Nephrology is Dead - stay away

[NewYorkDoctors]

What do you mean?

I think the subject matter is fascinating.

Nephrologists in my hospital seem to be the only IM subspecialty who remember a lot of things about IM not related that much with nephro

well when you dont have any procedures or H&P/discharge summaries to do, guess you gotta do something right lol?

glomerulonephritis is not any more exciting than interstitial lung disease. trust me.

there is just a lot of fancy lingo that is "locked behind a paywall" (do the fellowship get the training)

but once you take time to learn the lingo, nomenclature, etc... it's really not that esoteric or arcane at all.

im not sure any nephrologists know the engineering details of a dialysis machine. Oh sure we all know about the principles of diffusion, convection, and active transport but so does a high school AP chemistry student.

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[onconc]

Fundamentally the reason this specialty can’t attract fellows is simple: it’s a bad specialty. These PDs try to spin the narrative that it’s a misunderstood specialty, just makes it more fake and insincere when people have already voted with their feet. I would be more open to joining a program if PD came out and said I can’t offer you anything except to satisfy your itch of being a specialist.

You have posted hundreds of very similar messages in this very thread. I don't doubt your point. But this obsession is super weird. Hope you are all right.

 

[NewYorkDoctors]

You have posted hundreds of very similar messages in this very thread. I don't doubt your point. But this obsession is super weird. Hope you are all right.

you mad ?

 

[onconc]

you mad ?

Hope you are all right too. I see you have posted hundreds of very similar messages as well. Peace out

 

[Splenda88]

Hope you are all right too. I see you have posted hundreds of very similar messages as well. Peace out

He is trying to warn med students and residents. There is nothing wrong with that. What I have noticed in medicine is that we tend to buy whatever BS academia is selling.

There is a lot of things I don't like about medicine and I have also been very vocal about them here in SDN

Why does it take 11+ yrs to become a doctor here when my FMG co-resident graduated residency at 25?

Why does it take an extra 2-3 yrs to become an endocrinologist when 80%+ of what they see based on my experience is DM2, thyroid disorder and osteoporosis?

Why can't FM docs apply to "IM subspecialties"? By the way, I am an IM doc.

Why do we even have a specialty like EM (instead of a 12-16 months fellowship from FM) when 80%+ of patients who show up in the ED can be treated by an FM doc?

I can go on and on....

 

[NewYorkDoctors]

Hope you are all right too. I see you have posted hundreds of very similar messages as well. Peace out

stay mad bruh.

there is nothing wrong with doing a nephrology fellowship. But no one needs to enter the career death trap that is private practice without having a clear career plan in place.
go nephrology - stay academic
go nephrology - take over a practice
go nephrology - use the knowledge to do something else with the knowledge

 

[Renal_Prometheus]

I’ve just had too many friends and cofellows who really screwed themselves by going into nephrology. Hard to turn back the clock when you have invested this many years. When we went into the specialty, there was darth of info on what was really happening in private practice , and so academics lied thru their teeth to get fellow to stick around. I don’t want the same fate for newer generations as they are the ones taking all the career risks here.

 

[Splenda88]

I’ve just had too many friends and cofellows who really screwed themselves by going into nephrology. Hard to turn back the clock when you have invested this many years. When we went into the specialty, there was darth of info on what was really happening in private practice , and so academics lied thru their teeth to get fellow to stick around. I don’t want the same fate for newer generations as they are the ones taking all the career risks here.

They can always become hospitalists. The 2-yr opportunity cost is not outrageous. I only make a little bit over 1 mil in the 2.5 years as a hospitalist since I left residency.

 

[Splenda88]

These threads are necessary. I don't think there's a strong IMG presence here on SDN, and everyone who matches into nephrology from my IM program is an IMG. I doubt they know half of what's posted here.

Are they IMG or FMG? There is a difference.

 

[onconc]

stay mad bruh.

Sorry that is not logically possible. I can't stay mad if I was never mad to begin with.

 

[Renal_Prometheus]

They can always become hospitalists. The 2-yr opportunity cost is not outrageous. I only make a little bit over 1 mil in the 2.5 years as a hospitalist since I left residency.

The problem is if you invested 2 yrs of fellowship, you would at least want to try out private practice. This is what happened to my cofellows. By the time they figure out nephrology was a mistake, they are already year 5 into it and they are faced with sunken cost fallacy. Try another group starting at the bottom or give up to go back to hospitalist. The opportunity cost is much higher.

 

[NewYorkDoctors]

because not many read all 35 pages of this thread (not that anyone needs to unless out of sheer morbid curiosity or if it's someone who did not match into Cardiology or PCCM and wanted to get a cold hard look at Nephrology), it's imperative that this thread is constantly bumped. Everyone loves to stop and watch a highway accident.

 

[onconc]

Curious, How much does being Medical director of a dialysis center pay on an average ? And how many hours of work is it.

Do you have to physically drive over to the dialysis center to oversee the directorship work ? Or can you do it over zoom ?

 

[Renal_Prometheus]

Curious, How much does being Medical director of a dialysis center pay on an average ?

Varies significantly with location and size of the dialysis unit. 100k/yr is fair for an average unit. The problem with these medical directorship agreement(MDA) fees is that many Neph groups have it in their contract that existing MDA fees are not shared with new partners. As an example, I know one group where the founding partner keeps all the MDA fees(4 units) and the other physicians just keep what they bill. Many Neph groups will have something along the lines that existing MDA fees are not shared with new partners, but if a new unit opens up, he can take that one. More of an empty promise because it may never happen.

Partnership contracts are written by partners to favor them. New grads are too green to pick up these sleight of hand changes and naively think there is endless growth of dialysis units when the ESRD population is actually shrinking in this country.

 

[NewYorkDoctors]

with all the heavy emphasis on preventing progression to ESRD, improving medical therapy for DM nephropathy (SGLT2, the weight loss and renoprotective effects of GLP1s, aldosterone blockade, increased awareness of early referral for CKD, reducing NSAID use, etc..) unclear how one thinks that there will be MORE incident ESRD patients?
moreover the very unhealthy patients who do not (or are unable to do so due to equity reasons etc...) do not live very long once they are on dialysis...

once the artificial kidney comes out (which probably will have all the same headaches as an LVAD), say bye bye to in center HD (at least in its current iteration)

 

[Splenda88]

Varies significantly with location and size of the dialysis unit. 100k/yr is fair for an average unit. The problem with these medical directorship agreement(MDA) fees is that many Neph groups have it in their contract that existing MDA fees are not shared with new partners. As an example, I know one group where the founding partner keeps all the MDA fees(4 units) and the other physicians just keep what they bill. Many Neph groups will have something along the lines that existing MDA fees are not shared with new partners, but if a new unit opens up, he can take that one. More of an empty promise because it may never happen.

Partnership contracts are written by partners to favor them. New grads are too green to pick up these sleight of hand changes and naively think there is endless growth of dialysis units when the ESRD population is actually shrinking in this country.

That is a pretty nice gig. No wonder these nephrologists here are freaking rich.

How many chairs an average unit might have?

 

[NewYorkDoctors]

That is a pretty nice gig. No wonder these nephrologists here are freaking rich.

How many chairs an average unit might have?

lol i dunno. doing dialysis rounds is supposed to be just focus on the HD , ESRD, AV access, BP, nutrition, transplant, etc...

but the patients make you their second PCP and ask about all their social issues, medical issues, ask for Z-paks, talk about their back pain (which could be due to secondary hyperparathyroidism causing renal osteodystrophy and compression fractures....)

better just be a PCP and get that 99213 mill going honestly

 

[NewYorkDoctors]

now that I think about maybe this is why nephrologists fancy themselves a "super internists."

they figure they are doing free uncompensated PCP work during HD rounds anyway...

 

[Renal_Prometheus]

I can go on for days about the crazy partnership contracts I’ve heard of and how new grads get screwed. But the gist of it is that there’s no money left for new grads and senior partners just use them as indentured servants to staff their dialysis units with patients. They keep bouncing between different neph groups trying to find the right one that will treat them “fairly”, but it’s all an exercise in futility. Whatever juice that is squeezed out isn’t going to them. Whatever financial value that is derived from dialysis pts have been monopolized by the senior partners.

 

[NewYorkDoctors]

Should Your Kidney Doctor Have a Financial Stake in Dialysis?

Joint ventures between nephrologists and dialysis centers have expanded treatment. Critics ask: At what cost?

www.scientificamerican.com

Don't forget about the "moral hazard" of being a dialysis provider.
This article delves into how JVs are a form of self - referral. how this does not violate Stark laws is not imminently clear. The article mentions this but I'm sure the real answer is hidden behind red tape, bureaucracy, and Washington lobbyists

but the greatest moral hazard probably lies in harm by neglect/omission.

i cannot think of any non-academic nephrologist who spends the time and effort to go all out on renoprotective strategies. it just does not pay to do that. better just "send back to PCP" and wait for the eventual decline and start of HD. revenue incoming!


for me, the moral hazard is the great issue I have an issue with. that's why I no longer do HD (except in rare circumstances in which I am covering MICU for colleagues and I just place acute orders - but the consulting nephrologist bills for it)

 

[Kidknee Doc]

Decline of Nephrology: 2 main reasons; 1) Financial: Anyone who do nephrology fellowship has financial loss is in the vicinity of $800,000 over 4 years (2 years fellow at 65,000 vs hospitalist at 300,000 or more, then a job with a deficit of 125K or more). If the candidate join a good private practice, they can recover their losses overtime. If they join academic, they will never recover.
2) Regulations: Dialysis is the only fully socialized medicine. Any US citizen can get Medicare/Medicaid, regardless of age, when they become dialysis dependent. Private insurance can be forced to carry them for 30 month, but frequently carriers and employers convince the patient to take medicare.
ASN each year has a meeting to see what can be done to turn this freight train around. Frequently, those in the room are main contributor to the problem. And they refuse to address elephant in the room.

 

[Renal_Prometheus]

If the candidate join a good private practice, they can recover their losses overtime.

I think the big caveat here is with the assumption that the private practice group will treat them fairly. In my experience, at least half of Neph grads will enter exploitative groups where there is unequal split in ancillary income post-partner and they may not make more money than a hospitalist. Unfortunately, most new grads are not sophisticated enough to “figure out the trap” when they sign their employment contracts.

 

[Renal_Prometheus]

Frequently, those in the room are main contributor to the problem. And they refuse to address elephant in the room.

They refuse to address the problem because they are the stakeholders in the game. They benefit from the ignorance of neph applicants who continue to supply the slave labor needed to churn the wheels of academic programs and private practice groups, while the benefits only flow to the top.

 

[NewYorkDoctors]

hence the term I coined “dialysis industrial complex .” The game is rigged there is no free market economy . Nothing to see here folk . Move on along .


addendum:

I do see a little bit of nephrology as I am not a full time nephrologist. I only accept patients if one of the local PCPs whom I have a good work relation with asks me to see the patient for nephrology. I have a handful of CKD5 patients. I have done all the talk about fistula first. I have them see vascular surgery and they have gotten the fistula in place and matured. I will also keep nudging the patient to get a transplant evaluation (some just don't want to go... I tell them "it's better to be on line for someone you may not want now than to NOT be on line for something you might want later)

But as I do not personally do HD, my motivation is NOT "yep go on the machine." I have ZERO INCENTIVE to put the patient onto the machine unless it is to save their life.

I have a colleague who will gladly plug in the patient to his dialysis center once the patient is uremic enough or has an absolute indication seeing as how "I have done all the work." Therefore the "lifeline" is in place.

Given that I am well attuned with the lungs and point of care U/S, I have a far higher threshold before I tell a patient "yep you're fluid overloaded time to start." I'm fine using higher doses of loop diuretics and even osmotic laxatives (in the right setting) to keep volume balance under control.
A little kayexelate or veltassa and being strict with a low potassium diet is usually enough to keep the K under control.

The "fatigue" that is easily attributed to "uremia" I have found gets a little better once I motivate the patient's to get some exercise or I diagnose and treat their OSA.

I primarily have the patient get his fistula done in the event the patient has some other acute medical event that throws them into ESRD like septic shock, MI, GI bleeding, etc...

but "back in the day" (as the 80s to almost 90s director of nephrology used to tell me), people would have creatinines as high as 25 and used a little kayexelate and furosemide to keep on going. dialysis was not as widespread before it became a medicare benefit.

therefore I can sleep easy at night knowing I do not participate in the "moral hazard" of managing dialysis patients.
for that reason, I believe it is more ethical if dialysis became the purview of a "dialysis specialist" who does not do the general renal care.

Of course, too much skin in the game and money on the line so that won't ever happen.

 

[Kidknee Doc]

I train nephrology fellows. I help educate them about business. only one in 6 private group contracts is OK and I advice against joining the rest. I made one of the nephrology groups in town mad because I told a recruiter that I will never send fellows to then as they exploit new employees. Another group has a scaled up partnership over 7 years. Division chiefs and Dept chairs have their big salaries and they would keep fellows if they can. Now it is more common to hire from the inside than outside.
Here is the big one: Nephrology is now a BROWN specialty and most of new fellows are IMGs. This is a vulnerable population due to the VISA need (it takes some of them 9-14 years to get a green card through the H1 and labor cert route, yes we do not get fellows from Liechtenstein who has very short wait from green card). However, because almost all IMGs do not have medical school loans and >80% are 2 physician family, lower pay with low work load is not only acceptable, but desirable.

 

[Renal_Prometheus]

I train nephrology fellows. I help educate them about business. only one in 6 private group contracts is OK and I advice against joining the rest. I made one of the nephrology groups in town mad because I told a recruiter that I will never send fellows to then as they exploit new employees. Another group has a scaled up partnership over 7 years.

I hope nephrology applicants are reading this. Straight from the horses mouth. I wasn’t lying to you guys about the cesspool of exploitation waiting for you guys in private practice. If anybody actually thinks they will make the same money as senior partners, they are living in a pipe dream.

 

[UPCR]

I still don't understand how a supply : demand mismatch is not working well for nephrology.
And my second question is, how to fix this.

 

[NewYorkDoctors]

again only join private practice nephrology if
1) you plan to be the boss of your own practice
2) you are joining a family / friend practice in which you wil be treated equitably
3) you are joining a large employer like in California kaiser or something. you won't get top dollar but you will have a decent work schedule

otherwise go academic

or don't go at all


as for UPCR question, the answer lay in this thread even on this latest page

Dialysis is socialied medicine and controlled by the government. But the lobbyists from DaVtia and Fresenius are "in bed" with the politicians. It's crony capitalism and does NOT reflect a true free market economy. throw out all traditional ideas about "supply and demand." this is a rigged game and if you are in part of the elite, you won't get a cut of the dialysis.

 

[void88]

I train nephrology fellows. I help educate them about business. only one in 6 private group contracts is OK and I advice against joining the rest. I made one of the nephrology groups in town mad because I told a recruiter that I will never send fellows to then as they exploit new employees. Another group has a scaled up partnership over 7 years. Division chiefs and Dept chairs have their big salaries and they would keep fellows if they can. Now it is more common to hire from the inside than outside.
Here is the big one: Nephrology is now a BROWN specialty and most of new fellows are IMGs. This is a vulnerable population due to the VISA need (it takes some of them 9-14 years to get a green card through the H1 and labor cert route, yes we do not get fellows from Liechtenstein who has very short wait from green card). However, because almost all IMGs do not have medical school loans and >80% are 2 physician family, lower pay with low work load is not only acceptable, but desirable.

Do you still recommend that people apply for nephrology? And if yes, please tell me if Academic Nephrologists are trying to find solutions to make sure new grads don't go into these predatory Private practices. Also, IMGs who are US citizens, do they have any better chance of finding good private practices or have a chance to have a satisfactory career?

For context, I am an IMG practicing Hospitalist Medicine 7 ON 14 OFF (nights only) making $280K, who is looking for a possible career in nephrology. Thinking of applying next year. I enjoy the intellectual aspect of it. But I fully agree with Nephrologists in this group that pursuing a career purely based on that is not enough.

 

[Renal_Prometheus]

Do you still recommend that people apply for nephrology?

I’ve never met an academic nephrologist not recommend nephrology to an applicant. Have you ever met a realtor who says it’s not a good time to buy a house?

And if yes, please tell me if Academic Nephrologists are trying to find solutions to make sure new grads don't go into these predatory Private practices.

It would be naive to think academic nephrologists or even ASN, can do anything to change how private practice groups operate.

Also, IMGs who are US citizens, do they have any better chance of finding good private practices or have a chance to have a satisfactory career?

Yes, you have slightly higher chance of not falling into job pitfalls that an IMG needing visa waiver will typically have to take. But I know plenty of nephrologists who are US citizens who are not practicing nephrology right now.

For context, I am an IMG practicing Hospitalist Medicine 7 ON 14 OFF (nights only) making $280K,

That’s pretty good money for 7 on/14 off. You will certainly have to work a lot harder as a private practice nephrologist. Believe it or not, I actually encourage you to chase your dream. But make sure it really is your dream. And also go into it with the mentality if it doesn’t work out down the road, you are emotionally strong enough to stomach that outcome.

 

[NewYorkDoctors]

there is nothing stopping you from doing nephrology then doing GIM + Nephrology
If you are unable to get HD privileges without paying into a JV but you do not have the money to do so to start, then just go GIM + Nephrology and then manage patients up until CKD5/ESRD, set up the AV fistula and transplant talks, then another nephrologist who has the HD privileges wlil gladly take the patient for chornic HD while you get to still see the patient as PCP

You get the best of both worlds and the GIM + Renal will keep you very busy in your own private practice in which you are the boss


if you wanted to do nephrology to escape doing PCP... then do academics

In PP nephrology, you are essentially the PCP anyway since the actual PCP is rather hands off of the patient except for health care maintenance and vaccines usually i have found

 

[void88]

I’ve never met an academic nephrologist not recommend nephrology to an applicant. Have you ever met a realtor who says it’s not a good time to buy a house?


It would be naive to think academic nephrologists or even ASN, can do anything to change how private practice groups operate.



Yes, you have slightly higher chance of not falling into job pitfalls that an IMG needing visa waiver will typically have to take. But I know plenty of nephrologists who are US citizens who are not practicing nephrology right now.


That’s pretty good money for 7 on/14 off. You will certainly have to work a lot harder as a private practice nephrologist. Believe it or not, I actually encourage you to chase your dream. But make sure it really is your dream. And also go into it with the mentality if it doesn’t work out down the road, you are emotionally strong enough to stomach that outcome.

I know! I have a decent gig. It is a good lifestyle with the potential to make more money since more than half of the year I'm OFF. However, I don't like Hospitalist work. I have moved from days to nights, which is much better—less administration BS. However, covering multiple day teams at night has its issues. But I enjoy managing patients at night and doing a lot of POCUS. I tell my co-workers and friends that this gig is like a "Roller-coaster." At the end of my WEEK ON, this is the best job ever. However, my last three days of OFF are when I get so depressed and lurk around these forums. I can do this right now (12 hours shift in a week = 84 hours) given I'm young, I don't know if I would be able to do the same after 10 years. I can never do a DAYS Hospitalist job, though. That is what makes me think that if there is anything I should do, now is the time. I do like how @NewYorkDoctors has set up his practice. However, if I do Nephrology, I would like to do Nephrology only (ideally). I've noticed money doesn't drive me. Not that I'm saying that it doesn't matter. Of course, I also enjoy finer things in life, plus I have a family to feed. My friends keep picking up more shifts on their days off. Meanwhile, I would get depressed even if I had to pick one more shift in a month.

I do appreciate both of you, @Renal_Prometheus and @NewYorkDoctors, for all the guidance.

 

[deleted1164820]

One of the things I have learned in this forum is " Do Nephrology fellowship only if you can't live without doing Nephrology". Its definitely not like any other specialty where one can be happy practicing and not worry about the downsides, as the returns on investment are less from where you are right now. As both NYD and RP has reiterated multiple times in this thread, several people has traveled your path and became hospitalist again. If you think you are too bored with IM hospitalist and can't stand it, you are more likely to end in the same situation after fellowship or even worse with several years down the drain. Choose it wisely!

Talk to people who have travelled your path and see if they felt the life is better.

 

[Renal_Prometheus]

I still don't understand how a supply : demand mismatch is not working well for nephrology.
And my second question is, how to fix this.

If anything in nephrology can be fixed, it would not be languishing as a bottom rung specialty for a decade now. What amazes me though, that neph fellows are still unaware of what’s happening in the real world.

 

[void88]

I'm even ok NOT making Heme/Onc money in Nephrology as long as my quality of work improves compared to Hospitalist and I get to spend enough time with my family; I think I'll be happy. However, sounds like Nephrology doesn't even offer that.

 

[void88]

You can also consider allergy, rheum, and endocrine.

I enjoy the topic of Nephrology more than Allergy, Rheum, and Endocrine. But those are good options in terms of money and lifestyle.

 

[NewYorkDoctors]

I'm even ok NOT making Heme/Onc money in Nephrology as long as my quality of work improves compared to Hospitalist and I get to spend enough time with my family; I think I'll be happy. However, sounds like Nephrology doesn't even offer that.

It could if you subtract the chronic HD part of things. this is only feasible if you open up your own private practice.

but there is NO money to be made (you make LESS than PCP if you do nephrology minus chronic HD)
this is because there are no office CPT billing codes unique to nephrology like cardiology with echo/stress test/etc.. GI with colonosopy... hemeonc with chemo... PFTs with pulm... etc...

PCP has certain CPT codes for quality management that you can "nickel and dime" your way to a nice sum with.

logically you could do nephrology then do GIM + nephrology minus chronic HD.
just make sure you have a colleague who can accept your patients CKD5/ESRD at an HD center. You can manage them up to ESRD and get the AV fistula in place with vascular if you wish.
this is what I do
I have found my CKD5 patients have "lasted a long time" after their AVF has been put in at eGFR under 15

as long as they're not eating phosphorus, potassium , sodium fast food junk, the uremia diminishes their appetite to the point that they dont eat that much or drink that much and they are just in a balance. not bad enough to start HD. not good enough to take down their fistula.

all too often once a patient is "a little uremic" (very subjective term) - onto the machine you go! money time.

back before HD became a medicare benefit, patients would hang out with creatinines in the 20s or higher.
as long as BP, potassiu, and bicarb were controlled, there was no imminent need to go onto the HD machine

plus "fatigue" can be anything from OSA to depression to anemia.

 

[Kidknee Doc]

To be complete and clarify: Nephrology is great, it is greed and lack of trust that caused it to be this way. In the past 70% plus of academic nephrology faculty were researchers, did not care about RVUs as they were dependents on grants. Systems got used to under paying them and are not willing to adjust. There are 3 recipe for success after training:
1) Join a health care system that pays well (all fellow who did that started 350 K and above with good work load)
2) Start your own practice in market that is demanding with aging nephrologists. Work force analysis shows that 25% are above the age of 73. You need 2 nephrologist together to get privileges and never get help from local groups. You can make money in the 1st 6 month by taking few hospitalist shifts. I have trainees who did this and are doing great.
3) Find a good group which is collaborative, full partnership in 2 years. Productivity incentive in the first to years so you do not get killed. A reasonable formula is to get 60% of your collection after the group collect 1.5 folds your base salary. Never, Never, join a group who are saying senior partners are slowing down as this means, they will take all money making easy work and stick you with the grunt that does not make money. If they want to retire they need to divest completely and relinquish medical directorship.
Trust and multiples of 3 leads to great income, efficiency and peace. 1 week at a time; hospital consult, outpatient clinics, dialysis rounds. Last will take 1-2 years to be needed. 4 full days of clinic every 3 weeks is enough and can be increased. Local nephrologist where I am make between 450K-1.2M. One has a hobby of owning Ferarri, and purchased the 3rd one during the pandemic.
If you have blue blood, you can join academics as you will likely rise and do well. If not, will be second class citizen with low income.
Last advice for all medicine residents or students who want to do medicine PAY YOUR LOANS OVER 1 YEAR AFTER RESIDENCY, YOU WILL BE FREE.

 

[Renal_Prometheus]

Find a good group which is collaborative, full partnership in 2 years.

I don't have a problem with what you are saying. Every one of your scenarios is possible. I'm not saying it's likely or probable.
But I'm going push back on this statement full "partnership in 2 year." Not sure what you mean by full partnership. If you mean keeping
your collections minus a percentage for overhead expenses that everyone pays, that is reasonable. If you mean I'm going share all my existing JV and MDA fees with this new partner equally after just 2 years of "sweat equity", you are delusional. For senior guys, at least half of their take home income comes from JV and MDA fees. If you can find a group that is willing to share this ancillary income with new partner equitably, you are looking at putting in at least 3-5 years of sweat equity. There's no free lunch.

 

[Nephrology Fellow]

Every private Nephrology group hides their "dirty laundry".
I interviewed with a group who were excited about recently joining some national group Panoramic Health. At first, it sounded exhilarating.
On more probing, about my projected income after becoming a partner, I learned that they expect their projected income to plunge by 100k annually after joining Panoramic Health. I couldn't comprehend the reason for practice to join Panoramic Health. Later, local Nephrologist educated me, it appears that the group received $$$$ upfront to join. There is no upside for a graduating fellow to join such a group. If it was not for a "slip of tongue" moment during dinner among senior partners, I would have not know this. For me, this was RUN RUN RUN.
If anyone has more information about good groups to Join? Prefer warmer weather.

 

[Renal_Prometheus]

Every private Nephrology group hides their "dirty laundry".
I interviewed with a group who were excited about recently joining some national group Panoramic Health. At first, it sounded exhilarating.
On more probing, about my projected income after becoming a partner, I learned that they expect their projected income to plunge by 100k annually after joining Panoramic Health. I couldn't comprehend the reason for practice to join Panoramic Health. Later, local Nephrologist educated me, it appears that the group received $$$$ upfront to join. There is no upside for a graduating fellow to join such a group. If it was not for a "slip of tongue" moment during dinner among senior partners, I would have not know this. For me, this was RUN RUN RUN.
If anyone has more information about good groups to Join? Prefer warmer weather.

When you have been in private practice nephrology as long as I have, it’s more of the same. Most Neph groups are looking at new grads as pieces of meat to exploit. Very few groups will truly treat you fairly.

In your case, what happened is this neph group sold out to venture capital. The senior partners got a nice equity payout, but going forward they will be employees, with lower earnings ceiling. The new health system would want to squeeze out as much of the profit as possibly to recuperate their investment. Joining this group would have been disastrous.

 

[Renal_Prometheus]

Irritates the hell out of me when academics are still selling hopium to residents and telling them they will make big money post-partner. It’s more likely new grads will quite Nephrology after getting screwed by their partners than actually making the kind of money they are advertising. My friends who are still practicing nephrology, who made partnerships, are making around 350k/yr; less than a hospitalist when adjusted for income per hr. What can happen versus what’s likely to happen are very different. Too many times we let academics get away misleading advertising with no consequences.

 

[NewYorkDoctors]

hence we must keep the match rate down and try to keep the scramble rate down further.

the cream of the crop programs suffer no delusions and just want to foster academics and they will always get fellows

those bottom barrel programs that have NO REASON to have a fellowship other than to get a warm body should suffer the consequences of their half truths and deceptions.

 

[UPCR]

From my limited experience, I have never met a nephrologist who encourages residents to apply to nephrology. They are always approachable if you should interest, and they will not sell you hopium.

 

[Renal_Prometheus]

From my limited experience, I have never met a nephrologist who encourages residents to apply to nephrology. They are always approachable if you should interest, and they will not sell you hopium.

I take it you haven’t interviewed at a lot of neph programs. Hopium get sold all the time, especially when they can’t find anyone to take their fellowship positions.

 

[Renal_Prometheus]

Would you rather take the red pill or blue pill?

 

[NewYorkDoctors]

Would you rather take the red pill or blue pill?

im not sure that's the right analogy. Cypher took the blue pill. to him it was real and he had a nice steak.

i'm not sure private practice nephrology even offers the illusion of a good life... lol

 

[UPCR]

I take it you haven’t interviewed at a lot of neph programs. Hopium get sold all the time, especially when they can’t find anyone to take their fellowship positions.

You will not get interviewed unless you applied.
You wouldn't apply unless you are interested.
My point is, not all PD's and nephrologists promote their specialty or try to actively recruit applicants. They didn't even promise good money.

 

[NewYorkDoctors]

You will not get interviewed unless you applied.
You wouldn't apply unless you are interested.
My point is, not all PD's and nephrologists promote their specialty or try to actively recruit applicants. They didn't even promise good money.

the top tier programs who have real education, the full braedth of nephrology services, good careers for fellows (whether in academia, return to their own countries, or a decent PP set up) do not have to pander and grovel. They just offer how good their program is and the fellows will come

it is the bottom barrel feeding, trash bag, two cent nephrology programs that should have no reason to exist and does not match and has to rely on selling hopium in the scramble is what this thread is dedicated to.

if any resident/internist likes nephrology, apply and go to the top tiered programs that are linked to a tertiary care center and have in hosue transplant, a good PD volume of patients, good renal pathology, and all forms of CRRT. Get a real education and become a well respected academic nephrologist


no one should waste any time with these bottom barrel programs who just want a warm body otherwise

 

[Renal_Prometheus]

You will not get interviewed unless you applied.
You wouldn't apply unless you are interested.

Don’t be so sure. There are plenty of applicants who couldn’t match GI as their first choice, who scrambled into Neph as a backup.