Nephrology is Dead - stay away

[Nephroexp]

I did my fellowship with great interest in Nephrology - Acid base/electrolyte/Acute dialysis stuff. Joined a private practice - get around 170 K. my day starts at 6 and ends at 5. run around 4 hospitals and 3 dialysis units.

Real life of nephrology

- Oversupply - tremendous oversupply - so employers dont really have any need to offer a fair deal

universities need bodies to do the scutwork - there is no need for these bodies outside an academic setting

many nephrologists end up as hospitalists -" saw this in fellowship itself - but still liked nephro- s0 did not quit"
- Smooch primary care and hospitalists for consults - They dont absolutely have to refer,unless patient needs dialysis - No patient sues them for non dialysis requiring AKI

what do you treat ATN with anyway ???


- Dialysis patient compensation is awful and they expect you to sort out all their medical/social problems for which you dont get paid nor do u have the time.


- Dialysis rounding can easily replaced by a NP.

- Income in dialysis goes to davita/fresenius - they pretty much own everything across the country now


Nephrology is not what you see in residency - stay away from it. Dont waste 2 -3 years of your valuable life to become slave to either a dialysis company or a private group for the rest of your life with 1/2 - 2/3 income of a hospitalist


Do nephrology for right reason - It does not have income, does not have a lifestyle and does not have the charm that u see in residency

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[bronx43]

Yeah, no one has gone into neph from my institution in like 4-5 years. I honestly don't know how any program fills its spots...

 

[Nephroexp]

They fill the spots with IMGs
Reason IMGs have a fascination with sub specialization and desire some subspecialty training , if they ever return to their home country.

It's high time IMG's get away from this warped thinking.

Try to get a specialty that is worth the time and effort.

If not stay on as internist or Hospitalist - at least a better pay and lifestyle


Don't delude yourself thinking you made it to a stellar program in nephrology because of your talent. You make it because no American grad wants it and you fool yourself thinking you made it!!


IMGs get IM easily because AMG's choose the better specialities.
Nephrology fellowship is not desired even by most IMG's and you chose it!!

Nephrology is like the scum of the scum of all the specialities as of now

 

[bronx43]

They fill the spots with IMGs
Reason IMGs have a fascination with sub specialization and desire some subspecialty training , if they ever return to their home country.

It's high time IMG's get away from this warped thinking.

Try to get a specialty that is worth the time and effort.

If not stay on as internist or Hospitalist - at least a better pay and lifestyle


Don't delude yourself thinking you made it to a stellar program in nephrology because of your talent. You make it because no American grad wants it and you fool yourself thinking you made it!!


IMGs get IM easily because AMG's choose the better specialities.
Nephrology fellowship is not desired even by most IMG's and you chose it!!

Nephrology is like the scum of the scum of all the specialities as of now

Why don't you just do hospitalist then? Just because you finished neph fellowship doesn't mean you HAVE to be a nephrologist. At least two hospitalists at my institution had neph training.

 

[Nephroexp]

Thought of it. It's not an easy automatic thing. All the nephs who work as Hospitalist still miss Nephro. It's not that easy to consult a nephrologist when you know what to do and how to do the same?

It is that psych block that stops me from quitting.


Will stick to Nephro despite all the issues as came too far and can live within my means on a low salary.


My post is to provide information so that prospective candidates can make an informed choice based on reality, rather than hyped up/ distorted perspective.

 

[Silent Cool]

I did my fellowship with great interest in Nephrology - Acid base/electrolyte/Acute dialysis stuff. Joined a private practice - get around 170 K. my day starts at 6 and ends at 5. run around 4 hospitals and 3 dialysis units.

Real life of nephrology

- Oversupply - tremendous oversupply - so employers dont really have any need to offer a fair deal

universities need bodies to do the scutwork - there is no need for these bodies outside an academic setting

many nephrologists end up as hospitalists -" saw this in fellowship itself - but still liked nephro- s0 did not quit"
- Smooch primary care and hospitalists for consults - They dont absolutely have to refer,unless patient needs dialysis - No patient sues them for non dialysis requiring AKI

what do you treat ATN with anyway ???


- Dialysis patient compensation is awful and they expect you to sort out all their medical/social problems for which you dont get paid nor do u have the time.


- Dialysis rounding can easily replaced by a NP.

- Income in dialysis goes to davita/fresenius - they pretty much own everything across the country now


Nephrology is not what you see in residency - stay away from it. Dont waste 2 -3 years of your valuable life to become slave to either a dialysis company or a private group for the rest of your life with 1/2 - 2/3 income of a hospitalist


Do nephrology for right reason - It does not have income, does not have a lifestyle and does not have the charm that u see in residency

So the hospitalists in your area are making like 300K?

 

[Nephroexp]

260 FYI and 14 shifts. All of them do extra easily


pretty close to major metro

 

[bronx43]

260 FYI and 14 shifts. All of them do extra easily


pretty close to major metro

That's a bit higher than what I have been seeing, but not far off. Many hospitalists end up working 16-20 shifts a month and end up making 275-300k. I don't know how long this gravy train will roll on...

 

[Nephroexp]

Right now with obamacare and ACO's there will be an increased push towards early discharge /prevent readmissions. Hospitalists can acheive the first part easily - Hospitals will hire more and more hospitalists - wont be surprised if you start seeing late evening discharges too!! or even midnight!!

Nephrology does not fit well into an ACO model as in most areas too many groups to get together. Readmission prevention - extremely difficult.

Nephrology is split between dialysis companies/Private groups and hospitals - hard to unify - too many variables.

Hospitalist will likely grow with an elderly population needing more hospitalization. There will be more AKI but with pressure to discharge - Unlikely to be referred to nephro unless HD needed.

 

[DermViser]

I did my fellowship with great interest in Nephrology - Acid base/electrolyte/Acute dialysis stuff. Joined a private practice - get around 170 K. my day starts at 6 and ends at 5. run around 4 hospitals and 3 dialysis units.

Real life of nephrology

- Oversupply - tremendous oversupply - so employers dont really have any need to offer a fair deal

universities need bodies to do the scutwork - there is no need for these bodies outside an academic setting

many nephrologists end up as hospitalists -" saw this in fellowship itself - but still liked nephro- s0 did not quit"
- Smooch primary care and hospitalists for consults - They dont absolutely have to refer,unless patient needs dialysis - No patient sues them for non dialysis requiring AKI

what do you treat ATN with anyway ???


- Dialysis patient compensation is awful and they expect you to sort out all their medical/social problems for which you dont get paid nor do u have the time.


- Dialysis rounding can easily replaced by a NP.

- Income in dialysis goes to davita/fresenius - they pretty much own everything across the country now


Nephrology is not what you see in residency - stay away from it. Dont waste 2 -3 years of your valuable life to become slave to either a dialysis company or a private group for the rest of your life with 1/2 - 2/3 income of a hospitalist


Do nephrology for right reason - It does not have income, does not have a lifestyle and does not have the charm that u see in residency

I notice all the Nephrologists and Nephro fellows are IMGs.

 

[Nephroexp]

Yes we still have some twinkle eyes when we look at fellowship

 

[LoudBark]

I notice all the Nephrologists and Nephro fellows are IMGs.

Almost all applicants to nephrology fellowship in the last 5 years have been FMG's.

AMG's are more competitive applicants so they get selected in a Darwinian fashion into the specialties that provide either better pay or better lifestyle or both better pay and better lifestyle.

 

[IM2GI]

The problem with nephrology is that it just seems so painfully boring to practice.

Give fluids/take fluids away, stop nephrotoxic meds, control BP and BS, start an ACE/ARB.

Round on depressing chronic HD patients.

What about that seems appealing? Maybe every once in a while you get thrown a bone and get a cool intrinsic renal disease case that you can actually do something about, but the clinical practice of nephrology just seems so painful.

Add in the fact that you don't get paid, have a bad lifestyle, and can't find a job?

The field is in trouble.

 

[LoudBark]

The problem with nephrology is that it just seems so painfully boring to practice.

Give fluids/take fluids away, stop nephrotoxic meds, control BP and BS, start an ACE/ARB.

Round on depressing chronic HD patients.

What about that seems appealing? Maybe every once in a while you get thrown a bone and get a cool intrinsic renal disease case that you can actually do something about, but the clinical practice of nephrology just seems so painful.

Add in the fact that you don't get paid, have a bad lifestyle, and can't find a job?

The field is in trouble.

The problem is this: it is a field that has a bad lifestyle AND low pay

Boring and depressing.....sure......but that is not the real story why the field is in trouble with no AMG wanting to do it. You can argue that sticking a tube up someones butt hole and talking to them about their pooping habits is not the most fascinating thing (but you get paid very nicely to do it). Oncology is certainly depressing......but good lifestyle and pretty good pay too.

It is a problem where in the US of A, there are no US of A educated doctors that want to do a certain field of medicine. I can't think of any other field in all of medicine, any specialty, which has fewer American grads going into it today.

 

[IM2GI]

The problem is this: it is a field that has a bad lifestyle AND low pay

Boring and depressing.....sure......but that is not the real story why the field is in trouble with no AMG wanting to do it. You can argue that sticking a tube up someones butt hole is not the most fascinating thing (but you get paid very nicely to do it). Oncology is certainly depressing......but good lifestyle and pretty good pay too.

It is a problem where in the US of A, there are no US of A educated doctors that want to do a certain field of medicine. I can't think of any other field in all of medicine, any specialty, which has fewer American grads going into it today.

Endoscopy is actually a lot of fun, but yes, anything can be tolerable if you get compensated well to do it and have a good lifestyle.

Nephro has 3 strikes, no pay, no lifestyle, and boring.

 

[Nephroexp]

Gastro has it's bright side of an excellent pay and need(everyone needs colonoscopy unlike dialysis;every gi bleed will be consulted unlike aki or ckd)

Number of positions did not proliferate like Nephro

Intellectually though find Nephro more challenging.

 

[pH74]

This year nephrology programs are struggling to find fellows.

Only people who are applying are IMGs from small community programs who have fascination for "some fellowship"

Part of the reason why there is so much exploitation in nephrology is because most of the Nephrologists are FMGs from Asia and they have culture of exploiting young physicians there.

 

[pH74]

Thought of it. It's not an easy automatic thing. All the nephs who work as Hospitalist still miss Nephro. It's not that easy to consult a nephrologist when you know what to do and how to do the same?

It is that psych block that stops me from quitting.


Will stick to Nephro despite all the issues as came too far and can live within my means on a low salary.


My post is to provide information so that prospective candidates can make an informed choice based on reality, rather than hyped up/ distorted perspective.

I think you have to let your psych block fade away and think practically . Just accept that you made a bad decision in your career because of ignorance. I was in the same situation few months ago. I made a bold move of joining back as hospitalist and I feel happy and much more relaxed.

 

[rokshana]

I notice all the Nephrologists and Nephro fellows are IMGs.

and your point?

plus no…many, maybe most, but certainly not ALL..i know at least one USMD that is in a nephrology program.

 

[DermViser]

and your point?

plus no…many, maybe most, but certainly not ALL..i know at least one USMD that is in a nephrology program.

Meaning it's not wanted by AMGs for a reason as those above have alluded to.

 

[drfunktacular]

You can argue that sticking a tube up someones butt hole and talking to them about their pooping habits is not the most fascinating thing

My fairly competitive IM program sent several very smart talented AMGs into nephrology. Why that is, I'll never know...

 

[pH74]

My fairly competitive IM program sent several very smart talented AMGs into nephrology. Why that is, I'll never know...

How many are still doing it ? How many resigned ?

 

[rokshana]

How many are still doing it ? How many resigned ?

novel concept here, but maybe….MAYbe…they decided to go into something that they are actually interested in….(and not just making butt loads of money…pun intended)….

 

[Nephroexp]

novel concept here, but maybe….MAYbe…they decided to go into something that they are actually interested in….(and not just making butt loads of money…pun intended)….

What are they interested in?

1) smooching primary care / hospitalists for consults
2) be a social worker
3) wake up every single night for the silliest reasons
4) wait forever for some job security
5) least paid of the physician group takin care of pt.

If the above are true welcome aboard )

 

[LoudBark]

novel concept here, but maybe….MAYbe…they decided to go into something that they are actually interested in….(and not just making butt loads of money…pun intended)….

Oy, every time someone tells it like it really is......the inevitable, "you should just do what you love and forget about any other reality" post appears. There always is someone who tries to make it look like the real world is all peaches and cream as long as you just love what you do.

I have said this before, but will repeat it. Doing what you LOVE only goes so far. Forget that you love the intellectual stimulation of glomerular diseases or working up a new rare, case of vasculitis. Going into fellowship, that mindset is what gets you through the day. That is not reality when you get out in the real world. The day in and day out hassles get in the way of the 1 in a million case of amyloidsis that you nail after it gets missed and makes your job so fulfilling you couldn't imagine doing anything else in the world.

The daily hassles (which are spelled out by myself and other posters such as nephroexp, nephapp, pH74) can be read on previous posts and don't need to be spelled out again here.

Put simply, if there was a scale that measured frustration of daily practice vs gratification of the intellectual stimulation of nephrology it would look like this:

frustration > > > > > > gratification

 

[Nephroexp]

This is not ID or endocrine( 2 specialties that are Iikely to be paid same as Nephro) .

You will have plenty of nonsense that doesn't get reimbursed.

Phone calls for all minor electrolyte issues
Frustrated + needy dialysis patients who expect u to solve all their problems.


It's hard to get a job and even if you get one it is frustration rather than intellectual satisfaction that will fill you.


Loudbark summarized it for you very well.

Listen to him than a Program director who either knows the reality or will mislead you.

 

[rokshana]

trust me, when i was a hospitalist i played social worker too and did plenty of things that didn't get reimbursed…and chose to go back to do fellowship (and yes its Endo not Nephro) because I like the subject matter of Endo…could i make more money as a Hospitalist? yep! but I'd rather make 200k as Endo than 250 as Hospitalist…

if the money: frustration ratio bothers you, then fine…don't do the subspecialty…lets face it EVERY specially or subspecialty has crap…if your enjoyment of an area of specialty outweighs the crap….then you do it…

 

[rokshana]

Oy, every time someone tells it like it really is......the inevitable, "you should just do what you love and forget about any other reality" post appears. There always is someone who tries to make it look like the real world is all peaches and cream as long as you just love what you do.

I have said this before, but will repeat it. Doing what you LOVE only goes so far. Forget that you love the intellectual stimulation of glomerular diseases or working up a new rare, case of vasculitis. Going into fellowship, that mindset is what gets you through the day. That is not reality when you get out in the real world. The day in and day out hassles get in the way of the 1 in a million case of amyloidsis that you nail after it gets missed and makes your job so fulfilling you couldn't imagine doing anything else in the world.

The daily hassles (which are spelled out by myself and other posters such as nephroexp, nephapp, pH74) can be read on previous posts and don't need to be spelled out again here.

Put simply, if there was a scale that measured frustration of daily practice vs gratification of the intellectual stimulation of nephrology it would look like this:

frustration > > > > > > gratification

and like nephrology has the market cornered? PLEASE….hospital medicine has that beat...

 

[pH74]

trust me, when i was a hospitalist i played social worker too and did plenty of things that didn't get reimbursed…and chose to go back to do fellowship (and yes its Endo not Nephro) because I like the subject matter of Endo…could i make more money as a Hospitalist? yep! but I'd rather make 200k as Endo than 250 as Hospitalist…

if the money: frustration ratio bothers you, then fine…don't do the subspecialty…lets face it EVERY specially or subspecialty has crap…if your enjoyment of an area of specialty outweighs the crap….then you do it…

As a hospitalist I have more time and money for my family. My family is happy and so am I. It's a win win situation.

 

[Nephroexp]

trust me, when i was a hospitalist i played social worker too and did plenty of things that didn't get reimbursed…and chose to go back to do fellowship (and yes its Endo not Nephro) because I like the subject matter of Endo…could i make more money as a Hospitalist? yep! but I'd rather make 200k as Endo than 250 as Hospitalist…

if the money: frustration ratio bothers you, then fine…don't do the subspecialty…lets face it EVERY specially or subspecialty has crap…if your enjoyment of an area of specialty outweighs the crap….then you do it…

Endo atleast has the lifestyle. If one has to go through a grueling fellowship, they should be doing what they are trained for and atleast am equivalent pay that one could have made with out doing that training.
Nephrology private practice has neither.

Want to move away from Hospitalist - choose something that is atleast worth the effort.

 

[rokshana]

As a hospitalist I have more time and money for my family. My family is happy and so am I. It's a win win situation.

and for you the increased money and time with family outweighs the mindlessness of hospital medicine…that is kinda my point…someone may consider the frustration you describe as acceptable because their interest makes it worth it.

 

[rokshana]

Endo atleast has the lifestyle. If one has to go through a grueling fellowship, they should be doing what they are trained for and atleast am equivalent pay that one could have made with out doing that training.
Nephrology private practice has neither.

Want to move away from Hospitalist - choose something that is atleast worth the effort.

i did.

 

[Nephroexp]

i did.

Hopefully future applicants would be wise like you.

 

[pH74]

i did.

Since you are not a nephrologist and not even aware of difficulties new nephrology graduates are experiencing , please refrain from making your amateur comments

 

[rokshana]

Since you are not a nephrologist and not even aware of difficulties new nephrology graduates are experiencing , please refrain from making your amateur comments

don't presume to know about what my knowledge base is...my research was renal, much of my time in residency was spent doing renal inpatient as well s consult…my mentor in residency was the PD of the nephrology fellowship program, one of my best friends (who incidentally i met working as a hospitalist) is a SOLO nephrologist…and my family business is the kidney…father urologist, 2 uncles nephrologists, and cousin pediatric nephrologist….i was encouraged to do endo by all of them…I am quite aware but i really considered it…i just suck at acid/base…but seriously, decided against nephrology for many of the reasons stated above and endo was also a long standing interest and endo does have better life style and opportunities…so ultimately stayed in endo...

 

[LoudBark]

trust me, when i was a hospitalist i played social worker too and did plenty of things that didn't get reimbursed…and chose to go back to do fellowship (and yes its Endo not Nephro) because I like the subject matter of Endo…could i make more money as a Hospitalist? yep! but I'd rather make 200k as Endo than 250 as Hospitalist…

if the money: frustration ratio bothers you, then fine…don't do the subspecialty…lets face it EVERY specially or subspecialty has crap…if your enjoyment of an area of specialty outweighs the crap….then you do it…

OK, another "every specialty has its downsides...." post.
Lets make it simple. Real simple.

Lets take any medicine specialty. No, better yet lets take any specialty.

They can all be divided into 3 simple categories:
1. Good lifestyle (like your beloved endocrinology)
2. Good money
3. Good money and good lifestyle.

There is only one medical subspecialty......heck even one specialty in all of medicine that does not fit the bill of any of those three.
It is........nephrology. Please name one other medical subspecialty, or area in medicine at all, that doesn't fit into one of those three.
No one can argue that nephrology is good money. This is not the 1980's or even the 1990's. No one can argue it is a good lifestyle. An argument can be made for lifestyle or money for any other specialty. Even the stuff hospitalists have to deal with......well they still don't have to take call at home and they get lots of days off....hence, lifestyle.

Medicine has evolved so there is no more the do it all internist that rounds on his hospital patients at 6am and then again at 6pm after he finishes the office. Outpatient doctors want a better lifestyle so they all use hospitalists now. Specialties like your own, endocrinology, at least in private practice, never step foot in a hospital. When you are on call, if someone is really sick (sugar really high! sugar really low!), they go to the ER and the ER doctor or hospitalist or intensivist handles it. No one else will write emergent dialysis orders in the middle of the night.

Nephrology is unique in that it truly doesn't have the lifestyle or the money, unlike any other specialty. The "just do what you love and everything will be fine and dandy" or the "find a specialty where you really enjoy it more than the things that may bother you" posts just don't apply to nephrology. There is a reason why it is a dead specialty, a reason why no American grads go into it (yes you may provide an N=1 example of some American grad you know who does it, but the statistics don't support it), and a reason why there will be empty spots and programs will pull any disgruntled hospitalist they can find to fill the spots.

I am glad you have found a specialty that you truly love and that provides the lifestyle you are looking for. May others be as fortunate as you. I am not saying that you can't love the topic of kidneys / acid base / electrolytes, but it is really hard to let the cerebral and intellectual aspects of the specialty shine through and motivate you once you have left fellowship when there is no money and no lifestyle......unlike any other specialty. Those things do matter.

 

[rokshana]

i have certainly not said do what you love and everything will be fine and dandy…1st time I've ever been made to look like a pollyanna, btw! BUT for some people they WILL pick interest as an higher priority…your poor experience isn't necessarily shared by all nephrologists (and my n for AMGs in nephrology is greater than 1- and seriously other than gi and cards, there are many I/FMGs in subspecialty training).

and i'm sure there are plenty of ID, family med, peds, and PCPs who would say that their pain and the future of their specialties is as much (if not more) than the nephrologist…there are plenty of PCPs that have had to close or sell their practices because they cannot make a living…

and yes, of course as endo my emergencies are few and far between, but they are there and for you to feel the need to belittle another specialty to make your pain seemed to be more…well…its not like you didn't know that writing emergent dialysis orders was part of the deal...

 

[Nephroexp]

As said before - join nephrology with a good idea of what life is going to be.

It is not what you see in residency.

Older nephrologists had better days due to owning dialysis units and a lesser number of nephrologists overall.


Graduating nephrology fellows would find it difficult to find a job and even if one finds a job - it will be of lesser pay/quality.



Talk to new nephrologists if you want to know the reality as they see it.

Congratulate folks who dodged the nephrology private practice bullet and chose a better career. If you dodged it, help others do the same.

PCP/Hospitalist have their share of issues.

Nephrology is like a PCP+Hospitalist + nursing home doc(dialysis) combined in one job with a lesser pay than each one of them.


Trading internal medicine / Hospitalist for nephrology due to their hassles is ludicrous.

Love ))) and nephrology private practice don't go together.

 

[pH74]

don't presume to know about what my knowledge base is...my research was renal, much of my time in residency was spent doing renal inpatient as well s consult…my mentor in residency was the PD of the nephrology fellowship program, one of my best friends (who incidentally i met working as a hospitalist) is a SOLO nephrologist…and my family business is the kidney…father urologist, 2 uncles nephrologists, and cousin pediatric nephrologist….i was encouraged to do endo by all of them…I am quite aware but i really considered it…i just suck at acid/base…but seriously, decided against nephrology for many of the reasons stated above and endo was also a long standing interest and endo does have better life style and opportunities…so ultimately stayed in endo...

You are lucky that your mentor in nephrology was well informed about job prospects and lifestyle in renal and made you take right decision.

 

[pH74]

.

 

[NephroFellows]

.

 

[tartesos]

You are lucky that your mentor in nephrology was well informed about job prospects and lifestyle in renal and made you take right decision.

So many renal guys doing Hospitalist I don't get it.
I know a renal guy in the south making 300 k in a big group. He started at 250( he works, but fri is half day). Either he's lucky or some renal guys don't want to live in a small town.
Think outside the box.
If you only see yourself doing renal and you love it, go for it.

 

[CptNemo]

So many renal guys doing Hospitalist I don't get it.
I know a renal guy in the south making 300 k in a big group. He started at 250( he works, but fri is half day). Either he's lucky or some renal guys don't want to live in a small town.
Think outside the box.
If you only see yourself doing renal and you love it, go for it.

People do hospitalist because they often have geographic limitations (based on a spouse, family, or preference). In some locations it is either a) very difficult to find any nephrology job or b) difficult to find a nephrology job that pays better and/or has a better schedule than a hospitalist job.

Some states in the South and others in the mid-US are not yet saturated with nephrologists, so compensation is still relatively good, but not so incredible as to lure people out there. E.g., if someone offered me $500K/year starting and $750K partner to do nephrology in a podunk town, I'd be there yesterday (and it would be easier to convince the wife to agree to that), but if I'm only offered $250-$300K to go there while I can make nearly that much (or the same with extra shifts) as a hospitalist in the location of much choosing... not so much. So, I totally get why some people choose to become hospitalists after nephrology.

The coasts are more challenging for nephrology. I have not seen anyone starting at $250K on the coasts (and certainly no one has offered me that much). The highest offer I've seen was $220K for a position with a schedule that sounded terrible in a "churn and burn" group (i.e., very sketchy past history in making people partners). Most starting offers that I have seen have ranged from $160-$190K, which is less than most hospitalists get here.

 

[rokshana]

People do hospitalist because they often have geographic limitations (based on a spouse, family, or preference). In some locations it is either a) very difficult to find any nephrology job or b) difficult to find a nephrology job that pays better and/or has a better schedule than a hospitalist job.

Some states in the South and others in the mid-US are not yet saturated with nephrologists, so compensation is still relatively good, but not so incredible as to lure people out there. E.g., if someone offered me $500K/year starting and $750K partner to do nephrology in a podunk town, I'd be there yesterday (and it would be easier to convince the wife to agree to that), but if I'm only offered $250-$300K to go there while I can make nearly that much (or the same with extra shifts) as a hospitalist in the location of much choosing... not so much. So, I totally get why some people choose to become hospitalists after nephrology.

The coasts are more challenging for nephrology. I have not seen anyone starting at $250K on the coasts (and certainly no one has offered me that much). The highest offer I've seen was $220K for a position with a schedule that sounded terrible in a "churn and burn" group (i.e., very sketchy past history in making people partners). Most starting offers that I have seen have ranged from $160-$190K, which is less than most hospitalists get here.

but...did you not know that before starting fellowship? I mean there are a number of IM subspecialties that make less than what a hospitalist would easily make...I knew that endo's average is at least 30-50k less than what i was making as a hospitalist, but would rather make less to do what i like more... surely you weren't expecting job offers in the 500k range were you?

 

[CptNemo]

but...did you not know that before starting fellowship? I mean there are a number of IM subspecialties that make less than what a hospitalist would easily make...I knew that endo's average is at least 30-50k less than what i was making as a hospitalist, but would rather make less to do what i like more... surely you weren't expecting job offers in the 500k range were you?

Yes, I had a good idea of what a realistic nephrology salary would be before signing up for fellowship. However, I underestimated how few nephrology jobs are available in certain areas.

I just quoted $500K as an absurdly high salary to illustrate a point: location is very important to me, so it would take a large amount of money to get me to go to a less desirable location. If nephrology in a "worse" location pays similar to what I can get doing hospitalist medicine in a "good" location, my personal decision would be to do hospitalist work in the "good" location. Of course, "worse" and "good" are subjective, and will vary from person to person.

Unfortunately, the area where I have ties and would like to live, raise a family, etc. is very anemic when it comes to nephrology jobs. Basically, a few scraps are left over, and when investigating these further, there seem to be reasons why those positions are unfilled. So it is not merely a choice of giving up some salary to do what I love... I'd likely have to accept a long commute (or live in the outskirts), a rough call schedule, lots of driving b/w dialysis units and hospitals, bear the risk of smaller/less established practice groups (especially in the age of looming ACOs/ESCOs), and get a worse benefits package, while also accepting a lower salary.

 

[tartesos]

Yes, I had a good idea of what a realistic nephrology salary would be before signing up for fellowship. However, I underestimated how few nephrology jobs are available in certain areas.

I just quoted $500K as an absurdly high salary to illustrate a point: location is very important to me, so it would take a large amount of money to get me to go to a less desirable location. If nephrology in a "worse" location pays similar to what I can get doing hospitalist medicine in a "good" location, my personal decision would be to do hospitalist work in the "good" location. Of course, "worse" and "good" are subjective, and will vary from person to person.

Unfortunately, the area where I have ties and would like to live, raise a family, etc. is very anemic when it comes to nephrology jobs. Basically, a few scraps are left over, and when investigating these further, there seem to be reasons why those positions are unfilled. So it is not merely a choice of giving up some salary to do what I love... I'd likely have to accept a long commute (or live in the outskirts), a rough call schedule, lots of driving b/w dialysis units and hospitals, bear the risk of smaller/less established practice groups (especially in the age of looming ACOs/ESCOs), and get a worse benefits package, while also accepting a lower salary.

I agree with you there! Before I had my kids and I was fixated on staying in NYC I would have forego $ in order to stay there.
Now out of there( and don't see myself going back ever!) pa$tures are greener outside big cities / east coast. And life is good in smaller towns too! In many ways.

 

[Kidney007]

Nephrologists from USA should move to Canada where the average salary is 500k..

http://www.renalandurologynews.com/nephrologists-woefully-underpaid-in-us-vs-canada/article/331739/

 

[CptNemo]

Nephrologists from USA should move to Canada where the average salary is 500k..

http://www.renalandurologynews.com/nephrologists-woefully-underpaid-in-us-vs-canada/article/331739/

The question is why? Basically, they absorb more work and don't hire new people. The following article sheds some light:

"The issue in some hospitals, the piece argues, is that senior doctors have been given control over recruiting new physicians — or choosing not to. This has created a “disturbing potential for conflict of interest,” writes Dr. Robert Bear, a former University of Toronto professor who now works as a health-care consultant."

"In many specialties, a hospital physician’s annual income depends on the number of colleagues he or she shares patients with — the more doctors in a department, the less each one earns through government billing. As a result, even in departments where there might be room to hire, Bear says some choose not to."

http://www.thestar.com/news/gta/201...d_specialist_doctors_in_canada_find_jobs.html

This is also one of the same reasons why it's hard to find a nephrology job in some parts of the US. Because revenue growth is low or non-existent, groups choose to maintain their salaries by not adding on a partner with whom they would have to share revenue.

 

[Kidney007]

In Canada, 80% of a nephrologist salary comes from dialysis patients..Most nephrology service try to keep a ratio of "dialysis patients per nephrologist" around 30:1 to 50:1

Is it the same problem in USA?

 

[CptNemo]

Wow, those ratios sound pretty low.

From what I've seen down here, double those ratios and you'll get a more accurate range applicable to the US. I'd think most nephrologists would go bankrupt following only 30 patients (unless they're academics and have separate grant funding, etc.)

Dialysis reimbursements are very low in the USA, so you have to make it up in volume (and extra services, like vascular interventions). Assuming Kam Kalantar-Zadeh's article is correct, Canada's reimbursements are much higher (more than 2x), so one can get away with having lower ratios.