Interventional Nephrology?

[Redpancreas]

At my institution there's a nephrology fellow who basically trained in all elements of nephrology but is now doing all sorts of dialysis accesses. Normally this is IR's terf in the hospital, but I worked at a extremely busy hospital where even the robust IR department was booked at least a day in advance. No one actually knew of the service, but you page this Nephrology fellow and you basically get your tunneled line done within the hour and he teaches us a ton about the line and offered to teach me how to do it. I was wondering if Interventional Nephrology is a thing at other hospitals? He also mentions he's started to rountinely inserts PD catheters (he's done 30+), and encouraged me to call him when I needed a kidney ultrasound or a renal biopsy rather than just ordering it which takes a few hours, and tells me he'll soon be able to fix issues with blocked dialysis access and potentially do procedural stuff with renal artery stenosis (i.e. stenting) and plans to go into private practice and have 1000+ patients when he graduates? Is this really a thing?!? This is in a pretty major metro area at a quaternary care hospital known for its subspecialty services with strong vascular surgery, IR, and a nationally renowned Cardiology department.

If this is all true, what other nephrology fellowships train fellows to do all this and enter private practice?

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[Chemist0157]

At my institution there's a nephrology fellow who basically trained in all elements of nephrology but is now doing all sorts of dialysis accesses. Normally this is IR's terf in the hospital, but I worked at a extremely busy hospital where even the robust IR department was booked at least a day in advance. No one actually knew of the service, but you page this Nephrology fellow and you basically get your tunneled line done within the hour and he teaches us a ton about the line and offered to teach me how to do it. I was wondering if Interventional Nephrology is a thing at other hospitals? He also mentions he's started to rountinely inserts PD catheters (he's done 30+), and encouraged me to call him when I needed a kidney ultrasound or a renal biopsy rather than just ordering it which takes a few hours, and tells me he'll soon be able to fix issues with blocked dialysis access and potentially do procedural stuff with renal artery stenosis (i.e. stenting) and plans to go into private practice and have 1000+ patients when he graduates? Is this really a thing?!? This is in a pretty major metro area at a quaternary care hospital known for its subspecialty services with strong vascular surgery, IR, and a nationally renowned Cardiology department.

If this is all true, what other nephrology fellowships train fellows to do all this and enter private practice?

I would say the scope he is expecting to have is very wide. Yes, you can do interventional nephrology, but in my experience, it will probably land you a job at a large nephrology practice where most of the work is fistulograms to address clotted fistulas and grafts and tunneled dialysis catheters. That way, the practice benefits from the revenue stream of these very common needs instead of outsourcing it to a local IR group. Hospital systems tend to rely on IR. It really depends on the local situation. If there is already a robust nephrology group, IR (or vascular) may not see a way to take over that territory, and vice versa. When there is both, nephrology tends to do outpatient needs, and IR tends to do inpatient needs, but again, it depends on the local situation.

Nephrologists putting in PD catheters and doing their own biopsies is very old school. Having easy access to PD catheter placement is very nice. It seems like most people are pretty meh with doing their own biopsies. I don't know of anybody who stents their own RAS. My practice has US techs for ultrasound and dopplers, and my partners provide the interpretations.

I don't know what he means by 1000+ patients. 1000+ CKD patients? Taking over for a retiring nephrologist? Access to 1000+ dialysis patients who will need interventions occasionally? Maybe that is what he means.

One can do a formal interventional nephrology year, or one can do a more informal get-on-the-job-training-and-record-a-lot-of-procedures-performed route.

Good for him though. He very much likes procedures and has a lot of ways to keep himself busy.

 

[IRattending2021]

Getting credentials for RAS is going to be a bit difficult. This place sounds like columbia where each services are encourged to compete against each other.

 

[somedoc1595]

At my institution there's a nephrology fellow who basically trained in all elements of nephrology but is now doing all sorts of dialysis accesses. Normally this is IR's terf in the hospital, but I worked at a extremely busy hospital where even the robust IR department was booked at least a day in advance. No one actually knew of the service, but you page this Nephrology fellow and you basically get your tunneled line done within the hour and he teaches us a ton about the line and offered to teach me how to do it. I was wondering if Interventional Nephrology is a thing at other hospitals? He also mentions he's started to rountinely inserts PD catheters (he's done 30+), and encouraged me to call him when I needed a kidney ultrasound or a renal biopsy rather than just ordering it which takes a few hours, and tells me he'll soon be able to fix issues with blocked dialysis access and potentially do procedural stuff with renal artery stenosis (i.e. stenting) and plans to go into private practice and have 1000+ patients when he graduates? Is this really a thing?!? This is in a pretty major metro area at a quaternary care hospital known for its subspecialty services with strong vascular surgery, IR, and a nationally renowned Cardiology department.

If this is all true, what other nephrology fellowships train fellows to do all this and enter private practice?

All of the nephrologists in one of the groups at my hospital are trained in some interventional. One partner learned some interventional during his general nephrology fellowship. He then trained all of his partners, and now they all spend part of their time working in a vascular access center.

 

[Renal_Prometheus]

All of the nephrologists in one of the groups at my hospital are trained in some interventional. One partner learned some interventional during his general nephrology fellowship. He then trained all of his partners, and now they all spend part of their time working in a vascular access center.

vascular access centers are not very profitable these days. If only you know what I know