New Combined Glomerular Diseases and Onco-Nephrology Fellowship at Northwell

Northwell Nephrology is offering both a traditional two year general nephrology fellowship as well as a new fellowship that includes a third year fellowship specializing in glomerular diseases and onconephrology. The traditional two year fellowship can be applied for through this link

The new expanded third year is through the prestigious Northwell Nephrology Galdi Fellowship in Onconephrology and Glomerular Diseases. This fellowship offer a year of intensive training in these two important subject areas.

A candidate for the Galdi Fellowship will have completed internal medicine residency training, a general nephrology fellowship and demonstrate the highest level of performance and scientific and clinical potential. Candidates for the Galdi Fellowship would be carefully vetted based upon academic and other indications suggesting that advanced training as a Galdi Fellow would enable their ability to become one of a select few international leaders in glomerular diseases and onco-nephrology. The Galdi Fellowship will last for one academic calendar (July through June) year.  A new fellow will be recruited each year.

Training in glomerular kidney diseases is through the Northwell Nephrology Center for Glomerular Diseases directed by Drs. Kenar Jhaveri and Purva Sharma. The fellow will work in the Glomerular Disease Center and be exposed to all aspects of glomerular disease management including a rotation with Division of Rheumatology for extra training in SLE and ANCA vasculitis. The fellow will also have the opportunity to participate in ongoing clinical trials in glomerulonephritis at the Glomerular Disease Center. 

Onconephrology overlaps to an extent with glomerular diseases. Fellows gain experience both in the clinic and hospital with world renowned leaders Rimda Wanchoo and Kenar Jhaveri. Rotations will also include with hematology and oncology teams dealing with multiple myeloma, renal cell cancer and bone marrow transplant services. In addition, the fellow will have rotations with our nephropathologists as well.

 Currently we are accepting applications from current nephrology fellows or recent graduates for the Galdi Fellowship for start date of July 2023. In addition we are accepting applications from internal medicine residents for the general nephrology fellowship starting July, 2023 with a third year Galdi fellowship starting in July, 2025.

For inquiries regarding the advanced fellowship program, please email Dr. Kenar Jhaveri at kjhaveri@northwell.edu 

          Galdi fellowship website 

The application should include
1.      CV of the applicant
2.      Two recommendation letters (one must be from the Nephrology Program Director of Chief)
3.      A Personal Statement on the reasons for joining this fellowship.

In the News: Nephrology training in the Pandemic Survey by ASN

 A survey done of renal fellows training during the pandemic has now been published.

The link is here https://data.asn-online.org/reports/fs_21/

Some key take home messages of this overall positive survey on our field.

1. Over 80% of fellows felt their program had successfully maintained education and conferences via video and over 80% felt that they were ready for independent practice. 

2. Over 80% of fellows saw patients virtually as outpatients and a small number during the inpatient rotations.

3. Burnout was high though during the pandemic ( women more than men)

4. Overall employment perceptions improved from years prior

5. More fellows RECOMMENDED nephrology as a field this time around( the silver lining of the pandemic)

6. Where are fellows going?  Nearly 90% start a clinical position, and 2% or so did general internal medicine. Remaining were industry, other fields and joint fields with nephrology

7. Median starting salary was 200,000 US$. Interestingly, IMGs got a higher base pay compared to USMGs. NO difference in female vs male salaries( a big win for Nephrology)

8.  Income guarantees ( by far ) was the most common incentive for the job they took, followed by MOC and CME support, signing bonuses, career development resources. 

9. Most fellows chose nephrology during residency. Sadly only 6% want to do a career in research. 

10.  And on a final note, during their training, only 14% placed dialysis catheters and did renal biopsies. This speaks volumes and perhaps its time we move on from this unfortunate loss of skills. Let's focus on training our fellows on knowledge and improving therapeutics. 

In the NEWS: NephSim as an educational tool

Nephrology education related published work is sparse. NephSim, a mobile optimized website tool with cases and interactive approach was developed in 2018. Over 24 cases have been presented and discussed in this tool. Case contents have been amazing. But what the creators of this tool now did is- validate it with a peer reviewed publication. Recently published in JGME, a med ed journal, Farouk et al showcase the NephSim tool and discuss the results of their outreach of this tool and a survey that showed high rate of satisfaction and usability.

Innovation in Nephrology education is extremely important. Case discussions leading to differential diagnosis and then pathology and diagnosis helps in creating and making a Nephrologist a better diagnostician. The NephSim project also showcases the use of website, social media platforms such as twitter and other ways to share information.

This tool can easily be replicated in other fields in internal medicine or medicine. The ease of using and doing the cases makes it very accessible and able to be transformed in all fields in medicine. The drawbacks- survey response was low but enough to make major conclusions. But like most med-ed studies, it touches the first tier of outcomes- medical knowledge (self-assessed) and not addressing other ways of medical knowledge. We hope to see using some of these tools used( perhaps in combo)- such as NephSim, Nephmadness, Whatsapp, blogs, NephJC. Etc—to change practice patterns, behaviors and ultimately effect patient outcomes.

ASN 2018 Fellows in Training Bowl( FIT) Bowl

ASN 2018 Fellows in Training Bowl( FIT) Bowl

Every year since 2012, ASN has done the FIT bowl to inspire fellows to compete and learn nephrology in a fun and competitive way. Usually, there are 2 teams of various fellows from different fellowship programs mixed competing for the winning spot. First round is usually Case Based debates( Mystery case) run by Hitesh H Shah and myself and then a fun filled Jeopardy round with James Simon and team. 

This year, there is going to be some changes. It will move to a 2 days process to allow for more game time. The competition will start on Thursday, October 25, 2018 from 10:30am-12:30pm in the Scientific Exposition floor, Hall A of the San Diego Convention Center.

The overall competition schedule is as follows:

THURSDAY, OCTOBER 25, 2018

Elimination Rounds (Jeopardy based Nephron Challenge)

10:30 a.m. – 12:30 p.m. PDT

FRIDAY, OCTOBER 26, 2018

Semi-Finals ( Case-based debates rounds)

10:30 a.m. – 11:30 a.m. PDT

Finals

11:30 a.m. – 12:30 p.m. PDT ( Jeopardy based Nephron Challenge)

The winners of the competition will be recognized at the plenary session on Saturday, October 27, 2018 from 8:00 a.m. – 9:30 a.m. PDT in Hall D of the Convention Center. 

Details of the program at ASN website

https://www.asn-online.org/education/kidneyweek/2018/fellows.aspx

Fellowship programs have volunteered to compete.  Come support this fellows event on both days!

It should be a lot of fun, especially for residents, med students and fellows.

Topic discussion: Downsizing in Nephrology

A timely editorial just got published in CJASN. 

http://cjasn.asnjournals.org/content/early/2017/08/23/CJN.04740517.full

Three large NYC related programs give their thoughts on downsizing in nephrology fellowship spots. A comparison is made with anesthesiology that helped revert their trend of decrease supply in the 1990s.  The authors bring up few major concerns

1.       The debt burden of recent graduates and the compensation that nephrologists receive is not attractive. But the authors make a good point that while the starting salaries are low, there is room for growth and potential that other fields might not have. This is speculative and might depend on coast to coast in the US. While certain parts of the country, nephrologist make a lucrative salary, there are others where hospitalists make much more than nephrologists.

2.       The authors make an interesting suggestion of broadening our certification. This is an excellent thought. I urge the nephrology community to try to do this in the 2-3 year time frame of a fellowship. There are a minority of candidates who would do an extra year given their debt burden but incorporating something extra in your fellowship might help that candidate get that certificate along with Nephrology- be it glomerular disease, onconephrology or critical care.

3.       Chronic disease models have done well with PA and NP based teams in certain parts of the country. Examples are oncology, BMT, renal transplant, CT surgery. Nephrology should learn from these models. As the authors suggest, perhaps cautious downsizing might help reverse trend of supply/demand and help get outstanding candidates back in Nephrology.  A formula was suggested back few years ago by Desai and perhaps can be considered if need be.

4.       Overnight call is part of being a nephrologist. While authors suggest that the fellows might be called in a lot- one cannot ignore a K of 8 and wait till the 8AM fellow/attending comes in. Remote management might be possible but we have to be cautious in those methods.  Transplant overnight call should be reduced and can be the most helpful. A DDRT call should really not involve the nephrology fellow unless dialysis is required pre transplant. 

5.       Regardless of number of applicants a program is getting- the dependence on fellows for day to day work should be abolished.  This makes the applicant feel that the program is “fellow” centric and not “fellow” dependent. Attending directed services, NP, and PA based practice can help foster this environment. The flip side is loss of intensive education.  Given the rounding in the dialysis unit to only an NP or PA and relieving the fellow might lead to long term loss of education that we may regret. If planning this, would careful involve fellow in some of the rounding as well.  In addition, taking care of certain volume of patients and putting a cap on consults can also lead to “inefficient” graduates and unable to handle the volume when in private practice.  Fellows also have to learn how to manage and prioritize sick vs not that sick patients and how to manage a long and busy list. Nephrologists are smart physicians. We also want our fellows to be effective communicators, and efficient doctors.

I commend the authors on this very provocative essay and hoping this dialogue continues in making nephrology more attractive as it was many years ago.  

In the NEWS: Nephrologists compensations on a rise!!

The recently reported AGMA compensation survey suggests that there is an above average increase in the compensation and salaries of Nephrologists nationally in the USA.  The data even suggested an average of 20% increase in salaries compared to hospitalists.

This is important piece of information as currently there is a major drought in applications in nephrology fellowship. While content being difficult, tough physiology and exposure were considerations why residents never applied for nephrology, compensation might have played a major role in choosing alternative specialty of hospital medicine for their career choice.

Demand and supply working at it's best. Slowly, the tides will turn.

While passion and interest should dictate specialty choice, it doesn't hurt to add appropriate compensation for the work a nephrologist does for the complex patients with tough disease states.

http://www.kidneynews.org/careers/leading-edge/report-shows-increase-in-compensation-for-nephrologists

The Nephrology 2016 Match: Where do we go from here and a call for help!!!

The 2016 match for nephrology was just released. This is the first year following the ALL-in policy for the nephrology match. Clearly, this is a great way to benefit the candidate and the candidate get’s to see all programs and ranks based on their choice. 

ASN just released the key points that the match data revealed.

You can find the PDF of the information on this link. 

1.     There was a increase in programs (18%) and positions certified in the match.  Well this is because it was an ALL IN process so most programs participated. No big deal.

2.     The number of matched fellows increased—great! That is good news but this doesn’t imply increased interests.

3.     The number of applicants rose 11%- Perhaps reflection that we had ALL –in process and last few years-we never saw those candidates data. Since both the numerator and the denominator increased- we are counting candidates that we hadn't accounted for years ago. Not really an improvement!!

4.     Slight uptick in USA grads applying and major down trend in IMGs applying- big loss as they were the main stay for nephrology workforce last few years.

5.     Unfilled positions rose to a new high 58%-- biggest bummer of this process

Good news:

More US grads. More overall applicants( skeptic on that one as data is now due to ALL-in)

Bad news:

Still many more unmatched spots and programs. There are programs in the country unmatched 100%.

Do we have solutions?

While increasing interest in med school and residency is important and critical- clearly it is NOT working at a national level.  At the end of the day, re-imbursement of nephrologists calls the shots. We need to really push hard on the government level for more reimbursement for renal physicians.  A shortage will happen eventually, there will be a major medical need crisis and then hopefully there will be an uptrend in the salaries of nephrologists—even that is a dream in never never land.

What are programs going to do? Many programs fear- "they might be next."  Downsizing fellowship spots is an option and perhaps hiring physician assistants to help out with day to day duties.  Researchers will be asked to more clinical time, clinical educators will have to more clinical time and teach less--- all trickling down to less innovation and research in nephrology and less time with trainees.

Applicants to research positions are down-trending. This means that pure clinical fellowships that are big university centers( 2 year)- will fill.  The ones that won’t will be large research positions and or small community programs( perhaps).  Perhaps programs need to cater towards what the applicants want out of a renal fellowship-- times have changed( Nephrology was not what it was 20 years ago).

Time will change this. As any ups and downs in an economy- there will be eventually a shortage of nephrologists as this trend continues and eventually, there will be an upswing.

Clearly, I am being schizophrenic in this post but I am happy and sad with these results.

Clearly, the national strategy we have might not be working.  We need to all put our heads together( both academic and private nephrologists) to really come up with OUT of box ideas to change this trend.  

It’s a call for HELP and we need it soon!

ASN Nephrology Fellow's Events 2014

Welcome reception: Nov 12th: 6-7PM
Marriott Downtown, Grand Ballroom, Salon H

Fellows In Training Bowl( Mystery Case Debate): Nov 14th 2-3PM
Convention Center, Room  119A

Fellows In Training Bowl( Jeopardy game Nephrology Challenge): Nov 14th 3-4PM
Convention Center, Room  119A

Meet the Experts Session Nov 15th  9:30AM - 10:30AM( Meeting the ASN Award Winners)
Convention Center, Hall D

Fellows Forum Nov 15th 10:30-11:30AM
Convention Center, Room 203

Fellows Poster Discussion Section Nov 15th 2-3PM
Convention Center, Room 112