Hemodynamicsitis
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Starting a new thread for nephrology 2020-21, did not see one (please direct me to one if I missed it). I recently came to know from one of our year 3 IM residents that due to COVID19 pandemic, almost all fellowship interviews this year are virtual, and that most applicants are trying to stay in the same geographical area/ interviewing with programs where they did residencies/ medical school before. I personally felt that visiting a program and interviewing with 6-7 faculty members, and spending time at lunch/ hospital tour with the fellows was helpful for me in getting a sense of the culture of the section, back when I was an applicant and trying to find the right program for myself (especially during fellowship interviews, given the much smaller program size than the IM residency program ones - which makes one work far more closely with faculty). In view of this information and in spirit of trying to share information and experiences on SDN (which has been helpful to me over the last decade - I think there is great value to experiences/ feedback from people that have been in similar situations previously) to offer some insight to the applicants in these uncertain times, I am writing regarding nephrology programs in Philadelphia (compounded by Hahnemann hospital closure in July 2019).
In general, any US IM residency trained physician (especially fresh residency graduates, and those practicing as hospitalists for ~ 5 years) can easily match into their top nephrology program, and are highly sought after applicants for middle tier programs in nephrology (nationally ranked below 20). In Philadelphia, Penn and Jefferson have been leading the city-wide nephrology trainee education initiatives, and have been the preferred programs. Given the extreme difficulty with candidate recruitment for nephrology, most middle tier programs have been taking fellows that do not have IM residency training in the US (mostly senior physicians from foreign countries looking to get into training system in the US since they are several years out of medical school and most IM residency programs don't match them). In this setting, the remaining programs in Philadelphia (Einstein, Hahnemann and Temple) have been competing for fellows from the greater Philadelphia area mostly by reducing night calls/ weekend calls / coverage requirements assigned to fellows (Einstein has no night calls for fellows, several programs have two physicians cover the weekend/ rather than fellow coverage every weekend, most programs have NPs covering the chronic nephrology service etc, in some ways it makes sense to have the busiest services covered by fellows 70-80% of the time rather than not matching any fellow in match - common for nephrology). Hahnemann had a large nephrology section (used to also recruit non IM trained physicians to fill spots) but closed last year. Which brings me to the remaining program - Temple. There is minimum commitment to fellowship program as of this year. Given the painfully unstable nature of this transition, and other red flags of several faculty members leaving over the last two years (including previous program director, 4 out of 5 new faculty hired in 2018, some seasoned nephrologists retiring and some upcoming retirements), it would be a very unwise move to settle for this program at least for the next two to three years (I personally find this situation to the extreme detriment of any serious fellows/ genuinely interested faculty that are still in the section, and hope that they can recruit decent replacement faculty in the next few years, that can help improve the situation). In this setting, the fellowship program is obviously not a priority and has been suffering in many ways, there is no attention paid to trainee goals, no procedure training over the entire last year (except transplant biopsies), no focus on basic house keeping even (poor transitions of care, no jeopardy system, no research output with graduating fellows), very poor standards of work and an overall climate of reluctant engagement with trainees by mostly stressed/ scattered faculty (some have been leaving/ others are burnt out), and the overall culture with all the above problems is negligent and at times toxic. For most IM trained physicians applying to nephrology (IMGs and AMGs), the vast majority of other programs across the nation would be better, and can help them have decent fellowship experiences.
In general, any US IM residency trained physician (especially fresh residency graduates, and those practicing as hospitalists for ~ 5 years) can easily match into their top nephrology program, and are highly sought after applicants for middle tier programs in nephrology (nationally ranked below 20). In Philadelphia, Penn and Jefferson have been leading the city-wide nephrology trainee education initiatives, and have been the preferred programs. Given the extreme difficulty with candidate recruitment for nephrology, most middle tier programs have been taking fellows that do not have IM residency training in the US (mostly senior physicians from foreign countries looking to get into training system in the US since they are several years out of medical school and most IM residency programs don't match them). In this setting, the remaining programs in Philadelphia (Einstein, Hahnemann and Temple) have been competing for fellows from the greater Philadelphia area mostly by reducing night calls/ weekend calls / coverage requirements assigned to fellows (Einstein has no night calls for fellows, several programs have two physicians cover the weekend/ rather than fellow coverage every weekend, most programs have NPs covering the chronic nephrology service etc, in some ways it makes sense to have the busiest services covered by fellows 70-80% of the time rather than not matching any fellow in match - common for nephrology). Hahnemann had a large nephrology section (used to also recruit non IM trained physicians to fill spots) but closed last year. Which brings me to the remaining program - Temple. There is minimum commitment to fellowship program as of this year. Given the painfully unstable nature of this transition, and other red flags of several faculty members leaving over the last two years (including previous program director, 4 out of 5 new faculty hired in 2018, some seasoned nephrologists retiring and some upcoming retirements), it would be a very unwise move to settle for this program at least for the next two to three years (I personally find this situation to the extreme detriment of any serious fellows/ genuinely interested faculty that are still in the section, and hope that they can recruit decent replacement faculty in the next few years, that can help improve the situation). In this setting, the fellowship program is obviously not a priority and has been suffering in many ways, there is no attention paid to trainee goals, no procedure training over the entire last year (except transplant biopsies), no focus on basic house keeping even (poor transitions of care, no jeopardy system, no research output with graduating fellows), very poor standards of work and an overall climate of reluctant engagement with trainees by mostly stressed/ scattered faculty (some have been leaving/ others are burnt out), and the overall culture with all the above problems is negligent and at times toxic. For most IM trained physicians applying to nephrology (IMGs and AMGs), the vast majority of other programs across the nation would be better, and can help them have decent fellowship experiences.
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