In private practcie, a large proportion of a nephrologist's time is focused on doing dialysis. New medicare laws actually require nephrologists to see patients while they are getting dialysis, so most have to hang out at their dialysis center for most of the day. The other part of a nephrologists time is spent working up new patients with kidney problems. This involves doing things like ordering a standard battery of tests for any patient who comes in with protein in the urine and ultimately doing kidney biopsies. It's a very algorithmic work up. Some nephrologists in private practice can manage post-transplant nephrology patients as well, but for the most part, my impression is that these patients are managed by attendings at major academic centers. Call is pretty rigorous because there always has to be a nephrologist on call at most hospitals because lots of patients who are admitted need emergent dialysis, but like all specialties, call can be broken up if you are part of a large group practice. Salary in nephrology is variable and currently in flux. Right now, avg salaries run anwhere from 180K-250K, but nephrologists are particularly susceptible to whatever business goes on in Washington because all ESRD patients are actually covered under medicare, irrespective of how old they are. That means that if medicare decreases payments to all physicians or specifies a new pay scale for nephrologists (which they did this year, they decreased payment to many nephrologists in that new medicare law), there's not a lot you can do about it, because you can't have a practice as a nephrologist without having ESRD patients. I suspect that there will also probably be a shortage of nephrologists in the future though, given the large number of ESRD patients we are going to have with everyone being htn and diabetic, and there are some studies which suggest that dialysis may play some role in the management of things like CHF, thus creating a greater need for more nephrologist. I don't know how this increase in demand will effect the avg nephrologist's salary, but it will probably balance out some of the business they do in Washington.
