Nephrology is Dead - stay away

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I think it's very important that we don't hurt other peoples careers. I think it's very disgusting what fellowship programs will say to get fellows to join. I know because I was a victim of this, along with my cofellows, and many others on this thread. Using coercive and misleading information to lure applicants into a dying specialty when in fact the applicant is the one taking on all the risks and they are too naïve to know it. When statistics show only 45% of grads go into private practice, and god knows how many drop out after their first job, it is clear that people who go into it do not know the full breath of what they are getting into. The truth is being muzzled by organizations who stand to gain from peoples ignorance. SDN allows us to speak the truth so that people can make an informed decision on their career path.
 
renalfellow937 said:
Everything you say is true !! Except for the 200K .. it is even lower than that !! Most practices offer 180k and if they can't find a physician will just hire a NP. It is quite funny to see seasoned IMG hospitalists coming to do Nephrology fellowship with hopes of making more money and in a few years going back to their old jobs !
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Let’s put a stop to this tragedy. This is the reason why I am advocating so hard for transparency and removing the misinformation that applicants are fed. Watching idly by knowing that people are walking into a career trap is not cool.
 
just to reiterate -

Predatory private practice behavior also exists for other sub specialties also exist for the competitive specialties like cardiology and GI . What is the difference ? You can spend your savings and open your own practice and do your own procedures. You cannot open your own renal practice and just start hemodialysis . HD privileges are very territorial and very political . If you open a renal practice witout HD , you will go bankrupt very soon .
 
NewYorkDoctors said:
just to reiterate -

Predatory private practice behavior also exists for other sub specialties also exist for the competitive specialties like cardiology and GI . What is the difference ? You can spend your savings and open your own practice and do your own procedures. You cannot open your own renal practice and just start hemodialysis . HD privileges are very territorial and very political . If you open a renal practice witout HD , you will go bankrupt very soon .
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I would say for cards/GI, if you did not get offered partnership by the group, you can always find another job that start at 350K/yr which ain't bad; not 200k/yr like nephrology which is quite embarrassing. That makes nephrology financially unfeasible to to do if you are hoping between multiple groups in your career; and the single biggest reason nephrologists end up as hospitalist. I do know solo nephrology practitioners, but usually the reason they are solo is because they have been burned before and can't trust joining a group. It's unrealistic to do solo in nephrology now a days. You are spending more time driving than seeing patients. In an large metro area, you are hitting 3-4 hospitals, plus 1-2 LTACs, plus your own clinic. Financially, you are just better off as a hospitalist. Only way to do nephrology is to join a group that has monopoly control in a certain area, and you are stationed a certain part of town to limit driving. It's a volume based specialty and you don't have any high paying procedures under than accumulate a lot of dialysis patients. Of course joining a nephrology group also means abiding by their rules and giving sweat equity for x number of years with no guarantees other than a low salary. This is why so many grads try to escape into critical care or some just give up and go back to hospitalist. If people had little more foresight when entering fellowship and not put themselves in this kind of position, there would be less misery in this world.
 
Those who join academics are not necessarily better off . Unless you are a boba fide researched who puts out lots of good clinical and or bench research and are on the fast track to professor of medicine , you do not get salary incentives . Publish or perish indeed .

Often times clinician educators often lament how their private practice colleagues make so much more money than them despite the clinician educator having a FASN title (requires research ) and being up to date on the all the latest developments . (Basically I’m smarter than that community doctor who is not up to date and I get paid less )
 
NewYorkDoctors said:
Those who join academics are not necessarily better off . Unless you are a boba fide researched who puts out lots of good clinical and or bench research and are on the fast track to professor of medicine , you do not get salary incentives . Publish or perish indeed .

Often times clinician educators often lament how their private practice colleagues make so much more money than them despite the clinician educator having a FASN title (requires research ) and being up to date on the all the latest developments . (Basically I’m smarter than that community doctor who is not up to date and I get paid less )
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I know a few nephrologists who are doing academics(entry level clinical educator) because they were burned in private practice. Some people just can't acknowledge that nephrology was a mistake, and tries to mentally justify it by at least having an easy lifestyle, living off of the fellows,
 
Renal_Prometheus said:
I know a few nephrologists who are doing academics(entry level clinical educator) because they were burned in private practice. Some people just can't acknowledge that nephrology was a mistake, and tries to mentally justify it by at least having an easy lifestyle, living off of the fellows,
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I agree !
unless in academics a nephrologist is bringing significant grants , its useless financially to be academic nephrologist
they get paid less and the only charm is that they can use fellows and residents for their scut work and as warm bodies
there is no innovation and nothing dramatic
they are big time **** talkers but accomplish nothing and contribute little
 
georgestone said:
I agree !
unless in academics a nephrologist is bringing significant grants , its useless financially to be academic nephrologist
they get paid less and the only charm is that they can use fellows and residents for their scut work and as warm bodies
there is no innovation and nothing dramatic
they are big time **** talkers but accomplish nothing and contribute little
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This describes 98% of "academics."

I suspect that as more academic centers feel the financial crunch, these division chiefs (aka scam artists) will get canned or be forced into a lot more clinical duties.
 
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georgestone said:
I agree !
unless in academics a nephrologist is bringing significant grants , its useless financially to be academic nephrologist
they get paid less and the only charm is that they can use fellows and residents for their scut work and as warm bodies
there is no innovation and nothing dramatic
they are big time **** talkers but accomplish nothing and contribute little
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well spending one hour per patient and being super thorough about their CKD3 might be helpful for the patient.
Sure beats the community doc who spends 5 minutes on the same patient.
Though to be fair, that same patient may only need 5 minutes since that patient may not even need to see a nephrologist. But in PP, there is always a "downgrade" in the cases. Internists now see NP level cases and general screening. The basic Internist workup now falls onto the community specialist. Anything considered truly specialized (like for instance glomerulonephritis in nephrology or ILD workup outside of definite UIP / IPF ) will get referred to the academic specialist for "second opinion."
 
georgestone said:
I agree !
unless in academics a nephrologist is bringing significant grants , its useless financially to be academic nephrologist
they get paid less and the only charm is that they can use fellows and residents for their scut work and as warm bodies
there is no innovation and nothing dramatic
they are big time **** talkers but accomplish nothing and contribute little
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And life doesn’t get much better in academia even if you ARE bringing in significant grants…if you indeed manage to obtain an R01 or something, a significant portion of your income will now be in the hands of faceless decision makers at the NIH or NSF…you will be subjected to the shifting sands of political whims with regards to which research topics are considered “sexy” any given year, and if your research isn’t considered in vogue this time around you might get cut out altogether. You will be writing grant proposals constantly and will be forever stressed about whether they’ll be accepted etc. And if you have institutional grants or money from private donors, you’ll forever be kissing ass there too.

Never mind that you will have to publish, publish, publish at any cost to keep the grant money gravy train running, even if what you’re publishing is complete garbage…between residency and fellowship I saw soooooo much nonsense and trash quality research published just because some attending wanted to squeeze out one more paper this year, or because fellow XYZ wanted the paper for their CV, or whatever. I hate to say it, but frankly the medical research situation might be better if LESS of this nonsense was being published rather than more.

You’ll put up with all this for compensation that is *still* less than what your colleagues are earning out in the community. A $25-50k salary incentive for having an R01 means diddly squat when you started off making $150k less than your private practice compadres - all while you do probably double the work of those community docs. And what else are you getting out of the arrangement? You get to boast at family Christmas dinners that you’re an “assistant professor working at the Big Academic Institution?” Who cares? That’s worth jack **** especially when you consider how hard you’re busting your ass to keep your head above water in academia. (Not to mention that you probably missed the family Christmas because your institution made you round that day so some senior professor douchebag didn’t have to.)

Need I say that I think academia is pretty awful for almost everyone involved?
 
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Well nephrology is down to 47.7% program fill and 66.9% fellowship position fill . A fall from last year . Overall higher than years past likely due to the convenience of virtual interviewing . I would like to think that this thread and it’s contributors have dissuaded those who are not fully bought into the specialty from ranking.

Nephrology is a great discipline . But for the aforementioned reasons in this thread , there are many reasons why applicants who have not fully thought out their career plans should avoid this specialty .

For those who enter this with a plan, I wish the best of luck to you hand congratulations on your match . For those who went in without a plan , you better starting making some connections for critical care or other fellowship . You’re gonna need it .
 
Why even bother applying. Just wait for the scramble and go to the program you want to go without the uncertainty of the match. You can scramble into a top 10 academic institution.
 
I would like to think that this thread has had something to do with the match rates dropping back down to earth. Meaning dropping back down to pre-2020 virtual interview levels. This is taking into account that this year AY 2022 still HAD virtual interviews. Last year for AY 2021 there was great enthusiasm that the match rate was at a 10 year high thanks to virtual interviewing. well now with virtual interviews still going on, I would like to think that this thread has had something to do with the undecided applicants shying away from applying. I mean the baseline is probably always going to be around 50-60% because the top bona fide academic training programs are still going to fill and allow an candidate who otherwise would be a hospitalist forever to have a chance to be an academic physician with a fancy title and insert sub-professor of medicine title. If you are not after every single dollar, then you cant beat that set up! I am not being facetious. I really think academic nephrology is a good choice for those who like nephrology, have no debt, and have no desire to earn every single dollar he/she can.

If you are after every single dollar, then turn away from nephrology unless you have family/friend connections in the HD industry.
 
The neph PDs right now are frantically calling anyone with a pulse and promising the world to get a sucker to bite. They need to live off the back of fellows. At this point, lying is fair game and they are desperate enough to say anything. They will promise to try to get you into critical care afterward or they know the cards PD and somehow will get you on some cardio-renal research and you will be shoe in for cards fellowship down the row. All lies, don’t fall for it. I caution applicants against settling for a specialty for those who didn’t match their first choice specialty. You wouldn’t buy something just because it’s cheap? Why would you take a specialty just because it’s easy to get into?
 
I believe people have mentioned on this thread before that applicants who didn’t match into their first choice specialty, get blanked with emails from unfilled neph programs offering neph positions. This is true for people who never even applied to nephrology. These PDs have no shame.
 
One of my cofellows (who was a hospitalist for 15 years then decided he had enough savings and wanted an escape ) did a renal fellowship then opened his own solo private practice . He did have some friend connections who set up him with HD privileges are a local center and inpatient HD privileges .

He does not practice GIM becuase “he doesn’t like it .”

His renal practice is not thriving and he barely breaking even now . He does not have to run from hospital to hospital or center to center (the center is a few blocks from his office and the main hospital he is affiliated with is a short drive away ). But he does not get that many referrals whether inpatient or outpatient . Why ? The hospitalist groups prefer in house renal becuase the fellow is always there and receptive . The private internist groups have referral patterns (that extend both ways - a specific consultant might say you need a PMD I suggest this doctor he/she is good ) . He laments how he always has to achmooze for new referrals . I advised him to convert to GIM and only inpatient renal HD consults and whatever renal outpatient follow up he can get . He declines citing it’ll turn around . I said not in NYC it won’t .
 
NewYorkDoctors said:
One of my cofellows (who was a hospitalist for 15 years then decided he had enough savings and wanted an escape ) did a renal fellowship then opened his own solo private practice . He did have some friend connections who set up him with HD privileges are a local center and inpatient HD privileges .

He does not practice GIM becuase “he doesn’t like it .”

His renal practice is not thriving and he barely breaking even now . He does not have to run from hospital to hospital or center to center (the center is a few blocks from his office and the main hospital he is affiliated with is a short drive away ). But he does not get that many referrals whether inpatient or outpatient . Why ? The hospitalist groups prefer in house renal becuase the fellow is always there and receptive . The private internist groups have referral patterns (that extend both ways - a specific consultant might say you need a PMD I suggest this doctor he/she is good ) . He laments how he always has to achmooze for new referrals . I advised him to convert to GIM and only inpatient renal HD consults and whatever renal outpatient follow up he can get . He declines citing it’ll turn around . I said not in NYC it won’t .
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he will realize when he burns those 15 yrs of savings for this worthless solo nephrology practice
hospitalist know tht Nephrology has no respect or recognition so they want some one with instant access
I worked at a hospital where there were more solo nephrologist than hospitalist group , they would stop hospitalist in hallway and would demand consults and eventually beg , it was extremely sad to watch .
In my Nephrology Fellowship program faculty pretended to be important in front of residents but all subspecialties and hospitalist just gave them a middle finger !
I admit I was really dumb to still do Nephrology
LOL
 
georgestone said:
he will realize when he burns those 15 yrs of savings for this worthless solo nephrology practice
hospitalist know tht Nephrology has no respect or recognition so they want some one with instant access
I worked at a hospital where there were more solo nephrologist than hospitalist group , they would stop hospitalist in hallway and would demand consults and eventually beg , it was extremely sad to watch .
In my Nephrology Fellowship program faculty pretended to be important in front of residents but all subspecialties and hospitalist just gave them a middle finger !
I admit I was really dumb to still do Nephrology
LOL
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It’s just really sad that with so many red flags, people still fall prey to the misinformation perpetuated by the academics. The ones who stand to gain the most is the program who brainwashed you into believing the specialty is worth doing. In some ways I can understand, because the inner desire to be a subspecialist is strong. But it’s still sad to see these people pay a heavy financial prize years down the road when they realize are making less than a hospitalist.
 
Renal_Prometheus said:
It’s just really sad that with so many red flags, people still fall prey to the misinformation perpetuated by the academics. The ones who stand to gain the most is the program who brainwashed you into believing the specialty is worth doing. In some ways I can understand, because the inner desire to be a subspecialist is strong. But it’s still sad to see these people pay a heavy financial prize years down the road when they realize are making less than a hospitalist.
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Now that ccm is in the match , it is unclear how this afffects prospective renal fellows . Before it was all word of mouth and recommendations for prematch . Now the renal fellow is pitted against all cardiology fellows , pulm only fellows , general IM residents who don’t like pulm (and are more valuable for the two years they offer to the ccm programs ), etc..

So if you don’t have the bona fode resume (if you did you would be doing pccm ) , then don’t think renal fellowship (without dedicated ccm research or connections ) makes you competitive for CCM now since the fresh third year IM resident (who is still fresh in icu procedures ) will probably get the nod now over you (especially for the two years of service they offer )

Another door closed
 
the Neph fellowships are cold emailing applicants who didn’t match into cards/GI/pulm/cc and offering them spots without interview. I hope these people don’t get enamored with a big name institutions and think nephrology is way out. In my experience, the ones who do neph because they can’t get anything else rarely ends well. And trust me, my experience in this field is extensive.
 
NewYorkDoctors said:
Now that ccm is in the match , it is unclear how this afffects prospective renal fellows . Before it was all word of mouth and recommendations for prematch . Now the renal fellow is pitted against all cardiology fellows , pulm only fellows , general IM residents who don’t like pulm (and are more valuable for the two years they offer to the ccm programs ), etc..

So if you don’t have the bona fode resume (if you did you would be doing pccm ) , then don’t think renal fellowship (without dedicated ccm research or connections ) makes you competitive for CCM now since the fresh third year IM resident (who is still fresh in icu procedures ) will probably get the nod now over you (especially for the two years of service they offer )

Another door closed
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In My earlier posts I mentioned that CCM is incredibly competitive and there are less than 40 pure ccm programs leading to intense competition , cards/surg/anest/IM/ID/neph/Pulm/EM all apply for it and there are more than 100 applicants for a given spot

Neph fellows are at a significant disadvantage for ICU training , majority of neph faculty have no clue about Ultrasound, no concept of vent interactions and they cant even do a pocus ,they have no concept of SVV, PPV and hemodynamics , for them its all about following urine output, avoiding nephrotoxins and following creatinine and in case of anuria , asking ICU to place a temp HD line for CVVH, which is infact midlevel stuff.
their limitations are clearly known and program directors of CCM fellowship programs have gotten a wind of it and they ask Neph candidates about their level of comfort with POCUS , Hemodynamics , vent management etc , which those poor Neph fellows have no clue about , this makes them at a significant disadvantage.
one yr of CCM fellowship isnt enough to learn all the above skills effectively for a lot of individuals and tons of landmark trials in Critical care medicine

unless neph candidate is offered CCM at the spot as lot of neph programs are now offering Neph/ccm pathway from get go ( more than a dozen that I am aware of , their chances of getting ccm in open competition are slim.
 
The lesson is do not go into nephrology unless nephrology (and perhaps general IM on top) is what you can see yourself doing . Do not think of neph as back door to anything . No other fellowship PD will see you as”smarter and more learned.” On the contrary , they will see you as a drain on acgme funding at the higher Pgy level ... unless you bring something big to the table like publications and the promise of more
 
Neph/ccm programs will produce a lot of candidates with less than desired critical care skills , its a lot to learn in just one yr of ccm fellowship esp when your Neph faculty is so hopelessly out of touch
 
To be fair , PCCM fellows usually have something like 9 months of micu spread over 12 months with elective time for other icus. (This varies ). But it’s the didactic sand learning over time .

Some integrated neph CCM programs do something like that with the renal fellows having ccm time in years 1 and 2 .

But thats the exception not the rule
 
I think what it comes down to is that neph fellowship just need to reduce their fellowship spots by 1/3. You will have some better quality candidates and give a chance for supply and demand to rebalance in private practice. I know, it will never happen because programs are self motivated and would rather take substandard applicants to ease clinical burden than do what’s right to save this specialty. I think we all know what needs to be done. I’m not saying it can be done.
 
Fellows are free (paid by Medicare ) for a hospital . Mid level providers can cost quite a bit and they may not generate the appropriate revenue on an inpatient renal service. Unless the renal faculty want to take a haircut with their (already low salary relatively to other specialties ) , this felllowbexploitation is not going to end .

The tip academic programs should work theirbfellows hard since they are getting world class education .

The community based centers with fellowships are the ones that have no business having a fellowship
 
Yello, IM PGY-2 here. I've stalked this thread quite often throughout the year as I'm trying to decide what speciality (if any) to pursue. I gotta say, this thread does make the nephrology profession sound rather bleak.

However I do want to put in my two cents from talking to nephrology attendings at fellows both at my institution and at other institutions. I've spoken to a number of nephrology attendings at my institution as well as fellows at other institutions who have been quite happy with their career choice, and are honestly confused about why nephrology has such a bad reputation. The ones that I've talked to are either clinical only (do consults at our academic hospital plus some transplant work), or mainly focus on transplant; others are more focused on research and don't do much clinical work because that's where they are happiest. Some do a little bit of dialysis but they are not as focused on it. They all report to have great quality of life, are happy with their work life balance, don't feel that they are over worked and are satisfied with their career choice.
It's true that the salary might be lower for neprhologist vs say cardiologists, however to say that making 200k as a specialist is 'embarrassing' as I think someone pointed out earlier is a bit perplexing to me as it is still a substantial salary and many specialists make that money other than nephrology. i guess the argument is that nephrologists work more than the other specialities that make that salary such as endo? But ID is also in that range and there's no 'ID is dead' thread.
That being said, I haven't talked to nephrologists who are in private practice, have to do a lot of HD etc so i'm sure my veiw point is also skewed based on what I see around me. I just wanted to breathe in an alternative view point for nephrology, which I do find a quite fascinating field 🙂
 
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charmedpumpkin01 said:
Yello, IM PGY-2 here. I've stalked this thread quite often throughout the year as I'm trying to decide what speciality (if any) to pursue. I gotta say, this thread does make the nephrology profession sound rather bleak.

However I do want to put in my two cents from talking to nephrology attendings at fellows both at my institution and at other institutions. I've spoken to a number of nephrology attendings at my institution as well as fellows at other institutions who have been quite happy with their career choice, and are honestly confused about why nephrology has such a bad reputation. The ones that I've talked to are either clinical only (do consults at our academic hospital plus some transplant work), or mainly focus on transplant; others are more focused on research and don't do much clinical work because that's where they are happiest. Some do a little bit of dialysis but they are not as focused on it. They all report to have great quality of life, are happy with their work life balance, don't feel that they are over worked and are satisfied with their career choice.
It's true that the salary might be lower for neprhologist vs say cardiologists, however to say that making 200k as a specialist is 'embarrassing' as I think someone pointed out earlier is a bit perplexing to me as it is still a substantial salary and many specialists make that money other than nephrology. i guess the argument is that nephrologists work more than the other specialities that make that salary such as endo? But ID is also in that range and there's no 'ID is dead' thread.
That being said, I haven't talked to nephrologists who are in private practice, have to do a lot of HD etc so i'm sure my veiw point is also skewed based on what I see around me. I just wanted to breathe in an alternative view point for nephrology, which I do find a quite fascinating field 🙂
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Your problem is that you are talking to academics who do have great quality of life. They are doing it for the research and quality of life, not for the money. Have you done nephrology in private practice? it's brutal, and pay per hr is lower than a hospitalist. Honestly when I was fellow, I didn't know better and believed a lot of the BS that academics were say. In private practice, I learned it was all a lie and the reality was much worse than what everyone was saying. And a big part of this thread is dispelling misconception of what people have to what really happens in private practice. Many posters here have change changed specialties because nephrology was so bad, but they didn't figure it out until graduating. Ask yourself this question, if the specialty is really as great as what the academics are saying, why are there so many unfilled programs every year? Wouldn't you expect a higher match rate if the specialty wasn't that bad? Even specialties like rheum/endo, who openly admits to not making a lot of money, has like 98% match rate every year. The market is telling you something sinister is going on here that you are not taking into account. Listen to the market, not some academic who is trying to fill his fellowship positions because no one else is taking the bate.
 
www.healio.com

COVID-19 takes a toll on recruiting renal fellows

Nephrology News and Issues | With the most recent delta variant – and the potential for others to follow – the coronavirus has made hospitalization rates and high death tolls a way of life. There is nothing in the foreseeable future that makes one believe things will get back to normal anytime...
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The percentage of fellows completing training who chose who choose private practice has gone down substantially from 70.3% in 2011 to 45.9% in 2020.
Does this sound like a specialty that people are dying to do? The sinister part here is that these neph graduates found out private practice is very bad after they graduated. Why? because they were misled by academics, the same ones who are trying to recruit you. Read the last paragraph, the author is actually trying to implore the field as a whole to make a stronger effort to keep neph graduates from leaving the specialty. WTF? Does that sound like the type specialty where people are happy and satisfied with their career choice?
 
Renal_Prometheus said:
Your problem is that you are talking to academics who do have great quality of life. They are doing it for the research and quality of life, not for the money. Have you done nephrology in private practice? it's brutal, and pay per hr is lower than a hospitalist. Honestly when I was fellow, I didn't know better and believed a lot of the BS that academics were say. In private practice, I learned it was all a lie and the reality was much worse than what everyone was saying. And a big part of this thread is dispelling misconception of what people have to what really happens in private practice. Many posters here have change changed specialties because nephrology was so bad, but they didn't figure it out until graduating. Ask yourself this question, if the specialty is really as great as what the academics are saying, why are there so many unfilled programs every year? Wouldn't you expect a higher match rate if the specialty wasn't that bad? Even specialties like rheum/endo, who openly admits to not making a lot of money, has like 98% match rate every year. The market is telling you something sinister is going on here that you are not taking into account. Listen to the market, not some academic who is trying to fill his fellowship positions because no one else is taking the bate.
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I appreciate your response and I totally understand what you're saying in regards to academics and not talking to attendings in private practice. I am also more interested in academics and would not be interested in going into private practice at this point. In any speciality, I am wary of private practice and I prefer to be attached to an academic hospital.

Maybe don't go into private practice then?

Also while I hear what you're saying, I don't think the academic individuals are trying to talk me into the fellowship in order to fill the spots, one of them is at another institution across the country and is a fellow and not trying to recruit me there (they went there for a specific research project that wouldn't apply to me). I do not feel that I am being 'recruited' by my hospital's nephro attendings, and if anything they encourage people who are applying to spread their wings and go elsewhere (we are a bit rural, even though we are academic). I'd like to think that I am not completely blind as to not see when people are trying to recruit me with false pretenses.
I don't think that a nephrology speciality is GREAT but I'm also not convinced that it is negative as as SDN paints it to be (in general SDN skews to the more negative side) as I feel that there is some inherent selection bias.
 
charmedpumpkin01 said:
I appreciate your response and I totally understand what you're saying in regards to academics and not talking to attendings in private practice. I am also more interested in academics and would not be interested in going into private practice at this point. In any speciality, I am wary of private practice and I prefer to be attached to an academic hospital.

Maybe don't go into private practice then?

Also while I hear what you're saying, I don't think the academic individuals are trying to talk me into the fellowship in order to fill the spots, one of them is at another institution across the country and is a fellow and not trying to recruit me there (they went there for a specific research project that wouldn't apply to me). I do not feel that I am being 'recruited' by my hospital's nephro attendings, and if anything they encourage people who are applying to spread their wings and go elsewhere (we are a bit rural, even though we are academic). I'd like to think that I am not completely blind as to not see when people are trying to recruit me with false pretenses.
I don't think that a nephrology speciality is GREAT but I'm also not convinced that it is negative as as SDN paints it to be (in general SDN skews to the more negative side) as I feel that there is some inherent selection bias.
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When I was a resident, I had the exact same experience as you. My nephro attendings all encouraged me to do purse nephrology, and not with any malicious intentions. I talked to couple of fellows, and they all encouraged me as well. The problem with fellows is that they don't know what's about to hit them. The same fellows who encourage me to purse nephrology years ago, guess what they are doing now? Hospitalist Medicine. This was the same outcome for majority of my co-fellows, some after practicing neph for many years. But hey, you be you. If you want to take the risk, go for it. Academic nephrology may not be a bad option. If you plan to go private practice, just don't be disappointed when things are worse than you anticipated.
 
charmedpumpkin01 said:
I appreciate your response and I totally understand what you're saying in regards to academics and not talking to attendings in private practice. I am also more interested in academics and would not be interested in going into private practice at this point. In any speciality, I am wary of private practice and I prefer to be attached to an academic hospital.

Maybe don't go into private practice then?

Also while I hear what you're saying, I don't think the academic individuals are trying to talk me into the fellowship in order to fill the spots, one of them is at another institution across the country and is a fellow and not trying to recruit me there (they went there for a specific research project that wouldn't apply to me). I do not feel that I am being 'recruited' by my hospital's nephro attendings, and if anything they encourage people who are applying to spread their wings and go elsewhere (we are a bit rural, even though we are academic). I'd like to think that I am not completely blind as to not see when people are trying to recruit me with false pretenses.
I don't think that a nephrology speciality is GREAT but I'm also not convinced that it is negative as as SDN paints it to be (in general SDN skews to the more negative side) as I feel that there is some inherent selection bias.
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The truth always lies somewhere in between . Most renal fellows who do fellowship do not have the pedigree for research or academics Z moreover there are so many academic center faculty jobs .

For those that can make it into academic nephrology , I would agree they have a pretty good career . Not the highest paying but satisfying .


But not everyone can be an academic nephrologist. Most doctors in any field are private practice . This thread is meant to warn those physicians from not making a mistake of pursuing nephrology for private practice .


Nephrology the discipline is great .

Nephrology the business is not .

Like the rap song - “don’t hate the player , hate the game !”



Also there’s nothing to be wary about private practice . It’s lazy doctors who don’t write notes and who take shortcuts that should raise eyebrows . But that’s not unique to private practice .

One of my renal attendings is in his late 60s and busting it hard in PP and has a thriving HD panel and does all the crrt as private consultant for his hospitals Ccu and cticu. He hasn’t always a “money maker.” He was chairman of nephrology at a large well known academic nephrology center in his earlier career and did many of the Ace inhibitor clinical trials in the 80s and 90s. Politics is what drove him out of academics . That is the dark side of academics that residents fellows are not privy to .

We should remove the stigma of private practice doctors being dumb lazy not up to date physicians and the stigma of academic doctors as being out of touch elitists .
 
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Fellowship programs need to have some skin in the game. I don't know how, but success of the fellowship needs to be tied to how well graduates do in private practice, and this is certainly not the case in nephrology. Brainwashing a fellow into taking your night calls for you, then watch him/her get destroyed in private practice without taking any responsibility for the lies you propagated is beyond sickening. Look at how many neph graduates are returning to hospitalist. There is a big discrepancy to what academics claim will happen to what will actually happen. This is what I find most sinister about this specialty today.
 
It’s a buyers market. Buyers beware . Those who went into the season aiming to match to renal probably have a plan . Whether academics or some connected PP job later on . It’s the fail to match cards pccm candidates and disillusioned hospitalist that should beware of scrambling into renal .


For the disillusioned hospitalist , leave the big city and get a higher paying lower work day/hour job . Or stay in the city and open your own private practice GIM practice. See your patients in and out of the hospital like the traditional model . Yeah it’s a lot of work but if the hospital can be very nearby , why not ? You need to see some soft ball GIM patients once in a while .


For the fail to match candidates , do research and try again . Renal does not open doors to their subspecialties . It closes them . Don’t think knowing how to do dialysis makes you more appealing to a cards PD. It won’t . Helping the cards PD publish cards research makes you more appealing.
 
Thank you both for your replies and insights! I have a better understanding now of what you say about private practice. And @NewYorkDoctors, I appreciate what you say about how the discipline is great but the business is not, and I'm glad that there is at least a positive spin on academic nephrology although it's not an option for everyone.
 
charmedpumpkin01 said:
Thank you both for your replies and insights! I have a better understanding now of what you say about private practice. And @NewYorkDoctors, I appreciate what you say about how the discipline is great but the business is not, and I'm glad that there is at least a positive spin on academic nephrology although it's not an option for everyone.
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I will encourage you to stay on this forum and share you experience of the wonderful academic Nephrology world once you are in fellowship and after completion , but we will appreciate your honesty once you realized the cost of your decision
Its not about money at all ,
what kind of innovation can you point out in Nephrology recently ?
anything groundbreaking ?
you will see ton of **** talkers but few doers 1 so share with us plz
I did Nephro from a large academic program and there were few who really were able to bring research grants , the rest were lazy , inept , timid fools who were arrogant of their useless unfunded and futile research work

so can you find a balance in Academic Nephrology ? may be ? best of Luck
but please share your experience with us down the road
there are just too many who have been burned and had their careers destroyed and finances ruined bc of Nephrology, at the end of the day its about being happy , gaining some meaning ful respect and recognition and paying bills
can Nephrology provide any of the above ?
None for me and others on this forum , may be for you , so stay with us and share
 
But… but… The neph fellows look really happy and the academics tell me nephrologist do really well in private practice? What a lie. They do so well that less than half of the new grads even go into private practice. Neph does so well that 1/3 of fellowships spots don’t fill and 75% of fellows are IMGs(nothing against IMGs). Yes they do well, for the old guys who are living off the new grads while you waste away your prime years. But of course, academics won’t tell you this.
 
Renal_Prometheus said:
But… but… The neph fellows look really happy and the academics tell me nephrologist do really well in private practice? What a lie. They do so well that less than half of the new grads even go into private practice. Neph does so well that 1/3 of fellowships spots don’t fill and 75% of fellows are IMGs(nothing against IMGs). Yes they do well, for the old guys who are living off the new grads while you waste away your prime years. But of course, academics won’t tell you this.
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FYI I will encourage the readers and writers on this forum not to underestimate IMG's as they have earned their residencies and fellowships in one of the best programs through out the country in every subspecialty , so IMG predominance in any field shouldn't make it less marketable
Plenty of IMG's In Cardiology and other prime subspecialties too .

I hear you and completely agree with you , but unfortunately experience and wisdom doesn't come through osmosis ! it comes thru time , so despite your best efforts and others on this forum , there will be plenty of readers who will think somehow they will find comfort in Academic Nephrology or will somehow find a cool private practice , that doesn't usually happen but exceptions exist , if someone is willing to waste their prime years hopping to have those exceptionally few chances then we should let them try 🙂)

This forum is open ( I Hope ASN doesn't come after our true identities LOL as this forum is gaining a lot of attention ) so we should continue to share and educate regardless of the results
 
I doubt ASN REALLY cares that much about the state of Nephrology. It's not because they are apathetic. It's because they have done a lot already to stimulate academic interest in the discipline. But they are POWERLESS to overcome the business / economic aspect of the discipline. As i have alluded to before, this situation is not unique to nephrology. It is the Medical Industrial Complex. Dialysis is just affected the most because it has always been a government sponsored procedure since Clyde Shields went to Congress.
 
What’s funny about this thread is that there’s 3 board certified nephrologist(me, NYD, georgestone) here consistently bashing this specialty. And then you have a resident come on and say it’s really not that bad because person x told me so. Just find it hilarious at times.
 
Renal_Prometheus said:
What’s funny about this thread is that there’s 3 board certified nephrologist(me, NYD, georgestone) here consistently bashing this specialty. And then you have a resident come on and say it’s really not that bad because person x told me so. Just find it hilarious at times.
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Count me in .. although I am not a frequent contributor !! 4 board certified nephrologists trying to learn positive aspects of nephrology practice from residents !!
 
Renal_Prometheus said:
What’s funny about this thread is that there’s 3 board certified nephrologist(me, NYD, georgestone) here consistently bashing this specialty. And then you have a resident come on and say it’s really not that bad because person x told me so. Just find it hilarious at times.
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George stone and I are also CCM BC (and I am pulmonary on top ) so we have been where the grass is greener .

Nephrology the discipline is an amazing discipline . I find doing renal consults (office and hospital ) breaks up the grind of CCM . GN cases tickle my brain the same way it does for an ILD workup . After all, most medical students enter Internal Medicine with the idea of being "the thinking person's doctor." Nephrology encompasses that "classic Internist" profile better than most of the other IM subspecialties. ID is also on par. (For reference, I have left full time faculty PCCM practice after two years and I opened up my own private practice. PP is the only way to practice both pulmonary and nephrology. but I am still on voluntary faculty for the PCCM and Renal fellowships where I am at and I cover ICUs for my colleagues once in a while ... like now during the holiday season)

But it’s the business aspect of it that is killing the specialty for many young graduates . See entire thread . I have offered many suggestions for how to beat taken advantage of your renal degree (see entire thread ). But going in blindly and accepting a random nephrology job hoping “it’ll all work out” is just not going to happen .

Either go full academic and enjoy the discipline and accept lower remuneration . (Prestige and lifestlye)

Or build connections in the dialysis industrial complex (easier said than done - has the high pay here )

Or skip this sub specialty all together (three strikes if you don’t succeed in the top two- no lifestyle no pay and no prestige otherwise )
 
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Renal_Prometheus said:
What’s funny about this thread is that there’s 3 board certified nephrologist(me, NYD, georgestone) here consistently bashing this specialty. And then you have a resident come on and say it’s really not that bad because person x told me so. Just find it hilarious at times.
Click to expand...
I'm a board certified nephrologist and work at an academic center. I certainly acknowledge the many issues with nephrology outlined in this thread but your statement seems to suggest that three disgruntled nephrologists should have a monopoly on framing the subspecialty. Nothing the resident said was unreasonable, and as long as he enjoys the work and knows what he's getting into I don't see a problem with him considering the field. I enjoy my job and the work that I do. This is the beauty of self-selection. When we were younger and had opportunities to pursue lower-stress & higher dollar-per-hour jobs than medicine we still chose to feed this monster our 20's/early 30's, dating lives, ovaries/sperm count, and $100K(s) in loans. Personally, I wouldn't chosen any differently but that's too crazy a tradeoff for many people. I sure we can all recall individuals from undergrad to attending-level who have quit along the way to pursue non-medical interests. Certainly, the high pan-physician burnout rate speak to the myriad unforgiving pressures within the profession. Because of this reality, I think if you are able to find a) something you are good at and truly enjoy, and b) someone to pay you for it, then it would be a shame to write it off.
 
Medisaint said:
I'm a board certified nephrologist and work at an academic center. I certainly acknowledge the many issues with nephrology outlined in this thread but your statement seems to suggest that three disgruntled nephrologists should have a monopoly on framing the subspecialty. Nothing the resident said was unreasonable, and as long as he enjoys the work and knows what he's getting into I don't see a problem with him considering the field. I enjoy my job and the work that I do. This is the beauty of self-selection. When we were younger and had opportunities to pursue lower-stress & higher dollar-per-hour jobs than medicine we still chose to feed this monster our 20's/early 30's, dating lives, ovaries/sperm count, and $100K(s) in loans. Personally, I wouldn't chosen any differently but that's too crazy a tradeoff for many people. I sure we can all recall individuals from undergrad to attending-level who have quit along the way to pursue non-medical interests. Certainly, the high pan-physician burnout rate speak to the myriad unforgiving pressures within the profession. Because of this reality, I think if you are able to find a) something you are good at and truly enjoy, and b) someone to pay you for it, then it would be a shame to write it off.
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we have finally attracted the attention of the academics! welcome. Don't forget about renalfellow937, there's at least 4 disgruntled nephrologists posting here. I just want to highlight the disparity between what fellows think they are get into vs the brutal reality of private practice(high attrition rates, opportunity costs, and exploitation by senior partners). Things that you may not be aware of, but the grad will pay the full price down the road. And this the saddest part, when only 45% of neph grads are going into private practice, they clearly didn't know what they were getting into.
 
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Renal_Prometheus said:
we have finally attracted the attention of the academics! welcome. I just want to highlight the disparity between what fellows think they are get into vs the brutal reality of private practice(high attrition rates, opportunity costs, and exploitation by senior partners). Things that you may not be aware, but the grad will pay the full price down the road.
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Thank you for the warm welcome. It sounds like your beef is with the pay/leadership structure of private practice nephrology. You'll notice this gripe has nothing to do with me or the PGY-2 you shot down.

Save the sanctimony for the professors who get their teenage, gender studies majors into $100K of unpayable debt; we are talking about 29+ year old physicians pursuing a subspecialty. I would advise these adults to do what I did--research what it is they want to do with their lives after fellowship and plan accordingly. That involves talking to private nephrologists if they are considering a career in private nephrology.
 
Medisaint said:
I'm a board certified nephrologist and work at an academic center. I certainly acknowledge the many issues with nephrology outlined in this thread but your statement seems to suggest that three disgruntled nephrologists should have a monopoly on framing the subspecialty. Nothing the resident said was unreasonable, and as long as he enjoys the work and knows what he's getting into I don't see a problem with him considering the field. I enjoy my job and the work that I do. This is the beauty of self-selection. When we were younger and had opportunities to pursue lower-stress & higher dollar-per-hour jobs than medicine we still chose to feed this monster our 20's/early 30's, dating lives, ovaries/sperm count, and $100K(s) in loans. Personally, I wouldn't chosen any differently but that's too crazy a tradeoff for many people. I sure we can all recall individuals from undergrad to attending-level who have quit along the way to pursue non-medical interests. Certainly, the high pan-physician burnout rate speak to the myriad unforgiving pressures within the profession. Because of this reality, I think if you are able to find a) something you are good at and truly enjoy, and b) someone to pay you for it, then it would be a shame to write it off.
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I wouldn’t say I am disgruntled or that I should “frame the sub specialty .” Read all my comments on this whole thread and you will see I am pro academic nephrology but anti - corporate dialysis and caution those who enter nephrology without a clear career plan (say an academic clinician educator ) as it will lead to nothing but opportunity cost .

Again you are welcome to “defend your honor .” Your input is welcome to help enlighten those who might want to join this subspecialty.
 
Medisaint said:
Thank you for the warm welcome. It sounds like your beef is with the pay/leadership structure of private practice nephrology. You'll notice this gripe has nothing to do with me or the PGY-2 you shot down.

Save the sanctimony for the professors who get their teenage, gender studies majors into $100K of unpayable debt; we are talking about 29+ year old physicians pursuing a subspecialty. I would advise these adults to do what I did--research what it is they want to do with their lives after fellowship and plan accordingly. That involves talking to private nephrologists if they are considering a career in private nephrology.
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Actually mine main gripe is with the academics who embellish how well nephrologists do in private practice, luring fellows to take their night calls for them, while taking no responsibility for the actual outcome of their careers. Have you heard of first do no harm? There’s plenty of harm that has been done to many here and beyond.
 
Renal_Prometheus said:
Actually mine main gripe is with the academics who embellish how well nephrologists do in private practice, luring fellows to take their night calls for them, while taking no responsibility for the actual outcome of their careers. Have you heard of first do no harm? There’s plenty of harm that has been done to many here and beyond.
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The top cream of the crop academic physicians are okay because they are leaders in the field and actually provide their fellows with a world class education . It’s those mid to low tier fellowships that have nothing to offer besides indentured servitude . Those are the ones that should not have fellowships and are merely creating future hospitalists.
 
NewYorkDoctors said:
The top cream of the crop academic physicians are okay because they are leaders in the field and actually provide their fellows with a world class education . It’s those mid to low tier fellowships that have nothing to offer besides indentured servitude . Those are the ones that should not have fellowships and are merely creating future hospitalists.
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Those so called world class programs are producing grads who eventually leave this subspecialty with in 5 years of graduation, so there is something wrong with fundamentals its not broken private practice model only , its a broken specialty tht's a fundamental fact
Nephrologist have given away their procedures
temp HD catheters/Tunneled lines, Fistulogram, AVF stenting , Grafts , biopsies etc , giving up a premium source of their skill and revenue
these so called academic people have contributed what to innovation ? answer is Nothing
85 % of hemodialysis patients are still hypertensive , majority of the Nephrologist do a ****ty job even with volume challenge of their dialysis patients ( just one example )
so these amazing phenomenal academics are stating facts during training which arent working !
we the icu crowd believe in immediate results, as its a matter of life or death , this is where their true skills are exposed , what does a nephrologist do in ICU ?
except monitoring cr and UOP ? and CRRT at the most which can be run by a tech !
oh I FORGOT ELECTROLYTE REPLACEMENT .
most of Nephrologist do a suboptimal job with vol management ( I have worked in several diff states and worked with tons of Nephrologist and I am appalled )
I am not trying to disparage a certain individual so my comments shoudnt be taken personal ( please ) , I am merely stating some rough facts
 
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