New grad- Nephrology vs Heme/onc


Hello experienced NPs working in heme/onc and nephrology! I am really torn between 2 full time job offers. I am a new grad interested in both jobs. The heme/onc clinic is with 10 Doctors, 1 FNP and 1 PA. Heme/onc will train for 4 months and want you to see patients in clinic, monitor chemo infusion adverse reactions with some future hospital rounding opportunities. vs. a nephrology clinic working with 1 MD, 1 month of training and which he expects you to see patients in clinic 2 days a week with 3 days rounding in dialysis centers. Nephrology says that he has 110 patients in dialysis currently MWF AND TTHSAT consisting in 7 different centers nearby.

I have a family and a 3 year old girl. I want to have a life outside of work but also want to have an awesome career. They are both private practice.

Let me me know what you guys have experienced in your nephrology or heme/onc clinic and what you recommend.... please help!


446 Posts

I am not a big fan of nephrology my opinion, they r usually 'difficult'

Hem/onc patients on the other hand....r my favorite patient population to work with

Trauma Columnist

traumaRUs, MSN, APRN

153 Articles; 21,229 Posts

Specializes in Nephrology, Cardiology, ER, ICU. Has 31 years experience.

I've been a nephrology APRN for 11 years now. Like with any job, there are pros and cons. I am in a large 21 MD, 8 advanced practice providers - we have our own surgical center also. My current job is just rounding on dialysis patients in dialysis units but I also have administrative duties as I'm the supervising APP.


1. Pay - private practice usually pays more than being hospital-employed. I pay nothing for my healthcare, I have 8 weeks PTO/year, and a completely paid retirement plan.

2. Flexibility - I make my own hours - as long as I work 40 hours and get my visits done, I'm golden. 3 of our APPs have young children and if they need to rearrange their week, like come in late one day if they are working late, leaving early if they come in early, etc., that is up to them.

3. Orientation - we offer 3-4 months of orientation depending on prior experience.

4. Autonomy - I make care decisions on my own. Of course I do have MD back-up (by phone) but at this point, I call MDs only very occasionally.


1. Biggest con for me (my background is ER/ICU) is the chronicity of nephrology patients. I remain on my rural EMS squad (for the last 18 years) so that I can still get my adrenaline rush.

2. The complexity of dialysis pts does make you think on your feet - we now have pts in the outpt environment on inotropes, Life Vests, LVADs, trachs, etc. (Personally I view this as a pro because I like learning but some APPs feel that the acuity is getting very high, especially in some of our more rural clinics).

3. Little interaction with other APPs - we talk/text but for the most part you are on your own.

Thank you for taking the time to respond. I really appreciate that! Now if I can get some heme/once views too, it would be golden!

Globalrn, Have you worked with both populations?


446 Posts

Oh wow....sorry I am reading this after nearly 2 yrs!

I have worked hospital acute care, medical units and specialty units of hematology/oncology as a NP. I currently work in a hem/onc daycare/triage and also in a cancer associated thrombosis subspecialty clinic as adult NP