This summer I was really optimistic. I was riding a #Flozin high that was being further buoyed by the successes of finerenone. Long dormant fields were yielding fresh life. How long has it been sin…
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This Dr topf is a leader of the field and he’s onto something . But even so most renal jobs out there are NOT going to split up consults clinic and outpatient HD.
Anyway one of my former med students who is now an IM resident at a new and relatively unknown IM program done in Florida has IM faculty who are mostly neprhologists (lol) and whom started a renal fellowship as the first one . The other cardiologist GI and Pccm to come . But lol what was the point other than to get some cheap labor ?
Right big picture to establish their “academic non med school attached “ medical center .
Nephrology is considered to be among the most intellectually demanding subspecialties. Expertise in this field is a result of lifelong learning built upon the foundation of excellent fellowship training. The Nephrology fellowship program at [censored[ Hospital Center provides that foundation.
yeah nothing against this fellowship program (I know of no one there). But this is the extreme arrogance of Nephrologists as a whole that turns many non-diehard nephrology fans away. They keep insisting nephrology is the most intellectually rigorous IM subspecialty. stop it! before UpToDate (which was created by nephrologists in the beginning , ironically) you may have a point.
But what is the basis of this statement? the ability to do arithmetic for a triple acid base equation that only happens in very rare situations? (probably the most common is a DKA patient who got too much NS and who is also vomiting nonstop... but even an IM resident can figure that one out...)
Glomerulonephritis? trust me as someone who knows how to work up GN and ILD, I can say that both are analogous in their workup. I am sure a rheumatologist who is working up undifferentiated CTD, hepatologist working up less common hepatitides, hematologist working up pancytopenia, CHF cardiologist working up restrictive cardiomyopathy have the same kind of "intellectual rigor and puzzle solving."
writing a dialysis prescription? lol puhlease. optimizing Kt/V and URR? puhlease. Optimizing the UF rate on HD? puhlease.
knowing how about the reverse osmosis and carbon filters work? puhlease.
knowing how the engineering aspects of HD work? i dont think most nephrologists know that kind of engineering detail...
"being a good internist who can tie in all of the organ systems?"
stop it. all other subspecialties do this. some more than others.
Cardiology - they have to run a CCU and protect their cardiac patients. they have to know about all other organ systems to a decent degree
GI - sure screening colonoscopies don't demand much. but IBD, malabsorption syndromes, motility issues, hepatology workups etc...
PCCM - just the critical care part ties in all organ systems alone much less working up some of the interstitial or cystic lung diseases.
HemeOnc - oncology itself have to know about all organ systems
Endocrine - hormones affect everywhere
Rheumatology - manifestations of CVD can occur in any organ system not just the joints
ID - have to be a good internist and know how infections affect all organ systems
im sure im missing some but you get the point
okay being a nephrologist is more rigorous intellectually than doing a screening colonoscopy or ordering a nuclear stress test... but cannot compare apples to oranges like that.
is ordering a renal panel (CMP, Mg, Phos, CBC, PTH, 25D, 125D Iron TIBC Ferritin + U/A + UPC + UACR + renalbladder ultrasound) really that much more intellectually rigorous than a screening colonoscopy or cardiac stress test?
"yepp gotta reduce animal protein intake. gotta reduce phosphorus in the diet. by how much? dunno let me refer you to the dietitian"
then again none of this would matter if career prospects were lucrative.