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A nephrologist is a physician who has undertaken additional training to become an expert in nephrology. Additionally, due to their unique skills, nephrologists may provide care to people without kidney problems and may work in general/internal medicine, transplant medicine, immunosuppression management, intensive care medicine, clinical pharmacology and perioperative medicine. Nephrologists may further sub-specialise in dialysis, kidney transplantation, chronic kidney disease, cancer-related kidney diseases (Onconephrology), procedural nephrology or other non-nephrology areas as described above. Procedures a nephrologist may perform include native kidney and transplant kidney biopsy, dialysis access insertion (temporary vascular access lines, tunnelled vascular access lines, peritoneal dialysis access lines), fistula management (angiographic or surgical fistulogram and plasty), and bone biopsy. Training__ Australia and New Zealand__ Nephrology training in Australia and New Zealand typically includes completion of a medical degree (Bachelor of Medicine, Bachelor of Surgery: 4–6 years), internship (1 year), Basic Physician Training (3 years minimum), successful completion of the Royal Australasian College of Physicians written and clinical examinations, and Advanced Physician Training in Nephrology (2–3 years). The training pathway is overseen and accredited by the Royal Australasian College of Physicians. Increasingly, nephrologists may additionally complete of a post-graduate degree (usually a PhD) in a nephrology research interest (3–4 years). Finally, all Australian and New Zealand nephrologists participate in career-long professional and personal development through the Royal Australasian College of Physicians and other bodies such as the Australian and New Zealand Society of Nephrology and the Transplant Society of Australia and New Zealand. United Kingdom__ In the United Kingdom, nephrology (or often renal medicine) is a subspecialty of general medicine. A nephrologist has completed medical school, foundation year posts (FY1 and FY2) and core medical training (CMT) and passed the Membership of the Royal College of Physicians (MRCP) exam before competing for a National Training Number (NTN) in renal medicine. The typical subspecialty training is five years and leads to a Certificate of Completion of Training (CCT) in both renal medicine and general (internal) medicine. Subspecialty trainees often interrupt their clinical training to obtain research degrees (MD/PhD). United States__ In the United States, after medical school nephrologists complete a three year residency in internal medicine followed by a two year (or longer) fellowship in nephrology. Once training is satisfactorily completed, the physician is eligible to take the American Board of Internal Medicine (ABIM) or American Osteopathic Board of Internal Medicine (AOBIM) nephrology examination. Nephrologists must be approved by one of these boards. To be approved, the physician must fulfill the requirements for education and training in nephrology in order to qualify to take the board's examination. If a physician passes the examination, then he or she can become a nephrology specialist. Typically, nephrologists also need two to three years of training in an ACGME or AOA accredited fellowship in nephrology. Nearly all programs train nephrologists in continuous renal replacement therapy; fewer than half in the United States train in the provision of plasmapheresis.[1] Only pediatric trained physicians are able to train in pediatric nephrology, and internal medicine (adult) trained physicians may enter general (adult) nephrology fellowships. Physicians that achieved training in both medicine and pediatrics may subspecialize in both adult and pediatric nephrology.[citation needed] |
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