Nephrology involves the management of patients with disorders of the kidney. A nephrologist will typically deal with conditions such as diabetic nephropathy, acute kidney injury, and end stage kidney failure.
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Entry Route into Nephrology
Applicants must have completed the two-year Foundation Programme before they can apply for core training on one of the following pathways:
In general, trainees will complete four to six medical placements, including acute on-call work.
Job Progression as a Nephrologist
Higher speciality training starts at ST3 and takes at least three years to complete. Trainees should have the full membership of the Royal College of Physicians before applying for higher speciality training at this level. Most nephrologists train in both renal and General Internal Medicine, which usually includes three years’ post-ST3 training in renal medicine, and two years in General Internal Medicine. Dual accreditation with other specialties such as Intensive Care Medicine is also possible. Many nephrologists go on to develop subspeciality interests in haemodialysis, peritoneal dialysis, transplantation, acute kidney injury, or vasculitis and hypertension
Trainees can apply for consultant positions six months before obtaining their CCT, and there are opportunities to work in management as a clinical lead, or a clinical or medical director. There are also formal opportunities to become involved in the education and training of junior doctors by working as
- a director of medical education overseeing postgraduate medical training,
- a training programme director responsible for the education of trainee doctors in the local region, or
- an associate dean responsible for managing the training programme.
Academic Nephrology Roles
Trainees interested in an academic career can apply for an academic clinical fellowship. Alternatively, trainees can continue the ST clinical training programme after ST4 level.
Fellowships in renal research are available through Kidney Research UK, the MRC, the Wellcome Trust, and other funding agencies. Teaching hospitals with active research units employ academic nephrologists for senior lecturer, reader, and professorial posts. Some nephrologists work for companies that are involved in transplant immunosuppression or dialysis.
Competition for Nephrology Posts
In 2017, the competition ratio at ST3 was 1.5 in the first round, with 105 applications for 67 NTN posts and 4 LAT posts, with 48% of applicants applying for Nephrology only. In the second round, the competition ratio was 1.4, with 95 applications for 68 NTN posts.
In December 2017, there were
- 553 consultants,
- 10 associate specialists,
- 21 speciality doctors,
- 1 staff grade,
- 361 speciality registrars,
- 156 core trainees,
- 77 F2 trainees, and
- 66 F1 trainees.
The starting salary for junior doctors in England ranges from £26,614 to £46,208, and from £37,923 to £87,521 for speciality doctors. Consultants can expect to earn between £76,761 and £103,490. There are additional supplements for on-call work, antisocial hours, and other commitments and situations. For additional information, please check our page on pay scales.
A Day in the Life of a Nephrologist
Nephrologists generally work in district general hospitals or renal units within teaching hospitals. Many renal departments manage satellite haemodialysis units based in community hospitals. In larger renal units, consultants will spend two-week on-call periods managing inpatients on behalf of other consultants. During these weeks, consultants will generally conduct daily wards rounds and participate in out of hours on-call work. Most nephrologists will run several outpatient clinics per week that may include more specialized teams – such as transplant or dialysis – as well as general nephrology.
Most renal trainees will participate in acute medical takes during their training, with most on-call work undertaken remotely – although some trainees may be resident within a hospital. Consultants participate regularly in on-call rotas and the frequency of the on-call work depends on the size of the renal unit. Almost 80% of consultants have reported that they are routinely on-call at the weekends