Nephrocritical care? does it make sense?

[Scope guy]

Recently seeing a trend of candidates going into nephro, with plans to do nephro critical care. Is there a real need for nephro-critical care specialists outside of highly specialized ICUs like UPMC?

If end point is critical care intensivist job, why not just do good ol fashioned 2 year critical care program? May be add a sleep year to work off weeks?

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[chessknt]

No need to do nephro if your endpoint is CCM if you don't like and want to do nephro idependently. If you want low key outpt work I dont think nephro qualifies for that anyways. Pulm/CCM offers that combo or you could do 2 CCM + 1 sleep.

 

[siliso]

Like most combined things people generally end up doing one or the other in the end. So you might as well IMO just make your choice about which thing you’d rather do. An actual combined position will be a rare bird so it’s more about what you want to do when you’re burned out on the excitement of the ICU: pulmclinic/consults/procedures or renal clinic and dialysis? If you’re not sold out and gung ho for the ICU coming out of residency I think the chances you will be later, after renal fellowship, seem slim. JMO.

As a philosophical aside I feel like the decision to start RRT in a critically ill patient is at times (not always) a point where things may be on the verge of futility and getting an outside set of eyes on the situation at that point may be valuable (again not always nor that renal is the only consult that could provide it). Just that you can get into a momentum of going from action to action as long as it’s in your scope without re-evaluating the big picture sometimes in my experience. There are other ways to remedy that than needing to call a consultant to take the next action...but sometimes it helps. Just musing.

 

[Scope guy]

No need to do nephro if your endpoint is CCM if you don't like and want to do nephro idependently. If you want low key outpt work I dont think nephro qualifies for that anyways. Pulm/CCM offers that combo or you could do 2 CCM + 1 sleep.

in Nephro CC case, the CC is done only one year and if one is planning to do it full time post training, it is gonna be always inferior to someone who spends 2 years doing CC alone. There are quite a few CC programs in the country, so not sure why ppl do nephro CC

 

[NewYorkDoctors]

Anecdotally, the most often candidate that pursues this route is the PCCM or Cardiology candidate who did not match (whether credentials were not as good as other candidates or restrictive geographical limitations) and did not want to do hospitalist/research and accepts a scramble nephrology position that wants to do CCM. At a large academic research oriented institution, Neph/CCM serves the role of rounding and teaching both services but with expertise in various modalities of CRRT.

That being said, there is no real role for a community based Renal/CCM physician except perhaps in a niche community hospital in which intensivists are in short supply and this individual has a good outpatient/HD practice set up.

 

[aus1ander]

Either do Pulm-CC or Nephrology. Every trainee that I seen who has done Neph-CC has not ended up practicing both.

 

[doctornephron]

It does make a difference as it increase your job chances and your pay , it is true that there is no much job for nephrology CC but it is growing and you can start with CC and ask to have nephrology work in same hospital later/ recently there is a trend in PCC groups to add nephroCC phyicians to work with them.
Combined nephrology CC program are few, It is also tricky to secure one CC after nephrology. try to consider combined nephrology CC fellowship. I know some of them like Jersey shore university hospital, Allegheny med center, University of Texas dallas and St antonio, Henry Ford hospital. there is almost only 6-7 programs that offers combined training.

 

[Doccritnephro]

I totally agree that nephro critical care makes a big difference . I am in my final year training nephro CC and I am able to get jobs same salary range of cardiology and GI first year with even less demanding work. It is very promising.

 

[NewYorkDoctors]

I totally agree that nephro critical care makes a big difference . I am in my final year training nephro CC and I am able to get jobs same salary range of cardiology and GI first year with even less demanding work. It is very promising.

Just do PCCM in that case .

Though I am empathetic to the fact that not all IMG and FMG applicants can get into PCCM given the competitiveness of the field so more power to anyone who does nephrology and is lucky enough go back door into CCM .

 

[Bobbbyyyy]

I know someone applying to ID so that she can do ID-CC later. She only cares about doing CC but feels that she isn't competative enough for CC or Pulm-CC therefore doing ID first. Maybe the same is true for some people wanting to do renal-CC as well, people who were unable to or think they will be unable to land a fellowship in pulm-CC or CC. Does it make it easier to get a CC fellowship afterward doing renal or ID? I'm guessing it does. More time to do research and network at your institution.

 

[Doccritnephro]

It is not easy

I know someone applying to ID so that she can do ID-CC later. She only cares about doing CC but feels that she isn't competative enough for CC or Pulm-CC therefore doing ID first. Maybe the same is true for some people wanting to do renal-CC as well, people who were unable to or think they will be unable to land a fellowship in pulm-CC or CC. Does it make it easier to get a CC fellowship afterward doing renal or ID? I'm guessing it does. More time to do research and network at your institution.

it is not easy to get one year CC after ID but it may help , there are very few combined ID/CC program which could give you both without worrying reapplying for CC again , Nephro /CC is slightly more common there are like 8-9 program.