Nephrologist Salary (2026): What Nephrologists Earn, How Dialysis Drives Pay, and Why Fellowships Go Unfilled

What nephrologists earn in 2026

The sources agree on the middle: a practicing nephrologist earns somewhere between about $360,000 and $390,000. Doximity's figure rose 5.0% in its latest report, more than double the roughly 2% for physicians overall. Medscape's moved the other way, from about $363,000 to $359,000, a reminder that one-year changes in any single survey are noisy.

The bigger story is the spread. SalaryDr's middle half runs from $335,000 to $433,000, and the top of that range is mostly private-practice partners with dialysis income. The bottom of the real-world range is lower than any of these averages: first jobs.

Nephrology vs. other internal medicine fellowships

Nephrology sits in the middle of the medicine fellowships: about $46,691 a year above general internal medicine on Doximity's averages, ahead of infectious disease, rheumatology and endocrinology, and well behind the procedural fellowships, cardiology, gastroenterology and pulmonology and critical care. It's the highest-paid of the mostly non-procedural fellowships, which is the honest way to describe where it fits.

What new nephrologists are actually offered

The American Society of Nephrology surveys graduating fellows every year. Its 2025 survey (387 of 996 fellows responding) is the best public view of first jobs:

• Base, not total. These are base salaries. Productivity bonuses, call pay and directorship stipends often start later, and partnership income only after the partnership track.
• Below hospitalists, at first. The $249,000 median is less than the $345,000 median hospitalists report on SalaryDr. Many internal medicine residents see that and stop there; the comparison only flips once a nephrologist reaches partnership or picks up dialysis income.
• The pay gap is about hours. Women's median base was lower, but per full-time equivalent their mean was slightly higher, suggesting the difference comes from part-time and reduced-FTE jobs rather than lower rates.
• Plenty of offers. In ASN's 2024 survey, fellows reported a median of three job offers and half went into private practice. In 2025, 90% of fellows said they'd recommend the field.

Most fellows also carry debt: U.S. medical graduates in the 2025 survey reported a median of $220,000, against $40,500 for international graduates. A ramp from about $250,000 to partnership income is exactly when the choice between PSLF and refinancing matters most.

How nephrologists are paid

A nephrologist's income has four parts, and the mix varies more than in almost any other specialty:

1. Professional billing. Clinic visits for chronic kidney disease, hospital consults, inpatient dialysis orders and the monthly dialysis capitation payments. Employed nephrologists usually see this as a base plus a wRVU bonus. SalaryDr's nephrology reports show a median of $50 per wRVU, with the middle half between $49 and $51.
2. Medical directorships. Every dialysis facility must have a medical director, and the facility pays for it. CMS treats the role as roughly a quarter of a full-time position. Directorships are often held by senior partners.
3. Partnership distributions. In private groups, partners split what's left of the group's billing after expenses, including income from advanced practice clinicians and ancillary services.
4. Dialysis ownership. Some practices own minority stakes in dialysis facilities through joint ventures with the large dialysis companies. Distributions from those stakes are investment income, not salary, and they sit under strict fraud and abuse rules (more below).

The wRVU math shows why the second through fourth parts matter. FastRVU, citing MGMA's 2026 benchmarks, puts median nephrology production at about 5,800 wRVUs a year. At $50 per wRVU, that's about $290,000 from clinical productivity, roughly $100,000 short of SalaryDr's $390,000 median. The difference is directorships, call pay, partnership and ownership. Treat the volume figure as approximate: it's secondhand, and MGMA's nephrology sample has historically been small.

The dialysis economics

The monthly capitation payment

Medicare doesn't pay nephrologists per dialysis visit. It pays one amount per patient per month, scaled by how many times the nephrologist (or an advanced practice clinician) sees the patient face to face. For in-center dialysis patients age 20 and older in 2026:

The fourth visit is worth about $62 a month per patient over the two-to-three-visit rate, which is why rounding schedules are built around it. Scale it up: a panel of 60 in-center patients seen four times a month earns about $269,719 a year in Medicare professional payments and about 4,874 wRVUs, worth about $243,700 at $50 per wRVU. That's before clinic patients, hospital consults and inpatient dialysis. Panel sizes vary a lot: an international survey found U.S. nephrologists responsible for about 128 dialysis patients on average, and in a study of 41 California nephrologists, the group with the lowest patient mortality had a median caseload of 65, against 103 for the highest.

Medical directorships

Directorship pay isn't published, but research shows it tracks market power. A 2025 JAMA Health Forum study of dialysis markets from 2005 to 2019 found that the two largest chains, DaVita and Fresenius, grew from 59.1% to 77.1% of facilities, and that markets with a large chain paid $564.56 more in medical director compensation per patient (in 2019 dollars) than markets without one. The authors describe the chains as strengthening financial ties with nephrologists through both ownership stakes and higher director pay. For a practice, more directorships and bigger units mean more income; for a new hire, the question is whether you'll ever hold one.

Joint-venture ownership

The same study found the share of dialysis facilities with a physician owner rose from 11.4% to 29.1%. Joint ventures can add substantially to a partner's income, which is why offers in groups that own dialysis units look so different from employed offers. They also carry real legal risk. In 2014, DaVita agreed to pay $350 million under the False Claims Act, plus a $39 million civil forfeiture, to settle allegations that it offered nephrologists joint-venture stakes at below fair market value to win patient referrals; it didn't admit liability. Any buy-in should be at documented fair market value and reviewed by a healthcare attorney. Our partnership buy-in guide covers how to evaluate one.

A worked nephrology offer

Take an illustrative employed offer near the ASN starting median: a $250,000 base, plus $50 per wRVU above 5,000 wRVUs (the base divided by the rate). At three production levels:

Even at the 75th percentile, a wRVU-only job lands near $350,000, below the average nephrologist. So the questions that matter are the ones outside this table: how many dialysis patients come with the job and who rounds on them, whether the monthly capitation codes credit to you, whether a directorship is realistic within a few years, and what partners earned.

Hours and pay per hour

SalaryDr's nephrologists report about 51 hours a week, more than most cognitive specialties. At the $390,000 median, that's about $147 an hour:

The hours come from the job's shape: clinic, dialysis rounds across several units, hospital consults, and call for urgent dialysis and inpatient kidney injury. In SalaryDr's lifestyle survey of 34 nephrologists, satisfaction averaged 3.6 out of 5 and 82% would choose nephrology again. A 2022 Kidney Medicine survey found about a quarter of nephrologists reporting burnout, with lower odds among those seeing 25 or fewer patients a week, working in academic settings, or spending time on non-clinical work.

Nephrology pay by practice setting

Private practice

Half of ASN's 2024 graduating fellows went into private practice. The pay is higher and the hours longer. Partnership often comes after two to three years; partners share billing, advanced practice clinician revenue, directorships and, where the group has them, dialysis joint-venture distributions. Before signing, get the partnership timeline, the buy-in and how it's valued, what partners earned in each of the last three years, and how directorships are assigned.

Academic

Academic nephrology pays less in cash and asks fewer hours, with teaching, research and transplant programs. Academic medical centers are usually nonprofit or public, so years there count toward PSLF; with a $220,000 median debt, that can be worth more than the pay difference. Check your employer with our PSLF employer guide.

Hospital and health-system employment

Many nephrologists are employed by hospitals and health systems, on a base plus wRVU bonus like the worked offer above. Pay is steadier and starts sooner than partnership income, but directorships and ownership usually stay with the system or the dialysis company. Nonprofit systems count for PSLF; for-profit ones don't.

Transplant, interventional and pediatric nephrology

• Transplant nephrology is usually a one-year fellowship after general nephrology, mostly at transplant centers. Starting pay is slightly higher than general nephrology, and dedicated transplant jobs paid more than joint transplant and general roles in ASN's data ($250,000 vs. $230,000). The jobs are concentrated in academic centers.
• Interventional nephrology (dialysis access procedures such as fistulagrams, angioplasty and catheter placement) adds procedural wRVUs, and some practices run their own access centers. There's no good public survey of what it adds; ask for actual procedure volumes.
• Pediatric nephrology pays far less, about $269,825 on Doximity, and filled fewer than half its fellowship positions in the 2026 match. Nearly all jobs are at children's hospitals, most of which count toward PSLF.

Take-home pay by state

At the Doximity nephrology average of $385,965, a single nephrologist takes home:

That's about $36,908 a year more in Texas than California on the same salary. Across all 50 states and DC, take-home at this salary ranges from $269,034 in the states with no income tax to $231,375 in Oregon. Because 72% of U.S. counties had no nephrologist in 2023, the best-paying jobs are often in smaller markets, many of them in lower-tax states. Run your own numbers in our take-home pay calculator, which covers every state, and see our salary by state guide.

The fellowship and workforce gap

• Supply is flat while demand grows. About 551,000 Americans were on dialysis in 2022 and 816,000 had kidney failure in total, per the U.S. Renal Data System. The Migration Policy Institute projects nephrologist supply will meet only about 85% of demand by 2038.
• The pipeline runs through visas. In 2025, 43% of nephrology fellows weren't U.S. citizens: 26% on J-1 visas, 10% on H-1B and 7% green-card holders. The $100,000 fee on new H-1B petitions announced in September 2025 had no physician exemption; a federal judge struck down the latest version of the fee at the end of September 2026, and the administration has said it will appeal. Our H-1B physician financial guide covers the costs.
• What it means for pay. A thin pipeline gives nephrologists leverage, especially in rural and underserved areas: ask for a signing bonus, loan repayment or a shorter partnership track. It also means heavier dialysis panels per nephrologist, so ask about patient counts before you sign.

Medicare and payment models

• The 2026 fee schedule. The conversion factor rose 3.26% to $33.4009 for 2026, which lifted the capitation codes above. CMS also applied a 2.5% efficiency cut to the work value of non-time-based services; check how your employer's wRVU credit treats it.
• 2027 looks flat to slightly down. CMS's proposed 2027 rule estimates a 0% change in nephrology's allowed charges from relative-value changes, but proposes a conversion factor 1.68% lower, so Medicare professional revenue would fall slightly. Our 2027 fee schedule guide tracks the final rule, usually published in early November.
• Value-based kidney care is shrinking, for now. CMS extended the Kidney Care Choices model through 2027 after it lost Medicare about $304 million in 2023, but ended its Kidney Care First option early, cut the quarterly capitation payment for chronic kidney disease in 2026, removed the transplant bonus, and applied a 1% discount to benchmarks. Practices whose income depends on shared savings should expect less from it.

Is the nephrology fellowship worth it financially?

The alternative for most internal medicine residents is hospital medicine. Two fellowship years at PGY-4 and PGY-5 stipends ($77,593 and $81,807) instead of a hospitalist's $345,000 median cost about $530,600 in gross pay. The average nephrologist then earns about $40,965 a year more than that hospitalist median, so recovering the fellowship takes roughly 13 years before taxes and investment growth.

That average hides two very different careers. In an employed job near the $249,000 starting median, a nephrologist may earn less than a hospitalist for years. In a private group with partnership, directorships or dialysis ownership, the edge is much larger: SalaryDr's private-practice nephrologists average $449,091, about $104,091 above the hospitalist median, and the payback takes a few years. People rarely choose nephrology for money, but if you do, choose the job structure as carefully as the specialty. Our internal medicine salary guide compares every IM fellowship this way, and our hospitalist salary guide covers the alternative.

Evaluating a nephrology offer

1. Dialysis load. How many in-center and home dialysis patients will you round on, in how many units, and how far apart are they?
2. Who gets the capitation credit. Do the monthly capitation codes count toward your wRVUs or collections, including visits made by advanced practice clinicians?
3. wRVU rate and threshold. Compare with the $50 median (middle half $49 to $51), and check how the threshold compares with a realistic panel.
4. Directorships. How many does the group hold, who holds them now, and when would you be eligible? Are stipends paid to you or to the group?
5. Partnership and ownership. Years to partner, buy-in and valuation method, partner income for each of the last three years, and whether dialysis joint-venture interests are offered at fair market value, with an attorney's review.
6. Call. Nights and weekends, hospital count and urgent dialysis coverage. ASN's fellows ranked overnight call frequency among their top job factors.
7. Restrictive covenants. Nephrology non-competes can be broad, sometimes tied to dialysis units. Read our non-compete guide and contract red flags before signing.

Use our contract analyzer to compare offers, and our salary negotiation and signing bonus guides before you respond.

Sources

1. Doximity Physician Compensation Report 2026 (nephrology $385,965, pediatric nephrology $269,825) and 2025 report ($367,425).
2. Medscape Physician Compensation Report 2026; 2025 figure via The DO, What physicians got paid in 2024.
3. SalaryDr: nephrology salaries, nephrology wRVU rates, lifestyle survey, private practice, academic and transplant nephrology. Self-reported; accessed October 17, 2026.
4. American Society of Nephrology: 2025 Nephrology Fellow Survey, first look, 2024 Fellow Survey report and First Look: AY 2026 Match.
5. Results and Data, Specialties Matching Service 2026, National Resident Matching Program.
6. CY 2026 Medicare Physician Fee Schedule monthly capitation amounts, via PD Empowers; work RVUs via FastRVU (90960, 90961, 90962, 90966) and nephrology wRVU benchmarks.
7. Dive Into the 2026 Medicare Physician Fee Schedule Final Rule, American College of Cardiology (conversion factor and efficiency adjustment).
8. Xia et al. Financial Ties, Market Structure, Commercial Prices, and Medical Director Compensation in Dialysis. JAMA Health Forum. 2025;6(6):e252659.
9. Inpatient Dialysis Services: Nephrologist Leadership and Improving Quality and Safety, American Journal of Kidney Diseases (medical director as about 0.25 FTE).
10. DaVita HealthCare Partners finalizes its $389 million settlement, McGuireWoods, October 2014.
11. Nephrologists' perspectives on dialysis treatment, BMC Nephrology 2014 (dialysis patients per nephrologist), and Dialysis patients fare better when doctors have fewer cases, UC Irvine.
12. A Survey of Burnout Among Nephrologists in the United States, Kidney Medicine, 2022.
13. Physicians in an Era of Changing Immigration Policy: The Case of Nephrology, Migration Policy Institute, 2026, and Judge strikes down latest version of $100,000 H-1B fee, Forbes, October 1, 2026.
14. U.S. Renal Data System 2024 Annual Data Report (2022 data), via ANNA.
15. CMS: CMS Fine-Tunes and Extends the Kidney Model to Rein in Spending.