Nephrology Job Market And Work Hours

[TechToMD]

Hello all, I have recently done some horizontal electives in nephro and absolutely loved them. I was planning on doing an IM subspecialty anyway and am now seriously considering nephro.

 

However, I have heard some concerns from residents on job market. One of them straight up told me to do endo or rheum instead. Can anyone comment on how good/bad it is? Is it fine if I'm willing to go somewhat rural (within 100-200 km away from GTA or Hamilton)?

 

Would doing USMLE be necessary? I don't mind working in a major urban center in US (not middle of nowhere) but much prefer to be in Canada. How transferable are IM subspec FRCPC licenses to the US?

 

How common is it for nephros to cover CTU part time? I also really like GIM and it would be a bonus if I could incorporate some of that in my future practice (maybe 4 days/week nephro and 1 day CTU), just want to know how common that is?

 

Can anyone comment on the work hours for nephro? How much call is expected?

 

Can any internist also comment on other similar subspecs to look into that are like nephro? I am not too concerned about salary, does not need to be paid as much as nephro.

 

Any advice would be really appreciated. Thanks so much.

[ameltingbanana]

Hey! Have done some nephro electives as a medical student in clerkship (starting IM residency next year).

 

They were on call 1:4 from what I recall (varies by center), but it's usually home call and they were backing up an IM resident (typically R2). That being said, some of the patients who came in during call were quite sick (sicker than the average CTU patient, but not quite ICU levels of sick - somewhere in between). As well, nephro from what I saw really takes ownership of their patients (e.g. hemodialysis patient with cholecystitis comes in - nephro admitted with general surgery consulting). Staff lead fairly decent lives lifestyle-wise when they're not on service for consults/ward was the sense I got, but maybe that's inaccurate...when they were on service, they stayed pretty late (usually ~730 AM to 6 PM while being available via phone in the evenings).

Talking to the residents, they do say there is a job crunch, particularly in academic centers where a lot of the big hemodialysis units are. I can't comment too much on the need for nephrologists in a rural setting (I'm sure there's a big need for them and access to dialysis in general). 

Speaking from my personal experience, I haven't seen too many nephros who cover CTU..which is a bit weird, because to me, nephro felt like the most "GIM-like" of all the subspecialties. You get cardiac issues (e.g. pts arresting due to their K being skyhigh), hematologic issues (anemia, GI bleeds and uremic platelets), respiratory issues (skipping dialysis, going into pulmonary edema), etc. However this might just be at Mac, and I may have simply not run into the nephrologists that do CTU (they're mainly at SJH, and most of my medicine experiences at Mac have been at Juravinski and HGH).

 

Hard to say what other subspecs to look into might be without knowing what it is you loved about nephro. Subspecialties that I found awesome for IM knowledge and learning during clerkship: cardio, ID, nephro (actually did both a general nephro and transplant nephro rotation). GI is useful too - you'll see a lot of cirrhosis workup and management of GI bleeds, and it's good to check out if you think you'd like a more procedural specialty (scopes, paracentesis, etc). Also did an ICU elective which I loved, but you may not get to do a whole lot as a medical student depending on the centre and the residents on with you (you might get a chance to try art. lines, bag-mask ventilation, etc but often times the residents take priority for learning procedures).

 

Hope this helps!

[LittleDaisy]

Hey you meant starting IM residency this year!!  ! Glad that you got your first choice !!!

Hey! Have done some nephro electives as a medical student in clerkship (starting IM residency next year).

 

They were on call 1:4 from what I recall (varies by center), but it's usually home call and they were backing up an IM resident (typically R2). That being said, some of the patients who came in during call were quite sick (sicker than the average CTU patient, but not quite ICU levels of sick - somewhere in between). As well, nephro from what I saw really takes ownership of their patients (e.g. hemodialysis patient with cholecystitis comes in - nephro admitted with general surgery consulting). Staff lead fairly decent lives lifestyle-wise when they're not on service for consults/ward was the sense I got, but maybe that's inaccurate...when they were on service, they stayed pretty late (usually ~730 AM to 6 PM while being available via phone in the evenings).

Talking to the residents, they do say there is a job crunch, particularly in academic centers where a lot of the big hemodialysis units are. I can't comment too much on the need for nephrologists in a rural setting (I'm sure there's a big need for them and access to dialysis in general). 

Speaking from my personal experience, I haven't seen too many nephros who cover CTU..which is a bit weird, because to me, nephro felt like the most "GIM-like" of all the subspecialties. You get cardiac issues (e.g. pts arresting due to their K being skyhigh), hematologic issues (anemia, GI bleeds and uremic platelets), respiratory issues (skipping dialysis, going into pulmonary edema), etc. However this might just be at Mac, and I may have simply not run into the nephrologists that do CTU (they're mainly at SJH, and most of my medicine experiences at Mac have been at Juravinski and HGH).

 

Hard to say what other subspecs to look into might be without knowing what it is you loved about nephro. Subspecialties that I found awesome for IM knowledge and learning during clerkship: cardio, ID, nephro (actually did both a general nephro and transplant nephro rotation). GI is useful too - you'll see a lot of cirrhosis workup and management of GI bleeds, and it's good to check out if you think you'd like a more procedural specialty (scopes, paracentesis, etc). Also did an ICU elective which I loved, but you may not get to do a whole lot as a medical student depending on the centre and the residents on with you (you might get a chance to try art. lines, bag-mask ventilation, etc but often times the residents take priority for learning procedures).

 

Hope this helps!

[#YOLO]

Bad job market. The thing is nephro isn't well paid in the states, its an option. but you wont be making what you make up here surprisingly. theyre having a very hard time getting IM resdients to enter the field, most programs are unfilled or half filled. 


There isn't much in terms of "rural nephro/dialysis" Most sites in ontario at least are satellite sites, affiliated with major academic centres. You would never find a "rural" dialysis site big enough to have their own nephrologist running it. Most nephro jobs are in academic nephrology. You can find job postings easily, alot are interested in Masters or PhD, with quite a bit of time in research.  I loved nephro, and was considering at one point. The big thing for me was job market, and even predictions for the next 10 years aren't great. All the fellows I know are currently jobless - most pursuing fellowships or doing research. I know one that decided to fall back and do community GIM.