Nephrology and Nephrology CC Fellowship forum 2019-2020

[daguev]

I would say Columbia in NYC and Yale in CT but you must be willing to work very hard at least the first year . If you want to know more about programs in Ct PM me

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[htk21]

Any opinions regarding Cornell?

 

[Renal_Prometheus]

why the University of Colorado nephro program has been unfilled year after year??
It seems to be a desirable place to live, the program seems to care about fellows, but still, don't understand why doesn't fill all positions.

It’s not the program, it’s the specialty.

 

[Aspyn]

This isn't a bad time to start liking nephrology.. I know a physician who is pulling over 300,000 with his own practice. Also, it's still not competitive so you can virtually match at your top choice

 

[mastmastdonan]

You can easily make 300k+ as a hospitalist these days. Of course no extra two years of training required for that. Hospitalist has basically killed fields like ID and renal. Too much money for it to make sense financially. I would only do these fellowships if you have an actual interest in them. Financially it just does not make sense.

 

[Chemist0157]

This isn't a bad time to start liking nephrology.. I know a physician who is pulling over 300,000 with his own practice. Also, it's still not competitive so you can virtually match at your top choice

The ceiling of income can go well above that, and it is not very competitive at the moment, but I would recommend doing any fellowship only if there is an interest in the field.

You can easily make 300k+ as a hospitalist these days. Of course no extra two years of training required for that. Hospitalist has basically killed fields like ID and renal. Too much money for it to make sense financially. I would only do these fellowships if you have an actual interest in them. Financially it just does not make sense.

If you mean hospital medicine has affected applicant pools, sure. Otherwise, hospital medicine is more than happy to consult nephrology for expertise. At least in my part of the world.

It is hard to compare hospital medicine to nephrology or any other specialty for that matter. It is apples and oranges when comparing average income, income potential, work hours, daily workflow, independence, job security, flexibility...Just do what you think you will enjoy doing.

 

[Renal_Prometheus]

If you believe in market economics, then there's no way a specialty with high income ceiling would go unmatched or have this many specialists going back to hospitalist medicine. I agree that the top 10% of earners in nephrology have high income ceiling, but there's no guarantee anyone will be in the top 10%. You can't sell this to an applicant. The average nephrologist will struggle to justify financially, especially if factoring in opportunity cost, in doing this specialty. There are many nephrologists financially worse off than a hospitalist. So let's just be real about the current state of finances.

 

[Chemist0157]

If you believe in market economics, then there's no way a specialty with high income ceiling would go unmatched or have this many specialists going back to hospitalist medicine.

That would be true if fellowship spots were only dictated by income. I readily recognize that nephrology is not a popular specialty, and spots have gone unfilled for that reason, but it is also worth noting there are programs who did not need that many in the first place. A lot of research heavier spots. Much of the spots have gone unfilled because many IMGs have looked towards hospital medicine for the flexibility, geography options, etc.

Is there data regarding "specialists going back to hospitalist medicine"? I would be interested to see that.

I agree that the top 10% of earners in nephrology have high income ceiling, but there's no guarantee anyone will be in the top 10%. You can't sell this to an applicant.

I don't have to be in the top 10% of earners to outstrip a hospitalist salary. Hardly that. On my perusal of several websites reporting salaries, the average nephrologist makes about 50K more, and that is a reported salary. I trust the hospitalist numbers because the number is the number, but a reported base salary is less useful for nephrology. My partners and I have base salaries, but that hardly accounts for all compensation.

Geography will be important. Dialysis patient population will be very important. Competition will be important. I am aware there are bad jobs (bad roads to partnership, low dialysis patient numbers so have to compensate with a lot of hospital/clinic work), but that is not true across the board. You mentioned market economics. Well, there is supply/demand to consider. Don't get hooked into a bad practice.

The average nephrologist will struggle to justify financially, especially if factoring in opportunity cost, in doing this specialty. There are many nephrologists financially worse off than a hospitalist. So let's just be real about the current state of finances.

I am being real. Are you? "Average nephrologist"? "Many nephrologists financially worse off than a hospitalist"? What is this based on? Your own experience? People you know? Data I can peruse? I would sincerely love to know the finer details to try to make sense of this. Part of the country, base salary, size of practice, dialysis patient numbers, work schedule, USMG v IMG, etc.

I could see a nephrologist struggling if dialysis patient numbers are relatively low, cost of living of the area is high, practice is wrong size...basically a perfect storm. But that's not a problem with nephrology. That's just a bad gig.

I think it's a shame to present the job prospects to be so extremely bleak as has been presented in a couple of threads around here.

 

[Renal_Prometheus]

yes, there is data to support that many nephrologists are not practicing nephrology

• In this article a well known nephrology job recruiter laments that nephrology graduates are choosing hospitalist medicine over a nephrology career.

Fellows’ priorities are changing, so must the specialty

• Another article reveals data showing that 36% of nephrology graduates are returning to hospitalist medicine. And of the remaining people who join a nephrology practice, “some 50% leave within 5 years”.

An appeal to industry leaders: Take charge of the future of nephrology


Both authors are well known in the industry. They are not making this up. These are not insignificant percentages.

 

[Chemist0157]

First, most of my post was not addressed, but I took a look at the below.

yes, there is data to support that many nephrologists are not practicing nephrology

• In this article a well known nephrology job recruiter laments that nephrology graduates are choosing hospitalist medicine over a nephrology career.

Fellows’ priorities are changing, so must the specialty

Second, I do not consider someone's opinion piece as data. Regardless, the article is actually more focused on how practices can attract good candidates, primarily by adjusting the initial offer, incentives, etc. He notes priorities and attitudes of graduates have dramatically changed compared to 25 years ago. He does note some graduates would rather just go make some money and have a job instead of develop a career, but that was not the focus of the short article by any means.

• Another article reveals data showing that 36% of nephrology graduates are returning to hospitalist medicine. And of the remaining people who join a nephrology practice, “some 50% leave within 5 years”.

An appeal to industry leaders: Take charge of the future of nephrology


Both authors are well known in the industry. They are not making this up. These are not insignificant percentages.

Third, and by far the worst, is this article. I am familiar with Nephrology News & Issues and receive it myself. I am not familiar with Provenzano himself, but I am familiar with Nephrology Practice Solutions and Davita of course.

This is the quote in the article:

In addition to the ASN survey data, we also know private nephrology practices, particularly smaller practices, have difficulty attracting the new generation of incoming nephrologists. This is due in part to as many as 36% of graduating nephrology fellows decide to work for hospitals, but not as nephrologists.2 They become employed as hospitalists. In that role, fellows forgo specialty training and provide general medicine services within the “safer” confines of the hospital setting while enjoying higher initial salaried positions. The starting salary difference can be as high as $60,000, with an initial salary $240,000 for a hospitalist vs. approximately $180,000 for a private practice nephrologist.2 Even larger private practices that successfully sign new recruits have difficulty retaining them. Some 50% leave within the first 5 years.2 This is a huge resource drain on our specialty.

This is the source he cites:

Seven Job-Search Mistakes of New Physicians

Even in a hiring market that favors them, new doctors may be so eager to get a job that they overlook key issues. Here are several key blunders to avoid.

www.medscape.com

It is an article about mistakes new physicians make while looking for their first job.

These are the actual quotes from the source:

Call it "the curse of the first job," Stajduhar says. Overwhelmed by the sheer variety of choices and unaccustomed to negotiating for a job, new doctors often wind up in positions that are a bad fit for them, and they move on after just a few years. In a survey[1] of established physicians, Jackson & Coker found that more than half had left their first job after 5 years, and more than half of that group had stayed only 1 or 2 years.

Many new physicians prefer to work in hospital systems rather than physician-led practices. Merritt Hawkins' 2014 survey of final-year residents found that 36% planned to work in a hospital. Their preference for all kinds of employment with a hospital may be much greater because hospitals also offer many positions within group practices, which are listed as a separate practice location in the survey.

This is absurd. He might be a CMO, but he did a gross representation of this source. He cited this source about new physicians across the board and extrapolated to exclusively nephrologists. This was actually a good exercise in checking cited sources.

 

[Chemist0157]

Anyway, anyone can reach out to me if they have any questions regarding fellowship or starting out after graduation. My time with these things was not too long ago, and I get the impression there are very few nephrologists posting on SDN.

 

[Tenesmus83]

Just my observation. I live in a mid-sized city and I personally know of 5 nephrologists who are working as hospitalist in the community. Very sad. I don't think ASN would want to publish data on the percentage of grads who are not practicing in nephrology.

 

[Chemist0157]

Just my observation. I live in a mid-sized city and I personally know of 5 nephrologists who are working as hospitalist in the community. Very sad.

That is very unfortunate. I would be interested in knowing any further details, particularly the general area. Presumably, they want to do nephrology but cannot. Perhaps the market does not support that many in that area. Perhaps a practice went bad. Difficult to draw much from this.

I don't think ASN would want to publish data on the percentage of grads who are not practicing in nephrology.

Well...if you take the time to look, they do publish. They have an annual ASN fellow survey.

From 2018:

Seems like a minority to me.

 

[Eyeronic]

I'll never understand certain individuals' obsessions with coming onto an online forum and bashing a specialty field non-stop, often unprompted. Seems pathologic. Does posting the same whiny anecdote for the 25th time somehow release endorphins or something? Do you have literally nothing else to focus on in your lives?

Hey guess what? People can choose to do what they want with their lives, and they just might happen to choose a field of practice that you don't like, and for reasons that might not make sense to you. And they don't need your approval.

GET. OVER. IT.

 

[Mario_MD]

Hello, are there are Nephrology Fellowship programs that would consider an applicant without IM training?

I am an ECFMG-certified physician with 2+ years of ACGME-accredited residency experience from Harvard-affiliated training programs in General Surgery (2 years) and Anesthesia (6 months) and an MPH from Harvard T.H. Chan School of Public Health. I have been away from clinical practice since 2017 and am planning to apply to the 2020 IM match.

However, given that I have been away from clinical practice for a few years now, I am considering enrolling in an unfilled clinical fellowship to help my transition back into IM.

Thanks!

 

[Renal_Prometheus]

Hello, are there are Nephrology Fellowship programs that would consider an applicant without IM training?

I am an ECFMG-certified physician with 2+ years of ACGME-accredited residency experience from Harvard-affiliated training programs in General Surgery (2 years) and Anesthesia (6 months) and an MPH from Harvard T.H. Chan School of Public Health. I have been away from clinical practice since 2017 and am planning to apply to the 2020 IM match.

However, given that I have been away from clinical practice for a few years now, I am considering enrolling in an unfilled clinical fellowship to help my transition back into IM.

Thanks!

To answer your questions. Yes, programs will take you but that's because they need someone to cover their night calls. There's no guarantee you can
match into IM afterwards. I don't want you to come out with nothing and feeling exploited. This option is really of last resort and not recommended.

 

[Mario_MD]

To answer your questions. Yes, programs will take you but that's because they need someone to cover their night calls. There's no guarantee you can
match into IM afterwards. I don't want you to come out with nothing and feeling exploited. This option is really of last resort and not recommended.

I appreciate the transparency and words of advice. I am thinking that ANY clinical opportunity, no matter its explosive nature, would be helpful because it would help transition me back to the clinical environment and assuage any concerns that future PD's might have about my gap in clinical training.

 

[homar1991]

Hello all, just looking for advice here, we are looking for a nephro job in 2022 , what is the salary range we should go with ? we are looking at either Houston specifically or Florida in general.

Also, how to judge a good practice , I mean does productivity bonuses mean a lot ? and regarding partnership , is it good to join a corporates practice or smaller ones ?

any insights would be appreciated.

 

[Chemist0157]

Hello all, just looking for advice here, we are looking for a nephro job in 2022 , what is the salary range we should go with ? we are looking at either Houston specifically or Florida in general.

Also, how to judge a good practice , I mean does productivity bonuses mean a lot ? and regarding partnership , is it good to join a corporates practice or smaller ones ?

any insights would be appreciated.

I was looking for jobs in 2017. At the time, starting salary among different places I looked was $180k-220k. I don't know much about Florida or Houston specifically. I would look for a signing/moving bonus.

As far as practices go, it depends on what is important to you. I looked at a few places. One was very small, mainly one guy who had a part-time person who shared call with another small nephrology group in his area. Second was very large group (25+) in a large city. Third was medium group (10-12) in a medium sized city. Fourth was a small group (2) in a medium sized city. I would assume the work itself is about the same throughout the groups.

In smaller groups, you would clearly have more sway in decision making as a partner. Disadvantage that stuck out to me was you're on call a lot (though it's minimal on a nightly/weekend basis as your patient population is small), and he would get locums if he took vacation. Depending on the situation, that may be a small group because that is proportional to the need of the area. That is fine if you are the only business in town. It is not fine if you are having to compete with different groups in the area. That is less of an issue if it's you and an academic center.

In larger groups, you have less individual sway, but call coverage can be advantageous. A large group may have their own interventional doc which can be a boon.

IMO, I think it is important to join a practice in a town/city you would enjoy, and ideally they are the only practice serving that area. Groups tend to grow or contract depending on the work available so I would expect the work load to be about the same wherever you go, but I would care for heavy call/weekends.

I ultimately joined the group of 10-12. It's in a great area, and we are the only practice in our part of the state. We overlap a bit in 1 place with 1 other group, but it's not a problem. It's very nice to not feel like you have to compete heavily for work.

Different practices breakdown compensation. I would say a lot do a base salary so you have something to take home every couple of weeks, and then x number of times per year (2-4 maybe), the practice counts up productivity and makes distributions accordingly. Some practices are "eat what you kill" where you work as much or as little as you want. There is probably some minimal expectation but not always based on hearsay from other fellows. Some practices split all work and pay evenly; everyone does the same and gets the same.

My base salary is about half or less of total income.

I'm not sure if one is better or worse. I like what we have. MCP and medical directorship compensation are split evenly across the partners as it's really hard to make that even. Some people are going to have bigger dialysis units and some may have smaller ones, and it is difficult logistically to make that exactly even. Productivity is based off hospital work (which should generally even out anyway) and outpatient clinic load. The largest earners in my practice see the most clinic patients.

Path to partnership is significant. Typically practices will have you work as salaried or partial productivity for a while until 1) you have built up your own patient population and 2) you have "paid your dues" as partnership ultimately means ownership of part of the practice, a practice that you are just now entering. I think there is potential abuse here. 2-3 years should be sufficient. Mine was 2 years. 1 year salaried with some bonuses from other things then scaling productivity year 2 until full partner starting last year. I would caution partnership pathway that goes beyond that. I would caution if they have had people quit before making partner or if someone never made partner for some reason. This was not an issue at the places I interviewed, but I caution just the same.

I would also look at other revenue streams of the practice. Interventional nephrology partner(s)? Research studies? Ultrasounds?

Please let me know if you have questions.