Quantcast

USC Nephrology Fellowship FYI/Questions to Ask on Your Interviews

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

2020Zonal

New Member
Joined
Jul 12, 2020
Messages
1
Reaction score
0

Members don't see this ad.
Hello anyone interested in nephrology fellowship. Welcome!

The objective of this thread is to give a real insight into program so if you do consider it you know what you are getting. Also to provide you with the types of questions I wish I knew to ask on my fellowship interviews.

USC:

Pros:
There is a night float system that means you do not need to be on call as much as traditional call system.
Night float is a home call but see below.
There are some good attendings but see below.
The pathologist are wonderful and great teachers.
There are NPs/PAs but see below.
The transplant service support staff is amazing.
There is a good breadth of patients due to high volume.
The fellows work well together.

Cons:
Great attendings are leaving the program or being forced into retirement. The quality of teaching is going down. Teaching is getting pushed off onto the fellows, ie fellows teaching fellows.
Night float is a home call but in reality you will need to come in multiple times a night.
Night float also means that for the two week blocks of nights (1.5-2 months) you with routinely have more than 30 pages, and sometimes up to 10 consults between 3 hospitals and cross cover sometimes more than 100 patients. There is a Sunday night call that is 20 hours long. There is no help on night float.
Nephrology is primary on transplant patient which means surprise transplant middle of the night admissions, surprise transplants. The communication is poor and the fellow is often unaware of incoming transfers/admissions until they arrive at 3 AM. Night float is an extension of the transplant service in reality.
Fellow burn out scores were very high. There are wellness gestures (gifts, meals) but overall fellow wellness is poor.
There is no progressive autonomy. If you are a student that is returning from practice especially this will be extremely difficult. One such fellow quit in the last few years (he was a hospitalists and left during the first year).
There are multiple attendings that are not skilled clinicians and do not contribute to your growth or learning.
The NP/PAs are designed to help the fellows but get preferential treatment (as employees): more days off, less responsibility and readily transfer said responsibility to the fellows. Fellows have routinely had to cover the NP/PAs on days off, vacation, meetings from their lighter rotations.
The 2020 start year of 4 USC residents were interested in nephrology, none selected USC as their fellowship.
The 2020 start year also included 2 family members of a former fellow, neither selected USC as their fellowship.

Questions to ask of any program:
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?
What is the call system like? What are the expectations of the person on call? Ie is there 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? (In practice you would never see routine consults overnight.)
Who can consent the patient? (In practice the RN would consent the patient. Some fellowships force the fellow only to obtain consents which makes everything much more difficult.) Do ESRD patients need new consents? (They should not.)
What is fellow wellness like? Are there objective measures of wellness (ie burn out scores obtained routinely)?
What types of electives or learning enhancements are available? (Any program will have holes in education and you need to know how to you fill those gaps and if the program is supportive of you trying to learn more than it can provide meaning conferences and outside electives.)
Can I reach out to all the fellows to ask questions? (If a program only allows you to speak to a few select fellows be suspicious, especially if that is only the junior fellows. They are probably hiding something if they do not let you talk to every fellow if asked.)

Those should be some red flag questions to ask. Do not be afraid to ask them. Remember, they need you more than you need them. Two years can feel like eternity in the wrong program with a bad culture. Also trust your gut, if a place feels like everyone is miserable and putting on a good show to lure you in, they probably are. Also know that there are programs that are not toxic and nurturing; you just need to know how to find them.

Good luck and hopefully you have a great experience in fellowship!
 

blue.jay

Full Member
7+ Year Member
Joined
Feb 5, 2014
Messages
340
Reaction score
397
Cons >>>>>>>>>>>>> Pros

If they are coddling their NP/PA why don't these places close their program and make these midlevels nephrologists ? Lets watch them fry all those transplant kidneys with their advanced practice midlevel medicine.
Academic medicine just sounds much worse than American prisons.
 
  • Like
Reactions: 1 user

aafisahar

Full Member
5+ Year Member
Joined
Oct 22, 2015
Messages
663
Reaction score
1,088
Cons >>>>>>>>>>>>> Pros

If they are coddling their NP/PA why don't these places close their program and make these midlevels nephrologists ? Lets watch them fry all those transplant kidneys with their advanced practice midlevel medicine.
Academic medicine just sounds much worse than American prisons.

Nephrology is in a slow motion death spiral. Not enough trainees - > attendings get overworked - > abuse current trainees more - > fellows quit or don't practice Nephrology one they are done, rinse and repeat.

Boils down to pay. Why be a nephrologist who works harder and makes less money then a hospitalist? At least with other lucrative specialties, your hardwork is paid with money. In renal, you just get more work.
 
  • Like
Reactions: 1 user

Renal_Prometheus

Full Member
2+ Year Member
Joined
Aug 11, 2018
Messages
444
Reaction score
491
Nephrology is in a slow motion death spiral. Not enough trainees - > attendings get overworked - > abuse current trainees more - > fellows quit or don't practice Nephrology one they are done, rinse and repeat.

Boils down to pay. Why be a nephrologist who works harder and makes less money then a hospitalist? At least with other lucrative specialties, your hardwork is paid with money. In renal, you just get more work.


sounds like you've been around the block. Some people are desperate to get anything, and so grab onto nephrology in the hopes of it working out
 

Cous7985

New Member
Joined
Oct 26, 2020
Messages
2
Reaction score
0
Hello anyone interested in nephrology fellowship. Welcome!

The objective of this thread is to give a real insight into program so if you do consider it you know what you are getting. Also to provide you with the types of questions I wish I knew to ask on my fellowship interviews.

USC:

Pros:
There is a night float system that means you do not need to be on call as much as traditional call system.
Night float is a home call but see below.
There are some good attendings but see below.
The pathologist are wonderful and great teachers.
There are NPs/PAs but see below.
The transplant service support staff is amazing.
There is a good breadth of patients due to high volume.
The fellows work well together.

Cons:
Great attendings are leaving the program or being forced into retirement. The quality of teaching is going down. Teaching is getting pushed off onto the fellows, ie fellows teaching fellows.
Night float is a home call but in reality you will need to come in multiple times a night.
Night float also means that for the two week blocks of nights (1.5-2 months) you with routinely have more than 30 pages, and sometimes up to 10 consults between 3 hospitals and cross cover sometimes more than 100 patients. There is a Sunday night call that is 20 hours long. There is no help on night float.
Nephrology is primary on transplant patient which means surprise transplant middle of the night admissions, surprise transplants. The communication is poor and the fellow is often unaware of incoming transfers/admissions until they arrive at 3 AM. Night float is an extension of the transplant service in reality.
Fellow burn out scores were very high. There are wellness gestures (gifts, meals) but overall fellow wellness is poor.
There is no progressive autonomy. If you are a student that is returning from practice especially this will be extremely difficult. One such fellow quit in the last few years (he was a hospitalists and left during the first year).
There are multiple attendings that are not skilled clinicians and do not contribute to your growth or learning.
The NP/PAs are designed to help the fellows but get preferential treatment (as employees): more days off, less responsibility and readily transfer said responsibility to the fellows. Fellows have routinely had to cover the NP/PAs on days off, vacation, meetings from their lighter rotations.
The 2020 start year of 4 USC residents were interested in nephrology, none selected USC as their fellowship.
The 2020 start year also included 2 family members of a former fellow, neither selected USC as their fellowship.

Questions to ask of any program:
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?
What is the call system like? What are the expectations of the person on call? Ie is there 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? (In practice you would never see routine consults overnight.)
Who can consent the patient? (In practice the RN would consent the patient. Some fellowships force the fellow only to obtain consents which makes everything much more difficult.) Do ESRD patients need new consents? (They should not.)
What is fellow wellness like? Are there objective measures of wellness (ie burn out scores obtained routinely)?
What types of electives or learning enhancements are available? (Any program will have holes in education and you need to know how to you fill those gaps and if the program is supportive of you trying to learn more than it can provide meaning conferences and outside electives.)
Can I reach out to all the fellows to ask questions? (If a program only allows you to speak to a few select fellows be suspicious, especially if that is only the junior fellows. They are probably hiding something if they do not let you talk to every fellow if asked.)

Those should be some red flag questions to ask. Do not be afraid to ask them. Remember, they need you more than you need them. Two years can feel like eternity in the wrong program with a bad culture. Also trust your gut, if a place feels like everyone is miserable and putting on a good show to lure you in, they probably are. Also know that there are programs that are not toxic and nurturing; you just need to know how to find them.

Good luck and hopefully you have a great experience in fellowship!
Any way I can give you a DM? I've got some questions.
 

YeOleBoneWiz

Membership Revoked
Removed
Joined
Apr 10, 2020
Messages
88
Reaction score
235
Hello anyone interested in nephrology fellowship. Welcome!

The objective of this thread is to give a real insight into program so if you do consider it you know what you are getting. Also to provide you with the types of questions I wish I knew to ask on my fellowship interviews.

USC:

Pros:
There is a night float system that means you do not need to be on call as much as traditional call system.
Night float is a home call but see below.
There are some good attendings but see below.
The pathologist are wonderful and great teachers.
There are NPs/PAs but see below.
The transplant service support staff is amazing.
There is a good breadth of patients due to high volume.
The fellows work well together.

Cons:
Great attendings are leaving the program or being forced into retirement. The quality of teaching is going down. Teaching is getting pushed off onto the fellows, ie fellows teaching fellows.
Night float is a home call but in reality you will need to come in multiple times a night.
Night float also means that for the two week blocks of nights (1.5-2 months) you with routinely have more than 30 pages, and sometimes up to 10 consults between 3 hospitals and cross cover sometimes more than 100 patients. There is a Sunday night call that is 20 hours long. There is no help on night float.
Nephrology is primary on transplant patient which means surprise transplant middle of the night admissions, surprise transplants. The communication is poor and the fellow is often unaware of incoming transfers/admissions until they arrive at 3 AM. Night float is an extension of the transplant service in reality.
Fellow burn out scores were very high. There are wellness gestures (gifts, meals) but overall fellow wellness is poor.
There is no progressive autonomy. If you are a student that is returning from practice especially this will be extremely difficult. One such fellow quit in the last few years (he was a hospitalists and left during the first year).
There are multiple attendings that are not skilled clinicians and do not contribute to your growth or learning.
The NP/PAs are designed to help the fellows but get preferential treatment (as employees): more days off, less responsibility and readily transfer said responsibility to the fellows. Fellows have routinely had to cover the NP/PAs on days off, vacation, meetings from their lighter rotations.
The 2020 start year of 4 USC residents were interested in nephrology, none selected USC as their fellowship.
The 2020 start year also included 2 family members of a former fellow, neither selected USC as their fellowship.

Questions to ask of any program:
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?
What is the call system like? What are the expectations of the person on call? Ie is there 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? (In practice you would never see routine consults overnight.)
Who can consent the patient? (In practice the RN would consent the patient. Some fellowships force the fellow only to obtain consents which makes everything much more difficult.) Do ESRD patients need new consents? (They should not.)
What is fellow wellness like? Are there objective measures of wellness (ie burn out scores obtained routinely)?
What types of electives or learning enhancements are available? (Any program will have holes in education and you need to know how to you fill those gaps and if the program is supportive of you trying to learn more than it can provide meaning conferences and outside electives.)
Can I reach out to all the fellows to ask questions? (If a program only allows you to speak to a few select fellows be suspicious, especially if that is only the junior fellows. They are probably hiding something if they do not let you talk to every fellow if asked.)

Those should be some red flag questions to ask. Do not be afraid to ask them. Remember, they need you more than you need them. Two years can feel like eternity in the wrong program with a bad culture. Also trust your gut, if a place feels like everyone is miserable and putting on a good show to lure you in, they probably are. Also know that there are programs that are not toxic and nurturing; you just need to know how to find them.

Good luck and hopefully you have a great experience in fellowship!


Might consider it for 450K per year. do you all do negotiations?
 

Chemist0157

Full Member
Lifetime Donor
15+ Year Member
Joined
Aug 1, 2007
Messages
7,831
Reaction score
3,618
That all sounds quite bad.

Fellows should not be seriously burdened by training others.
Night float would probably not be that bad typically if I am reading it right where you do night shifts for a couple of weeks. There should be time to do a bunch of consults and answer pages (though what is getting paged so much to the fellow at night?). Having to go between hospitals with unlucky string of consults would be rough.
Fellow burn out is bad.
Preferential treatment of NPs/PAs is bad.
Nobody wanting to stay there for nephrology is bad.

Programs should be reading the writing on the wall for the past few years. The better programs have been smart about it while others have imploded. It's a buyer's market so they have to make adjustments. Programs can 1) have attendings take on more work (unlikely!), 2) hire PAs/NPs, 3) or perhaps shift to more clinical work (many programs may have second year fellows do months and month of research time that may not be clinically relevant).

Once a program throws up red flags, it's over. The program collapses because nobody wants to be the 1-2 strung out fellows for the year. They have to make adjustments. For example, my home program got ahead of this thing and hired a couple of PAs to offset any potential holes. It is important to note that the PAs are at the service of the nephrology department. Think they take some call or evening call up to midnight or something like that. I think they failed to fill a spot for the first time in 2018, but it was not that big of a deal, and because they could show applicants there was a safety net, they have had no trouble filling for the last couple of years.

Survival of the fittest I guess. The applicants numbers have been steady for years with a steady number of spots that never fill. Might as well adjust to that reality.
 

Cous7985

New Member
Joined
Oct 26, 2020
Messages
2
Reaction score
0
I had a more favorable impression during my virtual interview there so I was curious.
 

Renal_Prometheus

Full Member
2+ Year Member
Joined
Aug 11, 2018
Messages
444
Reaction score
491
I had a more favorable impression during my virtual interview there so I was curious.

It's a failing specialty, if you haven't figured it out by now. If you don't mind me asking: do you really want to get into this mess just to be a specialist in something?
 
Top