment. I'm assuming no one forced you into applying to nephrology, and that you had 4-6 months to interview and ask astute questions about: nephrology, job prospects, work load, the future of the field, etc. Finding out that 51% of programs did not fill is a very bad reason for you to bail on a specialty that, presumably, you were interested in (so interested that you applied, interviewed, and ranked programs).

Finding out that you are the only one of 15 PGY-3s who applied to nephrology is also a very bad reason to break your commitment. After all, I presume that you speak with your colleagues on a regular basis -- perhaps even socialize with them. Wouldn't you already know (before you began interviewing) that you were the only person in your program who was applying to nephrology.

If I'm missing something please correct me.

Tejas Desai, MD
Assistant Professor of Medicine
Director, Nephrology Fellowship Program
Division of Nephrology & Hypertension
East Carolina University
Greenville, NC
Founder and Editor-in-Chief
Nephrology On-Demand
On your iPhone @ http://goo.gl/tfSAQT
On the Web @http://www.myNOD.org
On Twitter @nephondemand

Dr. Desai,
I am not the poster who wants to bail out.....however as a program director I have some questions for you.

Are you honest with applicants when they ask about the outlook of the future of nephrology?
Are you honest with applicants when they ask about job prospects for nephrology, particularly outside of rural areas?
Are you honest with applicants when the ask you where your previous trainees have ended up and where they are working now?
Are you honest when applicants ask about income potential and lifestyle as a nephrologist?

I am only asking because my program and nearly every program I interviewed at was not honest to me. While I do realize that programs have a vested interest in not being completely honest with applicants (after all they need to fill spots), it also comes across as being a little shady and sleazy. This is all in hindsight after I had already matched at a program. It took months to realize that programs on the interview trail were hiding things, in all likelihood intentionally not to scare away applicants.

I don't know the reasons behind the original poster, but there is a real possibility that someone can think they want to do nephrology and go on the interview trail and then afterwards think they were given a raw deal.......like buying a used car and being assured by the sleazy car salesman the engine is in great shape and it breaks down on the highway a week later. It just is not fair to blame the poster that "Oh you should have known what you were getting into". Sometimes that realization comes after you realize you were intentionally misled and dealt a raw deal.

 

[nephappl]

Agree with the post that programs always look after them when recruiting for fellows as I said before a fellow is half price a NP or a PA and can be worked up twice; for most programs is no secret education and fellows' career comes in third or fourth place but it does not excuse you from doing your homework and research before applying and comitting to this particular fellowship. It is not for PD or academic programs to find you a well paid job in a desirable location. That is your responsibility and I do have little simpathy for people that act first and then start thinking about what to do. We are dealing with highly educated smart people here so this common sense rule can not be forgotten.
By the way I am glad the impact we are having here ; we even have a program director discussing with us now. Please be nice with him even though academic people are the ones we should look for answers and accountability regarding the wrong decisions taken about the nephrology workforce "needs" that got us into this mess.

 

[CptNemo]

.

 

[Docdoc123456]

Guys , no need for such exagaration and dramatization , I will summarize the whole matter

-

 

[Docdoc123456]

I matched in a University program but just found out half of positions went unmatched. I am the only one out of 15 PGY-3 in my program who applied for nephrology. I feel I should have applied for GI or hem-onc. What should I do? Can I quit now? What kind of legal action will I face? If I reapply what are my chances to match in competitive fellowship next year? @nephappl please give me some advise. I am under lot of stress

I

 

[nephappl]

Keep the faith

 

[Concernedrenaldoc]

I'm a long time viewer of the forums (since medical school) but haven't felt compelled to post until now. I'm a graduating renal fellow and was born/raised and trained in the US. It is sad to see what is occurring in our field. I know of few residents who are interested in nephrology and when I ask many residents their perceptions of nephrology, it is NOT because of what certain academic physicians publish about. I do not get reply's back that it is because the field is too difficult to understand or the complexity of the patients. I hear it is due to a poor job market getting jobs in their area (read many US grads do wish to return to their family region after training), lifestyle (frequent calls, emergent dialysis/CRRT etc), poor reimbursements likely to worsen (Medicare funds the lions share of dialysis and we are under the congressional microscope given our patients make up 1-2% of the total Medicare population yet consume up to 7% of the total Medicare budget), high medical school loan burdens (after my years of training, I'm at 250K now from a midwest US medical school), perception from residents that renal fellows are work very hard in training compared to some other IM specialties (not a big deal if there were more rewards at the end).

The ASN is now studying this but I fear there will be long lasting effects. We need quick and clear solutions to which we have few. Academics was obviously behind in noticing these trends and agree with some of the above notions that most academic physicians have NEVER practiced in private practice and thus are generally clueless about the job market. It is true in my program where some appear to STILL tell students/residents that jobs are good. That just isn't true and I agree to say otherwise is unethical or at the very least deceptive.

Yes, fellow spots need to be decreased
Yes, education needs improved to engage and foster more interest
Yes, we need better role models/mentors (many starting academics are very low pay and it shows, some are disgruntled and learners sense this)
Yes, we need better pay structures and reimbursement to attract candidates
Yes, loan repayment should be considered

How to accomplish this, I do not know and am not alone. Just like our common diagnosis ATN, the root causes are multifactorial and thus we need a multifaceted approach to save the integrity, respectability of our field.

I'm fortunate to have found a job early on in a metropolitan city I grew up in. Great private offer with a large reputable group. Work-life balance though pay is not the best starting, I could make more starting as a hospitalist, but once partner this levels out and with joint ventures/partnership will be just as happy as the hospitalist from a monetary standpoint. I'm lucky and proud to have found a great job doing what I love to do.

 

[Docdoc123456]

I matched in a University program but just found out half of positions went unmatched. I am the only one out of 15 PGY-3 in my program who applied for nephrology. I feel I should haves a applied for GI or hem-onc. What should I do? Can I quit now? What kind of legal action will I face? If I reapply what are my chances to match in competitive fellowship next year? @nephappl please give me some advise. I am under lot of stress

I

 

[CptNemo]

.

 

[interested_party]

Dr. Desai,
I am not the poster who wants to bail out.....however as a program director I have some questions for you.

Are you honest with applicants when they ask about the outlook of the future of nephrology?
Are you honest with applicants when they ask about job prospects for nephrology, particularly outside of rural areas?
Are you honest with applicants when the ask you where your previous trainees have ended up and where they are working now?
Are you honest when applicants ask about income potential and lifestyle as a nephrologist?

I am only asking because my program and nearly every program I interviewed at was not honest to me. While I do realize that programs have a vested interest in not being completely honest with applicants (after all they need to fill spots), it also comes across as being a little shady and sleazy. This is all in hindsight after I had already matched at a program. It took months to realize that programs on the interview trail were hiding things, in all likelihood intentionally not to scare away applicants.

I don't know the reasons behind the original poster, but there is a real possibility that someone can think they want to do nephrology and go on the interview trail and then afterwards think they were given a raw deal.......like buying a used car and being assured by the sleazy car salesman the engine is in great shape and it breaks down on the highway a week later. It just is not fair to blame the poster that "Oh you should have known what you were getting into". Sometimes that realization comes after you realize you were intentionally misled and dealt a raw deal.

Thanks for these great questions. I will try to answer them all below.

1. Are you honest with applicants when they ask about the outlook of the future of nephrology?
Answer: Yes. People were honest with me when I was applying and the only way I can pay my mentors back is to "pay it forward" with honesty to the next generation of doctors

2. Are you honest with applicants when they ask about job prospects for nephrology, particularly outside of rural areas?
Answer: Yes. I'm very fortunate because at ECU, every single fellow since 2002 (that's right....2002) has found a job **before** graduating. In fact, I am so proud of this fact that I have added that to our Fellowship App (NOD Plus). Almost all of our fellows want to practice in the South (and in particular...the South East). As a native New Yorker (Queens) I never understood why one would choose a rural area over a metro. After living in the South for 7 years, I know why...life is really nice down here. So for any applicant who has desires to return to Boston/NYC/DC, etc, I tell them not to choose ECU at the interview in the most certain of terms.

3. Are you honest with applicants when the ask you where your previous trainees have ended up and where they are working now?
Answer: Yes. At ECU, 33% of graduates have remained in North Carolina, 67% have found jobs outside of our state. 21% have remained in academia (at their choosing); 79% have gone into private practice (all at their choosing). I highlight these facts (they are facts when it comes to the ECU program) at every interview and in our iOS App.

4. Are you honest when applicants ask about income potential and lifestyle as a nephrologist?
Answer: Yes. The biggest competitor to a career in Nephrology is a career as a Hospitalist. The latter generally work 7-days on, 7-days off. They work approximately 1/2 the month, while Nephrologists work 30 days on (the whole month). Yet when I ask every single resident "what is the number one drawback to being a hospitalist", they answer "burnout". Isn't that interesting....you work ~1/2 the month as a hospitalist and you hear more hospitalists burning out than nephrologists.


If you want to know **exactly** what I say at an interview, visit the ••Recruitment•• section of NOD Plus. I programmed the app myself and update it monthly with factual statistics about the ECU program. I am confident enough about the ECU program that I have made all these stats public here: goo.gl/tfSAQT


Lastly, if you are a program director, please consider identifying yourself.

Tejas Desai, MD
Assistant Professor of Medicine
Director, Nephrology Fellowship Program
Division of Nephrology & Hypertension
East Carolina University
Greenville, NC

Founder and Editor-in-Chief
Nephrology On-Demand
On your iPhone @ http://goo.gl/tfSAQT
On the Web @http://www.myNOD.org
On Twitter @nephondemand

 

[interested_party]

I'm a long time viewer of the forums (since medical school) but haven't felt compelled to post until now. I'm a graduating renal fellow and was born/raised and trained in the US. It is sad to see what is occurring in our field. I know of few residents who are interested in nephrology and when I ask many residents their perceptions of nephrology, it is NOT because of what certain academic physicians publish about. I do not get reply's back that it is because the field is too difficult to understand or the complexity of the patients. I hear it is due to a poor job market getting jobs in their area (read many US grads do wish to return to their family region after training), lifestyle (frequent calls, emergent dialysis/CRRT etc), poor reimbursements likely to worsen (Medicare funds the lions share of dialysis and we are under the congressional microscope given our patients make up 1-2% of the total Medicare population yet consume up to 7% of the total Medicare budget), high medical school loan burdens (after my years of training, I'm at 250K now from a midwest US medical school), perception from residents that renal fellows are work very hard in training compared to some other IM specialties (not a big deal if there were more rewards at the end).

The ASN is now studying this but I fear there will be long lasting effects. We need quick and clear solutions to which we have few. Academics was obviously behind in noticing these trends and agree with some of the above notions that most academic physicians have NEVER practiced in private practice and thus are generally clueless about the job market. It is true in my program where some appear to STILL tell students/residents that jobs are good. That just isn't true and I agree to say otherwise is unethical or at the very least deceptive.

Yes, fellow spots need to be decreased
Yes, education needs improved to engage and foster more interest
Yes, we need better role models/mentors (many starting academics are very low pay and it shows, some are disgruntled and learners sense this)
Yes, we need better pay structures and reimbursement to attract candidates
Yes, loan repayment should be considered

How to accomplish this, I do not know and am not alone. Just like our common diagnosis ATN, the root causes are multifactorial and thus we need a multifaceted approach to save the integrity, respectability of our field.

I'm fortunate to have found a job early on in a metropolitan city I grew up in. Great private offer with a large reputable group. Work-life balance though pay is not the best starting, I could make more starting as a hospitalist, but once partner this levels out and with joint ventures/partnership will be just as happy as the hospitalist from a monetary standpoint. I'm lucky and proud to have found a great job doing what I love to do.

Here is my proposal on how to decrease "fellowship positions" across the US: https://peerj.com/preprints/592v1/
It is a head-to-head comparison of 2 mathematical models, one based on historical experience and has withstood the test of time.

Let me know what you think.

Tejas Desai, MD
Assistant Professor of Medicine
Director, Nephrology Fellowship Program
Division of Nephrology & Hypertension
East Carolina University
Greenville, NC


Founder and Editor-in-Chief
Nephrology On-Demand
On your iPhone @ http://goo.gl/tfSAQT
On the Web @http://www.myNOD.org
On Twitter @nephondemand

 

[Docdoc123456]

N

 

[pH74]

Wow this is sad... Maybe DNPs will step in and fill in the need lol

or maybe PA-C

 

[NephroFellows]

It is so unfortunate to see our beloved field going down the drains and fast. I am a silent observer of this decline and could not resist to put in my 2 cents now.

I would post in from an IMG (which i am) and a seasoned Hospitalist perspective (which i was). I joined and finsihed nephrology fellowship, while liking each and every day of it.

I wanted to comment on the current trend of Nephrology fellowship positions being filled by the candidates who were Hospitalists before.

Many people have said that Nephrology should not become an "escape" for those hospitalists (or internists) who are unhappy with their current job and now want to get out of it. and just want to do Nephrology fellowship for the sake of doing a fellowship However the ground reality is, many of the fellowship positions are currently being filled up by these hospitalists or internists, who are "escaping" from their current jobs.

Now if that is indeed the case, is it a good or a bad thing?? People who may not be interested in a particular field, should they even end up in that field. It is difficult to answer for the future now, only time would tell, but in my books, and keeping all the ground realities, the answer is."Yes", it is good thing in currently "avaialble circimstances"!.

I think the biggest thing that needs to be dealt with now is to fill the currently available fellowship positions and to keep the Nephrology fellowship alive.

From a (past) Hospitalist perspective, the thing that attracted me to Nephrology fellowship was to "gain more knowledge" and to "add on more skills" in this field, without getting overly worked and killed. Unfortunately most current fellowship programs are constructed in a way that there is lack of interest in teaching, no role models, poor interventional skills and the fellows are over burdened with work.

We need to remind ourselves, that most Hospitalists who join the nephrology fellowship, were experienced (average 2-5 years experience) and, come from a background where they were making 4-5 times more then the fellowship and that too while working 2 weeks a month. They are not naive or stupid to sacrifice that lifestyle and jump in something that would make them vulnerable. Most IMG's have no visa issues (as they got their Green Cards, while working as Hospitalists in remote areas) and so no restraints to stick to a miserable job. They are smart enough to look into poor teaching or work atmosphere and will resign at the first opportunity.

Now is this an ideal candidate for nephrology fellowship, again a difficult question to answer, but then one has to work with what is available. The issue of the day is for the Fellowship programs to realize that fact. Solution is we need better teachers, that are role models, we need best inetrventionalists that teach from A to Z and do not feel frustrated doing that, we need a conducive working environment that do not kill our fellows and we need to keep the enthusiasm alive while providing them with a brighter and hopeful future.

 

[CptNemo]

.

 

[nephappl]

CPT nemo:

Totally agree with you; main issue is financial
-Nephrologist oversupply
-Flat or decreasing incidence of ESRD
-Fact that almost each patient with CKD 3 can be handle by IM or family practice
-Private practices able to use NP/PAs for many aspects of patient care
-For the few "good" jobs available (there are terrible jobs out there you do not want to take) there is plenty of competition from the whole pool of people unable to find a job all these years
-As the oversupply started < 10 years ago almost 70% of practicing nephrologist are < 60 year old so retirements will not happen in decades
-Low salaries, lower reimbursements for all aspects of practice

I even think programs could totally shut down for several years and there would be no problems finding nephrologists; the only ones suffering would be the fellowship programs as they would lose their source of cheap labor.

Except for academic interest and getting increased medical knowledge (that you can get without giving up 2-3 years of earnings just by reading) there is no a compelling financial or practical reason to do this fellowship.

Still 250+ people will start it this year.... their choice. We told them so here.

 

[NephroFellows]

The teaching is program dependent. My program's dedication to teaching/scholarship and intellectual discussion is terrific. I've amassed great amounts of knowledge about nephrology and general medicine during the fellowship.

I agree with you that improved procedural training would be beneficial and may attract people, but from what I've seen, general nephrologists in the community rarely if ever do any procedures (the volume and reimbursement is too low to make it worthwhile to do a few biopsies or lines). So this is more of a bigger "nephrology as a whole" problem.

My thesis is that the main problem with nephrology's attractiveness is the job market. You give up ~$300K over two years to do a nephrology fellowship instead of taking a hospitalist position in order to then (two years later) get a position that pays less than a starting hospitalist ($180K is the quoted national average nephrology starting salary). In a couple years, when you become a partner, you then get a salary that is hopefully somewhat higher than that of a hospitalist, after paying a partnership buy-in. Plus, the issue is compounded because some areas on the coasts are so saturated that you have to also give up location in order to find a job in the field.

Fire starts from a tiny flame, we need to work on things step by step. I know reimbursements are not that great, but then many other fields are struggling with the reimbursements too, even the cardiologists We have to keep nephrology attractive and valid enough, in order to have residents interested in this field. We need to grab back what we have given to other fields (mostly because of our laziness). One suggestion is to absorb back Renal ultrasounds, Nuclear scans, Biopsies, Tunneled caths, Fistulograms, etc, as an essential part of the nephrology training and dedicate compulsory rotations for them, and make nephrology a procedural speciality, even if the reimbursements are not going to be enough. Echocardiograms are mainly done by the Cardiologists and not the radiologists?! Only those fields succeed that keep them innovating. I know we all are interested in the physiology accept of the nephrology and there is ton of research in the basic sciences, but then most of us can read the books, and this may not be a good enough reason to spend 2 extra years and learn and earn the same.

 

[nephappl]

@NephroFellows
Do not know if you are a fellow a program director or a practising nephrologist but your comments are more wishes that real solutions.
You forget that despite all the academic talk and denial financial reward + quality of life are the main reasons an individual would pick a medical specialty (why is so hard to get into Plastics, Derm or HemOnc while nephrology is giving away positions?). Residents are not fools and they see how fellows are doing after finishing fellowship. Increasing procedures and all you are mentioning is not worth from a financial perspective when:
-Reimbursement for interventional is down 30+%
-Reimbursement for dialysis keeps dropping
-Just to survive practices are using more mid levels for almost everything
-Supply / demand balance The more availability of doctors the lower the salaries is a basic law of economics
-The average student debt for an AMG is around $ 250-300K
Here in my practice I give away biopsies and catheters because I make more seeing people in the office or writing consults in the floor than spending hours waiting for OR time + all the calls and the headache associated with procedures not telling you that if you do procedures your malpractice insurance is higher. Also my day is too busy to do this extra work but with reimbursement so low we can not afford bringing another doctor.
Looks to me you do not know how private practices (the ones that generate jobs for neew grads by the way) work.

 

[NephroFellows]

@NephroFellows
Do not know if you are a fellow a program director or a practising nephrologist but your comments are more wishes that real solutions.
You forget that despite all the academic talk and denial financial reward + quality of life are the main reasons an individual would pick a medical specialty (why is so hard to get into Plastics, Derm or HemOnc while nephrology is giving away positions?). Residents are not fools and they see how fellows are doing after finishing fellowship. Increasing procedures and all you are mentioning is not worth from a financial perspective when:
-Reimbursement for interventional is down 30+%
-Reimbursement for dialysis keeps dropping
-Just to survive practices are using more mid levels for almost everything
-Supply / demand balance The more availability of doctors the lower the salaries is a basic law of economics
-The average student debt for an AMG is around $ 250-300K
Here in my practice I give away biopsies and catheters because I make more seeing people in the office or writing consults in the floor than spending hours waiting for OR time + all the calls and the headache associated with procedures not telling you that if you do procedures your malpractice insurance is higher. Also my day is too busy to do this extra work but with reimbursement so low we can not afford bringing another doctor.
Looks to me you do not know how private practices (the ones that generate jobs for neew grads by the way) work.

No it's not a wishful thinking at all. First people who like nephrology will keep on applying in this field as much as you or anyone else would like to discourage them here. Second the world is not that gloomy for nephrologists that some have been portraying in here for the last 2-3 years. Third, all my colleagues who did nephrology fellowship ended up getting good jobs of their likings and at good places. And lastly i am a practicing nephrologist for the last almost 2 years and worked as a hospitalist for 5 years. I enjoy working as a Nephrologist as much as i liked working as a Hospitalist. I am just curious how do you get this much time posting in here (which you do a lot) if your life is so busy working as a nephrologist?

 

[nephappl]

Glad you and your friends are doing so great, me too as I was very lucky. Different from what I see now.
I expect to raise discussions based on facts , literature and statistics.
Not relevant to this but 129 posts in 5 years is one every 2 weeks. Sometimes more often as my tolerance for fantasy and ilussions is low.

 

[CptNemo]

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[pH74]

I think that people should enter the field with accurate information. From what I've seen researching the market and looking for jobs while talking to people in the community, nephappl is giving accurate information to applicants.
They can check average starting salaries for themselves from an independent source:
http://www.davitasource.com/career-resources-salary-guide

Sure, one may find a great job in a great group (and people do), but statistically, that is becoming harder and relies on several stars aligning. I've heard lots of groups tell me that they are simply not hiring this year. Most of the jobs that are available look like they're available for a good reason (typically poor "middle of nowhere" location, small group with frequent call, lots of driving to many hospitals and dialysis unit, questionable ability to make partner based on past history, etc.)

I really love most aspects of nephrology and want it to succeed (it's totally in my best interest), however, I'm concerned about it's business model going forward. In-center dialysis and injectable revenue was already gutted. Vascular center reimbursements helped groups for a while, but people tell me these are going down. Small one-off procedures are not worth it: as nephappl said, higher malpractice and not enough volume to make a profit. Maybe the home dialysis modalities will help (I'm not familiar with those reimbursement models)??? I doubt that the new K binders (e.g., zirconium cyclosilicate) will make us money. I honestly don't know what new revenue streams we will have in the future.

if you desire renal job in ideal location, become NP or PA not nephrologist. Most of the practices in nicer locations are looking for mid level providers.

 

[FutureInternist]

I worked for a hospitalist for 4 years and I ended by joking a fellowship as I find that hospitalist is not a career that anyone can do more Thant 3-4 years , although you work 7on 7 off , everybody burn out because you entirely do junk work , you do all the paper work and the social work for all other specialist and surgeon , you run the code and RRT , so hospitalist is paid resident job without any ACGME limitation ,hospitalist do night shifts , admit 12-15 pt a night , see 35/35 pt a day , so it has a lot of limitation ,

I am in program out of the 8 fellows 6 were hospitalist , I think this can answer the dilemma .

Not sure why you picked such a crappy job then
When I interviewed, there were MANY jobs available that are way better than what you described
Currently, I do 15 shifts a month (not a strict 7 on, 7 off), cap is 18 patients, night shift admits only 7 (each admission after that is extra money), do 2 admissions on your day shift (unless you are capped) & any admissions after that is also extra money
Nurses do 95% of triage & cross-cover, although there are back-up attendings, who very rarely get called, you never do codes, or procedures

 

[pH74]

Not sure why you picked such a crappy job then
When I interviewed, there were MANY jobs available that are way better than what you described
Currently, I do 15 shifts a month (not a strict 7 on, 7 off), cap is 18 patients, night shift admits only 7 (each admission after that is extra money), do 2 admissions on your day shift (unless you are capped) & any admissions after that is also extra money
Nurses do 95% of triage & cross-cover, although there are back-up attendings, who very rarely get called, you never do codes, or procedures

I agree. There are plenty of good hospitalist jobs. Maybe this person needs visa

 

[Docdoc123456]

erorr

 

[doub]

We are here to give the people an honest advice , not just to say crab things , what you are telling about your hospitalist if it is true it is a rare exception , every body here know that hospitalist is a crab dumps collecting job , and that why the hospital need you , because this is the only thing hospitalists are good in , hospitalist does not have any expertise in any specilaity in medicine , they are being hiered in any hospital to collecet all the Pts that no body wants to admit , do the h&P for other specilaist and surgeons , handle the social issues and that is why called hospitalists , it a kind of resident work or mid level provider kind of clerkiship being done by a licensed physician for safety of Pts ,

i have worked for both private practice and academic hospitalisist , i dont have any visa , so what I am telling here is a real fact comes from experience not from hearing stories from other people , because when you talk to other people about what they do , they will never frankly say we do a crab job in the hospital for money , any way what do you expect a general internal medicine doctor to do in a hospital ?? it mainly a crab job because this is general internal medicine in this country .

i am not trying to say do or dont do hospitalist , this is a personal choices of people , I am trying to give an honest advice for applicants who comes to this page before applying to fellowship , guys , dont believe that hospitalist is good career , that is not true , and you should ask your self why people burn out although it is 7 on and 7 off . ?/ also why most of the hospitalist end up by doing fellowships , most of them do nephro , ID , rheumatology ??

My personal advice , go to fellowship early , be a specilaised doctor , have your area of focus , and let the others comes and ask you about your opinion in your speciality rather than spending your life collecting the trash from under the other feets as a hospitalist .

this is just a personal perspective from somebody who did a hospitalist for 4 years then ended doing a fellowship , most of my co fellows has the smae story and smae opinion.

Nephrology market us not the best know , but I still see people getting good jobs , things will change by time , if you dont like nephrology , take other fellowship , do critical care , pulmonology , GI or cards ,

I tried to say honest advice , dont let the others guide you . good luck for every body.

I'm confused in your previous posts you talk about resigning from your nephrology fellowship after 2 months in 2013. Now you allude to the fact you are still a fellow.

 

[fatal familal insomnia]

Every field of medicine has its crappy parts about it. Lets be honest there are no perfect specialties in this medical system. If you are waiting/searching for that perfect field you are delusional. Everyone of us, no matter what specialty you end up in, will make more enough money to be financially stable (even after loan repayments). so financial stability should not be the sole reason for choosing a medical field.

The true question that everyone has to answer is what is going to make them happy today and 30 years from now. Only you can answer that question. Once you figure out what will make you happy than choose that career. What makes someone happy may be spending time with kids and doing endeavors away from medicine. I personally don't think being an hospitalist is a career (this is a job). However one can always be a teaching attending/hospitalist and make a medical career out of teaching with that good hospitalist lifestyle. As i said above, it doesnt have to be all about medicine. Life occurs outside the hospital walls.

My recommendation is to choose a specialty/subspecialty that will give you a career in medicine (whether that being a teaching attending or a subspecialist in private practice), but don't make medicine your life. Find interests outside of medicine. if you make medicine your life you will be disappointed as there will always be another BS consult if your a subspecialist as you are walking out the door or another angry patient at 345 pm wanting pain meds if you are primary care.

 

[CptNemo]

.

 

[pH74]

We are here to give the people an honest advice , not just to say crab things , what you are telling about your hospitalist if it is true it is a rare exception , every body here know that hospitalist is a crab dumps collecting job , and that why the hospital need you , because this is the only thing hospitalists are good in , hospitalist does not have any expertise in any specilaity in medicine , they are being hiered in any hospital to collecet all the Pts that no body wants to admit , do the h&P for other specilaist and surgeons , handle the social issues and that is why called hospitalists , it a kind of resident work or mid level provider kind of clerkiship being done by a licensed physician for safety of Pts ,

i have worked for both private practice and academic hospitalisist , i dont have any visa , so what I am telling here is a real fact comes from experience not from hearing stories from other people , because when you talk to other people about what they do , they will never frankly say we do a crab job in the hospital for money , any way what do you expect a general internal medicine doctor to do in a hospital ?? it mainly a crab job because this is general internal medicine in this country .

i am not trying to say do or dont do hospitalist , this is a personal choices of people , I am trying to give an honest advice for applicants who comes to this page before applying to fellowship , guys , dont believe that hospitalist is good career , that is not true , and you should ask your self why people burn out although it is 7 on and 7 off . ?/ also why most of the hospitalist end up by doing fellowships , most of them do nephro , ID , rheumatology ??

My personal advice , go to fellowship early , be a specilaised doctor , have your area of focus , and let the others comes and ask you about your opinion in your speciality rather than spending your life collecting the trash from under the other feets as a hospitalist .

this is just a personal perspective from somebody who did a hospitalist for 4 years then ended doing a fellowship , most of my co fellows has the smae story and smae opinion.

Nephrology market us not the best know , but I still see people getting good jobs , things will change by time , if you dont like nephrology , take other fellowship , do critical care , pulmonology , GI or cards ,

I tried to say honest advice , dont let the others guide you . good luck for every body.

what you mean by "crab dumps collecting job" We don't collect crabs as hospitalist.

You cannot generalize that all hospitalist jobs are bad. In fact lifestyle of most hospitalists is way better than their nephrology colleagues (more time off the work, better salary, easy to find job in desired location, happier family, less divorce rates and less exploitation from senior partners)

 

[pH74]

I'm confused in your previous posts you talk about resigning from your nephrology fellowship after 2 months in 2013. Now you allude to the fact you are still a fellow.

This forum seems to be an epicenter for all frustrated budding nephrologists

 

[rokshana]

We are here to give the people an honest advice , not just to say crab things , what you are telling about your hospitalist if it is true it is a rare exception , every body here know that hospitalist is a crab dumps collecting job , and that why the hospital need you , because this is the only thing hospitalists are good in , hospitalist does not have any expertise in any specilaity in medicine , they are being hiered in any hospital to collecet all the Pts that no body wants to admit , do the h&P for other specilaist and surgeons , handle the social issues and that is why called hospitalists , it a kind of resident work or mid level provider kind of clerkiship being done by a licensed physician for safety of Pts ,

i have worked for both private practice and academic hospitalisist , i dont have any visa , so what I am telling here is a real fact comes from experience not from hearing stories from other people , because when you talk to other people about what they do , they will never frankly say we do a crab job in the hospital for money , any way what do you expect a general internal medicine doctor to do in a hospital ?? it mainly a crab job because this is general internal medicine in this country .

i am not trying to say do or dont do hospitalist , this is a personal choices of people , I am trying to give an honest advice for applicants who comes to this page before applying to fellowship , guys , dont believe that hospitalist is good career , that is not true , and you should ask your self why people burn out although it is 7 on and 7 off . ?/ also why most of the hospitalist end up by doing fellowships , most of them do nephro , ID , rheumatology ??

My personal advice , go to fellowship early , be a specilaised doctor , have your area of focus , and let the others comes and ask you about your opinion in your speciality rather than spending your life collecting the trash from under the other feets as a hospitalist .

this is just a personal perspective from somebody who did a hospitalist for 4 years then ended doing a fellowship , most of my co fellows has the smae story and smae opinion.

Nephrology market us not the best know , but I still see people getting good jobs , things will change by time , if you dont like nephrology , take other fellowship , do critical care , pulmonology , GI or cards ,

I tried to say honest advice , dont let the others guide you . good luck for every body.

you DO know the word is "craP", right?
and I know that the rules are a bit more relaxed on internet fora, but really? your English is atrocious....proof read maybe before you hit the "post reply" button...

 

[Leo Spaceman]

 

[juggernaut16]

We are here to give the people an honest advice , not just to say crab things , what you are telling about your hospitalist if it is true it is a rare exception , every body here know that hospitalist is a crab dumps collecting job , and that why the hospital need you , because this is the only thing hospitalists are good in , hospitalist does not have any expertise in any specilaity in medicine , they are being hiered in any hospital to collecet all the Pts that no body wants to admit , do the h&P for other specilaist and surgeons , handle the social issues and that is why called hospitalists , it a kind of resident work or mid level provider kind of clerkiship being done by a licensed physician for safety of Pts ,

i have worked for both private practice and academic hospitalisist , i dont have any visa , so what I am telling here is a real fact comes from experience not from hearing stories from other people , because when you talk to other people about what they do , they will never frankly say we do a crab job in the hospital for money , any way what do you expect a general internal medicine doctor to do in a hospital ?? it mainly a crab job because this is general internal medicine in this country .

i am not trying to say do or dont do hospitalist , this is a personal choices of people , I am trying to give an honest advice for applicants who comes to this page before applying to fellowship , guys , dont believe that hospitalist is good career , that is not true , and you should ask your self why people burn out although it is 7 on and 7 off . ?/ also why most of the hospitalist end up by doing fellowships , most of them do nephro , ID , rheumatology ??

My personal advice , go to fellowship early , be a specilaised doctor , have your area of focus , and let the others comes and ask you about your opinion in your speciality rather than spending your life collecting the trash from under the other feets as a hospitalist .

this is just a personal perspective from somebody who did a hospitalist for 4 years then ended doing a fellowship , most of my co fellows has the smae story and smae opinion.

Nephrology market us not the best know , but I still see people getting good jobs , things will change by time , if you dont like nephrology , take other fellowship , do critical care , pulmonology , GI or cards ,

I tried to say honest advice , dont let the others guide you . good luck for every body.

After readings posts of docdoc123456 I have decided to join nephrology fellowship next year rather than suffer as a hospitalist. By the way what is nephrohospitalist? is that a new concept?

 

[CptNemo]

.

 

[nephappl]

"I'm not sure anymore which posts are serious in this thread vs bait... but I'll bite."
I am not biting anymore, I am quitting this discussion
Enough is enough

 

[rokshana]

"I'm not sure anymore which posts are serious in this thread vs bait... but I'll bite."
I am not biting anymore, I am quitting this discussion
Enough is enough

i'll believe that when i see (or don't) see it....

 

[gutonc]

I'm not sure anymore which posts are serious in this thread vs bait.

I'm pretty sure this entire thread is trolling.

 

[11910]

As a current first year fellow, I will offer some advice to future applicants including post match scramblers who may still be looking for a position.

Try not to go to programs that did not match any fellows. Here is why....................most of them are in programs that may be nice but are in less desirable locations (compared to all the programs that went unmatched!!). The reason is that you will find yourself doing all the work and call/weekends that a first year does even in your second year.

My program did not match any of its three positions and now we are faced with a situation where the faculty is making plans to hire a NP/PA to help them with their work and dump maximum call on us when we are second years. As it is first years do more weekends, more call, ALL HOLIDAYS!! Now we will do it again since we did not attract any First year fellows!! Unfair right!! But who is listening.

So, Applicants beware.............................do not go to programs that have a less than stellar match record. This is a buyers market, you can pretty much get what you want.................so do not put yourself in a situation where you will not have any first years when you are second years and will continue to be scut monkeys for the faculty.

 

[CptNemo]

.

 

[Polish Farmer]

I think a lot of these thoughts are short sighted
I agree wholeheartedly there is a significant problem with the private practice of nephrology with regard to payment structure, capturing revenue and interesting cases from consults, mid-level creep, loss of procedures, worsening capitation with dialysis, competition in larger urban areas, and overall workload with poor work/life balance. All of these issues will be magnified with fresh fellows leaving academia and entering private practice as the low man on the totem pole-fyi those are the people likely posting here, not the partners in practice 15 years out.

But I would ask you might look at things a little differently:
1. Nephrology work is very complicated but rewarding. Most PCPs, hospitalists, surgeons, cardiologists, rheumatologists, etc. truly can't and don't want anything to do with managing AKI/glomerular disease/CKD/dialysis/electrolyte/transplant issues, regardless of interest, the scope of practice and liability dictates you will never have "other people" doing your job for you. Rheumatologists treating GN- sure but they tend to lose their marbles when things don't go well and make pretty dumb mistakes. Witness the hypertensive 20kg up pt I just saw with pauci-immune GN who just had lasix stopped by Rheum b/c creatinine started going up, face-palm to forehead!
2. As long as humans are born with kidneys...you will have a job, because nobody does this work better. Last I checked we have a billion inpatient consults and worst waiting list of any subspecialty for clinic- I don't see a dearth of patients drying up any time soon. I laugh at "bioartificial kidneys replacing nephrologists" argument. Who will manage those kidneys? Will they grow on trees for every homeless 70 year old diabetic with coronary disease? and pretty sure that won't solve your FSGS recurrence ma'am!
3. While Residents are excited that Pulmonary, Cards, GI, Oncology have such spectacular competition and a billion Fellowship spots. When you think of it- I would currently rather go into a specialty that matches 70 positions a year than one that is matching 300. You will be a dime a dozen Cardiologist in 10-15 years. Whereas in Renal the contracting of Fellowship positions and increase in percentages of FMGs is a GOOD thing to secure your future
4. There is downward pressure on the income of ALL physicians, I suspect we are only seeing the tip of the iceberg, so don't bemoan the salary of Nephrologists right now. I wouldn't be surprised if all medical subspecialties in the future have average salary rates that barely crack 6 figures, the key to life in medicine in the future is low expectations!
5. For all the begrudging of academia- Nephrology training is a wonderful segway into basic/clinical research careers- the focus on chemistry, biology, physics is a good prime on being a basic scientist and having large data sets of CKD and ESRD patients to mine from yields good opportunities for clinical research, along with the thirst for more needed clinical trials in CKD and AKI.

So in summation- if your goal in life is to get out of academia, make money fast, drive a Beamer and don't work- cool, go be a dermatologist. If you don't mind driving a Civic but love what you do and are in it for the long haul- consider Nephrology and don't listen to these jokers!

 

[RustBeltOnc]

One point that should be discussed: hospitalist jobs might not always be abundant. So, to think that this will always be an option for internal medicine grads (instead of fellowship / subspecialty career) might be too optimistic. After all, the trend we're seeing is the consolidation of medical facilities, closing of hospitals, etc ... so fewer jobs for hospitalists, long term.

 

[CptNemo]

.

 

[RustBeltOnc]

CptNemo and colleagues --

Yes, those figures / facts are grim. As of right now (early 2015), hospitalist is a better career path with respect to geographic choice, compensation, and lifestyle.

My concern is for several years from now, say 2020, 2025. I predict the hospitalist jobs will be fewer, poorly paying, and with bad lifestyle, due to the closing of hospitals.

I think if a prospective nephrology fellow finds the field interesting and can deal with the possible opportunity cost of fellowship (personal and financial) they should still matriculate into a training program.

Things won't get any worse in the nephro field; but they can get much, much worse in hospital medicine.

 

[rokshana]

CptNemo and colleagues --

Yes, those figures / facts are grim. As of right now (early 2015), hospitalist is a better career path with respect to geographic choice, compensation, and lifestyle.

My concern is for several years from now, say 2020, 2025. I predict the hospitalist jobs will be fewer, poorly paying, and with bad lifestyle, due to the closing of hospitals.

I think if a prospective nephrology fellow finds the field interesting and can deal with the possible opportunity cost of fellowship (personal and financial) they should still matriculate into a training program.

Things won't get any worse in the nephro field; but they can get much, much worse in hospital medicine.

really? can you show your source for that?

more and more hospitals are going with hospitalists as fewer and fewer PCPs continue to mange their pets in both the inpt and outpt setting...admissions are not necessarily decreasing...LOS stays certainly are, but all the more hospitalists are needed to take care of the inpt admissions...and subspecialties are not admitting their own pts so again, hospitalists are picking up these pts as well...

and soon enough hospital medicine will have its own board certification...that in and of its self will limit who can go into it and keep it competitive enough to make it a desirable choice.


whether or not people STAY in hospital medicine is a different question.

 

[CptNemo]

.

 

[Docdoc123456]

I recently discovered that somebody commented using my user name 3-4 times on this web site I really don;t know if somebody using same user name or used my username in some way , I did not comment since almost a year now since I left the fellowship ??
I am still believing that nephrology fellowship is wast of time and effort , I thought for a long time that it is good to do a fellowship but one year ago I discovered that hospitalist is a lot better than many fellowships specially nephrology , some people may disagree with this but that is Ok, the problem with nephrology it will make your job chances less, your job location farther and your income lower and your work hours more , it is a combination of disadvantages that rarely combine in a speciality , that is why many applicants try to avoid going to nephrology and many new to mid career nephrologist move to hospitalist career.
I think everybody should make his own decision based on personal interests however , getting the experience of the others is always a good thing . my personal advice if you like to choose a fellowship , it is better to chose one that will add something positive to your after the 2-3 years . it could be more money , better job lifestyle , etc.. , none of this exist in nephrology career…

I think this will be my last comment on this web site . I hope good luck for every body . this web site was really honest in advising the new applicants .

 

[pH74]

As a current first year fellow, I will offer some advice to future applicants including post match scramblers who may still be looking for a position.

Try not to go to programs that did not match any fellows. Here is why....................most of them are in programs that may be nice but are in less desirable locations (compared to all the programs that went unmatched!!). The reason is that you will find yourself doing all the work and call/weekends that a first year does even in your second year.

My program did not match any of its three positions and now we are faced with a situation where the faculty is making plans to hire a NP/PA to help them with their work and dump maximum call on us when we are second years. As it is first years do more weekends, more call, ALL HOLIDAYS!! Now we will do it again since we did not attract any First year fellows!! Unfair right!! But who is listening.

So, Applicants beware.............................do not go to programs that have a less than stellar match record. This is a buyers market, you can pretty much get what you want.................so do not put yourself in a situation where you will not have any first years when you are second years and will continue to be scut monkeys for the faculty.

Money is so tight in nephrology these days that some programs will go to any extent to use fellows to save their money. Same goes on in private practice also. Nephrology groups are taking advantage of weak job market and exploiting new grads by making them sign crappy contracts.

I completely agree with 11910, do not even interview at programs which didn't match. You will relive your first year again. If you really want to do nephrology , then do it at a top program. Do not make mistake of going to a sweatshop.