The kidney doctor. Thirteen years of training, then you keep people alive on dialysis and get them to transplant.
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Pay, the path, pros and cons and the facts on one printable page. Counsellors: send it to a student from your own email in one click.
The median pay is about $256,560 a year. Across everyone in the job it runs from about $73,570 at the lower end to about $475,430 at the upper end. The source is listed under Sources at the end of this page.
13 to 14 years after high school, on the usual route.
$185,000 to $260,000 all in for tuition, fees, exams and kit. Living costs are not counted.
Yes. It is a regulated job, so you need a license or registration before you can work.
Moderate demand nationally, from government outlook data. Demand varies by region, so check your area.
Or read the whole thing here
What you earn and what it costs to get there.
Median
$256,560
Bottom tenth
$73,570
Top tenth
$475,430
Nephrology has no wage code of its own. These are the figures for general internal medicine physicians, the group nephrologists are counted inside: a median of $256,560 a year, a bottom tenth at $73,570 or less and a top tenth at $475,430 or more. The survey covers physicians who are employees, so doctors in their own practices or in partnerships are not counted at all.
$71,052 to $82,992 a year
Duke University Health System's 2026 to 2027 scale, first year of residency to second year of fellowship
Each hospital sets its own scale, and pay rises each year of training. It is real pay for brutal hours, and you are carrying medical school debt the whole time. Nationally, the AAMC (Association of American Medical Colleges) survey of 345 teaching hospitals puts the average first-year stipend at $68,166 as of July 1, 2025, and about $81,807 in the fifth year. Read from the AAMC's data, downloaded in a browser with Claude in Chrome on 6 November 2026, because aamc.org refuses our checker.
A monthly fee per dialysis patient
Medicare pays the supervising doctor by the month, more for 4 or more visits
Many nephrologists look after a panel of dialysis patients on top of hospital consults and clinic, so the size of that panel shapes income. Partners in a private nephrology group are not counted in the wage survey at all.
Roughly, all in
$185,000 to $260,000
Tuition, fees, exams and kit. Not rent, food or travel
The low end is a four year bachelor's degree at in-state public rates of about $10,000 a year, four years of in-state public medical school at $35,000 a year, admission testing and applications, and the three licensing exam steps at $695, $695 and $955. The high end is the dearer end of that same route, closer to $50,000 a year for medical school, and private schools cost more again. Residency and the kidney fellowship afterwards are salaried jobs, so they add three or four more years of training but no tuition. Many hospitals and academic centers are nonprofit or public employers, and working for one lets the Public Service Loan Forgiveness program cancel the remaining federal balance after 10 years of payments.
Most graduates borrow, and the debt is large. At a nonprofit or public hospital, PSLF (Public Service Loan Forgiveness) cancels the remaining federal balance after 10 years of payments, and residency and fellowship years count toward that clock.
Employer paid malpractice insurance
Standard in a hospital or group contract, and expensive if you buy it yourself.
Signing bonuses and loan repayment
Common in rural and underserved areas, which are chronically short of kidney specialists.
A continuing education budget
Conferences and courses, because certification has to be maintained.
Call pay
Nephrology takes nights and weekends, and some contracts pay for call separately.
The exact path from high school to qualified.
One of the longest routes on this site. Thirteen years from high school graduation to independent practice.
Bachelor's degree
4 years
Any major, with the pre-medical science prerequisites and a high grade point average. Sit the MCAT (Medical College Admission Test).
Medical school
4 years
Two years of science, two years of clinical rotations, ending with a Doctor of Medicine or Doctor of Osteopathic Medicine degree. You pass the first two steps of the national licensing exam along the way.
Internal medicine residency
3 years
Paid hospital training in adult medicine, accredited by the ACGME (Accreditation Council for Graduate Medical Education). You get your state medical license during this.
Nephrology fellowship
2 years
Subspecialty training in kidney disease, dialysis, transplant and blood chemistry. Longer if you add transplant or research training.
Board certification
Exams
Certify in internal medicine, then in nephrology, through the ABIM (American Board of Internal Medicine), and keep it current afterward.
Chemistry
Nephrology is the most chemical of the medical specialties: salts, acids, bases and fluid balance.
Biology
Physiology is the whole foundation.
Math and statistics
You will read research papers critically for the rest of your career.
English
Medical school admission turns heavily on writing and on interviews.
Medical licenses are issued by state medical boards, not by the federal government. Everyone takes the same national exam on the way there: the USMLE (United States Medical Licensing Examination), in three steps spread across medical school and the first year of residency. Board certification is separate and voluntary in law, but in practice almost every employer requires it. You certify first in internal medicine and then in nephrology through the ABIM (American Board of Internal Medicine), and you keep it alive with ongoing assessment for the rest of your career. If you move states you apply to the new board, which is mostly paperwork, though some states add a short test on their own law.
Things you don't need, but that help.
Transplant nephrology
An extra year working with transplant surgeons on donor matching, rejection and immunosuppression.
Interventional nephrology
Placing and fixing dialysis access, a procedural skill many groups lack.
Critical care nephrology
Kidney failure in the intensive care unit, often combined with a critical care fellowship.
Onconephrology and glomerular disease
Narrow academic niches built around rare and difficult disease.
Research during medical school
Nephrology fellowships in academic centers care about it.
A second language
Kidney failure falls hardest on communities where English is not the first language.
Comfort with long relationships
You will see the same dialysis patients every month for years.
Business sense
Private nephrology groups are businesses, and partnership terms matter to your income.
Kidney specialists are scarce outside metropolitan areas, and patients in small towns often drive more than an hour three times a week for dialysis. Federal and state programs pay down student loans in exchange for a few years of service in a designated shortage area, and hospitals add their own signing bonuses on top. It is one of the few ways to arrive at the end of this training with the debt already gone.
Day to day, pros and cons, where you'd work.
Early rounds at an outpatient dialysis unit, 15 or 20 patients you have known for years, checking labs, access sites and blood pressure. Then the hospital: consults on patients whose kidneys are failing for six different reasons, an argument with a cardiologist about fluid, a decision about whether to start dialysis on someone who may not want it. Afternoon clinic is slower kidney disease, transplant follow-ups and blood pressure. You are on call for the hospital's dialysis service one week in three or four.
The good
The hard parts
Things people don't tell you.
In the nephrology fellowship match for the 2026 training year, 333 of 501 positions were filled, 66%, according to the American Society of Nephrology. Fewer than half of the training programs filled every slot.
Surgeons did 28,492 kidney transplants in the United States in 2024, about 6 in 10 of all organ transplants, and the kidney waiting list counted 147,091 candidates that year. Nephrologists care for many of them on dialysis while they wait.
Since 1972, Medicare has covered people with kidney failure who need dialysis or a transplant, at any age, as long as they meet its work history rules. It shapes how the whole specialty is paid.
Your kidneys filter about 150 quarts of blood a day, and only 1 to 2 quarts of that leave as urine, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Every list is built from the same numbers shown above, so you can see where this career sits next to the others.
Doctors first, then the rest of the field. See every career in health.
Last checked November 2026. Pay figures are typical full-time annual amounts in United States dollars, based on Bureau of Labor Statistics wage data and published pay scales. They vary by state, employer and experience. Tuition is for in-state students at public schools unless the card says otherwise. How every figure on this site is sourced and checked.
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