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How to become a Nephrologist? - A step by step guide

Posted by Callie Torres
January 15, 2024

Nephrology includes the study of kidney diseases and transplantation. It includes systemic diseases that affect the kidneys, such as diabetes and autoimmune disorders, as well as other medical issues that arise from kidney abnormalities, such as renal osteodystrophy and hypertension. A doctor who has completed internal medicine residency and nephrology fellowship is referred to as a nephrologist. In this article we will discuss what is a nephrologist, their salary, how to become a nephrologist, what a nephrology job entails, and more.

Quick Navigation Links + FAQs

  1. What is a Nephrologist doctor?
  2. What do Nephrologists do? 
  3. How to become a Nephrologist?
  4. How long to become a Nephrologist?
  5. Where do Nephrologists work?
  6. Nephrologist's salary?
  7. Nephrology residency length?
  8. Is becoming a Nephrology trained physician hard?
  9. Is Nephrology competitive?
  10. Nephrology fellowship length?
  11. Getting started in medicine

What is a Nephrologist

A nephrologist is a doctor who focuses on diagnosing and treating disorders of the kidney including autoimmune diseases, hypertension, inherited disorders, and more. They use various tools to reach their diagnosis, from blood and urine testing to imaging techniques. They can determine where renal issues may come from such as an infection like pyelonephritis or a complex autoimmune disease, like lupus. Once a renal disorder is diagnosed, nephrologists craft personalized treatment plans for each patient. This might involve medications, dialysis, transplants, or other procedures, depending on the specific problem. Nephrologists stay up-to-date on the latest advancements to ensure their patients receive the best medical care. Additionally, nephrologists are essential in helping guide their patients to make lifestyle changes that will improve their renal function and overall health. They provide patients the tools they need to take control of their health, simplify complicated medical issues, and provide advice on leading an everyday healthy life while dealing with renal disease.

What do Nephrologists do? - Nephrologist's responsibilities

A nephrologist can work in a variety of locations including private practices, clinics, or hospitals. They also commonly work with other medical specialists, such as nutritionists, surgeons, and primary care physicians, to offer patients with kidney-related diseases comprehensive care. Nephrologists have extensive training in treating a wide range of renal conditions, such as:

  • Hypertension: Nephrologists frequently treat hypertension as it can have negative effects on renal health since the kidneys control blood pressure.
  • Acute Kidney Injury (AKI): Nephrologists treat acute kidney injury (AKI), which is abrupt and can cause severe renal dysfunction. It can be brought on by drugs, infections, or inadequate blood supply to the kidneys.
  • Electrolyte and Fluid Imbalances: Nephrologists treat conditions that interfere with the body’s ability to maintain proper fluid balance and electrolytes (such as calcium, potassium, and sodium) as this is one of the important jobs of the renal system.
  • Chronic Kidney Disease (CKD): A nephrologist manages and treats disorders that cause kidney function to gradually decline over time, commonly referred to as chronic kidney disease (CKD).
  • Glomerular Diseases: A nephrologist will treat these conditions which impact the glomeruli, which are the kidney’s filtering organs for blood.
  • Kidney transplants: Certain nephrologists, called transplant nephrologists, assist with transplant candidate evaluation, pre-transplant care, and post-transplant follow-up.
  • Inherited kidney disorders: One of the most common inherited renal diseases that a nephrologist may treat is condition known as polycystic kidney disease (PKD) is typified by the development of fluid-filled kidney cysts.
  • Kidney stones: These are hard deposits of minerals and salts that can develop in the kidneys. Nephrologists may be involved in the prevention and treatment of kidney stones.
  • Dialysis: Nephrologists frequently treat patients who need dialysis, a medical treatment that is utilized when the kidneys are not functioning well enough. This treatment filters waste and extra fluid from the blood to simulate the function of the kidneys.


How to become a Nephrologist?

The career path to becoming a nephrologist is long, taking 12-13 years after graduation of high school. The following are the essential education actions to take to begin a career as a nephrologist:

  • Obtain a bachelor's degree: Students are eligible to attend medical school with a college degree in any major, but it’s advisable to focus on medicine-related subjects, such as biology, chemistry, biochemistry, or health sciences. No matter the major, it is vital to ensure you have completed every required class that your intended medical schools dictates.
  • Attend medical school: Next, one must obtain an M.D. by enrolling in allopathic medical school or a D.O. degree by enrolling in an osteopathic medical school. These rigorous four-year programs impart the fundamental medical information, skills, and abilities needed by all medical doctors. One should expect lengthy study sessions, classes, tests, as well as hands-on learning opportunities in the form of patient care and didactics. While the the first two years concentrate on scientific knowledge learned in the classroom, the final two years offer practical hands on medical training.
  • Complete an Internal Medicine Residency: Completing a three-year Internal Medicine residency program is the next crucial step following the graduation from medical school with a medical degree. During residency, doctors will receive comprehensive training in diagnosing, treating, and managing a broad spectrum of conditions in adult patients. This lays the groundwork for a further specialized nephrology fellowship.
  • Complete a Nephrology Fellowship: Following Internal Medicine residency, physicians must apply for and work as a Nephrology Fellow at a clinic or hospital. This specialized training is termed a fellowship and lasts for two to three years. During this time, fellows will work with senior nephrologists to gain experience in kidney disease management including dialysis, transplantation, kidney failure, stones, high blood pressure, renal problems, etc.

How many years does it take to become a Nephrologist?

The total time it takes to become a nephrologist and practice renal medicine typically spans 13 to 14 years after high school graduation. This includes:

  • Undergraduate Education (obtain a bachelor’s degree): 4 years
  • Medical School (obtain a MD or DO degree): 4 years
  • Internal Medicine Residency: 3 years
  • Nephrology Fellowship: 2-3 years

Where do Nephrologists work?

Nephrologists are employed in a range of healthcare environments, such as:

  • Hospitals: Manny nephrologists are employed by hospitals. They may work either in inpatient units or outpatient clinics. In this setting, they may treat hypertension, electrolyte imbalances, kidney stones, and more. In inpatient nephrology, they also provide renal consultations for hospitalized patients.
  • Dialysis Facilities: When treating patients who need hemodialysis or peritoneal dialysis to treat renal failure, nephrologists commonly work in dialysis facilities. While some nephrologists may work in a dialysis facility within a hospital, they can also work in stand alone facilities.
  • Clinics and Medical Practices: Some nephrologists work in outpatient clinics or private practices that specialize in treating kidney disease. These offices may be shared with lab testing facilities or renal infusion centers.
  • Transplant Centers: As members of the transplant team, transplant nephrologists assess candidates for transplant, oversee waitlists, conduct living donor evaluations, and provide post-transplant care for patients.
  • Universities and Research Institutes: If working for a large research university or institute, nephrologists may spend time teaching medical students and residents, as well as researching kidney disease.
  • Government and Public Health Organizations: Some nephrologists advise kidney disease prevention and treatment initiatives on behalf of government health authorities.

Nephrologist salary - How much do Nephrologists make?

According to the American Association of Medical Colleges (AAMC), a nephrologist who works in academic medicine can earn an average salary of $232,120 up to $335,092. The salary earnings increase as a nephrologists is promoted from assistant professor ($232,120), to associate professor ($274,153), and full professor ($335,092). Another source, Medscape, reports than the average nephrologist earned a salary of $312,000 in 2023.


How long is Nephrologist residency length?

Nephrology physicians complete an internal medicine residency prior to completing a nephrology fellowship. A residency in internal medicine typically lasts three years. During this time, an aspiring nephrologist is exposed to a wide range of medical subspecialties and undergoes thorough training in all facets of adult medicine, including both inpatient and outpatient settings. Residency provides a solid general basis for the diagnosis and management of illness before specializing in nephrology.

Is it hard to be a Nephrologist?

Nephrology is an advantageous field, but it also can require sacrifice and perseverance. Some ways in which nephrology may be difficult include:

  • Competitive Fellowship: Because there are few positions available and many applications, getting into an internal medicine residency program can take a lot of work.
  • Strict Training: Internal medicine residency requires taking care of extremely ill patients for three years during an 80 hour work week. This can be physically and mentally taxing to a physician’s health.
  • Complex Conditions: Patients in nephrology may have various comorbidities and medical problems that extend beyond the kidneys. It can difficult to treat a patient holistically while keeping in mind their complex medical background.
  • Intense Fellowship: Obtaining a nephrology fellowship can be tricky. Additionally, these two to three-year programs require lengthy, sometimes erratic hours to care for critically ill hospitalized patients. Fatigue is a typical occurrence.
  • Continuous education: This specialty requires constant knowledge such as new transplant techniques, immunosuppressive medications, and dialysis modes. The requirements to reach this high level of expertise are extensive and continuous.

Is Nephrology a competitive specialty?

Yes, nephrology is regarded as a reasonably competitive specialty in medicine that doctors can pursue upon graduation from medical school. This is due to a variety of reasons including:

  • Limited Number of Training Spots: Compared to other specialties, fewer nephrology fellowship positions are available. The number of few positions typically correspond to a more competitive application process
  • High Board Marks Required: Candidates for nephrology fellowships at prestigious hospitals typically have higher marks on the USMLE or COMLEX license examinations and internal medicine in-service exams. From an academic perspective, this increases its competitiveness.
  • Required Research Experience: Programs prefer applicants with a history of nephrology-related research, whether from residency or medical school. Candidates are more competitive if they have substantial research experience on their resume and can make additional academic contributions during their career.
  • Strong Clinical Skills: To get into a reputable nephrology fellowship and begin their career, applicants often need to submit strong letters of recommendation and receive great clinical ratings throughout their internal medicine rotations. Excellent patient care abilities are also highly regarded.

How long is Nephrology fellowship?

In the US, a nephrology fellowship commonly lasts two to three years depending on the program. In general, nephrology fellowship typically lasts two years. During this time period, fellows obtain instruction in general nephrology and care for a range of renal disorders. A third year of training is an optional feature of some programs. This time is frequently dedicated to further subspecialization, such as advanced kidney transplant care, dialysis treatments, pediatric nephrology, etc.


Getting started in medicine

We hope that after reading this article, readers will have a better understanding of Nephrologists, their licensing process, and the significant time and financial commitment required to finish medical school, residency and fellowship. The next step for aspiring medical students who wish to work as a Nephrology specialist is to apply to a reputable medical schools such as the University of Medicine and Health Sciences. Why hold off? Begin your application into medical school by clicking this link: Apply to UMHS school of medicine.

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Posted by Callie Torres

Callie Torres is a Captain in the United States Air Force and a chief resident at Wash U/Barnes Jewish Hospital in St Louis. She is a freelance writer with many published medical articles as well as multiple peer-reviewed medical publications

Topics: Feature Medical Practice

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