nephrology competitiveness, general information

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neurotrancer

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Hi all,

I am an M2 at an MD school in VA. I was wondering if you could give me some insight into the level of competitiveness nephrology residency. Are there any direct matches or does one have to go through an IM residency first? I found this very interesting after spending time with a nephrologist in a small community hospital. what might be some good things to do to ensure entrance into this field? Some physicians consider nephrology to be among the most intellectually challenging of IM subspecialties. Do you agree? Do any of you know any good sites for general career info for nephrology? The American Society of Nephrologists website wasn't so helpful.

Thanks!

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Nephrology is usually a 2-year fellowship, to be entered into after a 3-year IM residency. Amongst the context of IM subspecialties, it is of moderate competitiveness (less than Cards, GI, Allergy/Imm, Heme/Onc, but more than the others). Certainly, it is arguably the most intellectually challenging specialty in the entire medical spectrum, since you have to deal with complex metabolic disorders and have to know your internal medicine EXTREMELY well. Renal patients rarely develop simple illnesses, and have vast cardiovascular & infectious morbidities, and develop unique hematological and gastroenterological problems which one needs to understand, recognize and treat.

I found nephrology interesting enough to choose it as a career, and will be starting my fellowship this July.
 
I too want to eventually go into Nephrology. I will be graduating in a couple of months and while on the interview trail, I made it abundantly clear that thiswas my intention. I was assured by most of the Program Directors that I met with that I would have no problem getting a Nephrology spot at their institution. I did not kill Atep I and II, but I did pretty well. I think you should start planning on getting some rotations in Nephro early during your fourth year so that PD's see your interest (and try to get a least one LOR from one of those rotations). I only applied to IM programs that have Nephro fellowships and ones that do a lot of Transplants every year as it is often more difficult to get a Fellowship when you are not at the home institution.

The only thing that I could add is that some programs (very few in the US right now) offer a third year of Fellowship to focus your skills when dealing withg Transplants. That being said, many programs give you ample of tranplant experience and as a matter of fact, many Neprhologists practicing Transplant Nephro probably only did the 2 year fellowship.

Hope this helps.
 
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You may also have an additional option to add to your nephrology fellowship: Interventional nephrology. Yes interventional nephrology. One of my friends here is embarking on that path and is hoping to bring that aspect of fellowship training to UTSW next year. As I understand it, only 4 interventioanl nephrologists exist in Dallas and they have cornered the market on their procedures and make an incredible amount of money compared to their contemporaries.
 
I saw several programs that emphasized that they have interventional nephrology built into their fellowship, so I asked the Nephrologist that I trained under about it. He said every program teaches you interventionl nephrology (putting in dialysis catheters, atc) but he said it is not worth the money in most places because it is so time consuming and you are also competing with surgeons and radiologists. I would not favor one programm over another simply because they say they have interventional nephrology.
 
dochubert said:
I saw several programs that emphasized that they have interventional nephrology built into their fellowship, so I asked the Nephrologist that I trained under about it. He said every program teaches you interventionl nephrology (putting in dialysis catheters, atc) but he said it is not worth the money in most places because it is so time consuming and you are also competing with surgeons and radiologists. I would not favor one programm over another simply because they say they have interventional nephrology.

That is true, but from a business perspective, nephrologists control where these patients get these procedures done. The four IN's in Dallas purportedly make 7 figures+ each. The benefit of having those skills and being able to market those skills to fellow nephrologists who do not want to or cannot perform those procedures seems to be tremendous.
 
UTSouthwestern said:
That is true, but from a business perspective, nephrologists control where these patients get these procedures done. The four IN's in Dallas purportedly make 7 figures+ each. The benefit of having those skills and being able to market those skills to fellow nephrologists who do not want to or cannot perform those procedures seems to be tremendous.

Funny that the original post never mentioned monetary reasons for entering nephrology, yet that has become the focus of the discussion. Is it a sad reality about the present state of affairs in medicine or just sad? Better ask Jack Handy. ;)
 
UTSouthwestern said:
You may also have an additional option to add to your nephrology fellowship: Interventional nephrology. Yes interventional nephrology. One of my friends here is embarking on that path and is hoping to bring that aspect of fellowship training to UTSW next year. As I understand it, only 4 interventioanl nephrologists exist in Dallas and they have cornered the market on their procedures and make an incredible amount of money compared to their contemporaries.

You might find this interesting


http://ndt.oupjournals.org/cgi/content/full/19/5/1041

http://ndt.oupjournals.org/cgi/content/abstract/18/7/1321

As a chronic kidney patient, I wish the medical community would spend more time looking for cures rather than surgeries or long term care that includes being hooked up to dialysis machine. I have had one treatment under the cytonax method and have dropped my protein and blood in the urine to normal. I will not get back the 20% of my kidney function that is gone but I intend to stop the progression. This is what new physicians should be looking at. This is from a patient.
 
DadofDr2B said:
You might find this interesting


http://ndt.oupjournals.org/cgi/content/full/19/5/1041

http://ndt.oupjournals.org/cgi/content/abstract/18/7/1321

As a chronic kidney patient, I wish the medical community would spend more time looking for cures rather than surgeries or long term care that includes being hooked up to dialysis machine. I have had one treatment under the cytonax method and have dropped my protein and blood in the urine to normal. I will not get back the 20% of my kidney function that is gone but I intend to stop the progression. This is what new physicians should be looking at. This is from a patient.

My father in law is in the same boat. So is my cousin. Both have made tremendous strides since being near death due to their misdiagnoses and general stubborness to believe that they were afflicted with kidney disease. Finding cures to kidney diseases doesn't obviate the need for the current stopgap bridges that currently exist, but I expect the progress of research to accelerate over the next ten years as newer technologies begin to take hold.

Back to IN, having as many friends as I have in the field of nephrology and IM in general, I just find it heartening to see that some of them are finally reaping some much deserved extra rewards for the extensive work they have performed. Access placement and declotting procedures, done at significantly less cost than those performed by their surgical or radiology colleagues, have helped them expand the services they provide including doubling the clinic space of two of them.
 
Wow! I appreciate your comments.


I'm a third year resident who would like to embark in the field of nephrology and the personal statement I wrote involves a patient with the disease (Berger's disease) that your links bring me to.

So much of medicine is spent on cure; not as often, on care. I'm really very motivated to do more for my patients in terms of prevention, education, and appreciate the links!

By the way, as a renal patient, do you know what programs or hospitals are well-known for Geriatric Nephrology?

If you do, please comment,

Thanks!


DadofDr2B said:
You might find this interesting


http://ndt.oupjournals.org/cgi/content/full/19/5/1041

http://ndt.oupjournals.org/cgi/content/abstract/18/7/1321

As a chronic kidney patient, I wish the medical community would spend more time looking for cures rather than surgeries or long term care that includes being hooked up to dialysis machine. I have had one treatment under the cytonax method and have dropped my protein and blood in the urine to normal. I will not get back the 20% of my kidney function that is gone but I intend to stop the progression. This is what new physicians should be looking at. This is from a patient.
 
Thanks for sharing your stories!

I'm a newcomer to the website; and was wondering if you could offer some information on the nature of Nephrology interviews nowadays and the application process. The majority of programs, I'd say, 98%, are now going through ERAS.

This delays the interview process a bit; and from the discussions posted on student.doc, the interview process may occur in January now since programs can not obtain our information until December 1st. Do you know any programs that are call themselves "ERAS" but still offer positions before they get our applications downloaded December 1st?

Could you ask your nephrology friends?

I'd really appreciate it! My interest is in the field of Geriatric Nephrology; a unique field I believe that has much to offer especially in this day when everyone is getting CKD earlier; and more elderly are undergoing dialysis and renal transplants than in previous years when this wouldn't even be a consideration!




UTSouthwestern said:
My father in law is in the same boat. So is my cousin. Both have made tremendous strides since being near death due to their misdiagnoses and general stubborness to believe that they were afflicted with kidney disease. Finding cures to kidney diseases doesn't obviate the need for the current stopgap bridges that currently exist, but I expect the progress of research to accelerate over the next ten years as newer technologies begin to take hold.

Back to IN, having as many friends as I have in the field of nephrology and IM in general, I just find it heartening to see that some of them are finally reaping some much deserved extra rewards for the extensive work they have performed. Access placement and declotting procedures, done at significantly less cost than those performed by their surgical or radiology colleagues, have helped them expand the services they provide including doubling the clinic space of two of them.
 
hi,

i have been a avid reader of this forum. i am an IMG and finished my MD in internal medicine outside US. i have cleared MRCP part I exam. i have cleared USMLE step I and II and will be applying for step II CS in some time.

i am interested in direcr fellowship in US since i am planning to come back to home country after gaining experience and exposure in US.

i am interesed in neprology as my first option and then others being endocrine and hematology/oncolgy.

i wanted to know what r my chances in getting my fellowships. i have quiet a few publications, presentations in conference, my scores were ok that great like 85 and 88 in step I and II respectively.

i would also like to know if i can take american board exam for internal medicine directly without doing the residency......

pls also help me in finding good website which will guide me in this endeavour....

waiting for ur reply....

Dr. Harry
 
population is aging and percentage of diabetes and obesity is increasing (#1 and 2 causes of chronic kidney disease is diabetic and hypertensive - tied to obesity - nephropathy) There is and will continue to be a shortage of nephrologists in the future. Good career path.
 
neurotrancer:
what do you think of the university of virginia nephrology fellowship program?
 
Congratulations to those of you who've already matched in nephrology!

Would you be willing to pass along advice to us nephrology hopefuls as to how you organized your PGY-2 or PGY-3 year (or PGY-1 year, for those of you who were really on top of things) as you applied for a renal fellowship? For example, when did you set aside time for interviews, finish eras applications, request letters of recommendation, pursue research, etc?
Also, what things did you feel were important to fellowship directors in your applications, in particular research (publications vs. research experience alone)? And were there particular programs you thought were fantastic...or perhaps not-so-fantastic? Any advice you have would be appreciated!
 
I just matched into a nephrology program on the West Coast. Won't tell you which one, but it's a more academic program that will be 3 years in length. Most are usually 2 years.

This was a tough year to interview because when the year started, there was not precedent of when we'd be interviewing since this was the first year that they used ERAS. In years past, most interviews took place during Sept-Oct, so when we were arranging our PGY2 schedules during intern year, I scheduled lighter months then. But most interviews actually took place this year from Dec-Jan. I also had quite a few interviews scheduled for Feb which I ended up canceling.

Anyway, to answer you questions.
1. "when did you set aside time for interviews": Since there was no match this year, my interviews started as early as early December and went to most of January. Since it might be a match next year, it would likely extend much later than that. It all depends.
2. "when did you finish eras applications": I would recommend that you just have it done by Dec 1.
3. "when did you request letters of recommendation": mostly around September. one as late as late October. I would say that my biggest obstacle was getting the program director letter. Request that early!
4. "when did you pursue research": I started a project somewhere in the middle of intern year, and got a poster presentation out of it. I don't have a spectacular record by any measure.
5. "what things did you feel were important to fellowship directors in your applications, in particular research (publications vs. research experience alone)?": each program has its own personality and emphasis, so you can't make a blanket statement. For example, in one program 3/4 fellows already had MD/PhD, so they were definitely very research oriented. Others much less so, and they would tell you that all their fellows go to private practice.
6. "were there particular programs you thought were fantastic": well, i only ended up interviewing at 5 places. Obviously I thought that the program where I matched was great. But i canceled a lot of interviews, so I didn't see many other programs.
7. "were there particular programs you thought were perhaps not-so-fantastic?: BEWARE KAISER PERMANENTE! I had an interview scheduled and then later emailed to cancel it. And then my program director gets this nasty letter from their neph program director that I was "unprofessional" for not showing up. I just showed the email that I had sent to cancel my interview to my program director. Seems like Kaiser really needs to get their act together. That also speaks poorly of their program director for the miscommunication in their department and the assumptions that he then made. USC likewise had scheduled me for an interview, and didn't even notify me. So I got a phonecall one day asking me why I didn't show up. Well, it's because they never even told me I had an interview! Incredible! Well, that's enough of my ranting.

Also for the record, I really liked the George Washington University program, and really thought about going there. They have a really nice new program director. Their division chief was really nice to me too.

Feel free to ask any questions.



123sleepy said:
Congratulations to those of you who've already matched in nephrology!

Would you be willing to pass along advice to us nephrology hopefuls as to how you organized your PGY-2 or PGY-3 year (or PGY-1 year, for those of you who were really on top of things) as you applied for a renal fellowship? For example, when did you set aside time for interviews, finish eras applications, request letters of recommendation, pursue research, etc?
Also, what things did you feel were important to fellowship directors in your applications, in particular research (publications vs. research experience alone)? And were there particular programs you thought were fantastic...or perhaps not-so-fantastic? Any advice you have would be appreciated!
 
I felt that the interviews are very harried this year because of the new schedule. Seems like most programs want to rush in their best applicants and rush offers in the hope that they will commit, and in turn, place pressure on applicants to commit early without having the opportunity to "see the whole picture."

Knowing this, if things stay the way they are next year, my advices are:
1. Get all your stuff in Dec 1. Why? My first interviews came in on Dec 2, and pretty much got all my interview invites by Dec 15th. Your time frame is very narrow because programs are in a hurry to fill their spots ASAP, and are generally aggressive in trying to get interviews out to their best applicants ASAP. If you dont hear from somewhere by end of Dec, consider it a rejection.
2. Schedule easy Dec and Jan months - as above.
3. Interview at your top choices early - your goal is to get an offer from them ASAP. Dont go by the mentality of scheduling less-desirable interviews first so you can "practice" - by the time you get to your first choice programs in early January, they might already be filled, or have already made enough offers that they wont be able to make you one without someone else withdrawing - not the situation you want to be in.
4. Do your research about different programs BEFORE your interview. You wont be given much time to respond to offers - some as short as 1 week after an offer, and you want to be in a position to make good decisions.
5. Talk to the renal fellows at your program and ask them about the ins and outs about the places you are interested. You'd be surprised as to what they have to say.
6. Talk to your program director and section chief in the latter part of your internship year if you are interested in nephrology, and you can talk about where are the good programs, etc. You'd be surprised, some traditionally big-name programs actually dont have a good rep in nephrology which is actually a small circle.


123sleepy said:
Congratulations to those of you who've already matched in nephrology!

Would you be willing to pass along advice to us nephrology hopefuls as to how you organized your PGY-2 or PGY-3 year (or PGY-1 year, for those of you who were really on top of things) as you applied for a renal fellowship? For example, when did you set aside time for interviews, finish eras applications, request letters of recommendation, pursue research, etc?
Also, what things did you feel were important to fellowship directors in your applications, in particular research (publications vs. research experience alone)? And were there particular programs you thought were fantastic...or perhaps not-so-fantastic? Any advice you have would be appreciated!
 
mediocre said:
I just matched into a nephrology program on the West Coast. Won't tell you which one, but it's a more academic program that will be 3 years in length. Most are usually 2 years.

This was a tough year to interview because when the year started, there was not precedent of when we'd be interviewing since this was the first year that they used ERAS. In years past, most interviews took place during Sept-Oct, so when we were arranging our PGY2 schedules during intern year, I scheduled lighter months then. But most interviews actually took place this year from Dec-Jan. I also had quite a few interviews scheduled for Feb which I ended up canceling.

Anyway, to answer you questions.
1. "when did you set aside time for interviews": Since there was no match this year, my interviews started as early as early December and went to most of January. Since it might be a match next year, it would likely extend much later than that. It all depends.
2. "when did you finish eras applications": I would recommend that you just have it done by Dec 1.
3. "when did you request letters of recommendation": mostly around September. one as late as late October. I would say that my biggest obstacle was getting the program director letter. Request that early!
4. "when did you pursue research": I started a project somewhere in the middle of intern year, and got a poster presentation out of it. I don't have a spectacular record by any measure.
5. "what things did you feel were important to fellowship directors in your applications, in particular research (publications vs. research experience alone)?": each program has its own personality and emphasis, so you can't make a blanket statement. For example, in one program 3/4 fellows already had MD/PhD, so they were definitely very research oriented. Others much less so, and they would tell you that all their fellows go to private practice.
6. "were there particular programs you thought were fantastic": well, i only ended up interviewing at 5 places. Obviously I thought that the program where I matched was great. But i canceled a lot of interviews, so I didn't see many other programs.
7. "were there particular programs you thought were perhaps not-so-fantastic?: BEWARE KAISER PERMANENTE! I had an interview scheduled and then later emailed to cancel it. And then my program director gets this nasty letter from their neph program director that I was "unprofessional" for not showing up. I just showed the email that I had sent to cancel my interview to my program director. Seems like Kaiser really needs to get their act together. That also speaks poorly of their program director for the miscommunication in their department and the assumptions that he then made. USC likewise had scheduled me for an interview, and didn't even notify me. So I got a phonecall one day asking me why I didn't show up. Well, it's because they never even told me I had an interview! Incredible! Well, that's enough of my ranting.

Also for the record, I really liked the George Washington University program, and really thought about going there. They have a really nice new program director. Their division chief was really nice to me too.

Feel free to ask any questions.
hi....i graduated in 2004, will be starting residency in IM in july. i am planning to pursue a career in nephrology after the residency. you had said in your post that you got a poster presentation done during the middle of intern year. could you tell me how to go about any such work as a poster presentation or a research proposal? or even any kind of case studies?

thanks in advance
 
Hi,
This is a late reply to renovar and mediocre: thanks so much for your advice!
 
Any info on ratios of applicants to program spots in general for nephrology?
 
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