Anyone billing G2211 for nephrology patients? Specifically CKD in clinic or transplant. Seems like we longitudinally care for a chronic condition.

After some of my friends gave their nephro boards, they said it was very tough and rightfully so, I mean it’s nephrology the board with the lowest pass rate for ABIM. My only concern is, I’m almost halfway into my first year of fellowship, it’s hard to make time to study but my main concern is the content. I’ve read a lot of people suggesting book x or site y etc, it was easy to focus on one source with MKSAP and Board Basics with internal medicine. If someone has insight on how to go about studying during fellowship not only for boards but just for understanding the concepts I would really appreciate it. Is there a one source book that can encompass most of the info? I see Burton Rose, comprehensive clinical nephrology, hand book of dialysis and hand book of transplant as the go to’s but that’s A LOT of pages, texts to read through. I’ve never been one to read articles either. How does one understand the beans in under 2 years? lol any insight would be helpful! Thanks again.

So I've noticed that POCUS tends to give better estimation of volume status compared to the good ol auscultation and edema assessment. But obviously if you're not being compensated for it you won't be inclined to use it. What are your thoughts on this ?

Hey all! A couple of weeks back, I had shared the anonymous community salary sharing form here, and a few of you contributed to it - with details of comp structure and additional factors such as shifts, hours, and benefits, and the data is now really starting to take shape. Thank you for helping out the community!

I put together a quick summary of averages to how it looks. We only have 11 responses so far, but the good news is the community powered average is pretty close to other salary benchmarks that are out there, but now with our data - we can look much deeper into shifts, benefits, etc and into individual contributions.

Community Powered Salary Average - $320k (Avg Base = $309k, Bonus = $11k)
Other Benchmarks - Doximity - $365k, Medscape - $341k, MGMA - ??

Salaries range from $180k on the lowest end to $400k at the highest end. Thoughts on the numbers? Do they look reasonable so far? And if anyone has MGMA estimates, let me know and I can update it here

Once we get ~25 or so reponses, the community powered data will get more robust. If you haven't contributed and don't have access to the salary sheet - you can share your salary here to see the full data-set. And if you are a student and need access, please DM me.

Cleveland Clinic (Florida), Dartmouth NH, Indiana University, Virginia Commonwealth Univ, USF Tampa, and Univ of Minnesota. Thanks!

My boyfriend and I both want to apply to fellowship. We are currently PGY2s internal medicine. He wants critical care and I want nephrology. I was thinking that he can match during third year, I take a gap year and do hospitalist and then the next year I apple and get in around where his program is. My reasoning for the plan is because critical care is harder to get into than nephrology and so it’s best to land him a spot and then it would be easier for me to get in. I really really really do not and can not do long distance for my mental health and the health of our relationship. I also heard couples matching with fellowship is a joke and will completely ruin chances. Any advise?

Hey all - there are a few different threads here on salaries, but it's all over the place and does not have the full context of comp - e.g., including shifts, schedule, PTO, benefits, location, etc. to make it useful. We all know that medicine needs more transparency and this information is key to make sure we are fairly paid. All the salary reports out there are just not useful - either too broad and not specific to our situation or cost $$$.

A few months ago, my anesthesiologist friend tested a spreadsheet format in the Anesthesiology sub-reddit and has crowdsourced >500 anonymous salaries for the community. It has become an extremely helpful resource for them to ensure they are being paid fairly. I have worked with him to extend the sheet and the questionnaire to other specialties as well. A few specialties like Neurology, EM, Family Medicinehave already contributed hundreds of salaries - so it'll be great to get some Nephrologist salaries. If we can all contribute our salaries, this could become a really useful resource for Internal Medicine as well.

Let's do it together as a Community. This is fully anonymous, so it really decreases the taboo of discussing our comp.

Here is the salary questionnaire - https://marit.fillout.com/t/vfyw8PEHj2us

Let me know if you have any feedback on questions in there. And you see the data collected so far here. Add your comp info if you are willing, and it will unlock the full spreadsheet. The more data we get in there, the more useful it will be for all of us!

PS: This is for physicians and APPs in the US only

By the time i apply I would be a month or so into PGY-3 and if I do match I would be starting the fellowship 1 month maybe 2 months after being done with IM residency.

I’ve seen many foreigners doing it. Also would it be easier to get to do IM residency in the USA after nephrology fellowship is donde?

In a patient that has membranous nephropathy that is already on lasix and needs better BP control, is adding a combo ARB with HCTZ advisable? Or stick with just the ARB? I can't seem to find much information on this.

Can somebody help me with the new ADPKD KDIGO guideline in PDF? Apparently it got deleted from the KDIGO website. Thank you in advance!

Compare*

Starting 2 week long rotation in a few weeks. I’d like to show that I’m up to date on recent important evidence. Hoping I can get some recommendations on finding recent papers that have generated a lot of interest in the nephrology community.

Also one of the ways we’re graded is if we “educate the team” with interesting new papers/clinical trials.

Additionally, any other recommendations to do a really well on my rotation?

If the serum creatinine elevates on lisinopril, is it reversible upon discontinuing lisinopril or does the serum creatinine stay elevated? Like that does become the new baseline? Thanks in advance.

Same as title. A good comprehensive resource that doesn't put an internal medicine resident on call to sleep 🙏🏼

Good day doctors!

I am a general physician in my country. I recently have a patient with 3 years straight slight elevation (1.3mg/dL) of creatinine levels in his labs. However there are no other derranged findings. Is the elevation significant?

Thank you

I like nephrology but really like procedures and have fun with the interventional stuff. Any thoughts on interventional as a field? My understanding is that it’s a niche field, with the pay being about the same as general nephrology, but more liability. You also compete with interventional radiology and vascular surgery who might have an edge over you in some areas. Reimbursements are also trending down, so I’m worried what the future hold for this field.

Hi there, I am interesting in pursuing nephro fellowship currently and IM resident i wanted to ask those who are currently doing the fellowship about thoughts on nephro, im not too worried about the salary as much as me enjoying the actual job. I am worried about the physiology being too difficult and the dialysis machine being too difficult to learn ? Any thoughts advice as to how I should go on about making a final decision, tips, things to consider or read more about ? The reason im interested in it is that it focuses on more than one organ, the heart the kidney, physiology of the body. Diuresis, HTN, DM etc so its a wide array if interlinking stuff. Need some guidance, Thank you

Feel free to share your thoughts and questions as to the possible etiology, thanks!

I came upon this interesting article published in kidney international:

https://www.sciencedirect.com/science/article/pii/S2468024924018606#appsec1

The discussion online for this specialty has been trending negative. There appear to have re-occurring themes in these online discussions:

1. high workload and low salaries, motivating some to do hospitalist medicine

2. fellowship programs using fellows solely for cheap labor

3. Senior partners exploiting new grads and not sharing revenue evenly

4. training programs exploiting IMGs w/o residency for the same reasons as #2

Economic exploitation/destitution seems to be a re-occurring topic in these online discussions.

Hi! Nephro here. I'm looking for either part time nephro work in patient only (not a fan of clnic) or nephro hospitalist work 1 on 1 off or 2 on 4 off schedule. It seems like a niche position and am wondering if yall have seen something like this? 

I have a question pertaining to a case I had a while ago. Patient with CHF exacerbation and cardiogenic shock was on a dobutamine and furosemide infusion. Urine output was 30-50 mL/h despite the furosemide infusion. Hours later, the patient began dumping hundreds of mL of urine per hour. Lactic acid was steadily trending down, and S&S of cardiogenic shock had resolved hours prior to the furosemide infusion achieving desired effect.

My question: what would cause the furosemide infusion to work hours later?

Hello lads. I'm a new nephrologist and I'm looking to work in Europe. What is in your opinion the best country for a nephrologist, in terms of money ?

I know that there is 2 ways of transportation of water across a cell membrane. Osmosis (via concn gradient) Facilitated diffusion (via aquaporins)

Also, TAL of LoH contains NO aquaporins, so i understand that there is no movement of water in or out via facilitated diffusion.

But it contains a hypertonic urine, and doesn’t that cause osmosis to occur and pull water in the lumen of Loop of Henle?

Why would the books refer to the cell membrane as “impermeable” if so? Or is there a difference in constitution of cell membrane?