Specialty career profile: renal medicine

Dr Rosie Donne shares her experience in what influenced her to choose renal medicine, what training involves and what it's like to work in the specialty.

What influenced you in choosing renal medicine?

I was inspired by the dedication of some of the doctors I worked with as a senior house officer (SHO). I could see that specialist registrars (SpRs) and consultants were able to get to know their patients well over a long period of time which I thought I would enjoy. I also found the variety of kidney diseases and their treatment very interesting when I learned about them at medical school and for the MRCP exams.

I liked the variety of different ages of patients, the opportunity to look after very ill patients as well as those with long-term kidney problems. The multidisciplinary approach to care and the ability to look after patients in the long-term really appealed to me. I became completely hooked when looking after a particularly memorable patient. She was 20 years old and was admitted with atypical haemolytic-uraemic syndrome (HUS), passed no urine for 6 weeks and was kept alive with dialysis and plasma exchange. She recovered her kidney function and went home with a normal creatinine.

I went on to study the genetics of the disease for my postgraduate doctorate degree (MD) – a small part of a big project which has now led to an effective treatment for HUS which did not exist when I looked after my patient.

What training do you have to do to get into renal medicine?

Core medical training (CMT) followed by specialty training posts in renal medicine (ST3–6), with or without general medicine. Most people aim for dual accreditation in general and renal medicine, although you have the option to train in renal medicine only.

Many SpRs spend some time in research during their specialist training with the aim of attaining a research degree such as MD or PhD, but some choose to go straight through clinical training without research. Sometimes the lack of research experience can narrow the opportunities for certain consultant posts where research experience is preferred.

What rotations did you do in your training and what did you find helpful?

My SHO training included general acute medicine, cardiology, chest medicine, renal, diabetes, neurology and gastroenterology. All these things were very useful as I am usually involved in managing the general medical problems arising in long-term dialysis and transplant patients. The wider the experience you have before specialising, the better it will be in the long-term.

Do you work closely with other specialties?

I work particularly closely with ITU, renal transplant surgery, cardiology and diabetes teams plus a whole range of different hospital specialists in the care of my patients.

What are the best things about working in renal medicine?

I am able to provide life-saving treatment to ill patients and see them get better. I look after patients for a long time, building a trusting relationship and am their main source of help when they are ill.

Other health professionals who refer patients to me are often incredibly grateful for my help as they are usually worried when they have patients with renal failure.

I have learned procedures such as central line insertion and renal biopsy. I work in a multidisciplinary environment which adds interest and depth to decision making as well as the fun of working in a varied team.

And what are the main challenges?

Many patients are very ill and some will die. I have become used to talking with patients and their families when they are dying – despite a lot of experience this is never easy, but I have had the opportunity to be trained in advanced communication skills.

The evidence base for treatments in renal medicine is often lacking compared with some other specialties, which can result in difficult decision making.

What are your typical working hours?

I have been able to work part-time since having children, initially as an SpR and then as a consultant. I applied for flexible training through the deanery and was able to go back part-time after maternity leave (I started planning this during the pregnancy and would advise anyone else to do the same as it can take time).

I work three days a week (70% of full time), typically from 9am till 5pm on one day and till 7pm on the other two days. It would be possible to do some of this from home with the help of technology but I prefer to stay later and have my home time largely to myself. I am on call part-time on the rota, which works out as 1 in 20 nights on call for me. I job-share the acute ward work and on call with another part-time consultant (she does the first half of the week and I do the second half, which works well). We both find this fits in well with family and child-care arrangements.

Are there opportunities for teaching or lecturing?

There are always opportunities to teach medical students, junior doctors, nurses and other members of the multidisciplinary team.

Are there opportunities for research?

Many renal SpRs undertake a period of 2 to 3 years of research towards a research degree (usually and MD or PhD). Many continue to be active in research once in a consultant post, including supervising medical students and junior doctors in their research projects.

What advice would you give to someone considering a career in renal medicine?

Spend some time working in renal medicine, either as a foundation doctor or CMT doctor before deciding – it is like no other specialty so it would be good to have a taster before applying for an ST3 post.