Nephrology-ICU??

[anradam]

Here's my two cents (which is probably what's it's worth!!):
I went into medicine with the specific goal of doing internal medicine and then interventional cardiology. I'm med III now and I'm sure that I'm going to do internal medicine but am no longer sure about cardiology. I basically divide the subspecialties of internal medicine into two tracts: "doers" and "thinkers". By "doers" I mean specialties like cardio and gastro that are procedure based. By "thinkers" I mean specialties like nephro, endo and hem/onc. At first I thought I was a "doer" but 10 elective caths/day or 20 screening colonoscopies/day just doesn't stimulate my cerebral side. At the same time, I find alot of the other specialties too cerebral, and after awhile I think they would get pretty boring.... and in terms of pay they are a step down from cardio/gastro (not that I really care). So I'm thinking of doing a combined nephro/ICU; the nephro for my mind, the ICU for the procedures, and the combination should pay pretty well. Any thought's??

---

Members don't see this ad.

 

[UTSouthwestern]

Maybe it's just Southwestern but I've always viewed nephrologists as "doers" by your definition. On my nephrology rotation when I was in internal medicine, I remember placing 10-15 Quinton's a day, dialyzing 25+ patients per day, seeing 10-15 consults (majority being ATN), etc. The cerebral side of nephrology may not be as stimulating as you would like.

 

[ckent]

I was also surprised to see that nephrologists were more doers then thinkers. I thought that they the field was very intellectual prior to doing a rotation in it, but after doing a rotation in nephrology, I came to see it more as following protocols and writing orders for dialysis. Everbydoy gets a standard proteinuria w/u, biopsy if their kidney is large enough, and the dialysis patients seem pretty intellectually non-stimulating to manage as well. I think that doing a critical care fellowship after completing your nephrology fellowship would be reasonable though, as a lot of patients in intensive care units needs temporary HD or CVVD. I am surprised that nephrologists at your school place quintons and do procedures, at my school, that's all the transplant surgical team that handles all of that. It gets kind of annoying having to coordinate things with the surgeons though. Most ICU docs are pulmonologists or anesthesiologists (mainly because of airway issues), but any internists can be an intensivists or complete a crtical care fellowship.

 

[Renovar]

Originally posted by UTSouthwestern
Maybe it's just Southwestern but I've always viewed nephrologists as "doers" by your definition. On my nephrology rotation when I was in internal medicine, I remember placing 10-15 Quinton's a day, dialyzing 25+ patients per day, seeing 10-15 consults (majority being ATN), etc. The cerebral side of nephrology may not be as stimulating as you would like.

HOLY $HIT...

That's some serious do-age there. No wonder...

Now I have no reason to bitch about the attending I had when I was on nephrology clerkship. She was trained at Parkland as a nephrology fellow and she is heck of a gun-ho doer, and she just seems to able to go and go and go. She kept on saying she missed the days when she would stick 20 groins, take 20 consults and see 20 patients in clinic all in the same day, and bitching about the renal fellows at my institution having it way too easy, which at the time bewilders me because all the first year renal fellows are all clocking 100+ hours too, so it's not like they are slackers.

 

[UTSouthwestern]

That's Parkland. It was one of the reasons why I'm no longer doing internal medicine. Great training but terrible lifestyle. I would also think that becoming critical care certified after finishing a nephrology fellowship would be a good combination. An exhausting combination, but a good one. Again, you might be suprised at the amount of stuff you have to do.

Maybe it's different with respect to access placement but at least here, the nephrologists put almost all the accesses in. The transplant surgeons create the fistulas only.

 

[Renovar]

Originally posted by UTSouthwestern
That's Parkland. It was one of the reasons why I'm no longer doing internal medicine. Great training but terrible lifestyle. I would also think that becoming critical care certified after finishing a nephrology fellowship would be a good combination. An exhausting combination, but a good one. Again, you might be suprised at the amount of stuff you have to do.

Maybe it's different with respect to access placement but at least here, the nephrologists put almost all the accesses in. The transplant surgeons create the fistulas only.

At my institution, renal fellows do all the groin sticks as well. GS here does all the AV fistulas and grafts.