Official 2023-2024 Nephrology, Nephro+crit Fellowship Application Cycle

[NewYorkDoctors]

About

Welcome to NephroPOCUS.com, winner of the 2020 American Society of Nephrology Innovations in Kidney Education award as well as Nathan Hellman Social Media Project of the Year award by NephJC. The p…

nephropocus.com

This is a great POCUS for nephrologist blog/website.

More and more academic nephrology programs are beginning to add faculty who are trained in POCUS (if not necessarily board certified - which no such BC exists outside of the ICU advanced critical care echo certification by the ASE which also includes lung U/S as well asthe Emory course and ASDIN BC - but you do not need BC to do POCUS - you just should not bill for it and write formal reports unless you are BC) which is a boon

I would suggest that any renal applicant to make it a point to ask about their POCUS curriculum and rank a place higher accordingly.

with $2000 butterfly IQ ultrasounds (which is more than enough for renal purposes) on the market that ANYONE with an NPI can buy, you can literally ask for an educational stipend to buy your own ultrasound. this company also has a HIPAA secure cloud platform to save images to share on rounds. of course hospitals have their own compliance departments so run that by them to prevenet getting in trouble

POCUS is an absolutely crucial skilll for the "harder nephrology cases."
The "old fashioned way" was to get daily standing weights (lol yeah right in the hospital on the wards), do a personalized edema evaluation day by day, see the BP trends (which can be confounded), and maybe do orthostatics every day.....
yeah no. just do POCUS to get your volume assessment.
at the very least you will never give fluids to a cardiorenal patient who happens to have a low FENA but all the edema is in the sacral region and that patinet was unable to sit up for you for an edema examination and whose legs look deceptively normal and who does not have rales because the patient is not able to take deep inspirations... or even sit up for that matter

but the only excuse these days for a renal program not having a POCUS curriculum are older attendings who do not know how to do it themselves. but with young faculty who learned from MICU in IM first then attended more courses and became proficient themselves, this would be a great and welcome addition to a Nephrology fellowship program

for any older fossil attending who say "back in my day we did a physical exam..."

yeah bull**** back then no one was as obese as they are now.

if someone is a thin emaciated cirrhotic, ascites is easy. a med student reading Bates physical exam will figure it out

if someone is BMI 40 at baseline, how exactly are you going to get a palpable fluid wave or see neck vein distension with an OSA > 18 inch neck?

---

Members don't see this ad.

 

[humbertodiaz93]

Hello again everyone. What are your opinions on Loyola vs Rush in Chicago area? Which one do you guys think is better and why?

 

[MEGA-Rayquaza]

Hello again everyone. What are your opinions on Loyola vs Rush in Chicago area? Which one do you guys think is better and why?

Hello. I would rank Rush above (resources, research, name, post training options), but Loyola is cushier (Rush is one of the hardest working programs of Chicago by far). Source: Im a resident in the Chicago area.

 

[NickiMe]

So let's be real..are there actually any well-balanced programs out there? Strong academic reputation with multiple diverse opportunities but don't work their fellows to the bone? What I've gathered so far is a lot of the smaller programs have less volume but more call and less opportunities but the well-known hospital programs have large censuses and lots of research requirements even if the opportunities and flexibility is better. Just not really sure how to approach ranking at this point. Any advice?

 

[deleted1164820]

So let's be real..are there actually any well-balanced programs out there? Strong academic reputation with multiple diverse opportunities but don't work their fellows to the bone? What I've gathered so far is a lot of the smaller programs have less volume but more call and less opportunities but the well-known hospital programs have large censuses and lots of research requirements even if the opportunities and flexibility is better. Just not really sure how to approach ranking at this point. Any advice?

you just have to pick your poison. There is definitely no one good solution to all.

 

[NewYorkDoctors]

So let's be real..are there actually any well-balanced programs out there? Strong academic reputation with multiple diverse opportunities but don't work their fellows to the bone? What I've gathered so far is a lot of the smaller programs have less volume but more call and less opportunities but the well-known hospital programs have large censuses and lots of research requirements even if the opportunities and flexibility is better. Just not really sure how to approach ranking at this point. Any advice?

my take is you want to be busy in fellowship so you can be prepared for the larger censuses as an attending.

but if you are going to work that hard, you'd better be seeing the coolest and rares cases out there. you want to be seeing IgA nephropathy, Class 3/4/5 LN, Anti GBM disease, post renal transplant FSGS, ADPKD on tolvaptan, cystine stones in clinic and want to be doing CRRT + ECMO in the CTICU, managing collapsing FSGS acutely, managing the pulm renal syndromes (which renal usually takes the lead on rather than pulmonary. pulmonary does a BAL to confirm DAH and then calls it a day usually) acutely, doing ACUTE HD and CRRT in MICU and helping to make a difference, using lasix drips and aquapheresis in select cardiorenal patients, etc...
going to any of the top academic progrmas out there will ensure you have this wide selection of pathologies. you'll never be bored when you have a great variety of cases to manage.

if you were scutted out seeing nonstop missed HDs and cheap AKIs, they avoid that program. that's usually the bottom barrel programs

 

[Nephrololo]

Hi all, just wanted to see if I can get some help in ranking:

JHH/Weill Cornell/ Cleveland/Tufts/University of Chicago/Layola/UCLA/Washington St Louis.

(above is the none ranked list)

they all offer great opportunities but it is difficult to decide and would really appreciate people's experience as the way I would rank would depend on how many fellows, night calls, and transplant potentials, yet most of them (except for Tufts) offer transplant so it becomes difficult to choose.

 

[deleted1164820]

Did anyone interview at Westchester Medical center,NY ? Does anyone want to give an opinion of this program. Like Pros and cons

 

[kappa1337]

What are everyone's thoughts on UCLA vs USC vs UC San Diego?
Having difficulty ranking these 3, all good programs.

 

[deleted1164820]

Fellows & Alumni - Brigham and Women's Hospital/Massachusetts General Hospital Joint Nephrology Fellowship Program

Current Fellows | Outcomes | Alumni Map | Distinguished Alumni YIP 1 Medical School University of the East Ramon Magsaysay Memorial Medical Center Residency University of CT Health Center Medical School Chulalongkorn University Residency Mount Auburn Hospital Medical School Poznan...

www.bwhmghnephrologyfellowship.org

I see that there are several candidates at Brigam's who did not do US residency but they managed to secure a spot. When I do look at the NRMP match data all the positions are filled in mtach and no empty spots. Are Non-US residency candidates allowed to participate in fellowship match?

 

[cassis_Cake]

Fellows & Alumni - Brigham and Women's Hospital/Massachusetts General Hospital Joint Nephrology Fellowship Program

Current Fellows | Outcomes | Alumni Map | Distinguished Alumni YIP 1 Medical School University of the East Ramon Magsaysay Memorial Medical Center Residency University of CT Health Center Medical School Chulalongkorn University Residency Mount Auburn Hospital Medical School Poznan...

www.bwhmghnephrologyfellowship.org

I see that there are several candidates at Brigam's who did not do US residency but they managed to secure a spot. When I do look at the NRMP match data all the positions are filled in mtach and no empty spots. Are Non-US residency candidates allowed to participate in fellowship match?

Yes they are and it’s very common

 

[NewYorkDoctors]

Fellows & Alumni - Brigham and Women's Hospital/Massachusetts General Hospital Joint Nephrology Fellowship Program

Current Fellows | Outcomes | Alumni Map | Distinguished Alumni YIP 1 Medical School University of the East Ramon Magsaysay Memorial Medical Center Residency University of CT Health Center Medical School Chulalongkorn University Residency Mount Auburn Hospital Medical School Poznan...

www.bwhmghnephrologyfellowship.org

I see that there are several candidates at Brigam's who did not do US residency but they managed to secure a spot. When I do look at the NRMP match data all the positions are filled in mtach and no empty spots. Are Non-US residency candidates allowed to participate in fellowship match?

These doctors are usually the ones who “want advanced training and a degree to bring back to their home country .” Happens all the time and these are bright minds from their countries.

Anyway FMG who did US IM residency is usually planning to stay in the US and is less likely to be “returning to home country .” Never say never but let’s be real now

 

[deleted1164820]

These doctors are usually the ones who “want advanced training and a degree to bring back to their home country .” Happens all the time and these are bright minds from their countries.

Anyway FMG who did US IM residency is usually planning to stay in the US and is less likely to be “returning to home country .” Never say never but let’s be real now

I thought harvard did not have to fill their spots like this. If it was some low level, middle of nowhere program I get it, but seeing Harvard at this level is new low feeling for me for General nephrology.

 

[CRRT]

Yes they are and it’s very common

Cannot practice in US independently without a US or Canadian residency.

 

[NickiMe]

Good luck to everyone that submitted their rank list! T-minus 2 weeks

 

[NewYorkDoctors]

Congratulations to all who matched to their top choices. You will have an excellent fellowship and training at your top academic medical institution.

 

[NickiMe]

Thanks! Looking forward getting through this training with all you newly matched soon-to-be fellows!

 

[deleted1164820]

Thanks everyone. I did match in my top 3 choice of the ranking list. Virtual help has been very useful!. Appreciate it.

 

[NewYorkDoctors]

despite all the doom and gloom, Nephrology is a rewarding career for those who are:
1) fully bought into it and got into your top choice of academically oriented tertiary care center nephrology program.
those who did not match into PCCM or cardiology should NOT take a scramble spot
2) stay in academics
3) avoid practice practice meatgrinder unless you happen to be the boss of said private practice and get your own HD panel

we need all the academically oriented nephrologists out there

we don't need to support the bottom barrel non academic fellowship programs out there just because they want cheap labor. those fellows who graduate do not get academic job offers and end up slaving away cursing their lot

 

[CptNemo]

despite all the doom and gloom, Nephrology is a rewarding career for those who are:
1) fully bought into it and got into your top choice of academically oriented tertiary care center nephrology program.
those who did not match into PCCM or cardiology should NOT take a scramble spot
2) stay in academics
3) avoid practice practice meatgrinder unless you happen to be the boss of said private practice and get your own HD panel

we need all the academically oriented nephrologists out there

we don't need to support the bottom barrel non academic fellowship programs out there just because they want cheap labor. those fellows who graduate do not get academic job offers and end up slaving away cursing their lot

Congrats to all who matched!
I generally agree with the above advice, but a few things to keep in mind:
Academic jobs are not a chill as they used to be >=10 years ago.
-Research funding is harder to get.
-A lot of programs have expanded their clinical scope, but have not expanded the amount of fellows they have.
-Programs are much nicer to fellows than they used to be, so don't expect that fellows will do all of your work

While there are still great applicants to nephrology, the field is not very deep. Thus, there is lots of competition among top programs for top fellows. A lot of programs have had to readjust things to be more attractive to fellows. You do not want to be labelled as the tough "malignant" program.
-Generally less call plus night float systems
-More non-teach attending only services/clinics/dialysis rounding
-Protected learning time
-Salaries are pretty good. For example, UCSF pays $96,207 base (plus gives various stipends on top of that, so that a first year fellow can net $100K without moonlighting. Granted, in SF, that basically allows you to afford to rent a 100 sq ft studio, but that's another story.

The corollary of all this is that junior faculty members have to pick up some of that slack - so they end up working more clinical hours. Which then makes it hard to have time for research, etc.

Also, let's say that your program has 6 slots. I don't care who you are - you will not have 6 superstar fellows. You'll probably have 1-2 fellows who are terrific and will make your life much easier. Then 2-3 fellows who are pretty good and make your life somewhat easier. Then you may have ~1 fellow who just slows you down, causes confusion by poor communication with other teams, calls you at all hours of the day to discuss very basic things for the 100th time - and will make you wish that you were on a non-teach service instead

 

[deleted1164820]

Thank you so much guys. I am sure 99% of everyone in the thread who applied for nephrology matched to at least general nephrology if not critical care. The purpose of the thread is kind of served mostly.

Moving on to the next step, i am looking for some advice on what materials(online, book, guidelines) you read before or during the fellowship to equip yourself.

I know there is renalfellow.org. Anything else you guys would suggest?

 

[NewYorkDoctors]

Thank you so much guys. I am sure 99% of everyone in the thread who applied for nephrology matched to at least general nephrology if not critical care. The purpose of the thread is kind of served mostly.

Moving on to the next step, i am looking for some advice on what materials(online, book, guidelines) you read before or during the fellowship to equip yourself.

I know there is renalfellow.org. Anything else you guys would suggest?

i picked up Pocket Nephrology edited by the Dr Wooin Ahn and Jai Radhakrishnan from CUMC. I wish I had this in renal fellowship

but for actual learning I acutally did NEPHsap and KSAP. While some say that's more for attendings and board exam... my personal mantra has always been... you cant review what you never learned before.

I had a Johnson Feelhally and Floege clinical comprehensive nephrology but that was more for the figures and tables

i recall the Wash U renal path series on youtube was pretty good

 

[NickiMe]

Matched my top program in my home city so thankful, now hoping the next 2-3 years will be most of what I hoped for lol looking forward to having y'all as my colleagues

 

[Ab618]

Hi all,
Is it possible to accept an offer which in close to your city, once we have signed a contract for another program and onboarding has started for July 20/3?
Any guidance would be appreciated.

 

[void88]

A lot of the interviews are going to boil down to the same questions:

The general question types were: nephrology-specific, generic behavioral, favorite cases, and random.

-What made you interested in Nephrology?
-Where do you anticipate ending up as a nephrologist?
-What makes you a good candidate and fit for the (blank) program? Why apply here?
-What difficulties do you anticipate as a fellow?
-Tell me about yourself.
-What are your strengths/weaknesses?
-Some questions about research or something on your CV. If it's on your CV, you must be prepared to talk about it for >2 minutes.
-Tell me about a case that you found exciting and what you learned from it.
-Tell me about a case where you made a mistake.
-What do you do in your free time?
-What accomplishment are you most proud of?
-How do you deal with conflict? Possibly will be asked about an example as well. There will be several variations of behavioral questions that will come up. There are many examples all over the internet.
-If you weren’t a doctor, what would you have been?

If I remember correctly, U Wisconsin had a very generic interview where everyone was asked the same questions and it was honestly offputting to me. I enjoyed the interviews where it just felt like a discussion showing interest both ways. In some places, it felt like the interviewer just picked my CV off of the table and started reading it out loud then asked questions about it. My favorite interviews were spent talking about my dogs, hobbies outside of work, and common interests. Hell, the place I ended up matching, I talked with one of the interviewers for 30 minutes about espresso.

These interviews are long, think a 4-6 hour time commitment for everything including welcomes and Q&As. Some places had three 20-minute interviews, one had six 30-minute interviews.

It still feels like yesterday that I was going through this process and it's hard to believe a year has passed already. I'm excited for y'all.

One of the most important things you can do for yourself is to have an exhaustive list of questions ready to go to ask and fill out for each program. I'll just paste them directly from my spreadsheet.

# of vacation days

Night coverage system? How many times average called in per night? Are attendings available at night?

Is there a clear delineation of call being for emergency only or are you expected to see routine consults too? Are you expected to see ESRD face-to-face overnight?

Which EMR is used? How many hospitals do fellows cover? How far apart are they?

Food and parking situations

Who does the vascaths? Is there an option for a procedural team to place it?

Have any fellows left the program in the last 2 years? If so why?

Have you retained any residents from the parent IM program in the last 2 years?

Is there any onsite pathologist with training in renal path? Are they read in-house or sent out? Do fellows and faculty review biopsies with pathologists? How quickly are they available?

Are NPs/PAs used? What is the responsibilities/relationship of the fellows to these providers?

Are there simulation experiences?

Is there protected time for fellows to attend lectures?

What do fellows typically do after graduation and where do they go?

How does the program prepare fellows for the business aspects of nephro including private practice, academics, and medical directorship?

How many HD, PD, NHD, and Home Hemo patients are under the care of the program? Do fellows follow their cohort of chronic dialysis patients?

How many transplants per year?

How many kidney biopsies are performed in native and transplants by fellows by the end of two years?

How many vascaths are placed during day/week/month/year? What is the supervision like? How is competency determined?

What is the ICU service like? How much CRRT experience?

What is the experience with urinalysis interpretation, renal ultrasound, and pathology?

What is the outpatient continuity clinic like? Do fellows have the primary responsibility for these patients? What kind of patients are seen? How many patients are seen in a half day? What is the supervision like?

Is there experience with kidney disease in pregnancy, children transitioning to adulthood, advanced cancers, or nephrotoxic immunotherapies?

How many general nephro clinics are there besides the fellow continuity clinics? What is the ratio of faculty to fellows in these clinics?

Are there specialty clinics within the programs? Complex hypertension, GN/SLE/renal vasculitis, stones, PCKD?

What experience is there with plasmapheresis?

Any renal palliative care didactic?

Is there a research requirement? What are the expectations?

What are the quality improvement expectations for fellows?

What do fellows typically do after graduation and where do they go?

That is awful a lot of questions for specialty that is dying for fellows.

 

[NewYorkDoctors]

That is awful a lot of questions for specialty that is dying for fellows.

Academic nephrology Is still a decent career . Doesn’t pay the best but you get all the best parts of it with less hot garbage (fellows to do night calls )