Is a 1 year Critical Care fellowship a practical "escape plan" for nephrology?

[jonathanlikes]

I love renal medicine. I am 99% sure I will do a nephrology fellowship. I've heard all the warnings and have to say that they are concerning. I know about all the renal folks working as hospitalists, and I would not be happy at all doing hospital medicine. So, I want to ask what people think about doing a 1 year critical care fellowship after completing a nephrology fellowship. Is this a reasonable "back up" plan in case I can't make a nephrology career work?

1. How difficult is it to secure a 1 year CCM spot? Obviously most programs are designed as Pulm/CCM, so would it be the case that there are only like 20 or so spots each year?

2. What would the job prospects be for someone who had completed this training pathway? Would you be able to still practice nephrology some of the time? Would you be restricted to only major cities/academic centers? I am very interested in Critical care and could definitely do it as my primary/only job if need be.

Thanks

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[gutonc]

There are worse plans. Not many...but definitely some.

There are a few official combined N/CCM programs but (relatively speaking at least), a lot of places where the CCM program is happy to tack on a BC internist/BE nephrologist as an ICU scut monkey for a year.

I know 3 people personally who are N/CCM. 2 started renal and then added the extra CCM year (at the same program). The other started out CCM and then added renal (?!?!?) later. All 3 work primarily CCM with one of them (employed by the VA) doing a bit of both.

 

[CCM-MD]

I love renal medicine. I am 99% sure I will do a nephrology fellowship. I've heard all the warnings and have to say that they are concerning. I know about all the renal folks working as hospitalists, and I would not be happy at all doing hospital medicine. So, I want to ask what people think about doing a 1 year critical care fellowship after completing a nephrology fellowship. Is this a reasonable "back up" plan in case I can't make a nephrology career work?

1. How difficult is it to secure a 1 year CCM spot? Obviously most programs are designed as Pulm/CCM, so would it be the case that there are only like 20 or so spots each year?

2. What would the job prospects be for someone who had completed this training pathway? Would you be able to still practice nephrology some of the time? Would you be restricted to only major cities/academic centers? I am very interested in Critical care and could definitely do it as my primary/only job if need be.

Thanks

If you're a US MD, you should be able to land a spot easily if you're motivated enough. But CCM is getting more competitive. I know of a person who did nephrology and subsequently a 2 year critical care fellowship.

The bigger question is if you will be adequately trained, especially procedurally. Hard to be well trained in bronchs, airway management, thoras, lines, perc trachs, bedside ultrasound all in 1 year. I know that some IM based critical care programs won't take fellows for 1 year unless they have done pulmonary. Anesthesiologists and surgeons can get away with 1 year of ccm training but I think internists are better off with a pulm/cc or 2 year ccm fellowship.

In terms of jobs, intensivists are in high demand and compensation is great. The person I know who did nephrology and critical care does not practice any nephrology. Will be challenging to find a job with both but I think a hospital who may be having a hard time finding intensivists will probably be happy to let you do both.

 

[Nephro critical care]

I am nephrology and critical care board certified and practice only critical care. My path is a little bit curious, in my residency I initially did not have a good ICU experience and was much more drawn to nephrology. I had intended to do a nephrology fellowship after my residency . This was around 2007 when nephrology was still good. But then I decided to fix my visa and worked 4 years as a hospitalist. My last 3 were brutal as a nocturnist at a very busy program where average admissions were 12-17 , ICU was open, cross coverage issues were rife.

By the time I had my green card I was pretty much burned out. I applied for and got into nephrology. The fellowship was by itself cush especially when you compare with the 17 admits and multiple cross coverage issues I was dealing with as a hospitalist. But at the end of fellowship I was faced with an atrocious job market where in a bigger city I was working for a group working 3 weekends out of 4 and seeing 28-30 patients in 7 hospitals on weekends and getting paid $170,000. I got an opportunity to join a CC fellowship based on good word of mouth from my nephrology program director. Therefore I skirted getting into a nephrology job and took on a CC fellowship. Initially I had to work on my procedure skills it took 6 months to get really into top gear. Procedures are not particularly hard to learn unlike the patient management part which I still learn something new every day . I did a 2 year CC fellowship I believe that if you don't have a lot of procedural experience you should do a 2 year CC fellowship.

Now I am doing full time CC and am pretty happy . I will go out on a limb and say we CC guys have are much better at ICU as compared with our pulm /CC colleagues who do 1 week of ICU every 6 weeks and don't take ICU call.

I would ideally like to do a bit of nephrology as I did a 2 year fellowship. Maybe even interventional nephrology which would be fun to learn. But CC is a full time 1 FTE job and I would have to cram nephrology into my off days and with a very minimal addition to my salary which would not be worth it.

 

[jonathanlikes]

I am nephrology and critical care board certified and practice only critical care. My path is a little bit curious, in my residency I initially did not have a good ICU experience and was much more drawn to nephrology. I had intended to do a nephrology fellowship after my residency . This was around 2007 when nephrology was still good. But then I decided to fix my visa and worked 4 years as a hospitalist. My last 3 were brutal as a nocturnist at a very busy program where average admissions were 12-17 , ICU was open, cross coverage issues were rife.

By the time I had my green card I was pretty much burned out. I applied for and got into nephrology. The fellowship was by itself cush especially when you compare with the 17 admits and multiple cross coverage issues I was dealing with as a hospitalist. But at the end of fellowship I was faced with an atrocious job market where in a bigger city I was working for a group working 3 weekends out of 4 and seeing 28-30 patients in 7 hospitals on weekends and getting paid $170,000. I got an opportunity to join a CC fellowship based on good word of mouth from my nephrology program director. Therefore I skirted getting into a nephrology job and took on a CC fellowship. Initially I had to work on my procedure skills it took 6 months to get really into top gear. Procedures are not particularly hard to learn unlike the patient management part which I still learn something new every day . I did a 2 year CC fellowship I believe that if you don't have a lot of procedural experience you should do a 2 year CC fellowship.

Now I am doing full time CC and am pretty happy . I will go out on a limb and say we CC guys have are much better at ICU as compared with our pulm /CC colleagues who do 1 week of ICU every 6 weeks and don't take ICU call.

I would ideally like to do a bit of nephrology as I did a 2 year fellowship. Maybe even interventional nephrology which would be fun to learn. But CC is a full time 1 FTE job and I would have to cram nephrology into my off days and with a very minimal addition to my salary which would not be worth it.

That's very interesting to hear, thanks for the reply! Do you feel that your nephrology training gave you any sort of advantage during critical care fellowship? Did you already feel comfortable with some aspects of patient management? I did not anticipate that a TWO year fellowship would be recommended. I think maybe I have underestimated how difficult it is to become comfortable with procedures.

 

[Nephro critical care]

I don't believe my nephrology fellowship gave me any sort of an advantage. Honestly the bread and butter of nephrology i.e hemodialysis is learnt in a week , maximum in a month. It's hard to know too much when it's a 2/3/4 K , 2.5 Ca 35 HCO3 on everybody . Nephrology should not be a 2 year fellowship under any circumstances, maybe 1 year.
What I recommend to everybody , if you are interested in CC and you are in IM take the conventional route and do pulm / CC . You will be more marketable than straight CC and you will have an opportunity to do some clinic like everyone else as CC gets tiring / emotionally draining after a while . Pulm / CC is not as competitive as GI , they are looking for good solid residents not tons of research. CC job market and pay is also good but when you do it for a while you will get tired.
If you like nephrology and can deal with the job market / low pay / taking your chances getting abused in a partnership then do nephrology. Don't waste two years of your life to find that out in the end. And don't do Nephrology / CC and expect to do both those jobs are close to impossible to find.
They teach you that if you jump in front of a train you will become hamburger. You don't have to find that out by jumping in front of a train yourself. Similarly everyone is not lying to you when they say that nephrology pay is worse than a hospitalist and job market is 1000 times worse and you will get abused in crappy partnerships. If you can't get into a fellowship and want a decent job look harder they are some cushier hospitalist jobs out there. I know of job with a census of 10 , 1 - 2 admits and great subspeciality support for $210,000 to $260,000 which trust me you can do for a lifetime .

 

[IM2GI]

But at the end of fellowship I was faced with an atrocious job market where in a bigger city I was working for a group working 3 weekends out of 4 and seeing 28-30 patients in 7 hospitals on weekends and getting paid $170,000..

Awful. Why would anyone do that to themselves.

 

[drfunktacular]

Awful. Why would anyone do that to themselves.

Yeah reading that made my stomach hurt. JFC