The American Journal of Kidney Diseases expects the prevalence of chronic kidney disease to rise 27% by 2030. One of the medical specialties that will be helping these patients feel better and retain a good quality of life are called Nephrologists. Nephrology is the only specialty that can help someone live and have a reasonable quality of live after a major organ fails and stops working. Nephrology it is also one of the only specialties where treatments have been developed that can be administered by the patient, at his or her home, on an ongoing basis, which improves health and allows people to live longer.
What is a Nephrologist?
Nephrologists are internal medicine physicians focused on kidney care and the treatment of kidney diseases. Every day, the kidneys filter 120 to 150 quarts of blood to prevent waste buildup, stabilize electrolytes and create hormones that make red blood cells, strengthen bones and regulate blood pressure. Nephrologists work with patients who have lost some kidney function or are experiencing chronic kidney disease or renal failure. Patients may be referred to a nephrologist by a primary care physician for testing or treatment or may see a nephrologist regularly, depending on their condition.
Nephrologists are trained to treat the following:
• Chronic kidney disease (CKD)
• Polycystic kidney disease (PKD)
• Acute renal failure
• Kidney stones
• High blood pressure
Some nephrology patients, like those on dialysis, are able to administer the treatment themselves, in the comfort of their own home. The treatment and the technology used have been developed by nephrologists who work in a research setting alongside other specialties to improve patient care and access to the procedures that will help them feel better and live longer.
Nephrology is a specialty of internal medicine. Nephrologists must first graduate from medical school and complete a three-year residency in internal medicine. After residency, nephrologists-in-training take The American Board of Internal Medicine (ABIM) certification and apply to a nephrology program. Nephrology programs are two to three year fellowships that may require clinical or laboratory research. For those interested, further training can be obtained to be a pediatric nephrologist.
Step by Step Education Path of a Nephrologist
1. Earn a bachelor’s degree. A bachelor’s degree or three years of university study is required to enter medical school. While a specific type of bachelor’s degree is not required, majors in the biological sciences can help student’s get all of the necessary prerequisites for medical school. It is important during undergraduate studies to be aware of the GPA requirements of medical school admissions and choose classes that are required for medical school entry and will help with medical studies.
2. Apply to medical school. Applying to medical school will require taking the Medical College Admission Test or MCAT, which focuses on a student’s knowledge of the sciences, verbal reasoning and math. The MCAT score and the undergraduate GPA of the applicant, interviews, letters of recommendation, life experience and other factors all contribute to medical school acceptance.
3. Complete a medical school program. Medical school is four years for internal medicine – two years classroom time and two years working in a medical setting as training continues. During the second year of medical school students study physiology, which is an important subject for nephrologists. It is important to take advantage of any opportunity to shadow working nephrologists during medical school so students get a good idea of what is required of the profession and can begin to learn from experienced physicians. Shadowing also gives students insight into how the career works in different settings, which will allow them to choose their career path with more confidence post-training.
4. Complete a residency in internal medicine. Nephrologists complete an internal medicine residency after graduation from medical school, which is three years. This residency trains the doctor in providing care for patients, working with other doctors and teams, and offering treatments. The internal medicine residency is the basis for further specializing in kidney care during fellowship. After residency, doctors preparing for the specialty take the American Board of Internal Medicine (ABIM) certification exam.
5. Apply for a nephrology fellowship. After passing the ABIM, applications to nephrology fellowships can be sent. Fellowship programs will provide the concentrated study of the kidney, disease and disorders. Fellowships in nephrology are between two and three years total with a one to two year clinical or laboratory research component. The nephrology fellowship must be accredited by the Accreditation Council for Graduate Medical Education (ACGME).
6. Obtain a license. Doctors in the United States are required to obtain a license specific to the state where they will practice. State requirements differ, but all state licenses require passing a two-part exam.
7. Get board certified (optional). Board certification is an optional exam and indicates that the doctor has fulfilled specific certification requirements beyond state license.
According to the National Kidney Foundation, one in three adults is at risk for kidney disease. After the age of 50, the kidneys may not function with the same efficiency, which can lead to a higher risk of chronic kidney disease in people over the age of 60. It is more likely that someone will experience kidney disease than diabetes or a woman getting breast cancer.
The majority of nephrologists cite that their relationships with their patients and their ability to find answers and diagnose are the most rewarding parts of their jobs. Both of these skills require practice and experience in a patient care setting. Aspiring nephrologists can find mentors and connect with other kidney care specialists at National Kidney Foundation conferences and events. Students can apply for a travel grant to attend conferences, attendance at which shows a dedication to the field and improves hiring prospects post-graduation.
A good nephrologist will have the following characteristics, which they bring to their profession and enable them to help patients:
According to Dr. Charuhas Thakar, Director of the Division of Nephrology and Hypertension at the University of Cincinnati Medical Center and Chief of the Section of Nephrology at the Cincinnati VA Medical Center, “You have to be very patient. It is not a specialty that involves a lot of sudden action . . . There is a lot of deliberation, thinking and solving problems . . . If you like internal medicine, if you like physiology, if you like to think and you like numbers than you have the right skillset to be a good nephrologist.”
There are two national organizations that can increase connections and hiring potential. Both organizations have student chapters as well as continuing education. The American Society of Nephrology and the National Kidney Foundation offer courses, conferences, networking opportunities and mentoring programs for students and new graduates which are excellent ways to improve hiring prospects, hear about opportunities of interest and get involved in the community as a kidney care specialist.
Students who are interested in practicing nephrology and want to increase their salary range can pair their fellowship training with a third year study which will result in a dual certification. Third year studies can include transplantation, critical care and other specialized training which improves job prospects and increases salary.
Nephrologists work in a variety of medical settings including private practice, clinics, universities, hospitals, medical centers and more. In these settings, a nephrologist works with patients who have chronic disorders or acute diseases that affect kidney function. Patients may present with symptoms that indicate kidney stones, the need for dialysis treatment, or even kidney transplant. It is the nephrologist’s job to diagnose and plan treatment for any patient experience kidney problems.
The majority of nephrologists work in a private practice, but that is far from the only area where a nephrologist can practice. Doctors of nephrology can work in academic settings, healthcare organizations, hospitals, office-based group practices, solo practices, outpatient clinics and more. A nephrologist can be hired as a direct employee, as an independent contractor or be and owner or partner in a private practice.
Because nephrology deals directly with patient and patient care, the majority of nephrologist spend 30-40 hours per week seeing patients over 41-50 hour work weeks with the remaining hours being used for documentation, administrative or organizational duties. As a doctor of nephrology one can expect to spend approximately 15-24 minutes with each patient.
According to the Medscape Nephrologist Compensation Report, nephrology is the 14th highest income specialty. The mean income of a nephrologist is $263,000. 12% of nephrologists earn $400,000 or more and 11% earn $100,000 or less. The pay gap between male and female nephrologists is 13%, which is less than many other medical specialties. The following represent the median pay based on practice setting:
The following median incomes represent the various hiring situations:
Nephrologist compensation is also dependent upon region. Doctors in the Southwest have the highest compensation while doctors in the Great Lakes region have the lowest.
The Research Environment
Some nephrologists will succeed working in a research setting at least part time, perhaps alongside their practice or clinic time. The research environment has already given a lot to the field, but breakthroughs are still needed to further improve patient quality of life. For example, a team dedicated to finding ways to make new organs available for transplant, created by technology, would vastly impact the field.
Breakthroughs in new drugs and therapies that treat acute renal failure and kidney injury would also find significant place. Some doctors are currently working to improve the processes in hospitals and surgery centers to decrease the injury that kidneys experience because of other procedures and treatments, an area of the specialty that could further help patient care and understanding across specialties.
Research projects can be funded by universities or grants from stakeholders like non-profit foundations or private companies. In some instances government funding is available, though the majority of clinical trials, around 75%, are funded by private companies.
Those who are interested in the research environment must be able to withstand the feedback and rejection that may come with some theories. Those that understand their own limitations and mistakes, can adjust to new information and be objective are poised to the best job working on new projects, technology and advances in the field.
With the rise in Type II Diabetes rates in the United States increasing rapidly, and since Diabetes is one of the highest risk factors in the onset of kidney disease, the prospects for learning how to become a Nephrologist is on the rise. These specialists integrate advanced medical knowledge with a welcoming bedside manner that is critical when working with patients who are suffering from kidney afflictions and failure.