Working in nephrology: 5 Pros and 5 Cons

Working in nephrology: 5 Pros and 5 Cons

Nephrology is not for everyone. Here goes.

5 Pros – why should I work in nephrology

1. Practice general medicine. There are great first hand learning opportunities as patients with CKD and ERSF usually have other cardiac, endocrine (especially diabetic) and vascular surgical problems. And you get a chance to get your hands dirty and do stuff – e.g. central lines and kidney (and kidney transplant) biopsies
2. Senior supervision. There is usually excellent consultant and senior doctor cover on the wards (and in clinic); with whom you can always discuss anything you are unsure about. Hence there are also many chances to get your competencies signed off faster, as there are more on-hand tasks to be completed
   Note. Quite often the bosses are so keen they won’t go away and give you space. You may have to ‘encourage them’!
3. Variety and continuity. There is a huge variety of patients and illnesses – from common like diabetic nephropathy to very rare ones like Goodpasture Syndrome. No two days  in the nephrology are the same. On a renal ward, you will always be seeing something new, which means you will regularly face new challenges and learn new skills. You will also see the importance of a multi-disciplinary approach to sort out that variety of patients. Also the ‘hot work’ (mainly AKI, on the wards) is balanced by ‘cold work’ (mainly CKD/ESRF, in the clinics), where you will have to make careful plans for kidney transplants, for example. There are many long-term patients on dialysis or with a transplant who you will get really fond of. You end up being their GP. And a renal unit is like a big family
4. Lots of clinical immunology, pathology and numbers. For those of you that like clinical immunology and pathology, this is the place for you. There is lots of autoimmune disease, looking at biopsies with pathologists, and kidney transplantation is constantly changing and improving. Alot of the skill of nephrology relates to the careful analysis of numbers on computers, and predicting what will happen in 2 weeks, 2 months and 2 years. So nephrologists tend to be quite obsessional. Most collect weird stuff!
   Note. Don’t say ‘the creatinine is about 200’ to a consultant nephrologist. It won’t go well
5. You. If you are ‘do stuff now’ person – and like ill patients, numbers, science and medicine, technology and immunology, like being a GP – and not focused on money – this may be the career for you.

5 Cons – why you may not want to work in nephrology

Here is the list of cons.

1. The hours can be unsocial. Even as a consultant you will be working at night, weekends, and bank holidays. Your sleep pattern will often be out of whack because of the changing working hours
2. Social and family life. You may not have a chance to hang out with your friends, or study as much as you would like, because of the range of work hours, and the likelihood of feeling exhausted
3. Fast pace. Whilst most staff enjoy the fast-paced, multitasking work environment, others can find the constant high pace draining. You need to be able to handle multiple duties at once and keep going without many chances to catch your breath – i.e. there is a lot going on at once
4. Emotionally draining. In nephrology, you are likely to encounter a lot of pain and tragedy – e.g. horrible aggressive kidney disease, and a lot of deaths on the ward (dialysis dependent AKI has a 50% mortality). Seeing such things can be emotionally draining. And that’s doubly true when patients die before you can save them. While it is important to have empathy for your patients, the best renal staff need the ability to remain slightly detached and emotionally healthy, even in the face of other people’s suffering
5. Finance. And there is little private practice as a consultant. But you can boost your salary by doing teaching or medicolegal work.

Summary

We have described working in nephrology, and its pros and cons. We hope you have learnt something.