Nephrology

INSIDE INFORMATION

"I enjoy the challenge of managing complex patients and balancing their multiple comorbidities over long periods of time. Diagnosing and managing patients with interesting and often treatable autoimmune causes for their kidney disease such as vasculitis and SLE adds further variety and academic interest.

Patients under the renal service can be extremely unwell so the ability to recognise life threatening illness and to know when to investigate, when to manage and when to refer is important. Common sense is also very useful."

Dr Elizabeth Stallworthy, Renal Medicine, Auckland City Hospital

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Why did you choose this specialty, and what do you most like about it?


	Nephrology treats patients with acute and chronic disease and offers effective treatment through therapeutic interventions that include dialysis and transplantation. The specialty involves intellectual challenges in diagnosing and dealing with complex renal, fluid and electrolyte problems. Patients are managed in a multi-disciplinary environment and there care can continue for decades

What particular abilities are important in this specialty?


	Motivation in the specialty is important: you should desire to apply your skills and intelligence to understanding and managing renal problems. You should possess good diagnostic logic and you need to be able to handle a busy workload. The working environment is a collaborative one so you will require effective staff interaction and leadership skills.

When working as a specialist in this area, what does a daily schedule look like?


	The work is highly variable but a typical day for a hospital specialist might involve a combination of inpatient and outpatient work, consultations, interdisciplinary meetings, and leadership of treatment teams in dialysis and transplantation. A research component is desirable but not always possible.

What are the challenges for the future for this specialty?


	There continues to be rapid growth in the number of patients presenting with end stage renal failure. New strategies need to be developed and established strategies implemented to screen for renal disease and delay chronic progressive renal failure. Newer approaches to providing more efficient dialysis need to become available, preferably administered in the home environment. New therapies for primary glomerulonephritis, diabetes and its complications are needed, and renal transplantation requires safer therapies to enable further expansion. There is exciting potential in the future for the application of DNA and proteomic methodologies in diagnosis and guidance of therapy. The development of new agents, particularly monoclonal therapies will continue to expand therapeutic options. Epidemiological research and randomised controlled trials in Nephrology are increasing and expertise in epidemiology and bio-statistics is highly sought after.

What advice would you give to someone thinking about this specialty?


	Nephrology provides breadth of medical practice, intellectual challenges, satisfactory outcomes and considerable opportunities for clinical research.

What is your opinion about opportunities in this area?


	There is currently an insufficient number of advanced trainees to meet growth in demand for the services of this specialty. Ample employment opportunities will continue to exist both in main and smaller centres in New Zealand, and research opportunities are substantial.

How realistic is it to take time out to travel, have children, etc?


	It may be possible to take time out during training. Once you have qualified and gained employment as a specialist, your ability to take extended leave will be dependent on the availability of locum cover.

How has your specialty impacted on your family?


	At junior level the specialty can be taxing on family life, although at senior level the role does not usually require excessively long hours. For consultants, on-call work can be demanding if a registrar service is not available.

Disadvantages with the specialty


	Even when you are a senior consultant there is often an ongoing on-call requirement. Sources of frustration can include funding constraints in health care in the public sector and the lack of knowledge and experience of some primary health care service providers with regard to care of renal patients.