Nephrology board exam

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One other factor to consider is some renal fellows get scuttled so hard , they have no time to study for the test (without sacrificing family time or personal time etc ..)
 
Another reason to perhaps explain the high failure rate is, many graduates are undecided whether they are even going to practice nephrology, so motivation is not very high. Are they going to go back to hospitalist? or purse critical care?. The money is too low in private practice to get people excited about doing nephrology long term.
 
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