Combined Nephrology and Hospice & Palliative Medicine Fellowships

[kazill]

As a current third-year student I'm doing my due diligence and investigating as many specialties as possible, two of which I have a particular interest in being nephrology and palliative care. I coincidentally came across that three institutions (UPenn, Yale, UNC) are launching combined nephrology and palliative medicine fellowships. The major point of interest I find in these training opportunities is that they are 2 years, instead of needing 3 years as one would previously require to do fellowships in both these field. Here is an article I found discussing the programs briefly, but there is something of a paucity of information on them given how new the pathway is: Combined Nephrology and Hospice & Palliative Medicine fellowship opportunity - Renal Fellow Network

I have two major thoughts I'd like to posit to this forum:

1: Why have these programs come to exist? Is there a particular demand for physicians trained in both nephrology and palliative medicine? What is the advantage of being trained in both? One often hears from combined specialty training that you end up only practicing one the fields you train in, is that likely to be the case for this as well?

2: Will combined palliative medicine & insert-specialty-here fellowships become more common in the future? Oncology and palliative medicine training makes much sense but the extra year of training is likely to push interested persons away. Is combined training in palliative medicine a good way to fill the demand for palliative physicians, enticing those that wouldn't necessarily consider the field before to go through training, especially if the training doesn't add any additional years to training?

Would love to hear any thoughts on this!

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[I-dont-do-source-control]

Neither field is competitive or "prestigious" anymore. The fact that you can get two boards in 2 years and add to the pile of useless board certs that dont mean anything since an NP with 1 month of shadowing can do the same thing might still draw in some folks

Saltiness aside.

We have a Nephro palliative boarded staff at my center and I have worked with another during med school. The ESRD population has alot of palliation needed. Stopping HD is hard. Not starting HD is hard, this is a niche that needs to be filled. I have had my butt saved by said staff with some difficult patients. This staff rounds both on IPD Nephro consults, IPD palliative .

There is a push for palliative nephrology clinics to medically manage CKD-5 in elderly or those who will not benefit from HD.

 

[blue.jay]

Nephro-CC, Nephro-palliative are ways programs are luring residents into nephrology. There are so many institutions which sponsor H1 for nephrology fellowship and those same institutions don't sponsor H1 for other residencies and fellowships citing administrative costs for GME. This shows how desperate programs and institutions are to get warm bodies who are cheaper than even midlevels.

 

[Frazier]

I remember hearing about this being in the works back during my own interview cycle. Good topic for discussion. Will comment more later.

 

[blue.jay]

@Renal_Prometheus is this a new trend ?

 

[Frazier]

As a current third-year student I'm doing my due diligence and investigating as many specialties as possible, two of which I have a particular interest in being nephrology and palliative care. I coincidentally came across that three institutions (UPenn, Yale, UNC) are launching combined nephrology and palliative medicine fellowships. The major point of interest I find in these training opportunities is that they are 2 years, instead of needing 3 years as one would previously require to do fellowships in both these field. Here is an article I found discussing the programs briefly, but there is something of a paucity of information on them given how new the pathway is: Combined Nephrology and Hospice & Palliative Medicine fellowship opportunity - Renal Fellow Network

I have two major thoughts I'd like to posit to this forum:

1: Why have these programs come to exist? Is there a particular demand for physicians trained in both nephrology and palliative medicine? What is the advantage of being trained in both? One often hears from combined specialty training that you end up only practicing one the fields you train in, is that likely to be the case for this as well?

2: Will combined palliative medicine & insert-specialty-here fellowships become more common in the future? Oncology and palliative medicine training makes much sense but the extra year of training is likely to push interested persons away. Is combined training in palliative medicine a good way to fill the demand for palliative physicians, enticing those that wouldn't necessarily consider the field before to go through training, especially if the training doesn't add any additional years to training?

Would love to hear any thoughts on this!

So these programs have been in the works for a little while. I remember interviewing at UPenn the program talked about how excited they were about getting it off the ground. As noted earlier, the nephrology patient population is pretty much a "yes" when answering the question "is palliative medicine an appropriate service to assist in the care of this patient?" Also, there is a large interest in having palliative medicine offered through dialysis centers given the regularity and length of visits. This could be delivered by the nephrologist in the form of primary palliative medicine, or by a palli doc as subspecialty palliative medicine services.

What is the advantage of being training in nephrology and palliative medicine? Well, if the circumstances were that a person completed an entire nephrology fellowship and entire palliative fellowship, they would be well-positioned to offer both in the full breadth of their definition. However in this arrangement -- I'm sure the graduates will be competent -- but these combined programs (residencies, fellowships, etc) always make me wonder about what is getting cut? Is it fluff? If so, why do any of us have to do it?

I think this is a niche fellowship. The person best fit in my mind has a goal of going into academics and splitting their time (say 0.5 FTE nephro, 0.5 FTE palliMed). It saves a year of opportunity cost for the handful of nephrology-trained folks that know they want to also pursue palliative fellowship. That is fine, because there also happens to only be several spots available in these sorts of programs.

In the community, a hospital looking for a nephrologist isn't typically going to want to split their FTE to palliative. They want a nephrologist. So a graduate of this program would be able to offer excellent palliative services to their nephrology population. Similar case for palliative, however if anything less useful -- if you do a palliative fellowship you know enough about renal patients to take care of them fully under the scope of your expertise (i.e. nephrology fellowship NOT required). It likely helps with pursuit of research, but again that takes us back to academics.

Overall, I'm not a huge fan of combined programs because they water down everything involved (whether Nephro/Palli fellowship or an EM/IM/CC program [yes those exist]). They only make sense for a few people and given the current supply of programs -- it is a good match.

Regarding demand, I don't think the demand for palliative medicine is so outrageous that we need to make up new creative fellowships to bring more folks in. There are jobs available and every year 300+ new graduates. It is currently a good fit. There is HUGE demand at the patient level -- but regarding actual job openings, not nearly as much.

 

[kazill]

So these programs have been in the works for a little while. I remember interviewing at UPenn the program talked about how excited they were about getting it off the ground. As noted earlier, the nephrology patient population is pretty much a "yes" when answering the question "is palliative medicine an appropriate service to assist in the care of this patient?" Also, there is a large interest in having palliative medicine offered through dialysis centers given the regularity and length of visits. This could be delivered by the nephrologist in the form of primary palliative medicine, or by a palli doc as subspecialty palliative medicine services.

What is the advantage of being training in nephrology and palliative medicine? Well, if the circumstances were that a person completed an entire nephrology fellowship and entire palliative fellowship, they would be well-positioned to offer both in the full breadth of their definition. However in this arrangement -- I'm sure the graduates will be competent -- but these combined programs (residencies, fellowships, etc) always make me wonder about what is getting cut? Is it fluff? If so, why do any of us have to do it?

I think this is a niche fellowship. The person best fit in my mind has a goal of going into academics and splitting their time (say 0.5 FTE nephro, 0.5 FTE palliMed). It saves a year of opportunity cost for the handful of nephrology-trained folks that know they want to also pursue palliative fellowship. That is fine, because there also happens to only be several spots available in these sorts of programs.

In the community, a hospital looking for a nephrologist isn't typically going to want to split their FTE to palliative. They want a nephrologist. So a graduate of this program would be able to offer excellent palliative services to their nephrology population. Similar case for palliative, however if anything less useful -- if you do a palliative fellowship you know enough about renal patients to take care of them fully under the scope of your expertise (i.e. nephrology fellowship NOT required). It likely helps with pursuit of research, but again that takes us back to academics.

Overall, I'm not a huge fan of combined programs because they water down everything involved (whether Nephro/Palli fellowship or an EM/IM/CC program [yes those exist]). They only make sense for a few people and given the current supply of programs -- it is a good match.

Regarding demand, I don't think the demand for palliative medicine is so outrageous that we need to make up new creative fellowships to bring more folks in. There are jobs available and every year 300+ new graduates. It is currently a good fit. There is HUGE demand at the patient level -- but regarding actual job openings, not nearly as much.

Thank you for the thoughtful answer! As a third year student I haven't had much opportunity to see palliative care in action and gain an idea of what the scope of practice is. From the non-academic perspective it definitely makes sense this would more benefit the nephrologist looking to give palliative services rather than the inverse.