Nephrology is Dead - stay away

[NewYorkDoctors]

I have preordered his AR laptop. not shilling but I really need to "work anywhere and everywhere."

I have three kids and I always need to bring them around everywhere on the weekends. But I have so much documentation to do. Much of it is brainless work though

I am trying to improve my productivity by working "anywhere." I will just use my 5G ipad pro as the wifi hotspot.

I hope this will be the gamechanger for me

Maybe this can help nephrologists as well during the in between travel time

SpaceOS | AR Laptop Operating System | Sightful

Unleash peak productivity with SpaceOS, the AR operating system from Sightful. Specifically designed to maximize the performance of your Spacetop.

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Members don't see this ad.

 

[ych77805]

Hi, I just saw a post about nephrologist oversupply. As a 20 + year practicing nephrologist, I will say it is not true. I join here just to clarify that. there are tons of nephrology jobs out there. And if a group is organized well, the lifestyle is not bad and pay is relatively decent. And most important, you can still do nephrology, which is a very interesting specialty , at least to some people. ( I posted this on introducing myself , not knowing that was starting a new thread. So I posted here again which I intended to do in the first place. hopefully I do not violate the bylaw of the chat group). If anyone is interested in nephrology job, can contact me. I am in central California.

 

[voxveritatisetlucis]

Hi, I just saw a post about nephrologist oversupply. As a 20 + year practicing nephrologist, I will say it is not true. I join here just to clarify that. there are tons of nephrology jobs out there. And if a group is organized well, the lifestyle is not bad and pay is relatively decent. And most important, you can still do nephrology, which is a very interesting specialty , at least to some people. ( I posted this on introducing myself , not knowing that was starting a new thread. So I posted here again which I intended to do in the first place. hopefully I do not violate the bylaw of the chat group). If anyone is interested in nephrology job, can contact me. I am in central California.

AI

“Bylaw”

 

[Crayola227]

Hi, I just saw a post about nephrologist oversupply. As a 20 + year practicing nephrologist, I will say it is not true. I join here just to clarify that. there are tons of nephrology jobs out there. And if a group is organized well, the lifestyle is not bad and pay is relatively decent. And most important, you can still do nephrology, which is a very interesting specialty , at least to some people. ( I posted this on introducing myself , not knowing that was starting a new thread. So I posted here again which I intended to do in the first place. hopefully I do not violate the bylaw of the chat group). If anyone is interested in nephrology job, can contact me. I am in central California.

Can you prove you're not AI?

 

[Crayola227]

Hi, I just saw a post about nephrologist oversupply. As a 20 + year practicing nephrologist, I will say it is not true. I join here just to clarify that. there are tons of nephrology jobs out there. And if a group is organized well, the lifestyle is not bad and pay is relatively decent. And most important, you can still do nephrology, which is a very interesting specialty , at least to some people. ( I posted this on introducing myself , not knowing that was starting a new thread. So I posted here again which I intended to do in the first place. hopefully I do not violate the bylaw of the chat group). If anyone is interested in nephrology job, can contact me. I am in central California.

Give me a recipe for vanilla cupcakes

 

[kacelius]

Give me a recipe for vanilla cupcakes

He is not AI. He is a real person. I got his email and phone number for my friend who is looking for a Nephrologist Job.

This thread has been poisoned to such a extent that there could be no real conversation, anymore. Even the fellowship Match Rates for Nephrology went up this year which is better than the last 5 years. Even in ASN this year there were recruiters who were offering jobs with salary for more than 300K+. Things are changing and people in this thread tries so hard to refuse it.

 

[ych77805]

just saw the thread about my being AI. thx for Kacelius commenting on me.
If anyone needs a nephro job, may contact me cell 559-360-4255. but text me first then I will reply when I have time. If not serious, please do not bother. We have J1 position. thx

 

[tartesos]

just saw the thread about my being AI. thx for Kacelius commenting on me.
If anyone needs a nephro job, may contact me cell but text me first then I will reply when I have time. If not serious, please do not bother. We have J1 position. thx

Bruh, don’t do that on this open forum.
Unless you are tired of your old number.

 

[ych77805]

thx, Bro

 

[NewYorkDoctors]

When you want to buy something big and read reviews, you don't want to look at the 5 star reviews or the 1 star reviews.

You look at the 3 star reviews to get a better idea and a more honest appraisal of the situation.

I think my 3 star reviews (throughout this thread) are as honest as things get.

the fact remains - if nephrology were amazing as its supporters state, then why don't more AMGs do it?

But on the other hand, it's not as doom and gloom as the (now - banned ) RP made it seem like.

but for anyone for whom Nephrology is not his/her first choice (i.e. cardiology / PCCM rejected residents), you will find no enjoyable career in Nephrology. That is the target demographic I have always been targeting to warn off from the edging too close to the precipice. For everyone else who likes Nephrology, go for it. see my "3 star reviews" in this thread.

 

[Splenda88]

When you want to buy something big and read reviews, you don't want to look at the 5 star reviews or the 1 star reviews.

You look at the 3 star reviews to get a better idea and a more honest appraisal of the situation.

I think my 3 star reviews (throughout this thread) are as honest as things get.

the fact remains - if nephrology were amazing as its supporters state, then why don't more AMGs do it?

But on the other hand, it's not as doom and gloom as the (now - banned ) RP made it seem like.

but for anyone for whom Nephrology is not his/her first choice (i.e. cardiology / PCCM rejected residents), you will find no enjoyable career in Nephrology. That is the target demographic I have always been targeting to warn off from the edging too close to the precipice. For everyone else who likes Nephrology, go for it. see my "3 star reviews" in this thread.

If a fellowship is recruiting IMG with no US training, I am going to take the liberty to say it's doom and gloom

 

[UPCR]

One day, all the old nephrologists will retire/die in a crash while traveling between dialysis centers, and there will be a massive demand and increase in salary from 200k to 210k. One day..

 

[tartesos]

One day, all the old nephrologists will retire/die in a crash while traveling between dialysis centers, and there will be a massive demand and increase in salary from 200k to 210k. One day.

You know they will just hire an army of NP’s.

 

[NewYorkDoctors]

anyway the former RP poster and myself just want to shine a light to those doctors who are on the fence and not in love with nephrology to consider seriously what the realities of nephrology are before taking the plunge

For those attending nephrologists who have made a nice niche for themselves or may feel ongoing negative feelings from this thread, you should all be aware that you are living your life the way you want. The "poisoned" posts here are not meant to put you or your career choices down. It is merely to highlight to residents who might think "some subspecialty is better than none" (i.e. nephrology versus GIM / hospitalist) should reall contemplate this a bit more deeply and get both sides of the arguments.

As for NPs, i dont think any NPs will want to come in the middle of the night for K of 6.5 - 7.0 like a flelow does

Heck attending only hospital groups won't come in the middle of the night. buy as much time as possible with medical management, intubate if you have to, get some one to put in the access (if no AVF), and see the patient first thing in the morning. oh be sure to have the HD nurse come in just a little bit before you do lol

 

[tartesos]

anyway the former RP poster and myself just want to shine a light to those doctors who are on the fence and not in love with nephrology to consider seriously what the realities of nephrology are before taking the plunge

For those attending nephrologists who have made a nice niche for themselves or may feel ongoing negative feelings from this thread, you should all be aware that you are living your life the way you want. The "poisoned" posts here are not meant to put you or your career choices down. It is merely to highlight to residents who might think "some subspecialty is better than none" (i.e. nephrology versus GIM / hospitalist) should reall contemplate this a bit more deeply and get both sides of the arguments.

As for NPs, i dont think any NPs will want to come in the middle of the night for K of 6.5 - 7.0 like a flelow does

Heck attending only hospital groups won't come in the middle of the night. buy as much time as possible with medical management, intubate if you have to, get some one to put in the access (if no AVF), and see the patient first thing in the morning. oh be sure to have the HD nurse come in just a little bit before you do lol

Renal np can put crrt orders from home and see the guy next morning. Intensivist puts the access and handles overnight. Tried and true method all over the country

 

[NewYorkDoctors]

Renal np can put crrt orders from home and see the guy next morning. Intensivist puts the access and handles overnight. Tried and true method all over the country

too bad renal fellowship programs don't do this

unless one wants to be a nephrologist due to desire to be academic doctor or just really likes the beans then one has to

1) suffer brutal fellowship with no NP support
2) later on have NP do the work and less payment to junior attendings.



anyway this just furthers my point of "only do nephrology if you really like it and have a clear career plan in place."

 

[UPCR]

too bad renal fellowship programs don't do this

unless one wants to be a nephrologist due to desire to be academic doctor or just really likes the beans then one has to

1) suffer brutal fellowship with no NP support
2) later on have NP do the work and less payment to junior attendings.



anyway this just furthers my point of "only do nephrology if you really like it and have a clear career plan in place."

Many fellowship programs dont require fellows to come during on-calls. I think this is the norm now.

 

[tartesos]

too bad renal fellowship programs don't do this

unless one wants to be a nephrologist due to desire to be academic doctor or just really likes the beans then one has to

1) suffer brutal fellowship with no NP support
2) later on have NP do the work and less payment to junior attendings.



anyway this just furthers my point of "only do nephrology if you really like it and have a clear career plan in place."

But That applies to any specialty. I would be miserable as a cardiologist and some people would give their left nut or ovary to do it.

 

[kacelius]

Many fellowship programs dont require fellows to come during on-calls. I think this is the norm now.

And also Lately fellowship programs don't require you to place the lines either or do your biopsies. Definitely not where I did my fellowship for the past 10 years. I can 't speak for all the programs, but the people I met from other programs have the same trend. The bigger programs still ask you to do one of these things.

 

[sloh]

But That applies to any specialty. I would be miserable as a cardiologist and some people would give their left nut or ovary to do it.

Except cards pays really well

 

[tartesos]

Except cards pays really well

Missing the point.

 

[Drrrrrr. Celty]

Except cards pays really well

I think most cardiologists look hella miserable even the ones who really like it. I can't imagine being a cardiologist and not like it.

Like I'm cognizant I'm making up to half the amount a pretty high volume cardiologist makes. I'm ok with that

 

[RenallyDosed]

One day, all the old nephrologists will retire/die in a crash while traveling between dialysis centers, and there will be a massive demand and increase in salary from 200k to 210k. One day..

Not long ago Robert P. Geronemus died in a hit an Run in Miami. He did do a lot for the practice of Nephrology even in a now-soon-to-be-out-of-business-hospital.

Almost a decade doing this. Still driving everywhere. Volume is what pays in Nephrology. Competition is healthy everywhere but toxicity is not. Private practice can get ugly in a busy metropolitan area. I love it, and as an AMG, would do it again. But there are many other ways to make money if you like other things/have other talents. No one should go into nephrology if they don't love it. You write a lot, drive a lot, get called a lot, and see a lot of IM stuff because patients have you as their primary physician. I absolutely loved my Fellowship, but I went with the knowledge that the pay was not like any procedure based practice. I can see how others have been misled, and more so when spots are not being filled and programs get desperate to not lose the spot and extra money from the teaching positions.

I see more and more pre IM residents doing it and it just makes the field less exciting and less attractive. You see these fellows and talking about a patient's hyponatremia or GN case is like pulling teeth. If the money was there, it would not be an issue.

I do not believe this thread is toxic at all, I have been reading these for years and always saw it as a cautionary tale for those not decided yet.

I would give it 3.5 stars, mainly because of all the work driving back and forth. But the more I do it, especially my clinic, the more I love it.

 

[NewYorkDoctors]

Not long ago Robert P. Geronemus died in a hit an Run in Miami. He did do a lot for the practice of Nephrology even in a now-soon-to-be-out-of-business-hospital.

Almost a decade doing this. Still driving everywhere. Volume is what pays in Nephrology. Competition is healthy everywhere but toxicity is not. Private practice can get ugly in a busy metropolitan area. I love it, and as an AMG, would do it again. But there are many other ways to make money if you like other things/have other talents. No one should go into nephrology if they don't love it. You write a lot, drive a lot, get called a lot, and see a lot of IM stuff because patients have you as their primary physician. I absolutely loved my Fellowship, but I went with the knowledge that the pay was not like any procedure based practice. I can see how others have been misled, and more so when spots are not being filled and programs get desperate to not lose the spot and extra money from the teaching positions.

I see more and more pre IM residents doing it and it just makes the field less exciting and less attractive. You see these fellows and talking about a patient's hyponatremia or GN case is like pulling teeth. If the money was there, it would not be an issue.

I do not believe this thread is toxic at all, I have been reading these for years and always saw it as a cautionary tale for those not decided yet.

I would give it 3.5 stars, mainly because of all the work driving back and forth. But the more I do it, especially my clinic, the more I love it.

Yep great honest opinion. This also highlights the message I have been highlighting as well. Although my posts are more on the cautionary side for the residents who did not match in Cardiology and PCCM and get a cold call from shameless nephrology fellowships.

My prior posts in this thread have also shared how I try to get some more "office procedures" done for nephrology patients that does not involve Dialysis. See my prior posts.

Those who call this thread toxic are probably prefer to live in an echo chamber (or in the case of academic doctors - their ivory tower). I think those posters would feel more at ease on Reddit lol. Though to be fair, it was probably renal prometheus' approach to messaging that probably insulted certain doctors on here who might have felt the integrity of their life's decisions threatened or something....

 

[Chemist0157]

I am doing my periodic revisit of SDN and hope everyone is doing well. I do not know what made me think about it, but I looked at ASN match numbers recently and thought I would pop into here and see what else is going on in the forums.

Private practice is going well. Very busy. Happy to be out of our COVID era. Pretty busy flu season though lol.
I think CKCC is new since I was last here. We are navigating that.
I think we expanded to three smaller hospitals since I last posted.
We hired two new guys in 2023, and they will be up for partnership this summer. Another guy is on our "retirement track." I think everyone else is the same.

I remember @NewYorkDoctors 👋and see a couple other familiar names.

 

[Chemist0157]

I remember @tartesos !

 

[NewYorkDoctors]

I am doing my periodic revisit of SDN and hope everyone is doing well. I do not know what made me think about it, but I looked at ASN match numbers recently and thought I would pop into here and see what else is going on in the forums.

Private practice is going well. Very busy. Happy to be out of our COVID era. Pretty busy flu season though lol.
I think CKCC is new since I was last here. We are navigating that.
I think we expanded to three smaller hospitals since I last posted.
We hired two new guys in 2023, and they will be up for partnership this summer. Another guy is on our "retirement track." I think everyone else is the same.

I remember @NewYorkDoctors 👋and see a couple other familiar names.

congrats you made it well. good luck to you.

recall, RP was the "nephrology is doomed no matter what" poster. I miss him lol

I am on the the "if you are not sold on nephrology as a first choice, don't enter it thinking it will be easy to get rich like cardiology and GI."

 

[Chemist0157]

congrats you made it well. good luck to you.

recall, RP was the "nephrology is doomed no matter what" poster. I miss him lol

I am on the the "if you are not sold on nephrology as a first choice, don't enter it thinking it will be easy to get rich like cardiology and GI."

I see he got banned. Crazy.

 

[Prometheus_Renal]

Anyway, if you are having doubts about what to choose for your future, you have been warned about what the market is currently doing. Paying big bucks and paying with your time may be a big gamble if it does not work. Essentially, the odds of winning in other specialties are better than in Nephrology.

I appreciate the honesty from a practicing nephrologist. All too often the career risks of a non-competitive specialty get swept under the rug during fellowship, and the new grads waste the next couple of years of their lives figuring out it's not working out. This is what's so powerful about this thread, is that it allows applicants to see years ahead into their careers and make a decision whether it's worth the investment in time and energy. And if it doesn't work out, there are many neph bros in the community working as hospitalists for more money.

 

[Prometheus_Renal]

I'm also worried about the financial landscape in private practice nephrology and that dialysis unit joint ventures(JVs) are increasingly less profitable every year, which has historically been the backbone of what makes nephrology worthwhile. New neph grads appear to have a poor understanding of whats happening and are still banking on making it rich by buying into a JV with a large dialysis organization(LDO). From my experience, profit margins in these JVs on average have dropped into the single digits and it's very questionable whether you should just invest your money into an S&P 500 fund which historically has returned 8-10%.

Here is an update of the dialysis unit landscape post-covid
- labor pool has shrunken and HD nurses are demanding higher wages. Many RNs make 2x more doing locums forcing HD units to overpay
- HD reimbursement from CMS not keeping up with inflation, so revenue per treatment is declining
- Both incidence and prevalence of ESRD patients are declining due to newer oral agents for CKD
- profitability of the HD unit depends on how many commercial pts you have, which is out of your control
- LDOs have overbuilt HD units and many are not getting filled

Doing a JV 20 yrs ago was a no brainer but right now you may end up getting trapped into a business where if it loses money, you will get capital called every year. The sad part is that many in neph groups, the whole "benefit" of making partner is the opportunity to take out a loan to buy into an existing JV; otherwise there's not much financial difference between an associate and a partner. Some of my friends have avoided going into a JV with a LDO so they can maintain flexibility to move away, but I know many new grads are not financially sophisticated enough to see through the pumped up pro forma numbers. Hopium gets the best of us. In addition, buying into mature HD unit has high valuations, so your return on investment is not that great. You maybe better off buying into a denovo unit, but those are not popping up like they used to anymore. I think it's a tough time to go into nephrology right now, to completely honest. All these factors will need to be consider when making informed decision to go into nephrology.

 

[kacelius]

I know this thread has devolved into posting mostly negative information and fear mongering but real life situation has changed significantly than it used to be. This is from marit self reporting of salaries from users.

 

[Splenda88]

I know this thread has devolved into posting mostly negative information and fear mongering but real life situation has changed significantly than it used to be. This is from marit self reporting of salaries from users.

View attachment 398982

Not bad.

I make ~12k more working 62-64 hrs every other week as a hospitalist. We just hired a nephrologist.

 

[Chemist0157]

I know this thread has devolved into posting mostly negative information and fear mongering but real life situation has changed significantly than it used to be. This is from marit self reporting of salaries from users.

View attachment 398982

Still seems low. Maybe they are blending academic and private practice. Maybe not including benefits. I think these kinds of websites are helpful from a 10,000 ft view but hard to compare if the specialty guesstimates are closeish.

That guy in Wyoming is killing it though lol.

 

[Chemist0157]

Oh, he does a lot of call though so probably small practice.

 

[clinicmd]

Still seems low. Maybe they are blending academic and private practice. Maybe not including benefits. I think these kinds of websites are helpful from a 10,000 ft view but hard to compare if the specialty guesstimates are closeish.

That guy in Wyoming is killing it though lol.

Yeah - here's the link to all salaries. Looks like Academics is < $300k and Private Practice is >$350k

 

[kacelius]

Not bad.

I make ~12k more woking 62-64 hrs every other week as a hospitalist. We just hired a nephrologist.

Generally hospitalist work is 144 hours a week. Not a lot of places allow you to round and go. Even if you round and go much earlier, you are bound to get calls and take care of things becoz you are the primary, right?

Same way generally nephrolgist does not have to come in to the hospital at night, or place their lines or do biopsy. Its an acute care consult service and you get lot of calls, but not unmanageable.

It works both ways.

 

[Splenda88]

Generally hospitalist work is 144 hours a week. Not a lot of places allow you to round and go. Even if you round and go much earlier, you are bound to get calls and take care of things becoz you are the primary, right?

Same way generally nephrolgist does not have to come in to the hospital at night, or place their lines or do biopsy. Its an acute care consult service and you get lot of calls, but not unmanageable.

It works both ways.

Generally, hospitalist work 84 hrs every other week.

I work every other week 7 on/off from 7am to 7pm. 3 out of these 7 days, I am allowed to leave early, but be available to answer calls until 7pm. It's not 144 hrs (it's 84 hrs every other week). The days I am allowed to leave early, I am usually home between 1-2 pm.

Based on my residency graduating class, I would say 40-50% of us have jobs that are round and go.

 

[NewYorkDoctors]

I know this thread has devolved into posting mostly negative information and fear mongering but real life situation has changed significantly than it used to be. This is from marit self reporting of salaries from users.

View attachment 398982

" self reporting of salaries from users"

selection bias.

though I am not dismissing your post. rather, I am saying this does not reflect what "everyone can make."

on the flip side, some of the community nephrologists in NYC with thriving practices make over one million (see my prior posts)

the point is.... can everyone make it like this? or is this is a selection of the most successful nephrologists only and does not reflect the actual reality of what everyone can make?

there is just too much politicking and "marking territory" when it comes to getting dialysis center privileges that it's just a huge barrier to entry that virtually no other IM subspecialty has to deal with (outside of perhaps infusion center for an oncologist?)

this thread is also not really "fear mongering." you are being hyperbolic. this thread is "not a threat to democracy (lol)." Are your interests threatened in anyway by having fewer nephrologists?

this thread is encouraging those who LIKE nephrology to do so. But those who may not love it should beware of potential career and financial setbacks that are not really seen in the other Internal Medicine subspecialties. In a rare situation of someone not dealing with any debt or opporunity costs, one could do nephrology (out of passion for the field) and do another subspecialty (or two) as well along with IM (as I did) to get the "intellectual benefits of nephrology" but not get trapped into a career quagmire.

Nephrology should be seen as "high risk high reward and also a potentially very low career nadir if things don't pan out."

 

[Chemist0157]

I think that is a marginal difference to be honest. Dialysis patients *have* to have a center close to them because of burden of travel. The center then *has* to be staffed by a physician so a physician *has* to have that "territory." There is a huge barrier to entry because of regulation, CONs, etc, not because nephrologists are "blocking" others from coming in (though obviously they benefit from it).

But if I am a cardiologist, oncologist, etc., I cannot set up a new shop myself in an already saturated market. I mean I COULD, but it's probably not wise. Market forces are at work here. Most docs are employed anyway now right? Private practices declining? Margins shrinking? Fellows are mostly limited to joining well established practices and/or joining major health care organizations as an employee. None of that is specific to nephrology. All IM specialties have to fit into gaps, and there really are not a lot of gaps to fill besides retiring physicians for example.

 

[NewYorkDoctors]

I think that is a marginal difference to be honest. Dialysis patients *have* to have a center close to them because of burden of travel. The center then *has* to be staffed by a physician so a physician *has* to have that "territory." There is a huge barrier to entry because of regulation, CONs, etc, not because nephrologists are "blocking" others from coming in (though obviously they benefit from it).

But if I am a cardiologist, oncologist, etc., I cannot set up a new shop myself in an already saturated market. I mean I COULD, but it's probably not wise. Market forces are at work here. Most docs are employed anyway now right? Private practices declining? Margins shrinking? Fellows are mostly limited to joining well established practices and/or joining major health care organizations as an employee. None of that is specific to nephrology. All IM specialties have to fit into gaps, and there really are not a lot of gaps to fill besides retiring physicians for example.

fair points. hence, a resident (or hospitalist) who LIKES nephrology SHOULD be encouraged to do it without regrets.

But those who do not love the beans (i.e. residents who applie to Cardiology or PulmCrit who did not get in, are having a moment of existential dread and crisis, and get a cold call offer from an unfilled nephrology program) should realize "there are easier ways to make money."

 

[kacelius]

fair points. hence, a resident (or hospitalist) who LIKES nephrology SHOULD be encouraged to do it without regrets.

But those who do not love the beans (i.e. residents who applie to Cardiology or PulmCrit who did not get in, are having a moment of existential dread and crisis, and get a cold call offer from an unfilled nephrology program) should realize "there are easier ways to make money."

True, Agreed.
But one other thing is in that case they should not do Nephrology or any specialty of not of their preference. They will suffer regardless. What makes you think they are going to be great hospitalists/endocrinologists/ID specialists ? They did not prefer that one either. Lastly there is no such thing as "easy money" in being a hospitalist either. Everyone says they work the hardest. The grass always feels greener on the other side.

 

[NewYorkDoctors]

True, Agreed.
But one other thing is in that case they should not do Nephrology or any specialty of not of their preference. They will suffer regardless. What makes you think they are going to be great hospitalists/endocrinologists/ID specialists ? They did not prefer that one either. Lastly there is no such thing as "easy money" in being a hospitalist either. Everyone says they work the hardest. The grass always feels greener on the other side.

Why is the alternative always comparing to hospitalist / endocrinology and ID? I agree the ceiling in nephrology is definitely higher than those three subspecialties. Though, the floor may be lower.

I suppose if the logical idea is if someone were so competitive for cardiology and GI then one would never even have to consider nephrology. Hence that is the just the available options

But why not GIM? Sure EMPLOYED GIM jobs are terrible and horribly underpaid.

But I have outlined (relatively) easy and profitable ways how community private practice GIM can pay much better and be much easier to thrive in than private practice nephrology .

Anyway, all valid points all around anyway.


My whole thing is just trying to warn off residents who did not match in cardiology or PCCM from taking the renal fellowship cold call. That's just my whole schtick.

 

[Chemist0157]

fair points. hence, a resident (or hospitalist) who LIKES nephrology SHOULD be encouraged to do it without regrets.

But those who do not love the beans (i.e. residents who applie to Cardiology or PulmCrit who did not get in, are having a moment of existential dread and crisis, and get a cold call offer from an unfilled nephrology program) should realize "there are easier ways to make money."

Agree w/ that