Hello,
I know I have a long way to go before even coming close to deciding on a specialty, but just out of curiosity, how hard would it be to get a Nephrology fellowship after an IM residency? Would it be any more difficult becoming a Nephrologist if one goes the DO route? Would it be possible to do rotations with a nephrologist while in med school? I have heard there are less and less nephrologists coming into practice, but I am not sure if this is true. The kidneys and their disease states really interest me. I also like working with the elderly, which makes up a good portion of Renal Failure patients. Sorry for the odd question, but thanks for any help you can provide.
-Dd3
Nephrology is close to if not the least competitive IM fellowship.
The big problem with nephrology right now is the job market. The median nephrologist makes good money - about $330k. That's certainly more than a ton of other fields like Endocrine, Rheum, ID - but finding that job as a new graduate is getting harder and harder. The majority of money made in the field of nephrology is dialysis. Reimbursements have gone down over time. Lots of dialysis centers have consolidated over the years and most of their medical directors aren't retiring. The # of people on dialysis is fairly stagnant - they just don't live that long. Transplant nephrology lowers your salary if anything.
What this means is that competition to actually join a successful nephrology group is fierce - and that most of the time new employees get a really raw deal. Like, rounding at a half dozen hospitals working yourself to the bone for years before you can become a partner raw. And that's for those people that actually manage to get a nephrology job - there's more fellows than there are open positions, so a surprising number of people do a nephro fellowship and then end up working as hospitalists.
I don't know an exact # for expected salary for these fresh nephrology grads, but I've heard numbers as low as $180k. It could be even worse than that - that's an anecdotal number from one or two folks I've talked to over the years, and it isn't my field. You certainly aren't going to be getting those $300k+ jobs that the old guys have, not for a while.
This situation has lead there to be a LOT fewer applicants than there are nephrology fellowships. Last years data had 304 total applicants (91 US grads) for 474 fellowship slots. That's right - even with a 100% match rate for the applicants, 30% of slots don't fill. All it takes these days to match nephrology is an IM residency, a pulse, and no blatant red flags (like, multiple DUI level red flags). None of the other core fellowships are anywhere near as uncompetitive than nephrology except geriatrics, and I still don't quite understand how geriatrics fellowships are even a thing when that's like, 80% of internal medicine by default.
You can take a look at charting outcomes -
https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2018/10/2018-Charting-Outcomes-SMS.pdf for a lot of granulated data. I suppose the match rate was higher for MDs than DOs - but only because the US MD match rate was 100%, and the osteopathic match rate was 94% due to 2 of the 35 applicants not matching.
Obviously, how you do in medical school, your board scores, your residency program, letters, research projects, etc will make you more competitive for Nephrology... but really, unless it changes between now and when you apply, just have a pulse and not too long of a criminal record and you'll almost certainly match.
