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No idea...I have an interview coming up there as well, would be interesting to know
Official 2016-2017 Nephrology Fellowship Application Cycle
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interesting schedule.
So Lets say , if the consult fellow is called in 2 times at night, and he/she is too tired in am , then an outpt fellow will cover him in am .
How is it possible for outpt fellow ( who know nothing about the patients on that day , and the consult list is usually not a short list) to present in am rounds.
Who covers in pm.
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For the outpatient fellow: I assume (hasn't happened to me yet) the fellow and attending just approach the day like a weekend and divide up the list. We generally have 1-2 residents on service carrying 4-10 patients and our attendings do work. Put out fires, see urgent consults, write a few notes and back to research by noon.
For the inpatient fellow: get called in at 2:30 AM for emergency dialysis, leave at 4 AM, take 8 hours off, back by 12. Get updates / signouts on new consults from covering fellow and back to work. Maybe different institutions have larger volumes of work overnight, but our medicine / EM residents will generally hold consults until 7 and even for the real sick patient the ICU will try to manage themselves before calling us in overnight.
ok, just to give credence to Denjang's post from a few pages back... I am 2 months into my nephrology fellowship as well and so far i have enjoyed it. All of you guys applying in nephrology are making the right decision. You have to know what you are getting into though. I also had a lot of fun interviewing at different places and then starting my fellowship. Yes there are night calls but within reason. Yes you should stay close to the hospital when on call but then you are not going into ID or Endo. Your expectations have to be realistic but at the same time, calls dont kill you and they are not in house. Also the starting off salaries are not a good point to look at but the 3-5 yr salary. The hospitalist and ICU will start off with higher salaries but there are no options of buy in.. to the practice, there are still opportunities for medical directorship and you might get lucky and get shares in dialysis centers also. DO WHAT YOU ENJOY regardless of if thats nephrology or something else. Dont' pick a fellowship solely due to how much you will make because there are a lot of factors... trust me, i had been in practice for a while. And a word of advice for hospitalist jobs --- YOU WILL BURN OUT AFTER 5 - 10 yrs. Hope this helps
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There appears to be quite a bit of antagonism towards programs here, but I think the anger is misplaced. Why would you be interested in hurting your colleagues or their discipline? The common 'enemy' is the over-regulation of our discipline by non-docs and the rules that govern compensation. It's akin to political battles where one side is obsessed with taken down the other all the while those responsible are not held responsible. In general, academic institutions cannot support their faculty as in previous years b/c of less govt support and payers cutting reimbursement. This makes faculty, not just in nephrology, focused on RVUs and other productivity metrics. This trickles down to the educational experience, much of which has been described. So nothing particularly special about nephrology; it has impacted all disciplines and be wary of the tempting thought that the grass is greener on the other side. I hope we can all wise up and protect our noble discipline.
To address nephrology specifically, it is extremely rewarding. What subspecialty of IM will allow you the opportunity to actively manage and be an essential partner along with the intensivist to manage critically ill patients, place lines, perform biopsies, examine the urine for all its worth under a microscope, examine the tissue you just biopsied for a myriad of rare/interesting diagnoses, marry endocrinology (bone/mineral disease), hematology (anemia mgmt, uremic bleeding), manage transplanted patients and of course have the satisfaction of literally saving people's lives with dialysis? If this does not excite you then why are you a doctor? Maybe we should've gotten our MBA's and have done investment banking.
You also have to ask yourselves, who complains most vehemently about a test after it is over? Prob those who had the most trouble; it is human nature, so take in some of the comments with this perspective. Even in the biggest cities, there are wonderful and lucrative opportunities. It will be harder and you have to develop your networking skills overtime (much easier to find jem outside of the big cities, like any other discipline), but they do exist. Last I checked diabetes, htn is rampant and there are a record number of dialysis patients out there.
Lastly re: compensation. If you decide private practice, if by 5 years you are not making more money from your investments than your salary/pro fees then you have planned wrongly or signed a bad deal. If you are smart/informed you will do just fine; you will start off perhaps below a hospitalist salary, but your income after 5 years should be 2-3x. It is foolish to be short-sighted.
Not sure whar kind of audience this blog has, but wanted to set record straight and share some thoughts. Thanks everyone for their valid opinions and input.
To address nephrology specifically, it is extremely rewarding. What subspecialty of IM will allow you the opportunity to actively manage and be an essential partner along with the intensivist to manage critically ill patients, place lines, perform biopsies, examine the urine for all its worth under a microscope, examine the tissue you just biopsied for a myriad of rare/interesting diagnoses, marry endocrinology (bone/mineral disease), hematology (anemia mgmt, uremic bleeding), manage transplanted patients and of course have the satisfaction of literally saving people's lives with dialysis? If this does not excite you then why are you a doctor? Maybe we should've gotten our MBA's and have done investment banking.
You also have to ask yourselves, who complains most vehemently about a test after it is over? Prob those who had the most trouble; it is human nature, so take in some of the comments with this perspective. Even in the biggest cities, there are wonderful and lucrative opportunities. It will be harder and you have to develop your networking skills overtime (much easier to find jem outside of the big cities, like any other discipline), but they do exist. Last I checked diabetes, htn is rampant and there are a record number of dialysis patients out there.
Lastly re: compensation. If you decide private practice, if by 5 years you are not making more money from your investments than your salary/pro fees then you have planned wrongly or signed a bad deal. If you are smart/informed you will do just fine; you will start off perhaps below a hospitalist salary, but your income after 5 years should be 2-3x. It is foolish to be short-sighted.
Not sure whar kind of audience this blog has, but wanted to set record straight and share some thoughts. Thanks everyone for their valid opinions and input.
last years statistics showed out of 158 programs participated in the match only 65 were filled . interesting !
can anyone tell us about his interview experience. do they ask same questions as residency interviews ( tell me about your self, why to choose you , why nephrology, what is ur weakness, etc?)
can anyone tell us about his interview experience. do they ask same questions as residency interviews ( tell me about your self, why to choose you , why nephrology, what is ur weakness, etc?)
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I've only been to 1 so far with September being my main month for interviewing. I guess the only difference between interviewing for internal medicine residency is that the groups are typically a lot smaller (the one i went to was interviewing 5 people, a couple more programs only interview 2-3 ppl per day). You will also typically interview with more people. Otherwise, I would assume its the same (depending where you go, it can be a very intensive process). Just have fun and remember why your going into Nephrology!
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Most of the places will try to convince you on ranking them first. Some of the programs may also coax you to take prematch.
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Fellowship in Nephrology is not for faint-hearted. If you are someone you gets burnt out in cushy hospitalist job, you are not ready for a career in Nephrology. Expect to see between 40 to 50 patients a day in practice between clinic, dialysis unit and inpatient service.
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This is very much depending where you go. If you go to a University program with 3 or 4 fellows, and with good attendings to take the load off of you when your list starts creeping up to 25+, you won't be necessarily ground down to that degree. For smaller programs with only a couple of slots, then this may be a reality. However, typically you only get 2-3 intense consult months in the first year anyway, with second year in a lot of the stronger programs dedicated largely to research, with a couple of clinical rotations thrown in so you don't lose your touch
Nephrology is hard and if you are not passionate about it, it'll be that much worse for you. Go to larger programs with a history of good job placement and give yourself a chance at getting a good job.
not sure what exactly a 'cushy hospitalist job' may be. The hospitalist job pays well but sucks like anything. Its slightly better than being in primary care. Obviously ppl follow the money trail, less reimbursement in nephrology, less people applying. Well, which field's medicare reimbursements have not been cut in medicine or gone up, Ans: Nothing, everything has seen a cut not just neph. Honestly, i just cant see why neph gets such bad rep. All clinical fields have volume to see, not just neph. and since the dialysis population is growing but people going into neph are getting less and less, at some point ( maybe not soon ) the demand for nephrologists has to go up..
Well said Kudney...i has been a hospitalist for over 5 years now and i can frankly tell you its the most mundane and boring thing you can do , except for the money that is !!! As a hospitalist 60-70% of you time is social work and the rest is medicine .If you are someone who enjoys medicine and likes cerebral problems, i guarantee you will feel the same as i do within 5-7 years.Also keep in mind that reimbursement for Hospitalists has also gone down ,more metrics to meet which adds on to the work load.Hospitalists job is good for a few years as it teaches to how to deal with tough situations that are not taught in residency but i don't think it a good career choice.
Another thing i may add is that a lot of hospitalist today are subspecialists .. in my group the top leadership within the devision of Hospital Medicine are Nephrologist and ID guys.The chair of medicine is a nephrologist at my hospital.
Another thing i may add is that a lot of hospitalist today are subspecialists .. in my group the top leadership within the devision of Hospital Medicine are Nephrologist and ID guys.The chair of medicine is a nephrologist at my hospital.
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http://forums.studentdoctor.net/thr...llows-recent-grads-doing-hospitalist.1141745/
Useful thread for nephrology fellows who are planning their career as a hospitalist because of dearth of jobs.
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Ah unfortunately I only focused on the Northeast. I know there was one person that was talking about Southeastern and Texas programs so hopefully he posts soon.
Most of big name programs have busy consult services 30-40 a day and they consider it as strength since the fellow will get exposure to wide spectrum of pathology like GN, peritoneal dialysis , transplant and etc. And will prepare u to private practice after graduation in when u will have many patients to cover.
Is that a valid point or just an excuse for the heavy workload? If u see 35 pt a day u become more experienced nephrologist than if u see 20!!
Is that a valid point or just an excuse for the heavy workload? If u see 35 pt a day u become more experienced nephrologist than if u see 20!!
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It is a valid point. As mentioned before, expect to see between 30 to 50 patients a day in practice between clinic, dialysis unit and inpatient service. You should go to a busy program, so you are ready for the real life.
nephrology is dead - no question whatsoever about it.
as a hospitalist atleast your work is cut out for you. Nephrology, you have to go around with a begging bowl for your consults/referrals.. This is not going to change, as the old timers hire you, just a recruit for begging. they have no reason to retire as these guys will stay on directors for life for the dialysis unit - all they care is for you to provide bodies to dialyze.
this specialty has been dead for a while.
Program directors need you to be a glorified nurse practitioner(Fellow)- it is cheaper to hire a fellow than an NP . what awaits you on the other end is
A) being a slave to davita/fresenius
B) earn less than a hospitalist
c) begging all the primary care doctors/hospitalists for your consults
this is a dead speciality - DONT SEE IT AS AN ESCAPE from your hospitalist job. There is nothing more demeaning, than begging for consults. You will be slave to some guy who owns a dialysis unit and you work as a body supplier for dialysis.
Being a beggar is what this specialty has cut out for you. don't waste your life - no matter how much you love nephron or physiology - it is hard to beg every day.
Unless you want to be a beggar - don't waste your time
Don't care about what you guys do in the end. Only reason I post , is for you guys to know what it is out in real world.
Program directors know nothing or don't care - as they are not in real world.
Most of the nephrology fellows end up as hospitalists - why waste your time slaving for these programs ?
quit before you make the mistake of applying!!
as a hospitalist atleast your work is cut out for you. Nephrology, you have to go around with a begging bowl for your consults/referrals.. This is not going to change, as the old timers hire you, just a recruit for begging. they have no reason to retire as these guys will stay on directors for life for the dialysis unit - all they care is for you to provide bodies to dialyze.
this specialty has been dead for a while.
Program directors need you to be a glorified nurse practitioner(Fellow)- it is cheaper to hire a fellow than an NP . what awaits you on the other end is
A) being a slave to davita/fresenius
B) earn less than a hospitalist
c) begging all the primary care doctors/hospitalists for your consults
this is a dead speciality - DONT SEE IT AS AN ESCAPE from your hospitalist job. There is nothing more demeaning, than begging for consults. You will be slave to some guy who owns a dialysis unit and you work as a body supplier for dialysis.
Being a beggar is what this specialty has cut out for you. don't waste your life - no matter how much you love nephron or physiology - it is hard to beg every day.
Unless you want to be a beggar - don't waste your time
Don't care about what you guys do in the end. Only reason I post , is for you guys to know what it is out in real world.
Program directors know nothing or don't care - as they are not in real world.
Most of the nephrology fellows end up as hospitalists - why waste your time slaving for these programs ?
quit before you make the mistake of applying!!
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regardless of all the negative propaganda, it is ultimately up to the applicants to decide their future. If by now, they have not figured out that nephrology is in a deep state of distress, then they are not going to change their minds. They are going to interview in programs who are gonna be very humble and polite to hire as many as possible. The real deal would start a year later when they start applying for jobs and ll figure out that. Jus see the following examples from practicelink
http://www.practicelink.com/jobs/physician/nephrology/
http://www.practicelink.com/jobs/physician/gastroenterology/
GI has close to 500 jobs in one website alone vs nephrology with paltry 78 jobs. Although there may be more jobs out there, practicelink is a very good website of job listings. even if 50% nephro spots are filled, there would be 200 fellows a year and not everyone of them are going to be offered a nephrology job. These things definitely need to ring a bell among applicants but I am afraid it is not gonna change the reality.
http://www.practicelink.com/jobs/physician/nephrology/
http://www.practicelink.com/jobs/physician/gastroenterology/
GI has close to 500 jobs in one website alone vs nephrology with paltry 78 jobs. Although there may be more jobs out there, practicelink is a very good website of job listings. even if 50% nephro spots are filled, there would be 200 fellows a year and not everyone of them are going to be offered a nephrology job. These things definitely need to ring a bell among applicants but I am afraid it is not gonna change the reality.
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Add to that the number of unhappy nephrologist looking for another job + the amount of hospitalist nephrologist looking for jobs (ww have 2 here)
The rarional thing to do is not doing this fellowsip but for many people stupidity is limitless
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I think nephro as a specialty faced downturn when medicare cut dialysis reimbursement rates. It was followed by mad acquisition by fresnius and davita into all the small nephrology groups. On came the conditions: increase the number of patients seen in a day to keep up the income - from 20 odd to 30 odd. Cover more hospitals, see more patients, convince hospitalists to consult and show volume.
So if 5 nephrologist were seeing 100 patients a day about 10 years ago, now 3 ppl are willing to see the same 100 patients. Despite increasing population of ESRD and CKD patients, due to increased volume current nephrologists handle, the need for new nephrology fellows into jobs has diminished. Most of the current jobs are due to retirement of old nephrologists and ppl quitting practice for alternate career.
Everyone in this forum knows that there are way too many nephrology positions for the job market out there. The country does not need 400 nephrologists a year. ASN should have stepped in to cut positions but as argued repeatedly here, academic nephrologists(some, not all) dont like to work and do more calls. If there are only 2 positions instead of 4, there is a problem - who is gonna take those extra night calls? Academic nephrologists are used to supervising fellows and staying at home for many years that they dont wanna change.
This specialty is in doldrums due to selfishness of academic faculty. My 2 cents.
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to all the nephro bashers:
I believe you guys have made your point. This is a fellowship interview invite thread.
they have made their choice.
I believe you guys have made your point. This is a fellowship interview invite thread.
they have made their choice.
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They havent made the NRMP agreement. Have seen ppl who applied, went for interviews and changed their mind and did not submit rank order in the past couple years after they got to know the scope of the specialty. There are 2 types of ppl who applied nephrology
1. Who is genuinely interested in nephrology
2. Who wants to do a fellowship for other reasons: rigorous hospitalist/primary care work, prestige of a specialist, IMG lured into nephrology coz u can easily get in top institutes.
For both the groups, the ground reality of the job market needs to be imparted. You are investing 2 years of your productive lifetime in a training and you should know what lies ahead. Even if one person reconsiders their choice(especially IMGs on J1 visa - forget waiver opportunities when US citizens cant find good nephro jobs), this is a victory.
Again, no one in this forum has vested interests against nephrology or have conflict of interest. Ppl here are genuinely trying to help applicants with their perspective and true facts. yes this could be done in a different thread but the target audience unfortunately arent lurking at other forums as much as this one.
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there are probably equal if not more post on here regarding the doom and gloom of nephrology than there are post about invites and interview experiences. I am sure 3rd year IM graduates can easily scroll upwards and see the wall of text about nephrology.
i completely disagree with the discussion aimed at academic nephrologist though I agree that the job market/ number of positions needs to be adjusted.
i completely disagree with the discussion aimed at academic nephrologist though I agree that the job market/ number of positions needs to be adjusted.
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i disagree with your categorization that academic nephrologist are selfish and care only about their work life balance. I am disgusted with your incessant attack on academic nephrologist as they are some of the smartest hard working people i know. They obviously know the field isn't in a great place right now and the society as a whole is trying to fix the issue. It is not something that can be fixed overnight. Biggest problem right now is compensation.
-fellowship is suppose to be hard so I do not understand your whining about work.
Act like a professional of the medical field. Don't bash other physicians just because you chose the wrong field. I will leave it at that and not argue with you any further.
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why do you have a chip on your shoulder about academia?
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he comes here EVERY year and does the same thing...
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Academic nephrologists begging candidates at scramble to fill fellowship positions : priceless
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So besides feeding the trolls, anyone out there who can give insight into some of the programs that are out there? What I'd really like to know is which programs are malignant and which ones give their fellows the most opportunities to succeed?
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It doesn't matter if your fellowship is soft and cuddly and treats you like a princess. What happens after 2 years is what's more important ...
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Going to nephrology fellowship nowadays remind me with butterflies attraction to fire phenomenon (phototaxis ) . do not worry guys I am sure all the applicants will join top name programs because those programs they do not have anybody to fill their positions . you guys after joining the fellowship be ready to work very very hard day and night for 2 years . after graduation at the end of the road you guys will be a great hospitalists .
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lol great hospitalists
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Or great academic Nephrologists who perhaps will do something to advance the field and Medicine in general
Either or.
I stopped following this forum a month ago for the same reason you're listing. I guess nothing have changed since.
For the people who think that they have made a wrong decision, it is never too late for a career change. I don't understand why you guys are so adamant at bashing the specialty.
Thanks
Feel like this thread has been just overtaken by a few who keep repeating the same thing over and over --->nephrology is bad, don't go into it, become a hospitalist and enjoy life, are you guys hospitalist program recruiters or something ? you remind me of those hospitalist flyers which show mountains and a lake in the background ( and forget to mention that you will never have any time as a hospitalist to actually go to that mountain or lake )
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SUNY Downstate, Tulane, Mount Sinai, Mayo clinic (rochester), Westchester Medical Center, George Washington, University of Pennsylvania, Brown University,
Northwestern University, Tufts, Bringham, Cleveland clinic, Duke, Einstein, Columbia, cornell, Yale, Mayo Clinic (Arizona), Thomas Jefferson, George Town,
Stony brook, Boston University, Jacobi Medical Center, Lenox hill, Montefiore.
Any info would be appreciated.
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Nobody here recruit for hospitalist all of us went to nephrology at some point because we did not like hospitalist and we thought hospitalist is not life long career but later we discovered that we ran away from fire( hospitalist) to volcano (nephrology) . I totally agrees that hospitalist is disappointing but believe it or not nephrology is 100 fold more disappointing than hospitalist and the worst of it when you hate hospitalist and want get ride of it then you go to nephrology full of dreams to become specialist then after 2 years you find your self working as a hospitalist again at that time you will feel how bitter it is .
If you think people here are just recruiting for hospitalist , so why you think we are just recruiting in this forum only ? did you ask your self if we go to other fellowships forums and say the same words do you think it will work or make any sense ? I am sure if you think about it well you will discover where is the problem .
Theoretically speaking if we are in a different world logism should say that being a specialist in nephrology is a lot better than being general internist ,however on ground in this area of the world general internist is more wanted, more earning, less working, less stressed and more happy than nephrologist .unfortunately now nephrology now is on the bottom of all medical specialities including hospitalist, primary care and geriatrics .
If you think hospitalist who works 2 weeks a month does not have time to see the mountain and lake in the advertisement . I am pleased to tell you that as a nephrologist you may not have a chance to see your self in the mirror .
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