Transplant Nephrology

[nephrondoc]

Hi, I am new member to the forum....i am a PGY2 in typical community program hoping to apply for 2013 match for nephrology.

However, I am hearing all bad remarks about nephrology as a future career option due to dwindling reimbursements. Can someone enlighten me about few question:

1) How much is the starting salary after finishing Nephrology fellowship, assuming that i am willing to go to sub-urban or rural communities? how much is the average pay after 2-3 years after becoming partner ? I heard that nephrologists start with 120k for 2 years. Is it really that low ? Even hospitalists make 180k working half a year with absolutely no call.

2) How difficult is it to get transplant nephrology fellowship after finishing clinical nephrology fellowship ? how much salary do transplant nephrologist start with and what's their pay after 2-3 years?

3) How difficult is it to get a job after nephrology fellowship, if i dont need a visa?

4) What would my chances be to get into good nephrology program? My stats are IMG with scores in 80's with step3 pass, No visa needed, couple of posters, community hospital , with MPH, good LOR's.

Any input would be hugely appreciated,
Thanks.

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[ANCAdoc]

I wouldn't listen to all the doom and gloom. Reimbursements are affecting all specialties. We will see a lot more of bundling in many fields to come as Congress looks to contain medical costs.

As for salary, this is the data I was given from a physician recruiting firm. Do not extrapolate this to starting salaries. It's 2009 data gathered by the Medical Group Management Association:

Mean: $306,882
St Dev: $110,936
25th%: 226,247
Median: 283,226
75th%: 398,678
90th%: 447,500
Providers: 234 representing 67 different practices

I have no official data regarding transplant nephrology but my understanding from some nephrologists is that they actually reimburse a less but many groups will eat the cost and pay you similarly to other nephrologists since there is a need for your expertise.

 

[Nephro2012]

I wouldn't listen to all the doom and gloom. Reimbursements are affecting all specialties. We will see a lot more of bundling in many fields to come as Congress looks to contain medical costs.

As for salary, this is the data I was given from a physician recruiting firm. Do not extrapolate this to starting salaries. It's 2009 data gathered by the Medical Group Management Association:

Mean: $306,882
St Dev: $110,936
25th%: 226,247
Median: 283,226
75th%: 398,678
90th%: 447,500
Providers: 234 representing 67 different practices

I have no official data regarding transplant nephrology but my understanding from some nephrologists is that they actually reimburse a less but many groups will eat the cost and pay you similarly to other nephrologists since there is a need for your expertise.

As far as I know.. these figures are prior to bundling of dialysis! So current figures would be low...

I've had conversations with fresh grads and the usual starting range is typically 160-170 K.. in a private sector!

Academics as expected is LOW (bold as in real LOW) - 100-120 K for starting and may not got beyond 150K from universities... additional income generation can be from grants (which are difficult to come by)..
Harvard for eg. pays 95K to APs- SAD but true.. JHU- ~ 100-110!!

Dont compare this salary with hospitalists! You would never be able to beat 6 months/year 200-240+!! In Nephrology, you have to work long hours- atleast 5 days/week with calls.. with many hospitals to cover- + dialysis centers etc etc. But the better stuff is you don't do the social management!! drugs, and d/c summaries etc!! You just focus on beans and get done!!

So Nephrology is NOW for those who really want to do it!! Not a lucrative fellowship/lifestyle field!

 

[nephrondoc]

Thanks for the replies.....

Some of the new fellows expressed somewhat similar opinion that for 2 years your salary would be 160-170k...then, with partnership, you might make more depending on how many hours you want to work......expect pretty busy schedules, far greater than what hospitalist would do and fewer pay rates per hour

 

[suryapet]

Any more inputs? Even i am interested in nephrology but struggling to decide between hospitalist vs nephrology as a career ?

I am surprised that nephrology forum is so dull unlike other specialties. Is it because there are so few people out there who are interested in nephrology?

 

[Nephro2012]

Any more inputs? Even i am interested in nephrology but struggling to decide between hospitalist vs nephrology as a career ?

I am surprised that nephrology forum is so dull unlike other specialties. Is it because there are so few people out there who are interested in nephrology?

True to an extent as the fellowship match is over! and people are relaxing

As discussed in various threads here- you need to have the passion for the field ..it's not a lucrative or lifestyle field!! Hospitalist's salary and 6 months/year work can't be matched at all by Nephrology given that even the pay would be less than if at all close to Hospitalists!! Remember it would need 2 years min of extra work/toil/sweat..

So, if you wanna have additional qualification, passion for the field, don't wanna do the crap work of social medicine that Hospitalits do.. certainly go for Nephrology..for everything else think, discuss with more people esp. those in the field- old, new, retiring!!

Good luck with your decision!

 

[Jaded]

Any more inputs? Even i am interested in nephrology but struggling to decide between hospitalist vs nephrology as a career ?

I am surprised that nephrology forum is so dull unlike other specialties. Is it because there are so few people out there who are interested in nephrology?

If you have interest for Nephrology, you should do it, because no matter what anyone might say, it is still going to be better for you in the long run. You can always choose to work as an Hospitalist after completing a renal fellowship, but you cannot choose to do Nephrology without going through a fellowship. People say Nephrology is a dying field, and I totally disagree with that, but time will tell. For now, I will advice that you do whatever interest you. You will not regret doing that which sparks your interest. Good luck with your final decision.

 

[nephappl]

I am in my last year currently looking for a position.
My personal experience
Job market prospects are not good at all.
-Starting salaries vary but for a well established, serious group depending on location do not expect more than 170K. In big crowded cities 120K is reasonable
You can get offers for more but it is usually joining solo guys where you are on call almost every single day
-The worst thing is that there are not really many jobs now. With the bundling, health care reform and specially the current economic environment which is very likely to last for several more years the market is in contraction as retiring of physicians who used to be the source of new jobs have dried up as they want to work more years.
-Just an example DaVita one of the biggest dialysis companies has only 40 jobs available this year so if you do the math it is easy to predict there will not be enough jobs for almost 400+ fellows this year.
Just a pearl. There was a job in Wichita Falls TX north of Dallas. They stopped receiving CVs because they got many more they can handle.
-Transplant Nephrology: Not really interested on that but to use your skills you need to be in an academic institution where salaries are low to start. Not sure about jobs availability but if you look at the numbers there are around 50 AST certified Tx Nephrology programs, if each one gets 1 fellow I think is very unlikely there will be 50 new jobs in that field every year to do a something for which most of the time a general nephrologist with interest in transplantation can handle as has been the case for years. We have very good transplant nephrologists here and no one of them spent a single extra day of training in transplantation.
Hope this help.

 

[Jaded]

I am in my last year currently looking for a position.
My personal experience
Job market prospects are not good at all.
-Starting salaries vary but for a well established, serious group depending on location do not expect more than 170K. In big crowded cities 120K is reasonable
You can get offers for more but it is usually joining solo guys where you are on call almost every single day
-The worst thing is that there are not really many jobs now. With the bundling, health care reform and specially the current economic environment which is very likely to last for several more years the market is in contraction as retiring of physicians who used to be the source of new jobs have dried up as they want to work more years.
-Just an example DaVita one of the biggest dialysis companies has only 40 jobs available this year so if you do the math it is easy to predict there will not be enough jobs for almost 400+ fellows this year.
Just a pearl. There was a job in Wichita Falls TX north of Dallas. They stopped receiving CVs because they got many more they can handle.
-Transplant Nephrology: Not really interested on that but to use your skills you need to be in an academic institution where salaries are low to start. Not sure about jobs availability but if you look at the numbers there are around 50 AST certified Tx Nephrology programs, if each one gets 1 fellow I think is very unlikely there will be 50 new jobs in that field every year to do a something for which most of the time a general nephrologist with interest in transplantation can handle as has been the case for years. We have very good transplant nephrologists here and no one of them spent a single extra day of training in transplantation.
Hope this help.

What part of the country are you doing your job search, and when you say people in solo practice offer more, how much is more? Finally, has your job search come to an end or are you still searching? I am just curious, because this is going to apply to me very soon. Thanks for your time.

 

[suryapet]

very scary to hear....I thought of applying for nephrology fellowship for 2013 but considering medicare's recent change of nephrology payments to bundled care and hopeless health care system, i don't think nephrology salaries are ever going to increase and if at all there is anything, its only going to go down because atleast 90% of nephrology payments depends on medicare/medicaid.....for now, i plan to be a hospitalist and enjoy the high salaries while they last.....ofcourse its frustating not being able to go into the field that i like.

 

[Jaded]

very scary to hear....I thought of applying for nephrology fellowship for 2013 but considering medicare's recent change of nephrology payments to bundled care and hopeless health care system, i don't think nephrology salaries are ever going to increase and if at all there is anything, its only going to go down because atleast 90% of nephrology payments depends on medicare/medicaid.....for now, i plan to be a hospitalist and enjoy the high salaries while they last.....ofcourse its frustating not being able to go into the field that i like.

If you really would like to be a nephrologist, I don't think you will be doing yourself any favors by not applying due to recent changes. It is two extra years of your life, but it is definitely worth it, if you use it to learn more about what you really want to do. No matter how you look at it, things always turn around. Just saying.

 

[nephappl]

I looked all over the country, situation does not vary with geography except that it is easier to find a job in isolated , remote undesirable areas.
Have not found any job yet but still looking.
Solo practice can offer more than 200K but you are on call every other weekend, if the guy goes on vacations you will be on for more than 1 month in a row; many of them just want you for some time and then get rid of you and never would get you partnership.
Anytime a practice is offering above average salary, look up and check what you have to do. There is no free lunch.

 

[Jaded]

I looked all over the country, situation does not vary with geography except that it is easier to find a job in isolated , remote undesirable areas.
Have not found any job yet but still looking.
Solo practice can offer more than 200K but you are on call every other weekend, if the guy goes on vacations you will be on for more than 1 month in a row; many of them just want you for some time and then get rid of you and never would get you partnership.
Anytime a practice is offering above average salary, look up and check what you have to do. There is no free lunch.

That's really nice to know. I am really glad that we have a lot of interest for the field of nephrology, and I believe that interest will help us deal with the changes until things are stable again. Good luck with your job search. I hope you get something that fit your need in the end. Keep us updated.

 

[renaldoc2be]

Not sure if anyone is still reading this but let me just add this. I finished my nephrology fellowship in 2011.

1) Job opportunities are plentiful. Now, that being said, if you have ONE particular city in which you want to live, it may be tougher. If you are open, there are plenty of opportunities in cities large and small. I had a certain region of the country I wanted to be in, and I was able to get a great job there. Jobs in the smaller cities/towns will offer higher starting salaries and currently nephrologists in the smaller areas are making $600,000+.

2) As far as salaries go hospitalist vs nephrologist. We work hard, but we are doing things we love. The hospitalists I see may be making lots of money, I don't know, but I do know they are often in the hospital on their days off. I know one told me recently he hasn't had a full weekend off in months...and they are constantly getting called for things. Money may be good, but lifestyle...not so much. Remember it seems the hospitalist jobs are very often not as good as they sound when it comes to days on vs days off.

3) The money is there people. I did not look for jobs in any rural areas. I didn't want to live in a rural setting, and there are plenty of jobs so I didn't need to worry about that. The starting salary range for the jobs I interviewed ranged from 170,000 to 230,000. That was the guarantee, without bonuses (which all the jobs had).

4) The partners in the groups are making in the area of $400,000+ a year. Not interventional cardiology money, but better than hospitalist money.

Bottom line, if you like nephrology there are opportunities. If you HAVE to live in New York City or HAVE to live in San Francisco or HAVE to live in Seattle then you will be limited. My job is fantastic and it is in one of the top 10 largest cities in the US...and it's booming. My clinic was already booked solid for 3 months when I started.

The bundling which is now on applies to the dialysis units, not so much to the physician. Physician services are not included as part of the bundled payment, they are still two pay lines (physician services and dialysis treatment)

Hope this helps!

 

[Jaded]

Not sure if anyone is still reading this but let me just add this. I finished my nephrology fellowship in 2011.

1) Job opportunities are plentiful. Now, that being said, if you have ONE particular city in which you want to live, it may be tougher. If you are open, there are plenty of opportunities in cities large and small. I had a certain region of the country I wanted to be in, and I was able to get a great job there. Jobs in the smaller cities/towns will offer higher starting salaries and currently nephrologists in the smaller areas are making $600,000+.

2) As far as salaries go hospitalist vs nephrologist. We work hard, but we are doing things we love. The hospitalists I see may be making lots of money, I don't know, but I do know they are often in the hospital on their days off. I know one told me recently he hasn't had a full weekend off in months...and they are constantly getting called for things. Money may be good, but lifestyle...not so much. Remember it seems the hospitalist jobs are very often not as good as they sound when it comes to days on vs days off.

3) The money is there people. I did not look for jobs in any rural areas. I didn't want to live in a rural setting, and there are plenty of jobs so I didn't need to worry about that. The starting salary range for the jobs I interviewed ranged from 170,000 to 230,000. That was the guarantee, without bonuses (which all the jobs had).

4) The partners in the groups are making in the area of $400,000+ a year. Not interventional cardiology money, but better than hospitalist money.

Bottom line, if you like nephrology there are opportunities. If you HAVE to live in New York City or HAVE to live in San Francisco or HAVE to live in Seattle then you will be limited. My job is fantastic and it is in one of the top 10 largest cities in the US...and it's booming. My clinic was already booked solid for 3 months when I started.

The bundling which is now on applies to the dialysis units, not so much to the physician. Physician services are not included as part of the bundled payment, they are still two pay lines (physician services and dialysis treatment)

Hope this helps!

Thank for this message. I figured the job market is far better than what is described on this blog. Prior to reading your message, i had just asked a recent graduate of nephrology questions about the job market, and I was told exactly what you just said. Regardless, I am glad I love the field of nephrology.

 

[princebaghdad]

Not sure if anyone is still reading this but let me just add this. I finished my nephrology fellowship in 2011.

1) Job opportunities are plentiful. Now, that being said, if you have ONE particular city in which you want to live, it may be tougher. If you are open, there are plenty of opportunities in cities large and small. I had a certain region of the country I wanted to be in, and I was able to get a great job there. Jobs in the smaller cities/towns will offer higher starting salaries and currently nephrologists in the smaller areas are making $600,000+.

2) As far as salaries go hospitalist vs nephrologist. We work hard, but we are doing things we love. The hospitalists I see may be making lots of money, I don't know, but I do know they are often in the hospital on their days off. I know one told me recently he hasn't had a full weekend off in months...and they are constantly getting called for things. Money may be good, but lifestyle...not so much. Remember it seems the hospitalist jobs are very often not as good as they sound when it comes to days on vs days off.

3) The money is there people. I did not look for jobs in any rural areas. I didn't want to live in a rural setting, and there are plenty of jobs so I didn't need to worry about that. The starting salary range for the jobs I interviewed ranged from 170,000 to 230,000. That was the guarantee, without bonuses (which all the jobs had).

4) The partners in the groups are making in the area of $400,000+ a year. Not interventional cardiology money, but better than hospitalist money.

Bottom line, if you like nephrology there are opportunities. If you HAVE to live in New York City or HAVE to live in San Francisco or HAVE to live in Seattle then you will be limited. My job is fantastic and it is in one of the top 10 largest cities in the US...and it's booming. My clinic was already booked solid for 3 months when I started.

The bundling which is now on applies to the dialysis units, not so much to the physician. Physician services are not included as part of the bundled payment, they are still two pay lines (physician services and dialysis treatment)

Hope this helps!

THanks for the info, this is really helpful and add some light on our future.

 

[nephrondoc]

Can somebody throw some light on the current job market for nephrology, including the call schedule and starting salary ?

If there are any final year nephrology fellows reading this post, can you please tell me what kind of job offers are you getting ? In the current scenario, would you advise to do fellowship or work as hospitalist ?
I knew of atleast one renal fellow who is now interviewing for hospitalist position because of low starting salaries offered in nephrology. Is the job market that bad?

 

[nephrondoc]

no inputs from any kind souls?

 

[nephappl]

Just read prior posts to have an idea.
Not to be repetitive ; not so good.
NA

 

[Nepsap]

For people who are interested in nephrology there is good news and bad news.
The good news is the applicant this year 2012 is 60 percent less and all program are worried if they can fill all the position and the reason and the bad news is the future for nephrology job is the lowest with expected salary way less than hospitalist around 120k-140k with long hours of work which most after finishing nephrology are going back to hospitalsit.for those applying in nephrology please now this fact and currently I am doing Nephro fellowship and very disappointing .