GI vs. nephrology as a specialty?

Trauma Columnist · Jul 26, 2018

I've been in nephrology for >12 years now. Most nephrology practices will have you rounding on in-center chronic hemodialysis patients as that is where you can make money for the practice. All ESRD pts in the US are on Medicare unless there are extenuating circumstances and the neph practices are paid a "bundled" amt for their care. They require 4 visits/month in order to maximize this bundle.

Yes, the pts are sick and yes they are complex and yes, they code while on dialysis. That said, its a great job - lots of action, never the same thing every day. Depending on how large your area is that you cover you might see anywhere from 10-60 pts per day. I work for a very large practice with the best benefits in the business and see pts in three fairly rural clinics. Lots of driving, lots of autonomy.

Cococure · Jul 26, 2018

I am following this thread and any other threads TraumaRus discusses nephrology. I am in my last 2 semesters of my FNP program and I have rotated with a internal med/nephrology doc and I absolutely love the nephrology part of it. I have not been out at the clinics with her and my school will not let me do my last practicum in a specialty area. I would like to work for a nephrology practice after graduation, do you have an advice for an aspiring nephrology NP?

Good luck with your decision mep7296

mep7296 · Jul 26, 2018

The practice already has an NP that rounds in all of the dialysis centers, they are looking for an office based NP to round out the practice.

Trauma Columnist · Jul 27, 2018

The practice already has an NP that rounds in all of the dialysis centers, they are looking for an office based NP to round out the practice.

What will you be doing? Education for CKD 4? Will you be billing off your NPI?

Seems like a small practice? IMHO you always need to look at what revenue you produce in order to be valuable?

Riburn3, BSN, MSN, APRN, NP · Jul 29, 2018

I usually like to point students and new grads to nephrology if they are going to choose a subspecialty after they graduate outside of pulmonary/intensivist.

I find nephrologists are one of the only subspecialty that still do a lot of total care for their patients and it isn't quite so fragmented. In my area the nephrologists are also some of the smartest physicians that still retain a huge chunk of their internal medicine training.

As a new grad, you'll still get to see a good variety, and you're also taking care of patients with numerous chronic issues, so it isn't light work. It'll give you a nice base for when you want to move on. I think if you just did GI, the things you learn as a new grad would be a lot more focused compared to what you learn as an NP in nephrology.

At the end of the day though, the final factor should be which offer is better. If one blows the other out of the water, it'll be an easier decision.

Trauma Columnist · Jul 30, 2018

I usually like to point students and new grads to nephrology if they are going to choose a subspecialty after they graduate outside of pulmonary/intensivist.
I find nephrologists are one of the only subspecialty that still do a lot of total care for their patients and it isn't quite so fragmented. In my area the nephrologists are also some of the smartest physicians that still retain a huge chunk of their internal medicine training.
As a new grad, you'll still get to see a good variety, and you're also taking care of patients with numerous chronic issues, so it isn't light work. It'll give you a nice base for when you want to move on. I think if you just did GI, the things you learn as a new grad would be a lot more focused compared to what you learn as an NP in nephrology.
At the end of the day though, the final factor should be which offer is better. If one blows the other out of the water, it'll be an easier decision.

I agree. The nephrologists I work with are very smart, intuitive and at least in my practice, are great teachers. Our practice does hire new grads and we provide a very comprehensive orientation.