For many years now my plan was to establish myself as a researcher and then work my way into clinical nephrology, while continuing my research. Instead, I find myself at a crossroads. The department of nephrology at my hospital has no plans for another resident for at least two years, certainly not a combined research and clinical position. At the same time I have been offered just that in anaesthesiology and intensive care.
The research in medicine and nephrology is very much risk-factor based and focused on the progression of chronic disease, while intensive care is more focused on acute, homeostasis-based physiology. My research has connections to both areas: Acute regulation of renal blood flow on the one side, and more chronic progression of renal damage on the other. I can not say that I find either more enticing than the other.
So, my experimental research is about equally applicable in the two specialities, but the role as a doctor is completely different. In Sweden anaesthesiology is a service-speciality. That is, they keep the patient alive while the surgeons do their job. Intensive care is much the same, they maintain life-support while doctors from other departments are actually responsible for the diagnosis and treatment of the patient. Not that that may not be challenging or interesting in itself. It is just not the way I have looked at myself. On the other hand, practically everything in modern health-care are collaborations, and as intensivist you are really at the center of the treatment of the most critically ill patients. Sadly, it often means that the patients are not very talkative, and may not remember you at all.
In contrast, nephrologists get to diagnose and follow their patients through an often slowly progressing chronic disease. In short, they get to know their patients. In addition, the pace is decidedly slower, more measured, and the rounds longer, much, much longer.
At the moment, everything seems to head toward anaesthesiology and intensive care for me, while my self-image, and clinical practice so far has been focused on medicine and nephrology. Thus the identity-crisis.