Nephrology is Dead - stay away

[Renal_Prometheus]

The whole thing was a lie. Most neph grads coming out today will eventually figure out the job is worst than being a hospitalist. Dangling a carrot in front of a donkey to make him pull the cart that nobody else wants to pull.

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[CptNemo]

You really need to get out more and see what the rest of the country is doing. Majority of nephrology programs are not top 10 and get their pick of the litter. They are salivating over warm bodies and ready to pounce on anyone who show's the slightest interest in nephrology.

The point is that no one really gets the pick of the litter anymore. Even the top programs are all interviewing the same 50-100 candidates within a given region. Of those, maybe about 10-20 are really exceptional candidates that multiple programs are "salivating" over - and some of those candidates have research/clinical preferences or geographical preferences that guide their decisions. This is why even good programs sometimes don't fill.

I stand by my statement that I would rather do work by myself without a fellow than to be stuck with a fellow who is either poorly qualified, is overwhelmed, has personality issues, and/or just doesn't work well with others - they can totally make my life much more difficult (while likely also complaining to the GME office in the process) .

 

[Renal_Prometheus]

I stand by my statement that I would rather do work by myself without a fellow than to be stuck with a fellow who is either poorly qualified, is overwhelmed, has personality issues, and/or just doesn't work well with others - they can totally make my life much more difficult (while likely also complaining to the GME office in the process) .

You can make that statement. But most academics are more than overjoyed that someone is willing to cover their night calls. That doesn’t change the reality of what’s going on.

 

[NewYorkDoctors]

The point is that no one really gets the pick of the litter anymore. Even the top programs are all interviewing the same 50-100 candidates within a given region. Of those, maybe about 10-20 are really exceptional candidates that multiple programs are "salivating" over - and some of those candidates have research/clinical preferences or geographical preferences that guide their decisions. This is why even good programs sometimes don't fill.

I stand by my statement that I would rather do work by myself without a fellow than to be stuck with a fellow who is either poorly qualified, is overwhelmed, has personality issues, and/or just doesn't work well with others - they can totally make my life much more difficult (while likely also complaining to the GME office in the process) .

that's because you are a good attending physician.

but you know those bottom barrel programs just want any warm body they can get.

but usually highly qualified nephrology applicants who go through the match the first time do not have to worry about any of that.


this is why no one (and I mean no one) should be joining a nephrology fellowship in the scramble.
if one decided one day sure i can do neprhology. i'll give up cardiology or PCCM or hospitalist. i read the SDN thread and I have something planned out for my career that does not involve my becoming an indentured servant then the logic is to apply NEXT year and get into a top program.

 

[Renal_Prometheus]

I think this statement from neph fellow is the truest one:

“Lifestyle is difficult and reimbursement is low when you account for the effort required. Medicare reimbursements also continued to be cut which makes it difficult to care for those who need it and still be financially viable. As interesting as the field can be, it’s difficult for most to sacrifice both income and quality of life. Many can give up one or the other but not both.”

This is the biggest reason why Neph will forever languish at the bottom. The society can’t force Medicare to pay nephrologists more. ASN can’t force seniors partners to share JV/MDA fees fairly with junior partners. Maybe something could have been done about decreasing supply of practioners years ago by cutting fellowship spots, but that ship has sailed. What can be done? It’s dying a slow death. Don’t tell me taking bottom of the barrel applicants every year will help the specialty innovate itself.

 

[Renal_Prometheus]

One thing I’ve learned through the years is that people fall for hopium of being a specialist and making more money than a hospitalist. The brain is wired to believe in optimism, even if it’s untrue. This is why victims keep falling for the same scams over and over again. People want to believe others. They want to believe in hope, even if it’s misguided.

 

[NewYorkDoctors]

just because you did a nephrology fellowship does not meant you have to be an indentured junior attending private practice servant.

hospitalist is one route

private practice with more GIM and non-HD renal is another feasible option

or go medcial marijuana like this Nephrologist does

Dara Huang - Appointments | Patient Fusion

Read about Dara Huang on Patient Fusion and schedule an appointment online.

www.patientfusion.com

 

[Renal_Prometheus]

I also think there is significant information asymmetry between an applicant and nephrologist. Those who have done private practice nephrology for many years like myself knows that there is a lot hidden underneath the cover. But I still get approached by residents thinking they can make it big by owning several dialysis units down the road. Some are still living on the glory days of nephrology 30 yrs ago. There is stark difference in perception and reality in this field, potentially leading to neph fellows to be severely disappointed when reality hits them in the face.

 

[NewYorkDoctors]

yeah the government, big pharma, and big tech control dialysis. The dialysis-industrial complex. they are not ceding profits to the doctor lol.

 

[Renal_Prometheus]

The problem is when nephrologists give up on their specialty, they are not going to call their former PD and tell him he lied about private practice. People just quietly suffer and move on. Since I’ve graduated many years ago, not once has my former PD called any of my cofellows and asked how we are doing. Majority have left the specialty or thinking of leaving. So it’s incredible disingenuous for Neph PD to advertise to applicants that all of their grads have done well post-graduation. Based on what metric? Bald face lies.

 

[Test Boy]

The problem is when nephrologists give up on their specialty, they are not going to call their former PD and tell him he lied about private practice. People just quietly suffer and move on. Since I’ve graduated many years ago, not once has my former PD called any of my cofellows and asked how we are doing. Majority have left the specialty or thinking of leaving. So it’s incredible disingenuous for Neph PD to advertise to applicants that all of their grads have done well post-graduation. Based on what metric? Bald face lies.

To be fair, I don’t think cardiology, allergy, ID, or any other fellowship PD will call up a grad and ask how they’re doing a few years after they graduated. Maybe a few might if they developed a close relationship during the fellowship but most won’t. However, maybe this is even more true in nephrology.

 

[NewYorkDoctors]

happy holidays to everyone. especially to those renal fellows who are working the long weekend.

 

[Renal_Prometheus]

Due to low fellowship match rates, I’m starting to see increasing number of Neph programs turn to taking IMGs with no residency to make up the manpower shortage. Besides the patient safety issues, it scares off regular applicants as people inherently knows it’s a shady practice. How do you convince an applicant this is a viable specialty when it resorts to this type lowness just to get a warm body to exploit? Sadly, I believe this specialty is in a vicious cycle heading towards the bottom.

 

[NewYorkDoctors]

happy holidays to all the renal fellows working the new year's long weekend.

 

[sharpstickie]

speaking of reddit:



This poor individual. I can only say if you love renal stick with it. You will get better with time as you become more efficient and begin to realize you just need to "know about" the non nephrology parts of their care and how it relates to the kidney but you are NOT the internist/primary team and do not have to figure out all of the non-renal issues

But on the other hand, this is the reality of "academic nephrology." There are only so many "cool cases" and the faculty group has to pay the bills and their salaries by seeing these "creatinine stable c/w lasix" follow ups. The fellow is the cheap labor in this case.

I will also say if a private nephrologist did this many follow ups that nephrologist will be making some serious bank.
but that all entails having the right referral base and set up though. easier said than done

Yup, that's me. I wish I had taken the info from this thread to heart. I thought I would enjoy being a fellow in nephrology but that quickly faded away as I grew to resent the specialty fairly early into fellowship. The day-to-day is brutal with 25-35 patients on a list for mostly BS consults, the weekends of being in the hospital 5a-7p then being paged every 20 minutes the entire night then working 5a-7p the next day with minimal attending assistance or even an offer to send me home after a sleepless night. You'd assume this was at a small rural program, but that's far from the truth. I was at a program that never went unfilled in the last 10 years and my PD was baffled that anyone would even attempt to leave. At the time it was a full-blown crisis as I didn't have any backup plans as far as a job and I still had to take IM boards later that week. Luckily, my program was quite supportive and the leadership talked with future potential employers I was interviewing with and looked out for me to make sure I got my feet back under me. All I knew was that I couldn't stand going back to work as a nephro fellow again no matter the cost.

Part of me wonders why I didn't have a good hard look in the mirror before applying for a fellowship, but as someone who went to a low-tier med school, and a small IM program, the allure of a prestigious nephro fellowship was intoxicating. Looking back, I'm somewhat glad I went through the experience so I wouldn't be wondering "what if" for the rest of my life. I have absolutely zero regrets now that I've started an attending IM job and finally am getting some enjoyment out of work. I tried to be productive during my short period of unemployment including trying to become as financially literate as possible with the looming attending salary that I wanted to spend consciously. I never had time to think about anything financial during residency besides contributing to a Roth IRA, but now I feel that I have the financial tools to get my loans taken care of and hopefully retire a little early. None of that would have been possible if I hadn't left fellowship. I was at rock bottom just a few months ago and now this is the best I've felt about myself in years.

I've been reading this thread for years but always thought "It won't happen to me". I'm just glad that I was able to get out early and not be a victim of the sunken cost fallacy. After that Reddit post, I received several DMs from current first-year nephrology fellows who felt the same way but couldn't commit to leaving for one reason or another. I hope they find some sort of peace.

 

[NewYorkDoctors]

Yup, that's me. I wish I had taken the info from this thread to heart. I thought I would enjoy being a fellow in nephrology but that quickly faded away as I grew to resent the specialty fairly early into fellowship. The day-to-day is brutal with 25-35 patients on a list for mostly BS consults, the weekends of being in the hospital 5a-7p then being paged every 20 minutes the entire night then working 5a-7p the next day with minimal attending assistance or even an offer to send me home after a sleepless night. You'd assume this was at a small rural program, but that's far from the truth. I was at a program that never went unfilled in the last 10 years and my PD was baffled that anyone would even attempt to leave. At the time it was a full-blown crisis as I didn't have any backup plans as far as a job and I still had to take IM boards later that week. Luckily, my program was quite supportive and the leadership talked with future potential employers I was interviewing with and looked out for me to make sure I got my feet back under me. All I knew was that I couldn't stand going back to work as a nephro fellow again no matter the cost.

Part of me wonders why I didn't have a good hard look in the mirror before applying for a fellowship, but as someone who went to a low-tier med school, and a small IM program, the allure of a prestigious nephro fellowship was intoxicating. Looking back, I'm somewhat glad I went through the experience so I wouldn't be wondering "what if" for the rest of my life. I have absolutely zero regrets now that I've started an attending IM job and finally am getting some enjoyment out of work. I tried to be productive during my short period of unemployment including trying to become as financially literate as possible with the looming attending salary that I wanted to spend consciously. I never had time to think about anything financial during residency besides contributing to a Roth IRA, but now I feel that I have the financial tools to get my loans taken care of and hopefully retire a little early. None of that would have been possible if I hadn't left fellowship. I was at rock bottom just a few months ago and now this is the best I've felt about myself in years.

I've been reading this thread for years but always thought "It won't happen to me". I'm just glad that I was able to get out early and not be a victim of the sunken cost fallacy. After that Reddit post, I received several DMs from current first-year nephrology fellows who felt the same way but couldn't commit to leaving for one reason or another. I hope they find some sort of peace.

Thank you for being courageous to share your experiences. I only wish you the best for your career.

 

[Renal_Prometheus]

After that Reddit post, I received several DMs from current first-year nephrology fellows who felt the same way but couldn't commit to leaving for one reason or another. I hope they find some sort of peace.

This just goes to show you that many Neph applicants have no idea what they are getting into. They have been misled by the hopium that fellowship programs keep shilling out in order to maintain their fleet of slave laborers. These grads will pay heavy price with their careers down the road, realizing too late that it was all lie and there’s no money at the end of rainbow; just more work.

 

[Renal_Prometheus]

I'm just glad that I was able to get out early and not be a victim of the sunken cost fallacy.

Speaking of sunken cost fallacy. I’ve learned over the years that the mind will play tricks on itself in order to avoid acknowledging bad decisions. As couple of examples from my inner circle:

One of friends is already a partner at a large neph group in a major metro area. He is not making the same money as the senior guys(not a surprise!) and has to moonlight as a hospitalist to make ends meet. Very sad. But psychologically, he cannot justify all this work was for nothing so he continues his nephrology job.

I know another guy who is on his 4th neph job since Graduating. Each of his previous employers treated him badly or didn’t want to share income equitably, and each time he jumped ship, he had to start at the bottom with low starting salaries to make partner. Tremendous waste of human capital. Finally he has found a job with acceptable hrs and pay. But the number of years wasted get payed 180-200k/yr as a junior associate was just mind-numbing. I cannot wish this on my worst enemy. But that’s the reality in nephrology and I doubt any PD will tell applicants this during their interviews.

Sunken cost fallacy. You first get drawn in because of hope. Then you can’t get out because you have invested too much time and energy into it.

 

[NewYorkDoctors]

again the academic nephrologists on social media should not have any criticisms of this thread.

their academic job is a wonderful and great job and they love it and academic nephrology is indeed very nice. but can EVERYONE WHO DOES RENAL FELLOWSHIP have that wonderful job? this is not their issue at all and they are doing the best they can. it's market forces and how the "dialysis industrial complex" is siphoning all of the revenue and profits from HD to them and not much is left for most nephrology providers.

 

[Prehealth1011]

I was at rock bottom just a few months ago and now this is the best I've felt about myself in years. I've been reading this thread for years but always thought "It won't happen to me". I'm just glad that I was able to get out early and not be a victim of the sunken cost fallacy. After that Reddit post, I received several DMs from current first-year nephrology fellows who felt the same way but couldn't commit to leaving for one reason or another. I hope they find some sort of peace.

Congrats on having the guts to move on and doing well! It must've been not easy, especially as an AMG, presumably with loans.

The only people who want/match into nephrology from our residency have been IMGs. They don't have the compounding 300k+ debt, which is probably the main reason why cardio/gi/onc/pccm are competitive.

 

[Renal_Prometheus]

Nephrology is great career choice for those who purely love the subject matter and who just want to do nephrology. There are people like this. Some people don’t care about money, lifestyle, or the opportunity cost. For the majority of neph fellows, these things matter and so eventually they will have the reconcile the difference between what they were told to what the market is offering. Despite all the information floating on the internet, some grads are still surprised by the reality that many won’t make it in private practice and will have to go back to hospitalist.

 

[NewYorkDoctors]

Nephrology is great career choice for those who purely love the subject matter and who just want to do nephrology. There are people like this. Some people don’t care about money, lifestyle, or the opportunity cost. For the majority of neph fellows, these things matter and so eventually they will have the reconcile the difference between what they were told to what the market is offering. Despite all the information floating on the internet, some grads are still surprised by the reality that many won’t make it in private practice and will have to go back to hospitalist.

yep which is why I cannot think logical reason for any academic nephrologists to object to this thread other than

1) hurt feelings - don't worry you'll get over it as you rise in your academic ranjs
2) not having warm bodies as fellows for them at night

otherwise any objection from them is highly illogical

our message is not "die nephrology die." It is if you love it, do it. But buyer beware otherwise.

 

[Renal_Prometheus]

The fundamental challenge to this specialty today is that it has a hard time generating revenue. You can blame senior partners for being greedy and not wanting to share ancillary income with new recruits, but it circles back to not enough money to go around. Too many competing groups
Stepping over each other for a limited number of ESRD pts(prevalence of ESRD population actually declining in this country). Also, groups are too heavily dependent on JV/MDA fees to make it worthwhile, and that money is getting cut as profitability of the dialysis units continue to decline.

Here’s a probing question: “ Do Neph fellows really think that there are no career consequences for going into a specialty that is 1/3 unfilled?”

 

[jackinabox1]

Doing heme-onc myself, but reimbursement ebbs and flows right? Maybe nephro will have its time in the sun in another decade, just as onc will be a nephro if reimbursements take a hit or GI will be a nephro if scopes take a hit.

 

[NewYorkDoctors]

Doing heme-onc myself, but reimbursement ebbs and flows right? Maybe nephro will have its time in the sun in another decade, just as onc will be a nephro if reimbursements take a hit or GI will be a nephro if scopes take a hit.

unlikely. it's not a free market economy

CMS dictates the price of dialysis and the price has been rather constant since they initially made it a Medicare benefit after Clyde Shields went to Congress and was dialyzed in front of them

https://www.sciencedirect.com/science/article/abs/pii/S0272638607001163

the pries have been stable without adjusting for inflation...

there are no lobbyists for dialysis like the AHA for cardiologists or whatever big pharma lobbyists are out there getting the price for chemo high.

the only lobbyists are those by Fresenius and DaVita who want to consolidate all the HD to them and take all the profits and give the doctors the scraps.

If this were a free market economy, then dialysis would have its day in the sun

But nope this is another example of the crony capitalism and what I call the "dialysis industrial complex."

(I am not a socialist btw)


the power is not in the hand of the nephrologists.

 

[UPCR]

Not trying to give you heart attacks, but what about sub-subspecialities such as Transplant, onconephrology, and interventional nephrology?

 

[Renal_Prometheus]

Transplant - good lifestyle, low pay. People choose it to avoid the brutal night calls in pp. end up mostly in academic.

Onco-nephrology - complete BS subspecialty if you call it. It’s not like you are ordering chemo. You are just monitoring AKI from chemo

Interventional - dying. Many ambulatory surgery centers have closed due to low profit margins. Your group needs large ESRD population and you need to do >8 procedures/day to stay in the green. Some large groups keep it around more for better pt outcomes and facilitating optimal starts.

 

[NewYorkDoctors]

Transplant should be the "go to" subspecialty for those who just like the academic rigors and virtues of Nephrology
It's not just the transplant but all the glomerular, interstitial, cystic, etc... diseases that led to the transplant.
a common thing is you'll still likely be called upon to mange recurrent FSGS in a transplant with plasmapheresis and immunosuppression.
you'll get to see the whole spectrum of rare GN diseases as well.

but yeah you are the medical person who consults for the primary team (transplant surgery) and you aren't really doing any procedures other than some acute HD for those patients who get transplanted but still need some chronic HD in the peritransplant time period when there is delayed graft function.

You'll also oversee medical complications of the transplant from infections (though transplant ID is often on the case in those cases as well) to cardiovascular issues. you are truly the Dr House of the renal transplant ward


but no procedures and no chronic HD panel so you dont exactly get paid more than hospitalist.

but its the best option if you go all academic.


Onconephrology only exists in the academic sphere at large tertiary care hospitals where there is a lot of cancer, a lot of chemo and immunotherapy, and a lot of AKI. There is no role for this kind of subspecialists in the community.

even despite the low profit margins of interventional nephrology, you have to deal with turf wars with vascular surgery and interventional radiology who are not going let you get in on their cut of the pie.
you could go rural... but then again there aren't enough dialysis patients and regular nephrologists to support an interventional nephrologist.
there just aren't enough procedures to do
there are only so many tunneled catheters and AVF and AVG declotting that need to be done.

it's not like you are creating AV fistulas endovascularly (there is some literature on that but comon now go to the vascular surgeon for the best fistulae), stenting only renal arteries (it was looked into... and nope), or fixing hydronephrosis yourself... let's be real now.

 

[Renal_Prometheus]

the allure of a prestigious nephro fellowship was intoxicating.

The vast majority of neph applicants have been intoxicated by the hopium of being a specialist and the potential to make more money. The consequences of this decision will not manifest itself until years later. You can reason with them all day, and on same level, they understand there is no free lunch; but ultimately human emotions out trump common sense, especially for those without other career options and looking at neph as a way out of their current predicament.

 

[sloh]

Doing heme-onc myself, but reimbursement ebbs and flows right? Maybe nephro will have its time in the sun in another decade, just as onc will be a nephro if reimbursements take a hit or GI will be a nephro if scopes take a hit.

GI scopes won’t be taking a hit. Takes on average 17 years for evidence to reach clinical practice. And cuts to oncology are unlikely for the foreseeable future. Cancer is the poster child of medicine that deserves all the monies. You say “cancer” and everyone shudders.

 

[Renal_Prometheus]

By joining a nephrology fellowship, an IM resident is giving up 600k-700k in income over 4 years. Let that sink in for a moment! Forget about negotiating tactics to get an extra 50k/yr out of your job. Good decision making alone will save you years of wasted time and money. People can't fall for the hopium and stay level headed.

 

[Renal_Prometheus]

I love it how academics explain away the low fellowship match rates by saying things like “it’s a misunderstood specialty. You will make big money post-partner.” Well, clearly it’s not a common occurrence as I see younger nephrologists working as hospitalists everywhere. Funny when nephrology was lucrative 30 yrs ago, fellowship spots always filled, there was no misunderstanding back then. But now there’s a misunderstanding!

 

[NewYorkDoctors]

I love it how academics explain away the low fellowship match rates by saying things like “it’s a misunderstood specialty. You will make big money post-partner.” Well, clearly it’s not a common occurrence as I see younger nephrologists working as hospitalists everywhere. Funny when nephrology was lucrative 30 yrs ago, fellowship spots always filled, there was no misunderstanding back then. But now there’s a misunderstanding!

yep hallmarks of a predatory bottom barrel fellowship who has to scramble to fill

the top programs always fill (even if they have to struggle a bit to find the best applicants) by their pedigree, education, and research value alone

this just reinforces the notion that one should NEVER scramble into nephrology (unless like one of the top academic programs had a quirk and did not match fully.. they usually get a good qualified candidate rather quickly)

 

[Renal_Prometheus]

I find all scams to have some things in common. One is it targets a vulnerable group of peope who are in desperate search for hope. The other is that it promises an easy path to wealth that is outside of traditional paths. And the 3rd is that the scammers have something to gain. I’ve learned over the years that the human brain is willing to be lied to, but it cannot live without hope. That’s why so many people fall for scams year after year.

 

[deleted1164820]

yep hallmarks of a predatory bottom barrel fellowship who has to scramble to fill

the top programs always fill (even if they have to struggle a bit to find the best applicants) by their pedigree, education, and research value alone

this just reinforces the notion that one should NEVER scramble into nephrology (unless like one of the top academic programs had a quirk and did not match fully.. they usually get a good qualified candidate rather quickly)

How much of a difference does it make if you graduated from top programs or not after graduation?
Your life is pretty much still the same when it comes to private practice, right?

 

[Renal_Prometheus]

How much of a difference does it make if you graduated from top programs or not after graduation?
Your life is pretty much still the same when it comes to private practice, right?

I know many Neph grads who graduated from 10 programs who are not practicing nephrology right now. The issue is fundamental to the specialty, not to the program.

 

[deleted1164820]

I know many Neph grads who graduated from 10 programs who are not practicing nephrology right now. The issue is fundamental to the specialty, not to the program.

So it basically doesn’t matter where you go to do fellowship as the outcome in private practice is still the same.

 

[Renal_Prometheus]

So it basically doesn’t matter where you go to do fellowship as the outcome in private practice is still the same.

Basically. Is there such a thing as prestige in nephrology if any applicant can walk into a top 10 program? Will predatory senior partners not take advantage of you because you went to a big name fellowship program? The only benefit I see is if you are going to do academic medicine, then a big name might help. But there are plenty of open positions in academic centers that if you want one you can get it(just make sure they can fill fellowship spots otherwise you will be the one taking the night calls).

 

[NewYorkDoctors]

How much of a difference does it make if you graduated from top programs or not after graduation?
Your life is pretty much still the same when it comes to private practice, right?

Form private practice yes not much is different

The only exception I can see is if you went to a top center and get lots of glomerular experience and then you are very entrepreneurial and open a private practice and do your own infusions … naturally you probably need to be ina place with lots of lupus patients to give them the CYC and the RTX . I know one large practice that does this but they are the exception not the rule .
In nyc lotsa SLE patients out there

 

[Renal_Prometheus]

The last set of MGMA data I saw showed that nephrologist average 350k/yr(working whole year) and hospitalist average 300k/yr(working 6 months out of the year). On a per hr basis, nephrology is far worse. Private practice nephrology is well known to have bad lifestyle with brutal night calls for emergent HD and driving to multiple hospitals/HD units per day. So financially, it already does not make sense. You also add in the opportunity cost of 2 yrs fellowship and 3 yrs of associate pay to be potentially shown the door, and now you have taken career risks to astronomical levels. There’s just not enough juice to be worth the squeeze. Only IMGs with no debt and have a fascination with being a specialist would go for a specialty like this.

 

[Renal_Prometheus]

In my humble opinion, most Neph applicants are unaware of the risks they are taking on and how bad it is in private practice. Anecdotally, at least half of Neph grads will get screwed by their senior partners in one way or another.

 

[NewYorkDoctors]

it all comes down to how the individual nephrologist has no office procedures to make money like the general cardiologist, the GI, the A/I or even the pulmonary.

HD patients are a valuable commodity and hidden behind a "paywall" to use an internet / gaming term.
You must pay the subscription fee and pay tribute to the feudal lords (the senior nephrologists) to be permitted to be a serf on their land. you will never become a lord of the land unless you really break through and build up from scratch

that's way too much for most people.

 

[onconc]

$500k in arizona
$400k in missouri

These seem good numbers. No ?

Obviously pay will vary based on location etc; so NYC may be half of that. But still $400k or $500k salary jobs are available. No ?

 

[Renal_Prometheus]

$500k in arizona
$400k in missouri

These seem good numbers. No ?

Obviously pay will vary based on location etc; so NYC may be half of that. But still $400k or $500k salary jobs are available. No ?

These are job traps to lure in unsuspecting new grads to highly non-desirable locations that have a hard to finding anyone. The income guarantee is only for the first 1-2 yrs, and after that it’s based on your collections which means massive fall in income. These are not sustainable jobs.

 

[Osteoth]

These are job traps to lure in unsuspecting new grads to highly non-desirable locations that have a hard to finding anyone. The income guarantee is only for the first 1-2 yrs, and after that it’s based on your collections which means massive fall in income. These are not sustainable jobs.

Take the guarantee then leave to another one, take another guarantee and you’ve made up the difference between doing neph and Hospitalist. Most Hospitalist will never make $400k.

I am Hospitalist but can Nephro not just do clinic, day time HD consults?

 

[Splenda88]

There seems to something strange going on w/ nephrology.

For instance, the 3 established nephrologists at my shop are doing incredibly well. They are in their late 50s or early 60s.

One of them is a working machine. He had a partner that I was acquainted with and he already left. He told me the guy makes over 1 mil per year easily, but he was making 325-350k with picking up hospitalist shifts in my group.

That acquaintance also told me there was someone before him who left after 2 yrs as well.

Why these dynamics exist in nephrology?

 

[Renal_Prometheus]

There seems to something strange going on w/ nephrology.

For instance, the 3 established nephrologists at my shop are doing incredibly well. They are in their late 50s or early 60s.

One of them is a working machine. He had a partner that I was acquainted with and he already left. He told me the guy makes over 1 mil per year easily, but he was making 325-350k with picking up hospitalist shifts in my group.

That acquaintance also told me there was someone before him who left after 2 yrs as well.

Why these dynamics exist in nephrology?

If you would have read the whole thread you would have known. Old guys derive majority of their income from investment income from dialysis unit ownership. Old guys don’t share that money with young guy. There are no more opportunities to for young guys as the market is saturated and no new dialysis units are opening up. The young “partner” essentially act like a serf to the feudal lord by supplying dialysis patients to the HD unit, but he gets none of the benefits. Neph applicants fall for this trap every time as PD will always bring up how well senior guys are doing.

 

[Renal_Prometheus]

It’s mind-numbing the amount of people falling for the same career traps over and over again. All they had to do was read this thread and they would know what they are getting into. Hopium is a strong drug.

 

[Splenda88]

It’s mind-numbing the amount of people falling for the same career traps over and over again. All they had to do was read this thread and they would know what they are getting into. Hopium is a strong drug.

It seems nephrology has become an FMG (not IMG) specialty. Many FMG want to be "specialist" no matter what.

It might be easier to take advantage of FMGs since many of them might need visa.

The other thing with FMG is that a lot of them don't have student debt. A salary of 200k/yr is a lot of money for some of them.

I remember when I was a PGY2 one of the seniors (FMG) got a low 200k hospitalist job offer in Tulsa, OK. Someone told her it was ridiculously low. Her reply was: I am young with no debt and get to live in a city.

 

[Renal_Prometheus]

Fundamentally the reason this specialty can’t attract fellows is simple: it’s a bad specialty. These PDs try to spin the narrative that it’s a misunderstood specialty, just makes it more fake and insincere when people have already voted with their feet. I would be more open to joining a program if PD came out and said I can’t offer you anything except to satisfy your itch of being a specialist.