Official 2020-2021 Nephrology Fellowship Application Cycle Thread

[arda]

anyone interviewed at california programs ?

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[Renal_Prometheus]

I did with most of them. You can DM me any questions you have.

I think I saw you mentioned that you have visa issues. I had 2 good nephrology friends who were in a similar situation,
both got expoited by their partners and are currently not practicing nephrology. You may or may not be aware of this.
So what ends happening a lot of times is that after graduating, due to visa restrictions, you end up having to take an
undersirable job usually in a rural area where there's a solo nephrologist. These rural groups have a reputation of
churning IMGs without ever making them partner knowing full well you can't leave because of visa restrictions. You
are then forced to go back to academic nephrology vs hospitalist. These groups live on the revenue they generate
off of young, unsuspecting new grads. It's sad that people in similar situation don't talk to each other. The issues
below can happen to anyone, but in my experience, it is much more prevalent in IMGs with visa issues.


The Choices We Make Dictate The Life We Lead

excerpt from the article:

"They have heard horror stories from their more experienced peers not being offered partnership, or not getting the Medical Directorships promised or not being allowed to participate in joint venture opportunities. As one nephrologist three years out of training put it, “There is greed in nephrology; many of the older physicians do not want to share and ultimately, they do not. There is a lack of stability for fellows going into practices and no guarantees that after all your efforts that you will get a fair shake.”

He believes this concern is another factor as to why residents are not going into the specialty or nephrologists coming out of training choose an employed Hospitalist position. These thoughts or similar have been shared by numerous nephrology fellows interviewed (all of which request anonymity for obvious reasons). There are nephrology practices out there that have a reputation for hiring, working people unfairly and then firing them without offering anything. In other cases, there are limited opportunities to joint venture and many practices in popular locations have the bulk of their units already opened with limited growth available. These are issues the residents and fellows are wrestling with that make the decision to go into nephrology a difficult one. "

 

[Awesomentin]

RoL time!
Can anyone provide feedback on the following list
Prefer strong clinical, transplant and critical care exposure over research.
1. Brown
2. BU
3. UMass

 

[kasrainystudent]

Brown seemed to have great transplant exposure and also have a stand alone critical care fellowship if this is something that interests you. If I recall correctly BMC did not have strong transplant exposure and seemed more research oriented than Brown. But ultimately I liked both programs.

 

[Renal_Prometheus]

I just wonder how long this type of unequal relationship can last. At this point, fellow is taking on all the risks of going into an undersirable specialty with high attrition rate. Fellowship programs stand to benefit from the cheap labor, often exaggerating how well nephrologist do in private practice. It will take the fellow years into private practice to figure out, financially, it was a very bad decision. How long can this last before everyone figures it out?

 

[blue.jay]

I just wonder how long this type of unequal relationship can last. At this point, fellow is taking on all the risks of going into an undersirable specialty with high attrition rate. Fellowship programs stand to benefit from the cheap labor, often exaggerating how well nephrologist do in private practice. It will take the fellow years into private practice to figure out, financially, it was a very bad decision. How long can this last before everyone figures it out?

Primary care and Hospitalists jobs are now being encroached by midlevels. Cards, GI, Pulmcrit and Oncology are competitive due to better reimbursement. I am guessing the coming wave of midlevels will force some graduates to settle for ID and Nephro just to be employed and have job security.

 

[Renal_Prometheus]

Primary care and Hospitalists jobs are now being encroached by midlevels. Cards, GI, Pulmcrit and Oncology are competitive due to better reimbursement. I am guessing the coming wave of midlevels will force some graduates to settle for ID and Nephro just to be employed and have job security.

With 30-50% grads who eventually will not practice nephrology long term, I don't know how much of an upgrade it is compared to a hospitalist job. That's why I say all this only benefits the fellowship program, who are unscrupulous in taking anyone to fill spots for the scut work. People come into specialty with the hope of being better off than a hospitalist, only to have their hopes dashed by crude reality. Then they will look back and realize, oh wait, their really is good reason why this specialty is so non-competitive. People are living on hope of escaping a dreary hospitalist job.

 

[blue.jay]

With 30-50% grads who eventually will not practice nephrology long term, I don't know how much of an upgrade it is compared to a hospitalist job. That's why I say all this only benefits the fellowship program, who are unscrupulous in taking anyone to fill spots for the scut work. People come into specialty with the hope of being better off than a hospitalist, only to have their hopes dashed by crude reality. Then they will look back and realize, oh wait, their really is good reason why this specialty is so non-competitive. People are living on hope of escaping a dreary hospitalist job.

I think I have asked you this before. How do you have this much knowledge about nephrology job market and realities ? Did you finish a nephrology fellowship and decided not to practice due to the stated reasons ?

 

[Renal_Prometheus]

I think I have asked you this before. How do you have this much knowledge about nephrology job market and realities ? Did you finish a nephrology fellowship and decided not to practice due to the stated reasons ?

Use your common sense, the truth lies within.

 

[Chemist0157]

Congratulations to those who matched. I was happy to hear about the success from a couple of you. Let me know if you have any questions about fellowship or practice.

https://data.asn-online.org/briefs/09_ay-2021-match/

Interestingly, number of applicants was quite a bit up this year compared to previous years, across all types of applicants except DOs. It will be interesting to see if that is related to some weird COVID/virtual interviewing year, or if it is a developing trend. The smart programs have been trying to spur more interest in nephrology with students and residents compared to the past so they may be seeing some results now.

 

[blue.jay]

Congratulations to those who matched. I was happy to hear about the success from a couple of you. Let me know if you have any questions about fellowship or practice.

https://data.asn-online.org/briefs/09_ay-2021-match/

Interestingly, number of applicants was quite a bit up this year compared to previous years, across all types of applicants except DOs. It will be interesting to see if that is related to some weird COVID/virtual interviewing year, or if it is a developing trend. The smart programs have been trying to spur more interest in nephrology with students and residents compared to the past so they may be seeing some results now.

Not surprising as many residents who were concerned about hospitalists and outpatient job market might have thought it is safer to rather do a fellowship (esp IMGs)

 

[Chemist0157]

Not surprising as many residents who were concerned about hospitalists and outpatient job market might have thought it is safer to rather do a fellowship (esp IMGs)

Yeah, undoubtedly, it is a challenge to extrapolate much from 2020.

 

[Renal_Prometheus]

Congratulations to those who matched. I was happy to hear about the success from a couple of you. Let me know if you have any questions about fellowship or practice.

https://data.asn-online.org/briefs/09_ay-2021-match/

Interestingly, number of applicants was quite a bit up this year compared to previous years, across all types of applicants except DOs. It will be interesting to see if that is related to some weird COVID/virtual interviewing year, or if it is a developing trend. The smart programs have been trying to spur more interest in nephrology with students and residents compared to the past so they may be seeing some results now.

If you look closely at the data, even though in the last 5 yrs 30-40% of fellowship spots didn't fill in the match, they were all filled in the scramble. I keep hearing this false narrative that there's a shortage of people going into neph and somehow job market will improve due to supply/demand. The problem is that there has never been a shortage of graduates! People are making too many assumptions.

 

[jackinabox1]

I've always found nephro fascinating. I know the job market isn't that good, but is it a field worth considering if you limit yourself to top 5-10 programs?

 

[Renal_Prometheus]

I've always found nephro fascinating. I know the job market isn't that good, but is it a field worth considering if you limit yourself to top 5-10 programs?

You can walk into any top 10 programs today if you want to. No need to apply to more than 5 programs. Attrition rate in private practice is very high, due to all issues discussed on this thread and others. Make sure you are doing it out of interest and not for any financial reasons. Many nephrologists in private practice are disappointed with reimbursement and lifestyle and end up back as hospitalists. Make sure you can take a punch if things dont work out down the road.

 

[Chemist0157]

I've always found nephro fascinating. I know the job market isn't that good, but is it a field worth considering if you limit yourself to top 5-10 programs?

https://www.asn-online.org/education/training/workforce/Nephrology_Fellow_Survey_Report_2019.pdf

There is a lot of job outlook data available from the ASN fellow survey. The general trend has been positive compared to years ago. There is still reported too few of jobs around a local program (within 50 miles), but most graduates are finding appropriate number of job opportunities on a more national level. From my home program, I can think of one person the year before me who joined a local practice, two people a couple of years before me who joined the academic program themselves, and everybody else finds a job in the region (state or neighboring states). Nobody had an issue finding a satisfactory job. When I was visiting fellowship programs, most of the second year fellows already had jobs lined up.

If you go to a top program, you are not going to have any problems. Even more so if an AMG. Even more so if you are willing to looking beyond your local program's area.

 

[Renal_Prometheus]

There's also a difference between accepting a job out of fellowship and staying a nephrologist long term. Most will take a nephrology job initially, but after practicing couple of years and you figure out how underpaid you are, people will jump ship.

 

[Renal_Prometheus]

I plead for applicants to use their brain. These fellowship programs will lie in your face on how well their graduates are doing in private practice. They will not tell you about the people who have given up and are not practicing nephrology. If neph was really as lucractive as they claim, they would not be begging you to join their fellowship. Simple market forces explain why this specialty is the least matched specialty. Don't go into it out of desperation. Too many of my colleages went into neph because they couldn't get anything else, end up wasting years of their lives, and now are right back where they started. A hospitalist.

 

[wanted101]

I plead for applicants to use their brain. These fellowship programs will lie in your face on how well their graduates are doing in private practice. They will not tell you about the people who have given up and are not practicing nephrology. If neph was really as lucractive as they claim, they would not be begging you to join their fellowship. Simple market forces explain why this specialty is the least matched specialty. Don't go into it out of desperation. Too many of my colleages went into neph because they couldn't get anything else, end up wasting years of their lives, and now are right back where they started. A hospitalist.

why do you keep saying nephro is such a bad financial decision when MGMA data states MEDIAN salary for nephro docs to be 400k??? I'm genuinely curious. I just don't think nephro salary is that bad, given data from legit sources like MGMA, especially with fields like interventional nephro that seem to be procedure heavy.

 

[Renal_Prometheus]

why do you keep saying nephro is such a bad financial decision when MGMA data states MEDIAN salary for nephro docs to be 400k??? I'm genuinely curious. I just don't think nephro salary is that bad, given data from legit sources like MGMA, especially with fields like interventional nephro that seem to be procedure heavy.

It's clear you don't practice nephrology. do you really think if everyone can make that salary that such a high percentage of graduates would choose hospitalist medicine over nephrology? The MGMA salary is an average of the people who are practicing nephrology and willing to volunteer their income data. It's not taking into account the people who have given up nephrology because they didn't think it was financially worthwhile to keep doing it. In other words, theirs a sample bias. You don't have to believe me. Just do nephrology and within couple of years in private practice, you will see your colleagues dropping out and quitting.

 

[wanted101]

It's clear you don't practice nephrology. do you really think if everyone can make that salary that such a high percentage of graduates would choose hospitalist medicine over nephrology? The MGMA salary is an average of the people who are practicing nephrology and willing to volunteer their income data. It's not taking into account the people who have given up nephrology because they didn't think it was financially worthwhile to keep doing it. In other words, theirs a sample bias. You don't have to believe me. Just do nephrology and within couple of years in private practice, you will see your colleagues dropping out and quitting.

yes obviously i dont practice it or else I wouldn't be asking about your pure hate for the field and asking questions regarding nephro on a nephro thread. your hate for the field is very interesting considering you give off the impression you are a nephro doc yourself. and you clearly seem to have initially liked the field with a name like renal prometheus. i guess the job market must really be that bad for you to strongly discourage everyone from entering the field

 

[Renal_Prometheus]

yes obviously i dont practice it or else I wouldn't be asking about your pure hate for the field and asking questions regarding nephro on a nephro thread. your hate for the field is very interesting considering you give off the impression you are a nephro doc yourself. and you clearly seem to have initially liked the field with a name like renal prometheus. i guess the job market must really be that bad for you to strongly discourage everyone from entering the field

Just think about the opportunity cost of doing nephrology. You are committing to 2 yrs of fellowship plus getting payed a starting salary of around 200k/yr for 3-4 yrs, to "hopefully" make partner in your group. This is full time hard work, with a lot of driving, not 7 on 7 off like a hospitalist. Partnership is not guaranteed and there are many groups who exploit fellows without the intention of making them partner. It happens with enough frequency that someone has written an article about it(see above). So you tell me. If you happen to be the poor fool who ends up with nothing after years of being underpaid, what are you going to do? Join another nephrology group and give them another 3-4 yrs of your life? Most go back to hospitalist job. There's no free lunch in this world. You should have enough common sense to know why a specialty is non-competitive.

 

[Renal_Prometheus]

You are putting yourself in a position for others to exploit you simply because starting salaries are so low and groups are faced with declining practice revenue. There’s a lot of shenanigans that are being pulled in private practice that you don’t know about because real world nephrologists don’t come on these forums to share how they were exploited or have dropped out. And even for those who do make partner many will discover they don’t make the same as older partners. Depends on the practice, not all medical directorships are shared equally or the older guys have the dialysis JVs and there are no more new dialysis units opening up. Literally after years of fellowship and getting underpaid, you might find yourself making 300-350k/yr working full time. This is laughable by cards/GI standards and less than a hospitalist on a per hr basis. I’ve seen the majority of my colleagues quit years into private practice when they realized that they were better off just being a hospitalist. Years of wasted earning potential because nobody told them the truth from the start to not waste their time. Who’s gonna tell you the truth? You expect fellowship programs who need fresh meat for scut work tell you to not join them? The fellowship programs will point to earning potential of the top 10% of nephrologists but that’s not realistic with new grads going into private practice today. What I am saying is, if money is important to you, do not waste your time here. Very few will make it worth their time and the average grad will constantly debate themselves whether to jump to hospitalist work or keep doing nephrology.

 

[NewYorkDoctors]

Truth.

It is honestly easier to run a primary care 99213 mill and make close or over 7 figures (depends on how good you get your assembly line rolling - in the NYC metro area there are lots of these 99213 mills) and just take care primary care issues. You can refer the "hard" cases. Hard cases like clotted vascular access, difficult to control hypertension in a non-adherent patient, missed dialysis, patients who are non-adherent to their CS+CYC or RTX because they want to try an "all natural homeopathic remedy" for their life threatenining GN.

Still I always run the disclaimer that if you want to be a renal academician and go the clinical instructor to professor route for your career, then more power to you and I hope you can publish (not perish) and climb those ranks. It is a very rewarding career if you can make it.

Otherwise for most people who end up in private practice, don't bother with nephrology unless you forego hemodialysis and use nephrology as an add on to your internal medicine practice (see my other threads)

You are putting yourself in a position for others to exploit you simply because starting salaries are so low and groups are faced with declining practice revenue. There’s a lot of shenanigans that are being pulled in private practice that you don’t know about because real world nephrologists don’t come on these forums to share how they were exploited or have dropped out. And even for those who do make partner many will discover they don’t make the same as older partners. Depends on the practice, not all medical directorships are shared equally or the older guys have the dialysis JVs and there are no more new dialysis units opening up. Literally after years of fellowship and getting underpaid, you might find yourself making 300-350k/yr working full time. This is laughable by cards/GI standards and less than a hospitalist on a per hr basis. I’ve seen the majority of my colleagues quit years into private practice when they realized that they were better off just being a hospitalist. Years of wasted earning potential because nobody told them the truth from the start to not waste their time. Who’s gonna tell you the truth? You expect fellowship programs who need fresh meat for scut work tell you to not join them? The fellowship programs will point to earning potential of the top 10% of nephrologists but that’s not realistic with new grads going into private practice today. What I am saying is, if money is important to you, do not waste your time here. Very few will make it worth their time and the average grad will constantly debate themselves whether to jump to hospitalist work or keep doing nephrology.

 

[snoopy89]

Anyone heard from any programs yet?

 

[rokshana]

Anyone heard from any programs yet?

this is last year's thread.