Interventional nephrology

[Interveno]

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Hello guys,
What I know about interventional nephrology is that you can be certified via training or practice pathway. Anyone knows if practice pathway can be done through practicing under the supervision of interventional radiologists or vascular surgeon rather than interventional nephrologist?

 

[Chemist0157]

Hello guys,
What I know about interventional nephrology is that you can be certified via training or practice pathway. Anyone knows if practice pathway can be done through practicing under the supervision of interventional radiologists or vascular surgeon rather than interventional nephrologist?

I do not believe there is a restriction.

 

[Interveno]

I do not believe there is a restriction.

I'm planning to do a year CCM fellowship once done with nephrology but also like to be certified in interventional nephrology. Would it be possible to work as an intensivist while getting trainee in IN? I noticed that some of HVA programs have a training of less than 1 year long.

 

[Chemist0157]

I'm planning to do a year CCM fellowship once done with nephrology but also like to be certified in interventional nephrology. Would it be possible to work as an intensivist while getting trainee in IN? I noticed that some of HVA programs have a training of less than 1 year long.

It would depend on your intensivist schedule primarily. I can think of nephrology attendings who were doing their regular jobs and then doing the interventional time on the side so it is doable.

 

[Interveno]

It would depend on your intensivist schedule primarily. I can think of nephrology attendings who were doing their regular jobs and then doing the interventional time on the side so it is doable.

Of I meant that once I'm done with CCM. There are only few programs where IN is an official one year fellowship and wondering if someone applies to those programs, would it be allowable to practice as nephrologist/intensivist while doing his training?

 

[Chemist0157]

Of I meant that once I'm done with CCM. There are only few programs where IN is an official one year fellowship and wondering if someone applies to those programs, would it be allowable to practice as nephrologist/intensivist while doing his training?

I think you would just have to ask the programs that interest you ahead of time. I googled a few programs, and it looks like their curriculum does not allow much outside it so I would expect much more inflexibility from a formal program. You be considered a fellow, not an CCM or renal attending.

 

[Renal_Prometheus]

I'm planning to do a year CCM fellowship once done with nephrology but also like to be certified in interventional nephrology. Would it be possible to work as an intensivist while getting trainee in IN? I noticed that some of HVA programs have a training of less than 1 year long.

Let me explain this to you. You are trying to do what pretty much every other neph grad is thinking, which is how to get out of general
nephrology because starting salaries are low. Everyone is thinking the same thing as you are. Trust me.

1) In regards to CCM, there are only limited number of 1 yr CCM fellowship programs, so it's far from certain that you will get it. One place I know had
50 nephrologist applying for 1 spot that year! Best of luck, but no guarantees you can get it.

2) In regards to IN, you can get trained, but you will not make more money than a general nephrologist in your group. You need a large dialysis population to feed you the fistulograms/declots, so it's not like you can open your own access center and expect referrals. Large nephrology groups start access centers as an investment. They often will train new recruits and get them to work in the access center. The physician compensation for these procedures is small. The majority of the revenue come from facility fees payed by medicare/insurance which is split between the partners. There's a reason why these older guys are asking you to do them! You may not know this, but you are actually 5 yrs late. Medicare reimbursement for these procedures has dropped 40% in the last 5 years! Many access centers are struggling to survive!

It will take you years down the road for you to appreciate what I said today. So all in all, good thoughts, but it may all come to nothing.

 

[Interveno]

Let me explain this to you. You are trying to do what pretty much every other neph grad is thinking, which is how to get out of general
nephrology because starting salaries are low. Everyone is thinking the same thing as you are. Trust me.

1) In regards to CCM, there are only limited number of 1 yr CCM fellowship programs, so it's far from certain that you will get it. One place I know had
50 nephrologist applying for 1 spot that year! Best of luck, but no guarantees you can get it.

2) In regards to IN, you can get trained, but you will not make more money than a general nephrologist in your group. You need a large dialysis population to feed you the fistulograms/declots, so it's not like you can open your own access center and expect referrals. Large nephrology groups start access centers as an investment. They often will train new recruits and get them to work in the access center. The physician compensation for these procedures is small. The majority of the revenue come from facility fees payed by medicare/insurance which is split between the partners. There's a reason why these older guys are asking you to do them! You may not know this, but you are actually 5 yrs late. Medicare reimbursement for these procedures has dropped 40% in the last 5 years! Many access centers are struggling to survive!

It will take you years down the road for you to appreciate what I said today. So all in all, good thoughts, but it may all come to nothing.

Thanks for ur input.
Do you think that interventional nephrology will become as independent significant as interventional cardiology or to some extent interventional pulmonology?

Interventional cardiology was part of IR back in the days but has become an independent field exclusively for cardiologist and as far as I know even IC reimbursement has been chopped off for the last few years.


You have a good point about the financial aspect of IN but would if u r given a chance to get certified in such field which requires only log of procedures to be certified, wouldn't be a good idea to expand ur practice?

 

[Renal_Prometheus]

Thanks for ur input.
Do you think that interventional nephrology will become as independent significant as interventional cardiology or to some extent interventional pulmonology?

Interventional cardiology was part of IR back in the days but has become an independent field exclusively for cardiologist and as far as I know even IC reimbursement has been chopped off for the last few years.


You have a good point about the financial aspect of IN but would if u r given a chance to get certified in such field which requires only log of procedures to be certified, wouldn't be a good idea to expand ur practice?

No, I do not think IN will become an independent specialty. It's been a thing in nephrology for over a decade now and nothing has changed. All you need is 3 months of real training, but finding a job that will allow you to do it is tricky. I would not waste a year of my life to do one of those IN fellowships. A lot of those programs can't fill fellowship spots so they create this type of fellowship to get another "warm body" to cover their night calls. You need to see for yourself these access centers close to know that venous procedures don't make much money. The money is in the PAD and endo AVF, which you can't do. One of my friends was working as an IN for a group few years back. Guess what he's doing know? Hospitalist medicine. Best of luck.