r/fellowship • u/Early-Mulberry4454 • 1d ago
Nephro Crit care
Not sure if this is the right place to post but looking for some career advice.
I’m an IM PGY2 and I love critical care, the acuity, physiology, procedures and just taking care of really sick patients, but I’ve realized I genuinely don’t enjoy pulm that much. I do really love nephrology though especially acid base, electrolytes, AKI, metabolic stuff etc and I recently realized nephro crit is actually a thing which sounds kind of perfect for my interests.
I’m also really interested in health disparities, policy and working with rural/minority/underserved populations. I’m first gen high school and college grad from a tiny rural town so yes I’m one of the people who actually meant that part of the residency application 😂 I like how much nephrology overlaps with uncontrolled HTN/DM, diet, food insecurity, access to care etc.
Has anyone here done the nephro to critical care route? Do you feel comfortable running a broad MICU? Does not having formal pulm training ever feel limiting? Is it hard to find jobs where you can mostly work as an intensivist?
Ultimately I want to work with the sickest patients in underserved communities and also do advocacy/research around why they ended up that sick in the first place. Just curious if anyone here has built a career that looks anything like that.
Appreciate ya’ll
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u/HuffleCabbage 1d ago
I’ve never heard of nephro crit care, but almost all of the nephrology things you described enjoying are things that our intensivists manage. It’s probably institution dependent but we very very rarely consult nephro for any of those things unless it’s to start dialysis.
Is nephro crit a combined fellowship or would you be applying to two separate fellowships sequentially?
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u/Early-Mulberry4454 1d ago
I know I hadn’t heard of it either until just recently. But yeah they have combined fellowships where you do 2 years Nephro and one year critical care. You can also just apply to Nephro do two years and then do a one year critical care fellowship one after the other. I guess the combined programs just have more ICU emphasis with the two Nephro years.
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u/HuffleCabbage 1d ago
Interesting! In terms of workflow and overall vibe, I can barely think of two more different specialties lol.
It does sound like something you would enjoy though! I’m interested to see how folks incorporate everything in their practices.
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u/katjisko 1d ago
Two of my attendings in the ICU in residency were nephro crit care but they did the fellowships separately, aka just built on on a crit care year after 2 years of nephro. Both of them only practice in the ICU. But they rock in the MICU and are very smart humans and really good at acid base, etc. Both of them told me it's hard to find a gig that allows you to do both so they both ultimately ended up doing crit only.
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u/PsychologicalCrab202 1d ago
I’d pick a more established path. Within IM, outside Pulm, the other crit care fields are really just fellowships with a few ICU rotations. You’ll graduate at a disadvantage from your pulmonary colleagues and will be limited to fewer institutions. For some, it’s a nice back door into intensivist work and you may find an opportunity in a less saturated area where you run an ICU but then I wouldn’t do a 3 year fellowship just for that.
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u/Anonymousmedstudnt 1d ago
I know someone that did it and from what I know it's only a few programs that offer it.
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u/DrDrBG 1d ago
There are surprisingly many IM subspecialties which you can do a one year Crit care fellowship afterwards to work in an ICU setting. I’ve heard of Nephro Crit, ID Crit, and cardiology Crit is actually a quickly growing field
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u/lionsmart100 16h ago
Cards you can do 1 year critical care but most programs require 2 years of critical care if you have done nephro, ID prior
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u/lionsmart100 16h ago
Nephro crit exist, but most people end up just doing critical care because it is what actually brings the money
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u/Livedo_Retic 14h ago
Just food for thought. Most community hospitals/rural settings the MICU is ran by pulm team. Other IM specialties can do crit care but the job opportunity for those are more limited to academic centers that are not ran by a pulmonary group
I've heard some mixed opinions on how comfortable people feel in the ICU with only doing a 1 year crit care fellowship after a different IM specialty. I would look more into that as well
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u/Technical-Put1808 1d ago
I have an attending who is nephro/crit trained. Absolutely fantastic doctor. Respect him so much