Nephrology salary (recent grads' input wanted)

[DrAwesomo]

Hey guys,
I know there are tons of "Nephrology is dead" threads but I want to hear from people who have actually graduated in the last 1-3 years and practicing nephrology. How was your job search? What kinds of compensations are realistic (non academic)? How are your hours?

I think we need to hear more about your experiences rather than doom and gloom prediction from current or prospective fellows. PM me if you are uncomfortable posting publicly.

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[CptNemo]

I'd be interested to hear some good news too from someone. But, I doubt that people are lying in the Nephrology is Dead threads (I won't rehash what I posted there).

If you look at survey stats, both Davita's fellow salary survey and the MGMA's starting salary survey for nephrology report a median starting salary of $180K. That seems pretty accurate from what I saw being offered while on the job hunt +/- $20K on the west coast.

Other parts of the country are hopefully better. I'd be interested to hear what offers other have received...

 

[asdf0987]

Most of the surveys show an average of 175, but it really depends where you live. There are jobs in some areas currently listed with $300k starting salaries, so it seems pretty variable.

 

[Handsome88]

Hey guys,
I know there are tons of "Nephrology is dead" threads but I want to hear from people who have actually graduated in the last 1-3 years and practicing nephrology. How was your job search? What kinds of compensations are realistic (non academic)? How are your hours?

I think we need to hear more about your experiences rather than doom and gloom prediction from current or prospective fellows. PM me if you are uncomfortable posting publicly.

Nephrology isn't dead, it's just living in certain areas. You can make 300+k if you are flexible in terms of location. Or you could move to Canada where they make 500+K

 

[drkristy85]

One thing that you can do is move to an area where they are offering $300 k + starting salary, work there for a few years and build your CV. Then when you want to move to a more desirable area in a couple of years, you tell them how much you made at your previous job, and they may be more likely to bump you up a notch (if they want you). They might only offer $175 starting salary, but if you're already experienced and made a higher salary at your last job, they will often offer you more.

 

[CptNemo]

Are you sure that would work? You may be more efficient, but are not bringing any additional patients or connections to the practice. I doubt they would pay you much more than a garden variety associate: maybe $10-20K/yr more. I have heard from others that upon relocating, you may be able to negotiate a fast-track path to partnership, but that is group dependent. Also, the main limiting factor in desirable areas is job availability (and especially the availability of quality jobs).

In either case, the $300K starting salary for a nephrologist is more of a pipe dream than the norm. I haven't seen anyone I know get an offer even in that ballpark. And the DaVita starting salary survey lists these averages based on location:

• Average Salary in a Metropolis is $173,750
• Average Salary in a Medium-sized City is $182,917
• Average Salary in a Rural Area is $185,833

They do mention that $300K was the highest recorded starting salary... great for that person, but certainly nowhere near typical.
http://www.davitasource.com/career-resources-salary-guide

 

[drluc]

As, a graduating fellow ,

I was offered around 175- 180 k in mid sized city.
Some rural areas were promising around 300 K , but those areas were in a rural setting with only 1-2 nephrologist covering the whole area.

Talking to other fellows from various programs across the country , it appears that starting salaries ranged from 150 - 180 K .

This is guaranteed salary only for 1-2 yrs and then after that income depends on the parternship track and many other things such as productivity , which varies from region to region and depends on the group .

Although , the starting salary is kinda of on lower side , but that doesnt mean you wont be very busy from day 1 or you wont cover weekends

This issue of such low starting salaries is unique to nephrology . Whereas in other specialties like hem or cards , the starting salaries are much higher.

 

[drfunktacular]

Heme, cards, and gi are all higher in general because of compensation biases favoring procedures

Other subspecialties like endo, ID, rheum, geri, non-cc pulm, and general medicine are in line with what you describe for nephrology. If you want more money be a cardiologist

That said, the most objective information you're likely to find is: http://www.medscape.com/features/slideshow/compensation/2015/nephrology#page=1

 

[PulmDr]

Please take page 26/28 into consideration when assessing the medscape report only 1% of nephrologists responded the same applies to other specialties too.

 

[Raryn]

Medscape tends to skew much lower than a source like MGMA, which is significantly more comprehensive in methodology. Unfortunately, MGMA data is behind a paywall. Fortunately, you can get some of the basic numbers from the AAMC CIM website (I think anyone with a generic AAMC account can access). From that data, for nephrologists:

Clinical Practice
Low Median High
Starting salaries $ 153,482 $ 180,000 $ 185,575
1‒2 years in specialty (median) $ 235,379
All physicians $ 252,709 $ 323,702 $ 418,141

Academic Practice
Low Median High
Assistant professor $ 151,000$ 176,000$ 208,000
Associate/Full professor $ 200,000$ 236,000$ 288,000

I don't know what the cutoffs are for low/high. My guess is either the 25th/75th percentiles or the 10th/90th.

 

[Mad Jack]

Two years of fellowship to be paid less than a hospitalist

 

[drfunktacular]

Two years of fellowship to be paid less than a hospitalist

How much is it worth to you to write for Colace and take orders from surgical PAs?

 

[thierryhenry]

How much is it worth to you to write for Colace and take orders from surgical PAs?

+1

 

[drluc]

Heme, cards, and gi are all higher in general because of compensation biases favoring procedures

Other subspecialties like endo, ID, rheum, geri, non-cc pulm, and general medicine are in line with what you describe for nephrology. If you want more money be a cardiologist

That said, the most objective information you're likely to find is: http://www.medscape.com/features/slideshow/compensation/2015/nephrology#page=1

Dialysis is considered as procedure and billed as procedure.
Same as chemo infusions are considered as procedures in hem/onc

Nephrology is up upthere, besides other medical specialties, when it comes to acuity of consults seen. An easy way to tell is by looking at how many stat/urgent consults are placed for nephrology.

From the job requirements, Nephrology is right up there with other acute specialties. Its not as acute as Acute STEMI needing urgent cath , Or Stat Intubation, but it is urgent/stat enough to be called multiple times in middle of night , for issues like hyperkalemia, CRRT, Hyponatremia. It is busy enough , that you will be rounding till 8-9 pm over the weekend. Sadly , the structure of nephrology is such that these long work hours dont get translated to equivalent higher compensation.

But , when it comes to compensation , the salary is not close to cards or critical care, its like a non interventional specialty .

As pointed out earlier ," If you want more money be a cardiologist"
or if you want a good lifestyle, then do other specialties ,as mentioned above.

 

[drfunktacular]

Important point about procedures: dialysis is almost exclusively reimbursed by government payors. Bad $$$

 

[nephro007]

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[ANCAdoc]

I'm a US MD in my second year of private practice for a large group. I really like what I do. Generally speaking, in private practice the pay tends to start on the low end (150-200k) but quickly ramps up as you make partner (>300k). When I'm in clinic (3 weeks/mo) I work 8:30-4ish with 1 hour closed for lunch, we still do 30min f/u and 60min new appts so I'm moving at a very comfortable pace (notes done before I go home, generally done by the next patient). In the hospital rounding week I'm on call 7-4 and only see inpatients. Average 1 weekend a month (following Monday off) and 2-3 weekday calls a month (following Afternoon off). 7 weeks vaca this year, 9 weeks next year, ultimately tiers up to 12 weeks. That's amazing. Generous business spending account for conferences/dues, etc. While I don't start over 200k I don't feel like I work too hard and have quite a bit of time off and next year when I start the partnership track the $$ will improve considerably.

The payor mix and bundling (Medicare) does hurt revenue generation, hence why starting salaries are lower than other fields. However, when you take into account Medical Directorships +/- Joint Ventures it remains a very profitable business and the pay as a partner is excellent. They key is finding a great group who has a track record of making employees partners. Also a group who's income is somewhat equitable is nice, rather than reimbursement on RVUs so essentially all the partners make the same amount every year. This promotes good will and the sense that everyone is working like everyone else. If you're a junior partner and work for a group that is not equitable (i.e., partners keep their own directorships) then that's not helpful. Good jobs exist, you just gotta find them. I feel very fortunate and really enjoy what I do.

 

[gloms]

I am currently in my second year of nephrology Fellowship and bit disappointed after my job interviews. Yes, Job situation is better than 2012-2013, but the amount of work to be done with a salary between 180-200 max is ginormous. Most places want 2 weekends to be covered (obviously after a 5 day work M-F). Job description with some employers i interviewed looks like i will have to see 15-20 inpatients and 7-18 outpatients Plus dialysis rounds (dialysis units) in certain days (unsure how many Pts) every day. When i interviewed as hospitalist it felt like a red carpet welcome, but some Neph employers made me feel like they are doing a favor by giving me a job. Most of them will not give a partnership until after year 2 or 3 or even 4. You will be employed for 2-3 years and after that there is no guarantee for partnership. They say if both parties mutually agree they will give partnership, which means that they can say goodbye to you after making you slog for 2-3 years and then again with another job you have to start from scratch. Hospital employed nephrology positions pay better with upto 300K salary but the amount of work is worse than what i have listed above including placing lines in night. Some fellowship programs are starting to train candidates who have no residency in US ( due to shortage of fellows) and some have plans to start fellowship where a week of hospitalist rounding is done so candidates don't suffer financially. With this said, there are going to be more nephrologists (Less demand and more supply is already an big issue). I felt like there are more jobs advertised, but when i call most of them are solo practitioners listing their job and they can't find anybody for years as people have joined and left to become hospitalists. When i went to ASN to interview with some large private employers, i was startled to see 20-30 graduates been interviewed for 2 positions. Joining with a solo practitioner is usually a disaster unless its your own family, so most candidates go for large private groups who have 30-100 physicians in 1-2 states. I don't want to sound kind of pessimistic here but there are certain advantages to do this fellowship. My knowledge of acid/base/ckd and even internal medicine has increased by many folds and am very happy how much i learned. But when it comes to the realities of finding a job am little disappointed. I feel doing academic nephrology is not a bad deal as you are on consult service only 3-6 months of year depending on the location and rest of year is research/CKD clinic which helps with a good lifestyle if you are ok with a paycut ( awesome option for e.g. Physician couples). Do not compare yourself with Hospitalist salaries who work for 6 months of year and base pay is around 250-280K (increased in last 3 years) with most employers+RVU=300-350K and more income if you take extra shifts on week off time. I will keep here everybody updated and i am kind of leaning back to becoming a hospitalist unless i find a reasonable job which i haven't so far. Well there a tons of nephrologists working as hospitalist anyways and i will be one of them. Inspite of all this, i don't regret doing fellowship as am a better physician now. Thanks for reading my post.

 

[ANCAdoc]

Gloms, are you a US MD or IMG? I have noticed IMG's having more difficult issues with obtaining desirable locations/jobs. Most (if not all) of the nephrologists I know working as hospitalists are IMGs.

 

[nephro007]

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