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While I believe that some people go into nephrology for the interest in subject matter, I do believe that the majority who go apply to nephrology are at least hoping that they will be better off financially than a hospitalist, after they make partner. In my humble opinion, there are 2 groups of people who get screwed the hardest and they don't even know they are falling into a trap.
1) I would heavily discourage IMGs with visa issues from trying nephrology. Reason being is that you get the worst jobs in the most undersirable locations. The average nephrologist is no better than the average hospitalist in terms of pay on a per hr basis, maybe even a bit worse. There are very few nephrology practices that are lucrative. Most are tolerable at best. The average hospitalist make around 250k/year, working half the year, at one location, with little to no night calls. The average nephrologist(if you make partner) makes maybe around 350K/year, working obviously more than half the year, hitting multiple hospitals per day, competing for consults with other neph groups, and taking night calls for your group. Which is better? Imagine as IMG with visa restrictions you do even worse than the average. Even more horrifying, there are many nephrology groups who exploit IMGs with visa problems, paying them 200K/year starting salary and after 3 years make up an excuse and tell them they didn't make partner. They can do this because they know you are tied to the practice and can't leave them, or you will have to go back to your home country. Yes, it can happen in other specialties, but they are not getting payed this low of a starting salary and working this hard, so that makes the exploitation that much worse.
2) second group is older applicants(Age > 45). Just do the math. You are investing 2 yrs of fellowship plus 3-4 years in a neph group with starting salary around
200k/year(yes, thats national average for starting salary) to "hopefully" make partner in your group. Assuming your group treats you fairly, and you make partner, how many working years do you have left to recuperate the opportunity cost. The average hospitalist salary in this country is around 250K/yr working 7 on 7 off. You pick up some extra shifts per month and you already at 350-400K/year. Many nephrology groups don't make that money, even as full partners! So that's your opportunity cost. From purely financial standpoint, you would have to find a neph job that pays you the top 25 percentile in nephrology and have enough working years left in you to justify this investment; for many, this simply is not justifiable or realistic.
I have tremendous personal experience with nephrology and have many nephrology colleagues who have ended up badly. They wish they can go back in time to know this stuff, but unfortunately the damage has already been done. You don't have to believe what I say. But you should have the common sense to know that a specialty that went from once highly competitive(15 yrs ago) to being unable to fill it's fellowship positions(60-70% fill rate in the last 5 yrs), has serious financial ramifications for the people going into it.
1) I would heavily discourage IMGs with visa issues from trying nephrology. Reason being is that you get the worst jobs in the most undersirable locations. The average nephrologist is no better than the average hospitalist in terms of pay on a per hr basis, maybe even a bit worse. There are very few nephrology practices that are lucrative. Most are tolerable at best. The average hospitalist make around 250k/year, working half the year, at one location, with little to no night calls. The average nephrologist(if you make partner) makes maybe around 350K/year, working obviously more than half the year, hitting multiple hospitals per day, competing for consults with other neph groups, and taking night calls for your group. Which is better? Imagine as IMG with visa restrictions you do even worse than the average. Even more horrifying, there are many nephrology groups who exploit IMGs with visa problems, paying them 200K/year starting salary and after 3 years make up an excuse and tell them they didn't make partner. They can do this because they know you are tied to the practice and can't leave them, or you will have to go back to your home country. Yes, it can happen in other specialties, but they are not getting payed this low of a starting salary and working this hard, so that makes the exploitation that much worse.
2) second group is older applicants(Age > 45). Just do the math. You are investing 2 yrs of fellowship plus 3-4 years in a neph group with starting salary around
200k/year(yes, thats national average for starting salary) to "hopefully" make partner in your group. Assuming your group treats you fairly, and you make partner, how many working years do you have left to recuperate the opportunity cost. The average hospitalist salary in this country is around 250K/yr working 7 on 7 off. You pick up some extra shifts per month and you already at 350-400K/year. Many nephrology groups don't make that money, even as full partners! So that's your opportunity cost. From purely financial standpoint, you would have to find a neph job that pays you the top 25 percentile in nephrology and have enough working years left in you to justify this investment; for many, this simply is not justifiable or realistic.
I have tremendous personal experience with nephrology and have many nephrology colleagues who have ended up badly. They wish they can go back in time to know this stuff, but unfortunately the damage has already been done. You don't have to believe what I say. But you should have the common sense to know that a specialty that went from once highly competitive(15 yrs ago) to being unable to fill it's fellowship positions(60-70% fill rate in the last 5 yrs), has serious financial ramifications for the people going into it.
