- What is unique or special about this specialty?
Good mix of outpatient and inpatient. Outpatient is particularly unique with dialysis and transplant patients
- What other specialties did you consider and why did you pick this one?
ID, rheumatology, endocrinology - I was a chemistry major so the physiology fits well, I just did not find them quite as interesting, was probably closest to picking ID
- What challenges will this specialty face in the next 10 years?
Probably navigating value based care, nephrology is a particular guinea pig with how much the govt pays for dialysis patients. Lots of emphasis on optimal dialysis starts, home dialysis (which is all good anyway). Currently, if you do well, you make more. Maybe that changes from carrot to stick? Who knows what the govt will do though I suspect this will eventually affect everyone in medicine.
- What are common practice settings for this specialty?
Inpatient consults - ICU, floor, just routine ESRD. Outpatient - in office and dialysis centers. Interventional would be at an outpatient center doing procedures. Academics vs private practice
- How challenging or easy is it to match in this specialty?
Easy. The top programs can still be competitive.
- What excites you most about your specialty in the next 5, 10, 15 years from now?
A lot has really come down the pipeline with treating diseases that have been difficult to treat like IgA. They are working on xenotransplants via genetic modification right now with some success. More genetic testing. Wearable dialysis equipment
- Does your specialty currently use or do you foresee the incorporation of technology such as Artificial Intelligence?
Probably the same stuff for other specialties - helping with notes, data collection + feedback A/P w/ guidelines or studies linked, could see better dialysis prescribing
- What are some typical traits to be successful in this specialty? (For example, organization skills, work independently)
Triaging consults by acuity in the hospital, meeting patients where they are in terms of info, typical time management when seeing office patients, honestly having a "palliative hat" to wear inpatient as there are frequent conversations about aggressive care or not (kidney failure can often be the "last straw")
- What does a typical workday consist of in your specialty?
7-5 inpatient consults, 8-5 outpatient clinic, about the same for dialysis though typically those days are more relaxed, work ~1 weekend per month, 3-4 night calls per month
- What is the career progression for your specialty?
Join private practice as employee -> become partner, academics I am less familiar with, seems like they hire fellows right out of fellowship who become associate or assistant professors and progress further with research etc
- How has your work impacted your life dynamics? What is your work-life balance?
Hospital weeks can be busy. Not bad if nights are not busy, but they can be. My outpatient weeks I am working 4 days a week. I get more tripped up on charts of the day and chart prep for the next day. I tend to be thorough (ie slow lmao). Learning all the time and trying to keep optimizing. I am married and have two kids, and I really do not miss much, just sometimes longer days. Normally not a big deal to move things around for birthdays, vacation plans, etc
- How does healthcare policy impact your specialty?
Would refer to the CKCC bit above. Dialysis is generally heavily regulated so that will be an ongoing thing.
