Nephrology is Dead - stay away

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Of course, we don't only follow dialysis patients..

For exemple, I work in a group of 6 nephrologist in a small community in Canada and we follow approximately:
- 300 hemodialysis patients
- 50 peritoneal dialysis patients
- 150 kidney transplant patients
- 700 patients with CKD (eGFR less 30)

Plus we also cover:
- inpatient nephrology consultations in two local hospitals
- outpatient nephrology consultations (ambulatory)

And we admit our patients with active medical problems (20 beds).


Is this similar to the practice of a small group of nephrologists in USA?

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I'm not sure what the average numbers are. From what I've seen, there's been a lot of consolidation, so the groups I've been exposed to tend to be bigger. They also tend to have vascular access centers to increase revenue. PD numbers tend to be quite low still.

Also, I haven't seen any nephrologists admit their own patients recently. The hospitalists do that now, nephrologists follow as a consultant. Sometimes, it seems silly... especially when we have to admit a patient to give an antibiotic that the dialysis unit is unable to give...
 
I'm a program director and the creator of Nephrology On-Demand. I would be more than happy to answer your questions about nephrology, fellowship, training, and anything else on your mind. Whereever possible, I'll try to give you hard data so you can make informed decisions based on evidence and not anecdote.

I'm not interested in "blacklisting" you. So feel free to send me anonymous messages on this forum or through Twitter (@nephOnDemand).

Thanks.

Tejas
 
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They fill the spots with IMGs
Reason IMGs have a fascination with sub specialization and desire some subspecialty training , if they ever return to their home country.

It's high time IMG's get away from this warped thinking.

Try to get a specialty that is worth the time and effort.

If not stay on as internist or Hospitalist - at least a better pay and lifestyle


Don't delude yourself thinking you made it to a stellar program in nephrology because of your talent. You make it because no American grad wants it and you fool yourself thinking you made it!!


IMGs get IM easily because AMG's choose the better specialities.
Nephrology fellowship is not desired even by most IMG's and you chose it!!

Nephrology is like the scum of the scum of all the specialities as of now

sounds about right
 
Almost all applicants to nephrology fellowship in the last 5 years have been FMG's.

AMG's are more competitive applicants so they get selected in a Darwinian fashion into the specialties that provide either better pay or better lifestyle or both better pay and better lifestyle.

yea but in general, IMG's go for sub-specialty fellowships, regardless of what the fellowship is..they all want to do fellowships. i think they do it as a security thing to stay in the US longer...
 
The problem with nephrology is that it just seems so painfully boring to practice.

Give fluids/take fluids away, stop nephrotoxic meds, control BP and BS, start an ACE/ARB.

Round on depressing chronic HD patients.

What about that seems appealing? Maybe every once in a while you get thrown a bone and get a cool intrinsic renal disease case that you can actually do something about, but the clinical practice of nephrology just seems so painful.

Add in the fact that you don't get paid, have a bad lifestyle, and can't find a job?

The field is in trouble.

Bingo.

I've done two months of renal this year and I can echo all the above points.

- The dialysis unit is the most depressing place in the hospital (save for possibly the burn ward). Who wants to constantly round on these groked-out, half comatose, seriously ill people all the time? They all look miserable.

- The day to day practice of renal is just boring as all hell. Get an AKI consult, twiddle around with some lytes. Play with ace inhibitors. Actually all this didn't bother me as much as all the mental masturbation that seemed to go along with it - watching the staff and fellow go back and forth once for twenty minutes over whether to use half normal or quarter normal saline on some patient pretty much did it for me. I just don't have the patience for this, and I'm not nearly as anal as I apparently need to be to be a nephrologist (I've never been corrected so often over totally unimportant things like units in a random equation or other trivial nonsense - get a grip, people.) Plus the staff I was with just wanted to go on and on about the technical aspects of dialysis and other stuff that zero relevance to me as a general internist/IM resident, and that stuff definitely pushes people away. This specialty more than any other seems to have trouble with keeping things relevant to trainees who are passing by.

- ESRD consults? Bleh.

- The physiology itself is interesting but difficult, and there's seemingly not enough time to learn all of it well as a resident. Plus, let's be honest - most people in medicine just don't enjoy math that much, and nephrologists apparently love it (nephrologists are seemingly always busting out paper to write out some equation or another to try to explain something etc). Renal is basically ground zero for the math freaks who somehow ended up becoming doctors, and everyone else just sort of stays away.

- Add bad lifestyle, bad pay, and inability to find jobs to the above points and it becomes patently obvious as to why people are lined up none deep to do this.
 
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and i would imagine that there are those that would say the same for rheumatology (maybe not the money part but as for the topic of rheum...)...just because YOU don't find it interesting doesn't mean others don't...if the money was what it was once before, I'm sure that nephrology would be more competitive.

and all those things that you don't have the patience for..well its probably why nephrologists are considered by many to be some of the smartest docs out there.
 
and i would imagine that there are those that would say the same for rheumatology (maybe not the money part but as for the topic of rheum...)...just because YOU don't find it interesting doesn't mean others don't...if the money was what it was once before, I'm sure that nephrology would be more competitive.

and all those things that you don't have the patience for..well its probably why nephrologists are considered by many to be some of the smartest docs out there.

Well, if you are going to do a fellowship I think it would be reasonable to expect at least one of the following:

1) Better lifestyle (Rheumatology, Endocrinology, Infectious Diseases comes in the far third)
2) Better pay (GI, Cardiology)
3) Better pay and better lifestyle (A/I, Heme/Onc)

Nephrology gets you none of the above. And the thing about nephrologists being the smartest docs out there is just plain subjectivity. I'm not going to deal with it.
 
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and i would imagine that there are those that would say the same for rheumatology (maybe not the money part but as for the topic of rheum...)...just because YOU don't find it interesting doesn't mean others don't...if the money was what it was once before, I'm sure that nephrology would be more competitive.

and all those things that you don't have the patience for..well its probably why nephrologists are considered by many to be some of the smartest docs out there.

Rheum doesn't make a whole lot more money than renal, so people don't exactly flock to it for that reason.

Let me rephrase it a bit - I've worked with nephrologists who were highly practical and who dealt with things in a relatively straightforward way, all while respecting the highly complex physiology involved. I've also worked with ones that just wanted to get way out into the weeds with everything. As a general philosophy in medicine (and life), I don't think making everything dramatically more complex than it actually is accomplishes anything. Feel free to disagree. Doing a bit of math doesn't automatically make you smarter either - this is something the overly 'math phobic' medical profession perpetuates. The math involved in nephrology was not overly complex.

I'm at the point in my career where I don't have anything to prove to myself or anyone else. I don't need to pursue a certain specialty because of 'the challenge' or because everyone will think I'm smarter because I'm doing it. I can simply pursue what I like, and I didn't particularly relish nephrology - and judging from the nephrology match list this year, most other people didn't care for it either. (And I'm not even the first person in this thread to point this out.)

Most people in medicine also view rheum as being a highly difficult 'intellectual' specialty, along with ID/heme-onc/endo etc. Different strokes for different folks.
 
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Well, if you are going to do a fellowship I think it would be reasonable to expect at least one of the following:

1) Better lifestyle (Rheumatology, Endocrinology, Infectious Diseases comes in the far third)
2) Better pay (GI, Cardiology)
3) Better pay and better lifestyle (A/I, Heme/Onc)

Nephrology gets you none of the above. And the thing about nephrologists being the smartest docs out there is just plain subjectivity. I'm not going to deal with it.
didn't you post this same post like a year ago?
 
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Nephro has 3 strikes, no pay, no lifestyle, and boring.


Recently I have been building up a side private practice while planning to finish all of my fellowship training. I do some primary care on the side.

The biggest shocker I have found is that the Esrd patients i do primary care for , the patients know I will soon have a renal board certification (though I only plan to practice renal in a limited fashion . As a hobby really and only as an extension of primary Care or icu care ) so they have told their nephrologists . The most shocking thing is I have been blacklisted (as have the patients) from requesting their HD center monthly labs and their in center nephrologist has begun to take an active effort in the patients primary care ! (Only the patient still tells me this and this isn’t prior authed ...)

The turf wars and pissing wars is strong among the community nephrologists around where I work .

So add another strike : no chance for opportunities as the old guard are desperately hanging onto the rope and will suppress the next generation from getting any traction .
 
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Recently I have been building up a side private practice while planning to finish all of my fellowship training. I do some primary care on the side.

The biggest shocker I have found is that the Esrd patients i do primary care for , the patients know I will soon have a renal board certification (though I only plan to practice renal in a limited fashion . As a hobby really and only as an extension of primary Care or icu care ) so they have told their nephrologists . The most shocking thing is I have been blacklisted (as have the patients) from requesting their HD center monthly labs and their in center nephrologist has begun to take an active effort in the patients primary care ! (Only the patient still tells me this and this isn’t prior authed ...)

The turf wars and pissing wars is strong among the community nephrologists around where I work .

So add another strike : no chance for opportunities as the old guard are desperately hanging onto the rope and will suppress the next generation from getting any traction .

anyone is going to protective of their patients being poached by another doctor, regardless of specialty.
 
anyone is going to protective of their patients being poached by another doctor, regardless of specialty.

While that is true, most nephrologists don’t want to do primary care . The fact that a nephrologist who has never done the primary Care before (no time and no compensation for doing primary care during HD rounds) and Is now doing primary care (potentially out of fear of poaching) is quite revealing .
 
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As for follow up, I happily prior authorized the MRI LS spine for the patient and PA Lyrica for the patient and said you need someone who understands the urine lytes but does not swim in them to take care of the non-renal stuff. I did not spend much time as I use the electronic PA system for both, which is honestly a godsend in many ways.
 
So what is a good IM speciality to get in to?
 
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There is no one size fits all answer. If your debt burden is low , you are more of a thinker than a doer doctor , and you like renal physiology, and you don’t mind doing lots of uncompensated work , then feel free to do nephrology .

In a happy world where all doctors got paid the exact same , More would do renal and fewer GI/cardiology in my opinion .
 
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In another note, there is a small town renal group that remains profitable that I know of (very) but they are the only group in town and admit all their esrd patients in all 3 hospitals and run all the hd centers in town . They work like beasts and are all awesome. Sometimes I feel bad putting a consult on the weekends for them.


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So what is a good IM speciality to get in to?

It doesn't matter.

Everything in medicine is cyclical dude.

Choose what you actually sort of like and hate the least.
 
It doesn't matter.

Everything in medicine is cyclical dude.

Choose what you actually sort of like and hate the least.

Ignorant statement. (Pardon queen James , I do not mean to say you are an ignorant individual . I am certain you are a fine doctor or other health professional. This was directed at the idea of “cyclical.”)

Rather the heavy reliance of nephrology revenue in CMS for dialysis and the corporatization of HD will squeeze the profits out of patients and doctors and direct it to fresneius and Davita. This is not GI in the 90s that got the screening colonscopy indication and took off in the 2000s.

“Everything is cyclical” may not apply to nephrology . For posters who are not fully in love with the nephron , please thoroughly re-read all prior posts.

Also I will emphasize that academic nephrology is another field that has its own rewards and can be quite worthwhile for some . But limited spots of course .

As a matter of fact for a bit of digression , i believe that individuals who say “the economy is cyclical” really need to stop listening to the mainstream media and start learning about the pitfalls of Keynesian economics .
 
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Ignorant statement. (Pardon queen James , I do not mean to say you are an ignorant individual . I am certain you are a fine doctor or other health professional. This was directed at the idea of “cyclical.”)

Rather the heavy reliance of nephrology revenue in CMS for dialysis and the corporatization of HD will squeeze the profits out of patients and doctors and direct it to fresneius and Davita. This is not GI in the 90s that got the screening colonscopy indication and took off in the 2000s.

“Everything is cyclical” may not apply to nephrology . For posters who are not fully in love with the nephron , please thoroughly re-read all prior posts.

Also I will emphasize that academic nephrology is another field that has its own rewards and can be quite worthwhile for some . But limited spots of course .

As a matter of fact for a bit of digression , i believe that individuals who say “the economy is cyclical” really need to stop listening to the mainstream media and start learning about the pitfalls of Keynesian economics .
ok since you don't like the word cyclical, lets try ebb and flow...you do not have crystal ball to say that nephrology (or any other specialty) won't become profitable (and therefor popular) again...queen james's point was go into what you like...or hate the least is an accurate one.

and please! the sorry, not sorry about saying ignorant is passive aggressive at best...you can alway edit your post...to leave it in is making a point...at least have the balls to stand behind your statements .
 
ok since you don't like the word cyclical, lets try ebb and flow...you do not have crystal ball to say that nephrology (or any other specialty) won't become profitable (and therefor popular) again...queen james's point was go into what you like...or hate the least is an accurate one.

and please! the sorry, not sorry about saying ignorant is passive aggressive at best...you can alway edit your post...to leave it in is making a point...at least have the balls to stand behind your statements .

Lol stay mad bro or sis . It’s like you have a crush on me every time I write lol. I hope to live rent free on your brain every time you log on SDN.

Anyway back to relevant and useful input ...

I agree do what you like . But to expect nephrology to “ebb and flow” (lol) back go the Mercedes’s 80s of dialysis shows a gross misunderstanding of the economics of healthcare and US Keynesian economics as a whole . Quote that as straight up aggressive and not passive .
 
For those interested these are what are listed in my delineation of privileges for Nephrology fellowship completion:
- Acute Hemodialysis
- Aquapheresis
- Chronic Hemodialysis
- CRRT
- Hypertension Consultation
- Nephrology Consultation
- Peritoneal Dialysis
- Renal Ultrasound guided biopsy via needle
- Total Parenteral Nutrition.

Sounds like a veritable bevy of procedures!

Of note, temporary HD catheter is no longer one of the requirements.
 
Any to cut the sarcasm, I have crunched some numbers based on the CPT codes and how much they pay and the relative amount of work to be put in. I know this as I practice GIM consistently in parallel to all of my fellowship training and I am my own biller.

Anyway, the bottom line is a nephrologist who is ABLE TO BE HIS/HER OWN BOSS (i.e. not pay tribute to some old guy or gal who is 65+ by giving half of your productivity for a chance to be junior partner) who has a thriving renal referral base from cardiology and primary care, chronic HD population (perhaps 75 patients on HD per nephrologist), and acute referrals in the hospital for HD and CRRT can make quite a handsome penny. Liberal estimates show at worst earning $400,000 a year if you are willing to have no partners and running around everywhere yourself doing everything. (Night calls for emergent HD are for the fellows... lol)

Owning your own HD unit is out of the question these days. The money seeing your own on HD patients is somewhat meager but it supplements your salary.

I don't know the monetary logistics and profits of owning your own infusion center or sharing it with hematology / rheumatology.



However despite all of these peaches and flowers, it is not easy at all for a new nephrologist, even one without debt and with good capital, to get the referral base and high number of HD patients. Even if you wheeled and dealed and hung out at multiple hospitals like an ambulance chaser waiting for ATN, the older guys/gals will indeed flex his/her muscles to squeeze you out of the market through various political means... but this is all outlined in previous threads.

But then again, this kind of advice can be said about any specialty. Any thriving private practice in any specialty can have big gains.

It's just that something like GI and cardiology has a guaranteed minimum "floor" earning potential that is higher than that of nephrology.
 
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Any to cut the sarcasm, I have crunched some numbers based on the CPT codes and how much they pay and the relative amount of work to be put in. I know this as I practice GIM consistently in parallel to all of my fellowship training and I am my own biller.

Anyway, the bottom line is a nephrologist who is ABLE TO BE HIS/HER OWN BOSS (i.e. not pay tribute to some old guy or gal who is 65+ by giving half of your productivity for a chance to be junior partner) who has a thriving renal referral base from cardiology and primary care, chronic HD population (perhaps 75 patients on HD per nephrologist), and acute referrals in the hospital for HD and CRRT can make quite a handsome penny. Liberal estimates show at worst earning $400,000 a year if you are willing to have no partners and running around everywhere yourself doing everything. (Night calls for emergent HD are for the fellows... lol)

Owning your own HD unit is out of the question these days. The money seeing your own on HD patients is somewhat meager but it supplements your salary.

I don't know the monetary logistics and profits of owning your own infusion center or sharing it with hematology / rheumatology.



However despite all of these peaches and flowers, it is not easy at all for a new nephrologist, even one without debt and with good capital, to get the referral base and high number of HD patients. Even if you wheeled and dealed and hung out at multiple hospitals like an ambulance chaser waiting for ATN, the older guys/gals will indeed flex his/her muscles to squeeze you out of the market through various political means... but this is all outlined in previous threads.

But then again, this kind of advice can be said about any specialty. Any thriving private practice in any specialty can have big gains.

It's just that something like GI and cardiology has a guaranteed minimum "floor" earning potential that is higher than that of nephrology.

Also worth noting (across specialties) that your ability to build this type of high-revenue practice will probably be higher in an underserved, non-metro area, eg <250k population (often referred to on SDN as "undesirable") due to more market concentration and less competition
 
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Training Nephrology Fellows in Temporary Hemodialysis Catheters and Kidney Biopsies Is Not Needed and Should Not Be Required
  1. Stuart J. Shankland
Training Nephrology Fellows in Temporary Hemodialysis Catheters and Kidney Biopsies Is Not Needed and Should Not Be Required

Another nail in the coffin.

Yeah I would agree with this - I feel like the standards of training are not there for this sort of interventional thing to become the norm.

To be honest, at my hospital, I trained in doing this as a resident and as a cards fellow I definitely feel much more comfortable putting in lines than the nephro fellows here. In the community I get the sense surgery does it (or IR) due to wRVUs as well. I think this makes more sense in general.
 
Yeah I would agree with this - I feel like the standards of training are not there for this sort of interventional thing to become the norm.

To be honest, at my hospital, I trained in doing this as a resident and as a cards fellow I definitely feel much more comfortable putting in lines than the nephro fellows here. In the community I get the sense surgery does it (or IR) due to wRVUs as well. I think this makes more sense in general.

Where I did fellowship we had a semi retired surgeon age 80 who had an ancient ultrasound machine and did all of the difficult lines for the hospital. He was even de facto line placer for micu if micu got too busy . He was the temporary hd line guy

I had placed my fair share to get certified but after a while it just became a drag to do it

But to take away renal biopsy is the real death knell .

Transplant Nephros do the biopsies all the time .

But In the community the revenue or RVU the biopsy brings is about the same as a 99214 office visit and many hours to do and monitor post op . Plus it’s a high bleeding risk and needs an inpatient or ambulatory surgical setting to do safely .

The math just doesn’t add up .

Anyway nephrology is going the way of “chronic HD doctor.” And even those jobs are being taken by NPs now .
 
Where I did fellowship we had a semi retired surgeon age 80 who had an ancient ultrasound machine and did all of the difficult lines for the hospital. He was even de facto line placer for micu if micu got too busy . He was the temporary hd line guy

I had placed my fair share to get certified but after a while it just became a drag to do it

But to take away renal biopsy is the real death knell .

Transplant Nephros do the biopsies all the time .

But In the community the revenue or RVU the biopsy brings is about the same as a 99214 office visit and many hours to do and monitor post op . Plus it’s a high bleeding risk and needs an inpatient or ambulatory surgical setting to do safely .

The math just doesn’t add up .

Anyway nephrology is going the way of “chronic HD doctor.” And even those jobs are being taken by NPs now .

Absolutely - makes no sense to have nephrologists in most places doing these kinds of procedures when they’re so busy just trying to keep their head above water with consults and HD unit mgmt and clinic. The fellows at my institution get 10-15 consults per day and they round on tons of folks who are chronic HD players. It’s not a fun time. I can imagine doing HD lines would just eat up portions of their day
 
My honest opinion is if you love renal as a discipline and must do it , then aim for
1) an academic job on faculty
Or
2) make nephrology value added to another specialty . Whether you do pmd renal or renal icu or do another set of fellowship (as I am) and then Just use the renal knowledge . I understand option two is rather costly from a time and training and money perspective but I am quite happy to be diversifying myself and taking care of DM back pain depression while rotating to ckd and secondary HTN and IgA nephropathy and then rotating over to some inpatient action and asthma / copd . I’m never claiming to be an “expert” in any one thing but if I can take care of al of my patients for everything from outside and inside the hospital , I feel like I am making a positive difference for them .
 
what are you doing fellowship in ? And what is PMD renal. would Critical care be a good option if procedures is not a strong point of a candidate. I likely the medicine aspect of CCM but sucks in procedure.
 
what are you doing fellowship in ? And what is PMD renal. would Critical care be a good option if procedures is not a strong point of a candidate. I likely the medicine aspect of CCM but sucks in procedure.

I finished renal and am doing pulmcrit .
I have arrangements to be part of all the divisions I specialize in at a specific institution hence this multiple track is feasible for me .

As for procedures you just need volume to get good .
And
A lot of community nephrologists also serve as pmd for their ckd or esrd patients.
 
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I finished renal and am doing pulmcrit .
I have arrangements to be part of all the divisions I specialize in at a specific institution hence this multiple track is feasible for me .

As for procedures you just need volume to get good .
And
A lot of community nephrologists also serve as pmd for their ckd or esrd patients.

kudos to your stamina going through so much training. Never ever will i spend that much time in training , life is too short, but that's just my way of life.
 
I finished renal and am doing pulmcrit .
I have arrangements to be part of all the divisions I specialize in at a specific institution hence this multiple track is feasible for me .

As for procedures you just need volume to get good .
And
A lot of community nephrologists also serve as pmd for their ckd or esrd patients.

Nice !!! I thought I was the only crazy one to do 8 years!
Hello Brother!!


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kudos to your stamina going through so much training. Never ever will i spend that much time in training , life is too short, but that's just my way of life.

This is far less stamina exerted over a lifetime than being a community nephrologist (i.e. slave to fresenius or Davita and junior indentured servsnt to some old guy or lady who has no intention of giving partnership )
 
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This is far less stamina exerted over a lifetime than being a community nephrologist (i.e. slave to fresenius or Davita and junior indentured servsnt to some old guy or lady who has no intention of giving partnership )

everybody to his own! best of luck in your hard work.
 
Another sobering fact :

My current fellowship PD (pccm) Told me he went out of his way to petition and make an exception for me to enter the program and how someone who’s has finished another fellowship is usually not accepted because of the highest “cost” to the program . It has to do with acgme and the pgy years .

Because I had publications , letters , and most importantly attendings vouching for me , I made the “escape.”

Anyway I am using my renal knowledge to good use in icu rotation right now . I own both ends of the acid base spectrum .
 
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Another sobering fact :

My current fellowship PD (pccm) Told me he went out of his way to petition and make an exception for me to enter the program and how someone who’s has finished another fellowship is usually not accepted because of the highest “cost” to the program . It has to do with acgme and the pgy years .

Because I had publications , letters , and most importantly attendings vouching for me , I made the “escape.”

Anyway I am using my renal knowledge to good use in icu rotation right now . I own both ends of the acid base spectrum .
Somebody in your program/GME doesn't know s*** about how fellowship positions are funded then.
 
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Somebody in your program/GME doesn't know s*** about how fellowship positions are funded then.

Probably . Though it would explain a lot why a ID/CCM person i know is turned down from every 2year pulm fellowship he applied to despite stellar research and etc ..
 
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I finished renal and am doing pulmcrit .
I have arrangements to be part of all the divisions I specialize in at a specific institution hence this multiple track is feasible for me .

As for procedures you just need volume to get good .
And
A lot of community nephrologists also serve as pmd for their ckd or esrd patients.
Why are you doing Pulm Cc instea of just 1 year of CC after Nephro? Do you plan on maintaining certification in Pulm, Nephro, and CC all three?
 
Why are you doing Pulm Cc instea of just 1 year of CC after Nephro? Do you plan on maintaining certification in Pulm, Nephro, and CC all three?

Ugh gross. That’s so much money on recert exams.

That said, I’m taking a total of four (maybe 5) cardiology boards at the end of training... maybe I’m the sucker hahaha
 
Wow
This thread is quite revealing, especially for candidates in current cycle
And.....quite depressing as well
 
Wow
This thread is quite revealing, especially for candidates in current cycle
And.....quite depressing as well

You should only do renal if you absolutely love it.
That really hasn’t changed has it?



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You should only do renal if you absolutely love it.
That really hasn’t changed has it?



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Although I wonder if it's worth doing, if not based on love, then on hate. Like, the ideal is running *towards* nephro and not just *from* gen IM, but it seems that some people just find themselves glad not to be in gen IM.

Some have told me not even gen IM is bad enough to make them want to do nephrology, and others have said all the ways nephro sucks compared to gen IM, it's still worth the trade off to get out of gen IM. Still others have said nephro represents most of the bad of gen IM, just slower and less pay.

All I can really say is what I always say - don't match gen IM if you're not prepared for the potentiality of being in gen IM. Don't count on "escape" to a subspecialty - some may be too difficult to get into, the "easier" ones may not be so much more pleasant to you than gen IM.
 
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Although I wonder if it's worth doing, if not based on love, then on hate. Like, the ideal is running *towards* nephro and not just *from* gen IM, but it seems that some people just find themselves glad not to be in gen IM.

Some have told me not even gen IM is bad enough to make them want to do nephrology, and others have said all the ways nephro sucks compared to gen IM, it's still worth the trade off to get out of gen IM. Still others have said nephro represents most of the bad of gen IM, just slower and less pay.

All I can really say is what I always say - don't match gen IM if you're not prepared for the potentiality of being in gen IM. Don't count on "escape" to a subspecialty - some may be too difficult to get into, the "easier" ones may not be so much more pleasant to you than gen IM.

Words of wisdom. Unfortunately, the desperation some people feel after doing years of hospitalist/general IM propel them to take the risk of doing neph.
You would think that a fellowship that's this easy to get in is a big red flag, but humans make illogical decisions. A good majority of them will waste several years to realize that they were financially better off with their old jobs. Some will go back to IM/hospitalist, and the cycle repeats itself. It's just sad and depressing. The only ones who benefit are fellowship programs who need warm bodies to cover their night calls. I'm reminded of the saying that common sense isn't all that common.
 
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This thread is a bummer. I have had a positive experience in the process overall and landed well. Anyone can reach out to me if there are any questions regarding fellowship and beyond.
 
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