Baylor College of Medicine Nephrology

[Lima-Beans]

Hi all
I am a current fellow in the nephrology program at Baylor college of medicine in Houston Texas (BCM). Wanted to share my experience, our program is completely blind to our requests, I am hoping this negative post will have some effect for change, but probably not. Firstly, the fellows have to cover 6 different hospitals. They will tell you this is a plus because you experience different practice environments. The truth is you quickly learn to adopt to whatever environment you choose to work in after you graduate. You don't need 2 years of grueling scut work to have this "exposure." You do not have protected didactics time, we brought this up and the PD threatened to hold all didactics after 5pm, putting it on us to stay after hours so that we can literally learn how to be nephrologists, instead of having the attendings cover the pager once or a couple times per week for one hour. You will come home exhausted EVERY day, you will not feel like reading or hearing anything medicine related. You do not have easy rotations. We have two so called "easy" blocks where we have busy outpatient clinic obligations with 1-2 days of self-study. Even then, you have to document everything you do and for how long so that the PD knows exactly what you are doing. In addition, on this so called "easy" block you will have 1 week of night float plus you will inevitably get pulled to cover random inpatient days. When one of your cofellows is on vacation there will be one fellow who covers both services with two different attendings. This is a huge nightmare. When you decide to take your week long vacation you yourself have to find clinic coverage amongst your cofellows!! On weekends you cover multiple hospitals with different attendings, another huge nightmare. Also on Saturday's you don't have night float coverage so even though you come in to see consults at night, you do not have a post call day on Sunday. It's business as usual with a full census and no help from the attendings. On night float you cover 6 very busy hospitals. We are supposed to see only sick patients but the attendings are always complaining about how we don't go in at night to see randon non urgent consults, we have been warned in the past with having night float taken away if we don't go see these patients. Of coarse the attendings are at home, not once have I seen any of them come in on a night call. Second year is no different from first year. You will NOT have a break for two years straight. Electives do not exist. Easy slow blocks do not exist. The program is of very poor quality because of these things. Last batch of fellows ALL FAILED BOARDS except for one!! The program is currently cited by our GME office due to the poor results on the ACGME survey and everyone is now prepared for an official ACGME citation. The fellows are depressed and unhappy. Two fellows quit recently and all have at least thought about it. The thing that our PD does not get is that we are learners, not full fledged nephrologists. We need time to read interesting articles, books etc in order to pick up on the fine details of our craft. We feel let down by our program in many regards, so please, think twice before you decide to come here..

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[Chemist0157]

Sorry to hear that. That sounds brutal. I would expect better from Baylor. Posting here probably won’t make any difference, but fellows quitting and failing tests will. Or the program will just implode. Word gets out about this kind of quickly, and the few upcoming applicants will go somewhere else.

 

[dozitgetchahi]

Sounds like a good old fashioned abusive GME ****show. Sorry to hear you’re going through this. I’m quoting it because you know it’s gonna get pulled down by OP before long.

Hi all
I am a current fellow in the nephrology program at Baylor college of medicine in Houston Texas (BCM). Wanted to share my experience, our program is completely blind to our requests, I am hoping this negative post will have some effect for change, but probably not. Firstly, the fellows have to cover 6 different hospitals. They will tell you this is a plus because you experience different practice environments. The truth is you quickly learn to adopt to whatever environment you choose to work in after you graduate. You don't need 2 years of grueling scut work to have this "exposure." You do not have protected didactics time, we brought this up and the PD threatened to hold all didactics after 5pm, putting it on us to stay after hours so that we can literally learn how to be nephrologists, instead of having the attendings cover the pager once or a couple times per week for one hour. You will come home exhausted EVERY day, you will not feel like reading or hearing anything medicine related. You do not have easy rotations. We have two so called "easy" blocks where we have busy outpatient clinic obligations with 1-2 days of self-study. Even then, you have to document everything you do and for how long so that the PD knows exactly what you are doing. In addition, on this so called "easy" block you will have 1 week of night float plus you will inevitably get pulled to cover random inpatient days. When one of your cofellows is on vacation there will be one fellow who covers both services with two different attendings. This is a huge nightmare. When you decide to take your week long vacation you yourself have to find clinic coverage amongst your cofellows!! On weekends you cover multiple hospitals with different attendings, another huge nightmare. Also on Saturday's you don't have night float coverage so even though you come in to see consults at night, you do not have a post call day on Sunday. It's business as usual with a full census and no help from the attendings. On night float you cover 6 very busy hospitals. We are supposed to see only sick patients but the attendings are always complaining about how we don't go in at night to see randon non urgent consults, we have been warned in the past with having night float taken away if we don't go see these patients. Of coarse the attendings are at home, not once have I seen any of them come in on a night call. Second year is no different from first year. You will NOT have a break for two years straight. Electives do not exist. Easy slow blocks do not exist. The program is of very poor quality because of these things. Last batch of fellows ALL FAILED BOARDS except for one!! The program is currently cited by our GME office due to the poor results on the ACGME survey and everyone is now prepared for an official ACGME citation. The fellows are depressed and unhappy. Two fellows quit recently and all have at least thought about it. The thing that our PD does not get is that we are learners, not full fledged nephrologists. We need time to read interesting articles, books etc in order to pick up on the fine details of our craft. We feel let down by our program in many regards, so please, think twice before you decide to come here.

 

[Kaustikos]

Tbt; I get a chuckle when programs boast about having multiple training sites.
"Increased variety of patients"
"Better experiences"
"Variety"
All I've seen is -
More commute
More commute
Different EMR
More passwords
Same patients
More stress

No thanks.
Sorry OP

 

[NewYorkDoctors]

In real life you could potentially work this hard in private practice … and can make well over a million dollars if you own the practice .

But nope these parasitic “academicians” want you to help make the hospital some more money or else the attending shave to “shock” pull their own weight .

Sad

It’s not like these academic attendings you have are putting out any meaningful research

Double sad

 

[Renal_Prometheus]

Hi all
I am a current fellow in the nephrology program at Baylor college of medicine in Houston Texas (BCM). Wanted to share my experience, our program is completely blind to our requests, I am hoping this negative post will have some effect for change, but probably not. Firstly, the fellows have to cover 6 different hospitals. They will tell you this is a plus because you experience different practice environments. The truth is you quickly learn to adopt to whatever environment you choose to work in after you graduate. You don't need 2 years of grueling scut work to have this "exposure." You do not have protected didactics time, we brought this up and the PD threatened to hold all didactics after 5pm, putting it on us to stay after hours so that we can literally learn how to be nephrologists, instead of having the attendings cover the pager once or a couple times per week for one hour. You will come home exhausted EVERY day, you will not feel like reading or hearing anything medicine related. You do not have easy rotations. We have two so called "easy" blocks where we have busy outpatient clinic obligations with 1-2 days of self-study. Even then, you have to document everything you do and for how long so that the PD knows exactly what you are doing. In addition, on this so called "easy" block you will have 1 week of night float plus you will inevitably get pulled to cover random inpatient days. When one of your cofellows is on vacation there will be one fellow who covers both services with two different attendings. This is a huge nightmare. When you decide to take your week long vacation you yourself have to find clinic coverage amongst your cofellows!! On weekends you cover multiple hospitals with different attendings, another huge nightmare. Also on Saturday's you don't have night float coverage so even though you come in to see consults at night, you do not have a post call day on Sunday. It's business as usual with a full census and no help from the attendings. On night float you cover 6 very busy hospitals. We are supposed to see only sick patients but the attendings are always complaining about how we don't go in at night to see randon non urgent consults, we have been warned in the past with having night float taken away if we don't go see these patients. Of coarse the attendings are at home, not once have I seen any of them come in on a night call. Second year is no different from first year. You will NOT have a break for two years straight. Electives do not exist. Easy slow blocks do not exist. The program is of very poor quality because of these things. Last batch of fellows ALL FAILED BOARDS except for one!! The program is currently cited by our GME office due to the poor results on the ACGME survey and everyone is now prepared for an official ACGME citation. The fellows are depressed and unhappy. Two fellows quit recently and all have at least thought about it. The thing that our PD does not get is that we are learners, not full fledged nephrologists. We need time to read interesting articles, books etc in order to pick up on the fine details of our craft. We feel let down by our program in many regards, so please, think twice before you decide to come here.

Let me ask you a question. Why are you still doing nephrology? Have you not read my posts? Even if you manage to finish fellowship, the same hard work and exploitation exist in private practice, by older partners. The majority of my colleagues who graduated neph the same time as I did, have all left the specialty because of poor reimbursement and bad lifestyle. Your attendings went into academics exactly to have some semblance of lifestyle, living off of your scut work and using guys as cheap labor. Why did you think it’s so easy to walk into a big name program like Baylor? Did you think you were the winner of this deal?

 

[Renal_Prometheus]

As much as I empathize with the OP, he has no idea the magnitude of exploitation waiting for him in private practice.
You can read all I have to say in the link before. I don't understand why people keep falling for the same trap over and over and over again. Why do people think going into a non-competitive specialty will end well for the fellow. The specialty is non-competitive exactly because it's known to have bad lifestyle, poor reimbursement, and working as an indentured servant for the first couple of years in the hopes of making partner. Promises of partnership and sharing revenue equally gets easily renegaded just likely OP found out about his PDs promises of good training and didactics. There are no guarantees when you enter nephrology. In some ways, his co-fellows did themselves a favor by not wasting time in this specialty any further and avoiding further damage to their careers in terms of opportunity cost.

Why Nephrology Grads Cannot Expect To Earn The Same As Their Partners !

Years ago, I had a colleague who accepted a neph job out of fellowship and he was excited with the prospects. Although starting salaries were low(180K/year), within 3 years he will make partner, and according to what the partners told him, they average around 500K/year. Sounds great right? Fast...

forums.studentdoctor.net

 

[NewYorkDoctors]

If OP is a second year fellow and almost done , then gut through And get your piece of paper . But I would strongly advise you not to take any private practice jobs in which you ar enjoy the boss and you do not have any friendly ties to .

Then find some Cush academic faculty job that doesn’t need too much travel . One HD center one hospital one clinic setup . This is if you can’t see yourself doing anything but renal .

Or

Do hospitalist if you need to make some money to build up capital . Eventual goal should be to open your own practice doing a hybrid GIM nephrology practice if you want to make the 99213 cash mill .

 

[Kaustikos]

If OP is a second year fellow and almost done , then gut through And get your piece of paper . But I would strongly advise you not to take any private practice jobs in which you ar enjoy the boss and you do not have any friendly ties to .

Then find some Cush academic faculty job that doesn’t need too much travel . One HD center one hospital one clinic setup . This is if you can’t see yourself doing anything but renal .

Or

Do hospitalist if you need to make some money to build up capital . Eventual goal should be to open your own practice doing a hybrid GIM nephrology practice if you want to make the 99213 cash mill .

The question is; would one even bother taking the board exam. I agree finish the second year and be done. But paying the stupid fee for the exam that you might fail and may not get into Nephrology? I'd say eff that.

 

[sloh]

Blows my mind this is Baylor. It’s not a no name program

 

[Kaustikos]

Blows my mind this is Baylor. It’s not a no name program

Meh,
I kind of get your point, but not every hospital has fantastic programs in ALL specialties. I'm pretty sure there are "prestigious" med schools with questionable residencies or even fellowships in other specialties. The fellows/residents there just may not have enough time to come on here because of the hours forced or maybe they're locked away in the dungeons of those programs without access to social media/forums.

 

[HemeOncHopeful19]

My guess is it’s hard to sell GME on expanding the program to have enough spots for adequate coverage (or hiring midlevels). I doubt your nephrology department is your big moneymaker nowadays compared to GI/Onc/Cards for example.

If they cover 6 hospitals that probably gives them what, 2ish fellows per hospital total?

 

[NewYorkDoctors]

The question is; would one even bother taking the board exam. I agree finish the second year and be done. But paying the stupid fee for the exam that you might fail and may not get into Nephrology? I'd say eff that.

For pride . Several of my colleagues who did not get a faculty job wanted to get BC and then do hospitalist and hold out hope for a break . Shrugs . If you’re all in by the turn better not fold at the river card

 

[Renal_Prometheus]

exploitation is a common theme in nephrology. Both in fellowship and private practice. The specialty offers false hope to victims, but in the end it was all for nothing. Crawling back to a hospitalist job after abused in private practice is all too common; nobody even bats an eye.

 

[NewYorkDoctors]

No other IM subspecialty has this pervasive and abusive mentality . It all revolves around diminishing revenue generated by these esrd patients (who don’t fit an ACO model well and have high comorbitidies and read mission rates ) It’s really a case of the rats are scrambling to eat each other as they seek to flee the sinking ship .

One can argue some cardiology and GI programs are “malignant” due to the high patient volumes. But we all know about the pot of gold at the end of that rainbow .

Moreover night call at most cardiology and pccm programs are either home call or a dedicated in house night fellow . Heck some big hospital systems have night intensivists and no need for icu fellows at night . The rationale is “septic shock at night is septic shock in the day time .”

Nephrology ? Nope go in and see the patient so attending can bill

Sad thing is private nephrologists don’t even stay for on HD visits or even see some overnight patients until first thing in the morning (tell icu resident or IR to put the line and nurse starts with some benign HD settings qb200 UFR minimal 1L in three hours 2K bath ) and bill retroactively . Heck no one will know …especially with remote EMR access

But when academics force their own fellows in for this nonsense to write an extra billing note and they don’t bother to do it themselves, I find it sickening . I would follow a leader by example. Not some virtue signaling do as I say not as I do fake academic (who doesn’t publish real research bench or RCT) who can’t cut it in private practice .

 

[Renal_Prometheus]

We have talked about so much how neph programs are just looking at fellows as warm bodies for night calls in the “nephrology is dead” thread. This post just re-affirms what we have been saying all along. You just cannot believe what neph attendings tell you during the interview. When you cannot get people to join your specialty(for reasons that have been explained a million times), you will resort to all kinds of lies and tricks to get a warm body.

 

[sloh]

Sad thing is private nephrologists don’t even stay for on HD visits or even see some overnight patients until first thing in the morning (tell icu resident or IR to put the line and nurse starts with some benign HD settings qb200 UFR minimal 1L in three hours 2K bath ) and bill retroactively . Heck no one will know …especially with remote EMR access

Clever

 

[Kaustikos]

No other IM subspecialty has this pervasive and abusive mentality . It all revolves around diminishing revenue generated by these esrd patients (who don’t fit an ACO model well and have high comorbitidies and read mission rates ) It’s really a case of the rats are scrambling to eat each other as they seek to flee the sinking ship .

One can argue some cardiology and GI programs are “malignant” due to the high patient volumes. But we all know about the pot of gold at the end of that rainbow .

Moreover night call at most cardiology and pccm programs are either home call or a dedicated in house night fellow . Heck some big hospital systems have night intensivists and no need for icu fellows at night . The rationale is “septic shock at night is septic shock in the day time .”

Nephrology ? Nope go in and see the patient so attending can bill

Sad thing is private nephrologists don’t even stay for on HD visits or even see some overnight patients until first thing in the morning (tell icu resident or IR to put the line and nurse starts with some benign HD settings qb200 UFR minimal 1L in three hours 2K bath ) and bill retroactively . Heck no one will know …especially with remote EMR access

But when academics force their own fellows in for this nonsense to write an extra billing note and they don’t bother to do it themselves, I find it sickening . I would follow a leader by example. Not some virtue signaling do as I say not as I do fake academic (who doesn’t publish real research bench or RCT) who can’t cut it in private practice .

I never want to hear a Cards or GI fellow complain about high patient volumes. But, then again, the programs I've seen have different teams that are split to alleviate the work load for the fellows where fellows are only 1 group and limit the number of consults and allows them time to do procedures as well. But, I'm not GI or Cards so my anecdotal views may not mean much.

Also, yeah, I struggle to see ANY subspecialty that's this bad.

 

[NewYorkDoctors]

ultimately, when faculty attending want their fellows see more BS consults to rake in some more revenue, that money doesn't necessarily go into the pockets of those attendings directly. it probably feeds into the revenue stream. if the revenue does not flow, then the higher ups will make the attendings do more clinic time or do more consults themselves or cut their RVU bonuses. sad.

if you make a fellow work that hard, that fellow needs to get rewarded. you award them with more educational opportunities. not necessarily more time off or a cushy schedule. but more education. but if your lower tier dirty filthy trash bag bottom of the barrel fellowship program does not see a lot GN, transplant, cystic disease, secondary hypertension, or other rare diseases and you mainly see CKD/ESRD and hyponatremia, then that is NOT the program you want to go to as you will get abused for nothing.

i have nothing but respect for the true academic centers of excellence who publish real research and see lots of rare kidney diseases. It's totally fine to drive those fellows hard for the sake of education. but not at the aforementioned programs that have no business having a fellowship program (other than to get those sweet sweet CMS dollars)

also, if you make a fellow work this hard, you cannot demand each consult to be PERFECT. I'd like to see you see that many patients and be PERFECT. get outta here lol. you couldn't make it in the private practice world so you're content to be a fellow slave driver. lol.

I've got nothing against hard work. We Gen Yers and Gen Zers have nothing against hard work. But the hard work needs to be for something. I dont want to divert too far onto a tangent about the consequences of Keynesian economics and how the boomers and older had it real good due to factors way beyond their "work ethic". But I will say that if the Nephrology faculty actually provide a strong education for the fellows, then that hard work will be worth it. In private practice, if you work that hard you should and will get paid more. But the OP seems to be describing a totally abusive situation with toxic and insufferable individuals running the program. This reflects many mid to lower tier nephrology programs.

 

[Renal_Prometheus]

Bottom line is all this hard work by the fellow amounts to nothing for the fellow. Attrition rate in private practice is very high and like NYD has said before, there is no pot of gold at the end for nephrology. Just more work and low pay until you give up. Only beneficiaries are the academics who enjoy a comfortable lifestyle from the fellow's scut work. The same people who lied to OP about the great training and didactics that fellowship provides, are also the strongest beneficiaries of having a full program. What do you guys think about that conflict of interest?

 

[NewYorkDoctors]

Like if someone went to Columbia university for nephrology (fyi not me ) and learned from the world leaders in nephrology , then work super hard to see those rare cases and become a highly respected academic nephrologist . That’s the way to go .


Getting scutted at some no name program that makes fellows do all the grind work (and possibly all the temp HD lines) with no rest time and then criticizing the fellows for not studying is asinine .

 

[Renal_Prometheus]

Like if someone went to Columbia university for nephrology (fyi not me ) and learned from the world leaders in nephrology , then work super hard to see those rare cases and become a highly respected academic nephrologist . That’s the way to go .


Getting scutted at some no name program that makes fellows do all the grind work (and possibly all the temp HD lines) with no rest time and then criticizing the fellows for not studying is asinine .

These are majority of neph programs out there. The specialty doesn’t lend itself to a good lifestyle.

 

[Renal_Prometheus]

It’s a specialty with bad lifestyle. Hitting 3-4 hospitals a day is common, and you end up driving more than seeing patients a lot of times. Most markets are competitive, and if you don’t have a monopoly in an area, you are simply not gonna make enough money to justify practicing nephrology. This is why you see a lot of new grads start out with a group, within couple of years they realize they are hustling for nothing, turn around and take a hospitalist job. At least you get paid for what your work and is stationed in just one hospital. You also don’t need to rely on charity of your partners to split non-clinical revenue evenly. Trust me, a lot of promises get broken when it’s time to make you partner. If OP thinks the exploitation in fellowship is bad, just wait until he goes into private practice. This another reason why many go into academics to at lease have some resemblance of quality of life, at the detriment of the fellows.

 

[Renal_Prometheus]

Hi all
I am a current fellow in the nephrology program at Baylor college of medicine in Houston Texas (BCM). Wanted to share my experience, our program is completely blind to our requests, I am hoping this negative post will have some effect for change, but probably not. Firstly, the fellows have to cover 6 different hospitals. They will tell you this is a plus because you experience different practice environments. The truth is you quickly learn to adopt to whatever environment you choose to work in after you graduate. You don't need 2 years of grueling scut work to have this "exposure." You do not have protected didactics time, we brought this up and the PD threatened to hold all didactics after 5pm, putting it on us to stay after hours so that we can literally learn how to be nephrologists, instead of having the attendings cover the pager once or a couple times per week for one hour. You will come home exhausted EVERY day, you will not feel like reading or hearing anything medicine related. You do not have easy rotations. We have two so called "easy" blocks where we have busy outpatient clinic obligations with 1-2 days of self-study. Even then, you have to document everything you do and for how long so that the PD knows exactly what you are doing. In addition, on this so called "easy" block you will have 1 week of night float plus you will inevitably get pulled to cover random inpatient days. When one of your cofellows is on vacation there will be one fellow who covers both services with two different attendings. This is a huge nightmare. When you decide to take your week long vacation you yourself have to find clinic coverage amongst your cofellows!! On weekends you cover multiple hospitals with different attendings, another huge nightmare. Also on Saturday's you don't have night float coverage so even though you come in to see consults at night, you do not have a post call day on Sunday. It's business as usual with a full census and no help from the attendings. On night float you cover 6 very busy hospitals. We are supposed to see only sick patients but the attendings are always complaining about how we don't go in at night to see randon non urgent consults, we have been warned in the past with having night float taken away if we don't go see these patients. Of coarse the attendings are at home, not once have I seen any of them come in on a night call. Second year is no different from first year. You will NOT have a break for two years straight. Electives do not exist. Easy slow blocks do not exist. The program is of very poor quality because of these things. Last batch of fellows ALL FAILED BOARDS except for one!! The program is currently cited by our GME office due to the poor results on the ACGME survey and everyone is now prepared for an official ACGME citation. The fellows are depressed and unhappy. Two fellows quit recently and all have at least thought about it. The thing that our PD does not get is that we are learners, not full fledged nephrologists. We need time to read interesting articles, books etc in order to pick up on the fine details of our craft. We feel let down by our program in many regards, so please, think twice before you decide to come here..

So now that you have experienced yourself how academics mislead you for their own benefits, do you now believe what they say about private practice. I’ve been saying on SDN for years that academics will say anything to get a warm body to cover their night calls. I’m sure they promised very lucrative career as a private practice nephrologist. Do you believe what they say, or can you expect some “shocks” down the road if you ever make it that far.

 

[Kaustikos]

So now that you have experienced yourself how academics mislead you for their own benefits, do you now believe what they say about private practice. I’ve been saying on SDN for years that academics will say anything to get a warm body to cover their night calls. I’m sure they promised very lucrative career as a private practice nephrologist. Do you believe what they say, or can you expect some “shocks” down the road if you ever make it that far.

Also, would you quit?

 

[stayinalive]

I have little insight into the nephrology specialty, but your experience sounds terrible and from what I hear here is that there likely will not be a good opportunity or significant benefit waiting for you down the line. If you are open at all to leaving, my suggest would be the following:
- use your limited time off to line up a hospitalist gig
- once it is lined up, give the program once last opportunity to hear your concerns and change. Those changes you should see within a week for it to not be broken promises. You will feel much more comfortable doing so knowing you have a job lined up if needed. If they are willing to make the changes you need to stay, then stick it out I guess to get that board certification...?. Otherwise stop suffering with no great future in sight.

Just my 2 cents

 

[NewYorkDoctors]

To the OP , if you are a first year fellow and going to be a second year , then seriously consider leaving unless you have the possibility of doing primary GIM one day and yo Ivan leverage yo ur renal degree to do non esrd care in private practice .

If you are second year well you’re almost there . You don’t necessarily have to spend money for that BC piece of paper .

 

[Renal_Prometheus]

To the OP. Your attendings are lying to you about lucrative career opportunities in nephrology. The specialty is very bad, that’s why it’s non-competitive. These big name programs are begging IMGs to join. Just think about whether this happens in other fields like cards/GI. I know you are trying to escape a hospitalist career and hoping for the best. But letting academics exploit you just so you can call yourself a specialist, to do what? The chances of you figuring out in private practice that you are overworked and underpaid and it’s just not worth doing nephrology is very high. So in the end, for what? Just to be a specialist in a field that cant get fellows and have to resort to lying and manipulation just to get applicants to sign on?

 

[Renal_Prometheus]

I've posted this link before. Nephrology programs are just using fellows for cheap labor to cover night calls. They are being looked at as meat to be taken advantage of. You can just imagine the stories they will tell to get an applicant to believe there is hope in this specialty. Fellows take on the career risks if private practice jobs doesn't work out.

Resizing Nephrology Training Programs

A once-attractive medical specialty faces challenges due to an oversupply of practitioners, particularly around large hospitals and in metropolitan areas. The geographic distribution of employment opportunities compels many graduates to practice either outside their specialty or in a manner that

cjasn.asnjournals.org

 

[NewYorkDoctors]

As a field, we take pride in our status as the smartest physicians in the hospital.

See ? That hubris is rampant amongst the older generation of nephrologists . A nephrologist is not more well rounded than a general internist (
A neph who thinks he can do as good a job as an academic general interest is FOS) . Moreover how is being a nephrologist and knowing how to work up and manage GN any different than a pulmonologist working up ILD and managing it ? How is a neph smarter than a rheumatologist working up CVD?

How is a transplant neph smarter than a transplant cardiologist CHF?

At least pulmonary manages workup of lung cancer . nephrologist turfs all Bosniak 2 Cysts to urology so fast …

At least cards runs their own Ccu

Pccm runs their own micu .

Please just stop older generation of boomers and old farts

 

[Renal_Prometheus]

The medium tier programs are open about taking IMGs who couldn’t match into residency. The specialty is so wide open there’s no shame how low they will go to get a warm body.

 

[NewYorkDoctors]

Fellows are free (well paid by Medicare) Mid levels are expensive . Median $100K per year plus with full benefits and no night call . That’s better than most nephrology jobs ROFL

https://amp.comparably.com/salaries/salaries-for-nephrology-nurse-practitioner

 

[Renal_Prometheus]

I just think practically, that if you are planning to go into nephrology today, you need to have a backup plan if it doesn’t work out. Expecting to land in a lucrative career by going into a non-competitive specialty just defeats all common sense. The market does not miscalculate. I know your PD will sell you on it, because I’ve been on the receiving end of that salesmanship, but you need to have to common sense to see through conflict of interest.

 

[FutureInternist]

Hi all
I am a current fellow in the nephrology program at Baylor college of medicine in Houston Texas (BCM). Wanted to share my experience, our program is completely blind to our requests, I am hoping this negative post will have some effect for change, but probably not. Firstly, the fellows have to cover 6 different hospitals. They will tell you this is a plus because you experience different practice environments. The truth is you quickly learn to adopt to whatever environment you choose to work in after you graduate. You don't need 2 years of grueling scut work to have this "exposure." You do not have protected didactics time, we brought this up and the PD threatened to hold all didactics after 5pm, putting it on us to stay after hours so that we can literally learn how to be nephrologists, instead of having the attendings cover the pager once or a couple times per week for one hour. You will come home exhausted EVERY day, you will not feel like reading or hearing anything medicine related. You do not have easy rotations. We have two so called "easy" blocks where we have busy outpatient clinic obligations with 1-2 days of self-study. Even then, you have to document everything you do and for how long so that the PD knows exactly what you are doing. In addition, on this so called "easy" block you will have 1 week of night float plus you will inevitably get pulled to cover random inpatient days. When one of your cofellows is on vacation there will be one fellow who covers both services with two different attendings. This is a huge nightmare. When you decide to take your week long vacation you yourself have to find clinic coverage amongst your cofellows!! On weekends you cover multiple hospitals with different attendings, another huge nightmare. Also on Saturday's you don't have night float coverage so even though you come in to see consults at night, you do not have a post call day on Sunday. It's business as usual with a full census and no help from the attendings. On night float you cover 6 very busy hospitals. We are supposed to see only sick patients but the attendings are always complaining about how we don't go in at night to see randon non urgent consults, we have been warned in the past with having night float taken away if we don't go see these patients. Of coarse the attendings are at home, not once have I seen any of them come in on a night call. Second year is no different from first year. You will NOT have a break for two years straight. Electives do not exist. Easy slow blocks do not exist. The program is of very poor quality because of these things. Last batch of fellows ALL FAILED BOARDS except for one!! The program is currently cited by our GME office due to the poor results on the ACGME survey and everyone is now prepared for an official ACGME citation. The fellows are depressed and unhappy. Two fellows quit recently and all have at least thought about it. The thing that our PD does not get is that we are learners, not full fledged nephrologists. We need time to read interesting articles, books etc in order to pick up on the fine details of our craft. We feel let down by our program in many regards, so please, think twice before you decide to come here..

PA-

RA-

GRAPHS 😏

 

[Renal_Prometheus]

Fellows are free (well paid by Medicare) Mid levels are expensive . Median $100K per year plus with full benefits and no night call . That’s better than most nephrology jobs ROFL

https://amp.comparably.com/salaries/salaries-for-nephrology-nurse-practitioner

Fellowship programs need to have some skin in the game. As is stands right now, they are incentived to overpromise and mislead the applicants to try to fill spots. The fellow take on all the career risks of a low reimbursement specialty with no guarantees of partnership or that even making partner will be sufficient to compensate for the years invested. Over times, it becomes a vicious cycle of exploitation and false promises that will never materialize. This is the state of nephrology.

 

[Renal_Prometheus]

Is A Medical Fellowship Worth It? [ROI Calculations] | White Coat Investor

Does a fellowship make sense for your finances? Do some calculations to determine your return on investment and know if you'll end up ahead financially or in the red.

www.whitecoatinvestor.com

You can read about opportunity cost of doing a sub-specialty above. I feel like younger residents have poor understanding of this concept and gets overly excited about doing a non-competitive sub-specialty and fall into a career trap that they regret later on when they are much wiser. These non-competitive specialties are non-competitive exactly because return on investment is very bad. The market does not miscalculate. In nephrology, it is horrendous. In a perfect situation, you cannot expect to make any real money until 5 years after residency(2 years fellowship + 3 yrs getting payed 200k/yr trying to make partner). And this is assuming a perfect situation where you end up in a lucrative practice and your partners dont try to take advantage of you. Trust, most people will end up in neph groups that are less than perfect. People in their 40s going into nephrology is a financial mistake because they do not have enough working years left to recuperate from this loss if they don't land in a lucrative practice(which I can tell you odds are very small). I hate watching tragedies repeating itself and people don't communicate or learn from others.

 

[Renal_Prometheus]

Let's call exploitation for what it is. I've been through it myself so I'm very familiar with the tricks that nephrology fellowship programs pull to get you in the door. Once they get you, all promises and cordiality go out the door. What's worse is that their is more broken promises and exploitation waiting for grads in private practice. There is a tremendous information disconnect between what a applicant/fellow's perception of neph private practice vs the real thing. I've been harping on SDN for years to help bridge this gap. The reality is much worse than what people are hoping for. If you are serious about nephrology, please PM so we can discuss issues in private and avoid unnecessary surprises down the road.

 

[Renal_Prometheus]

Moral of the story is just cannot trust what people say. Especially in nephrology where programs are desperate for fellows and they are the ones benefit from your cheap labor. Just thinking logically, you can imagine they will embellish the truth and sell you on False optimism that will never materialize. only one telling you the brutal truth is the market. He is telling you not to do nephrology because if the money in private practice is that good, fellowship programs should not have trouble filling spots. You have to tune out the noise, stop believing in what people say, and look at what people do. And clearly, people are avoiding nephrology for a reason.

 

[Renal_Prometheus]

I’m not going to mention where I trained, but the situation was exactly the same as mentioned before. Lies and misinformation to lure an applicant into the program to use for scut work. Years later, what do you think most of my co-fellows are doing now? That’s right, hospitalist medicine. These academic guys are not taking any responsibility for optimistic spin they sell to interviewees.

But just thinking rationally, it makes sense things are the way it is. There is no prestige in nephrology right now. Any applicant can walk into a top 10 program. So as an attending, why invest time to properly train a fellows when:

1) quality of fellows is at historic lows

2). They will likely not practice Nephro anyways due to low starting salaries and lots of driving.

So as an attending, why would you bust your behind to train the best possible candidates when the specialty is at this depressing state of affairs.