Renal is its own beast. Its true that 95% of jobs are in academics, and it is a very small field, but if you WANT to be in academics its actually a really good specialty. There are a handful (maybe one or two dozen?) centers with really large volumes where the renal paths sign out essentially only renal and are really experts. The other academic centers the volume dictates that you split your time between renal and surg path, which is nice if that's something you're interested in. While the market is small, it is actually quite good right now. I did some schmoozing at a renal meeting recently and was "offered" 3 jobs...I don't do my fellowship for a few years yet. There are actually jobs that have been unfilled for like a year and a half because of lack of adequate trainees (in contrast to nearly every other field in pathology). The last two renal fellows at my institution both had multiple institutions competing for them. Everyone knows each other and so they know who is coming through the training pipeline in the next year or two.
Because renal path is essentially a send out for all private practices and even some academic centers, it was ripe for a private group to swoop in and take the business. What's different and amazing, though, is that actually Nephropath is well-respected amongst renal pathologists and actually publishes a large number of papers (because their volume is so high and they still have academic interest). Many of the attendings there came from academics where they were the experts in the field. Fred Silva is the author of one of the major renal path textbook, Helen Liapis was head of Renal Path at WashU, etc. They essentially run an academic-like practice with the efficiency and business acumen of a private practice (and without the red tape)... sounds kind of nice doesn't it? Even at an academic center, it actually pays to have some business skills because a lot of your business will be outreach. My institution is a major renal path center and our volume has almost doubled in the past couple years by expanding our outreach. It comprises like 80% of our volume or something like that.
I don't know much about their fellowship, its not considered of the elite ones (Seattle is the center of the renal path world), but a number of their attendings did the Nephropath fellowship and were hired on.
