I want to thank everyone for their input, and please keep on contributing to the topic!
I'm currently an MS4 who already applied to a specialty. But, Internal Medicine was high on my differential. I also entertained the thought of doing nephro, but wasn't particularly swayed towards doing it. I looked at some of the nephro threads, and it seems that the general consensus at least on SDN is that nephro field has become much less popular with attendings having to put in much more hours than they used to, and also in part due to privitization(?) of dialysis centers/units in addition to other factors. I think I talked to someone at my hospital about this (forgot it internal medicine or actual nephro) and they said that it's quite untrue and that he loves what he does as well as the most if not all of the rest of the department. Details in the convo i forgot, but that was the general idea that I remember being conveyed. I was wondering if you could contribute your opinion towards this (ie. is it still like this? do i just have a very happy nephro department?--i can tell that many of our nephro attendings are quite happy and love what they do)
I would really appreciate it if you could just touch on this a bit--just for the sake of my own curiousity. Not trying to change the threat into this, unless if the rest of the commentators feel strongly to do so.
Nephrology as a discipline is a wonderful and delightful field.
Glomerular Disease, Electrolyte, Acid-Base, Hemodialysis, Hypertension.
Needing to know a bit of everything and essentially keeping your IM skills fresh.
The downside is the practice of nephrology is that community nephrology is nothing like what it is cracked up.
Private practice nephrology is basically government is cutting down on payments and everyone is feeling the squeeze. No lifestyle, no pay, and no respect by anyone. Least of all your own ESRD patients.
My solution?
Did Renal first after IM. Doing PCCM next year. Graduating as a RenalPulmCC doctor.
I get to practice as much renal as I desire (i.e. as little ESRD as I desire... once my patients from CKD become ESRD... I will still be their PMD and pulmonary doctor.. the medical director at the HD unit can take care of their HD... so no abandonment planned) and I get to practice another dynamic field that I like as well.
Don't mirror my pathway. Too much angst and sleepless nights toiling away on research while getting up most call nights for missed HD, transplant call, among other headaches.
The "charm" you see from your attendings is that they are academic and they have TENURE and a guaranteed contract. They don't make as much as a private practice nephrologist who has "made it" and owns an infusion center and HD unit, but they have peace of mind.
Academic jobs are a "safe haven" of sorts. Though academic jobs have their share of headaches as well. Different strokes for different folks.
Colleague of mine graduated from top academic nephrology center... got a junior faculty spot in his dream job... making $130K in a major metro area... living the dream.
Another colleague entered community nephrology:
MidWest medium city.
First year attending. Call q3 nights and q2 weekends. Round in hospital x 3 daily. Go to HD center to round multiple days a week to catch all the shifts. Also have office patients in afternoon hours. $170K. Less than hospitalist.
Money isn't EVERYTHING. But when you don't have money or lifestyle or job security or even any respect (if you become a nephrologist, you will know what I mean when you deal with CTSx/CTICU), why are you even doing this? You can read renal physiology textbooks at home and get a high off of that.
