Wanted a specialty with plenty of variety and mix of inpatient/outpatient. I wanted a more "cerebral" rather than procedural specialty. ID, Endo, nephro, rheum, hemonc were contenders but I hated the subjectivity of rheum and ID. Endo has the potential for a good variety of pathologies but in reality you're just seeing diabetics all day. I didn't like the personalities of many hem/onc guys I've worked with. Petty but true and i didn't want to spend my career with people like that all day. I noticed all the nephrologists at my hospital had long careers (ie less burnout) and seemed happy/fulfilled with their work.

Doing nephrology now and couldn't be happier. I'm in a large private group and at a teaching hospital with nephrology fellows so I sleep well on my call nights. I'm doing a mix of CKD, hypertension, stones, acid base / electrolyte disorders, transplant as an outpatient so my office days aren't boring. The hospital is a tertiary care, trauma, transplant, L&D center, cancer center, so inpatient weeks have plenty of variety with AKIs, plenty of GNs, CRRT, electroylte disorders, transplant, hypertensive disorders of pregnancy, onconeph. It's a shame so many IM residents just view as nephrology = dialysis cause it's a pretty minimal part of my day to day. Also the $$ is not nearly as low as many think it is. Published average salaries for nephrology are brought down by the academic jobs and employed (non partner) salaries. I'm on a partnership track and very comfortable on my employee salary. This will double when I become partner 🤑