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Dr
U. Maggiore Ospedale Maggiore di Parma Dipartimento di Clinica Medica, Nefrologia e Scienza della Prevenzione Parma, Italy |
Dr Zoccali: Why did you decide to specialize in nephrology?
Dr Maggiore: Nephrology attracted me because it covers several important branches of Internal Medicine, encompassing cardiovascular medicine, acute care, clinical immunology, metabolism and nutrition, rheumatology, biotechnology, etc., not to mention its specific role in dialysis and transplantation. Its practice is by no means repetitive and is never boring, each working day in the ward is different from the other. No less attractive are the research challenges, ranging from cardiovascular morbidity to gene therapy.
Dr Zoccali: How important has your training in clinical epidemiology been for your present clinical and research activities?
Dr Maggiore: Training in epidemiology provided me with the appropriate instruments to definine clearly the object of the study and for choose the appropriate design to pursue it. It has been just as important for the critical evaluation of evidence presented in scientific literature. Last but not least, I found it most useful as a tool for "clinical reasoning" at the bedside.
Dr Zoccali: Would you make the same decision now or do you feel that other specialties offer better professional prospects?
Dr Maggiore: Among the other medical subspecialties, cardiology might offer better professional prospects because it deals with a much greater population of potential users than nephrology. However, clinical practice in this as well as in some other internal medicine specialties have evolved into much more pronounced “sectorialization” leading to the formation of subspecialties (e.g. invasive cardiology, electrophysiology, non-invasive cardiology, etc.) usually with little exchange between them. Because of this, I still find it more interesting - for my clinical involvement - to be a nephrologist rotating between dialysis, transplantation, acute renal failure care and the nephrology ward.
Dr Zoccali: Do you feel that clinical epidemiology deserves more emphasis in medical training?
Dr Maggiore: Yes, I think so. Clinical epidemiology is regarded as the scientific foundation of clinical medicine. It provides the tools to test the validity of any procedure used in clinical practice. For this reason, it should be regarded as a fundamental discipline in the academic teaching of medicine.
Dr Zoccali: Could you tell us what the major problems or obstacles are that you have encountered during your training years and now?
Dr Maggiore: The major problem I am facing now is the very restricted funding available for research activity. As you know, this is a general problem in Italy, not limited to nephrology or to the place where I work.
Dr Zoccali: Do you think that young doctors in academic centers should be given more time to devote to research?
Dr Maggiore: This is a big problem in any unit involved in clinical activity. To do both clinical and research activity during the same working day is very difficult, if not impossible. Ideally the working year should be divided in periods to be devoted exclusively either to clinical or to research activity. But this requires the Units to be equipped with a medical staff large enough to allow such rotation, which very rarely happens. So we are left with the typical Italian way of the "arte di arrangiarsi" (the art of making the best of what is available) to overcome the difficulties.
Dr Zoccali: How many hours a week do you work? Do you have any hobbies?
Dr Maggiore: About 45 hours per week. My preferred hobbies are tennis, listening music, and playing the guitar.
Dr Zoccali: Frankly speaking, what advice would you give to a young colleague wishing to enter a career in nephrology?
Dr Maggiore: In the present situation in Italy, I would hesitate to encourage a young doctor to start a career in nephrology. There are far too many nephrologists in Italy (nearly 3000?); there is also a widespread tendency to close the small nephrological units and incorporate them into larger Internal Medicine Units.
Dr Zoccali: I know that you are a wine expert. What red wine would you advise to accompany a Florentine steak?
Dr Maggiore:
You don’t have to go too far away: a nice “Chianti Classico”
will do if you can afford it. If you want to save money, choose a good trattoria
and ask for "un quartino della casa".
