Nephrology is Dead - stay away

[MD46]

one of the renal attendings I trained under at a large academic upper east side academic renal program.. use to be a director of renal in the 70s and wrote lots of papers on renin and angiotensin1/2 went full private some time ago.

currently has a park avenue office. rounds at two hospitals in upper east side
the renal fellowship handles the renal fellowship.
the other "not learning cases" go to privates. he is one of the privates and goes around putting orders for HD, CRRT, etc... all the intensivists, surgeons, hospitalists love him as he is very receptive and gives his cell phone out.
he has 200 HD patients spraed across 4 HD centers - all within fair walking distance

he is in the 70s and took a career accumulating this

he made it big.

he is a "senior partner."

though he is solo. oh sure he has other solo doctors cover his patients if he is away and the such. but he does not employ junior partners to exploit. that is respect

Ball park of how much he makes doing this?

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[NewYorkDoctors]

Ball park of how much he makes doing this?

dunno he does a lot of hospital consults and followups (all himself he does not bother the fellows unless its a glomerular case or something interseting)

he told me before he just bills 99204 in the office and calls it a day. does not spend too much time in the office.

if we just did the ESRD panel 200 patients 4 visit a month = 200 * $400 a month * 12 months in a year = $960,000
that is without even accounting for his hospital consults, billing critical care time for ICU patients, billing for CRRT and acute HD.

so im sure he's banking good bank.

 

[NewYorkDoctors]

anyway one of patient's with nephrotic syndrome and primary hypoparathyroidism just got a renal biopsy back as primary membranous nephropathy PLA2R positive (I call this "plotter positive"). intriguing.

Kidney biopsy:-Diffuse membranous glomerulonephritis, stage 2-3, PLA2R positive.-Global glomerulsclerosis (3/30).-Rare foci of tubular atrophy.-Mild arterio- and arteriolosclerosis.-No segmental or global proliferative lesions noted.

here is some "beautiful" renal path images

diffuse glomerulosclerosis

look at that spike and domes!

look at that podocyte effacement!

now its time to update his age appropriate cancer screening and investigate his hypoparathyroidism a bit more deeply (as his PCP isn't following my reccs)

anyway this patient's insurance will cover calcitriol but not Tums go figure

This patient won't spend money on Tums so I've had to give calcium acetate (not indicated for his Ph of 5.5 I know and it has low elemental calcium compared to carbonate. but hey if hes not shelling out for Tums gotta do something)


anyway i find the rat inside this same patient's lungs far more interesting

addendum: this patient has nephrotic syndrome due to primary membranous nephropathy

he also ha tuberculosis 2 years ago treated. he has a cavity and now he has been diagnosed with chronic cavitary pulmonary aspergillosis
this might be hard to treat. doing okay on voriconazole at the moment
he is considered "moderate risk of progression" for his membranous so just doing ARB and dietary control at the moment
I'd hate to see what happens to his CCPA if I arranged rituximab (not in my office but a NY blood and cancer - third party infusion center) for him.

this kind of case really needs a multidisciplinary approach but this patient is.... not documented.... refuses to go into tertiary care center .... has managed Medicaid though (nice for this patient).... I am solo-ing this case. wish me luck.

 

[Renal_Prometheus]

I spoke to a nephro fellow who picked it because you start at 250k but I’ll be a partner after 2 years and I’ll be good. I don’t think sdn has a strong IMG/FMG presence. Definitely think there’s utility in keeping this thread alive.

And if neph applicants actually read through this thread, they will realize there’s a lot more to the story than I will make partner after 2 years and make a lot of money. In fact, they will discover they have fallen into a scam perpetuated people who have a vested interest in having a continual supply of fellows.

 

[Renal_Prometheus]

You know Nephrology is in a bad place when academics have to post on a nephrology bashing thread(this one), to recruit fellows.

 

[NewYorkDoctors]

if the "academic" program in question were a good one, they would have no need to worry as they will get their fellows no problems.

There are still AMG who enter nephrology and they go to the best of the best


The "rest" are garbage programs that have no business existing other than to get some free labor (paid by CMS)