Pathologist

A pathologist is a doctor who interprets and diagnoses the changes caused by disease in the body's cells and tissues

As a pathologist you'll diagnose, treat and prevent a range of diseases. There are varying amounts of laboratory work involved in pathology, depending on your specialty and the role itself. Some pathologists don't tend to have any patient contact, whereas others combine lab work with direct, clinical patient care.

It's a myth that pathologists only deal with dead bodies - this is only the case with forensic histopathology, a sub-specialty of histopathology, which employs only a very small number of people.

Types of pathology

The four most common areas of medical pathology are:

• Chemical pathology - you'll combine laboratory and clinical skills, using biochemical tests to diagnose and treat patients. With metabolic medicine, a sub-specialty of chemical pathology, you'll treat patients whose chemical processes don't function properly.
• Haematology - you'll diagnose and treat disorders of the blood and bone marrow and provide clinical support for the haematology diagnostic laboratory, which includes the blood bank.
• Histopathology - you'll diagnose and study disease by medical interpretation of cells and tissue samples. Your role is integral to cancer management through the staging and grading of tumours. You'll also perform autopsies to determine cause of death.
• Medical microbiology and virology - in medical microbiology, you'll diagnose, treat and manage prevention of infection in patients and the community. You'll oversee the medical laboratory and provide a bridge between the lab and clinicians. Medical virology involves the management of blood-borne infections and other emerging viruses.

There are also options to sub-specialise, for example in paediatric pathology or neuropathology.

Responsibilities

As a pathologist, you'll oversee the management and running of a hospital medical laboratory and its staff. In many roles, you will also work alongside patients. In histopathology, you will be mostly lab-based.

Although specific tasks vary according to your specialty, there are some responsibilities common to all specialities and you'll typically need to:

• examine and talk to a range of patients, using diagnostic skills to determine what tests need to be carried out
• support and advise clinical staff to help them choose the correct tests
• work alongside biomedical scientists while they complete laboratory tests
• educate colleagues in the use and limitations of each diagnostic investigation
• provide advice and interpretation of test results and the appropriateness of further investigations
• deliver clinical care to patients (as a histopathologist, patient contact is limited unless you're undertaking a specific role such as taking fine-needle aspiration cytology specimens in breast clinics)
• conduct ward rounds and outpatient clinics
• undertake managerial responsibilities, such as planning the workload and staffing of the department, especially at more senior levels
• supervise and teach junior medical staff, depending on your post
• carry out research and keep up to date with new information relevant to your field.

Salary

• The basic starting salary for junior hospital doctor trainees at Foundation Training level is £29,384 to £34,012. As a trainee doctor you'll receive a basic salary plus pay for any hours over 40 per week, a salary enhancement for working nights, a weekend allowance and an availability allowance if you're on-call.
• As a trainee at specialty level you can earn between £40,257 to £53,398. Salaries for specialty doctors (staff grade) range from £50,373 to £78,759.
• If you are a specialist grade doctor you'll earn a basic salary of £80,693 to £91,584.
• Salaries for newly qualified consultants start at £88,364 rising to £119,133 depending on your length of service.

Beyond trainee level, you'll receive allowances for working nights, weekends and being on call. You'll automatically be enrolled in the NHS pension scheme but are able opt out.

Consultants may apply for local and national Clinical Excellence Awards and are also able to supplement their salary by working in private practice.

Figures relate to the pay and conditions of medical doctors within the NHS - the largest employer of pathologists in the UK.

Income data from NHS Health Careers. Figures are intended as a guide only.

Working hours

A working week usually comprises 40 hours, with hours generally between 9am and 6pm. However, depending on the trust you work for and your chosen specialty, you may have to work nights, weekends or be on call. Most trainees at foundation, core and higher level will be expected to work on call.

Part-time work is possible with opportunities for a good work/life balance. As a core and specialty trainee, you'll usually be employed on short-term contracts.

What to expect

• You'll work closely with biomedical scientists in the medical laboratory. You'll also attend clinical meetings with other doctors, nurses and other multi-professional staff.
• The lifelong study of disease, combined with the requirement to diagnose clinical conditions, means that pathology is rewarding and intellectually stimulating.
• There's a tendency to sub-specialise towards the end of your training once you've become a consultant.
• Most pathology specialties have patient contact, such as outpatient clinics and ward rounds. Within histopathology patient contact is limited, although you may have joint specialist clinics with surgeons.

Qualifications

To become a pathologist, you'll need to first complete a degree in medicine recognised by the General Medical Council (GMC). This usually takes five to six years to complete, although if you've already got a degree in a subject other than medicine (usually a 2:1 or above in a science-related subject) you can apply for a four-year accelerated graduate entry medicine programme (also known as a graduate entry programme). For a list of medical schools, see the Medical Schools Council.

Your medical degree is followed by two years of Foundation Training, common to all medical graduates, where you work in a hospital as a junior doctor on a rotational basis in different departments, which may include a pathology specialty. After successful completion of the first year of Foundation Training, you can apply for full registration as a doctor with the GMC. On successful completion of the programme, you'll be awarded a Foundation Programme Certificate of Completion (FPCC). For full details, see the UK Foundation Programme.

You will then undertake further core and specialty medical training (usually a minimum of seven years in total) to qualify in your chosen specialty. For further information, see the Joint Royal Colleges of Physicians Training Board (JRCPTB) and The Royal College of Pathologists.

On successful completion of the specialty training, you'll receive a Certificate of Completion of Training (CCT) and will be eligible for entry onto the GMC Register. It's possible to apply for consultant posts six months prior to your completion date.

For details on the qualifications and training required to be a doctor, see hospital doctor.

There is an alternative route into pathology as a clinical scientist, which doesn’t require a medical degree but also focuses on prevention, diagnosis and treatment of disease. This route is via the Scientific Training Programme (STP).

Skills

You'll need to have:

• excellent knowledge of the scientific processes behind changes in the body's cells and tissue, which can cause disease
• strong diagnostic skills to determine the type of disease, its severity and extent
• good problem-solving and clinical decision-making skills
• the ability to work alone and in multidisciplinary teams
• good time management and organisational skills
• the ability to communicate effectively, both verbally and in writing, with patients and staff from a range of backgrounds
• an inquisitive mind and self-motivation
• the ability to influence others and to prioritise effectively
• scientific curiosity and an analytical, enquiring mind
• leadership ability.

Work experience

Before applying to do a medical degree, you'll be expected to undertake work experience, either paid or voluntary, in areas relevant to medicine. This could be through work experience at your local hospital, nursing home or through work-shadowing a doctor. This experience shows your commitment to becoming a doctor and provides insight into the physical and emotional demands of working in medicine.

Once you're a medical student, consider becoming an undergraduate member of:

• Pathological Society
• The Royal College of Pathologists

In addition, you could join a university pathology student society to keep informed about developments in the area.

The Royal College of Pathologists also has social media threads that advertise training, opportunities, news or events, for example, The Royal College of Pathology annual summer school. These allow you to find out more about the different pathology specialties.

During your two-year foundation training as a junior doctor, you can try to get onto a pathology rotation. If that's not possible, you can talk to doctors in the pathology lab to arrange a taster session in a pathology specialty. This will give you a good insight into what the work involves.

Find out more about the different kinds of work experience and internships that are available.

Employers

The NHS is the largest employer of pathologists in the UK. You can also work in the private sector.

Look for job vacancies at:

• BMJ Careers
• NHS Jobs - England and Wales.
• NHSScotland Jobs
• Jobs.hscni.net - health and social care jobs in Northern Ireland.

Professional development

Once qualified, you'll be expected to continue learning throughout your career. Continuing professional development (CPD) is essential if you want to remain on the GMC register.

CPD activities include attending courses, conferences, meetings and workshops, as well as undertaking research and peer-reviewing journal papers. The Royal College of Pathologists runs a CPD scheme to help members record and keep track of their activities. Membership of the Pathological Society is also useful for keeping up to date with the latest research.

Additional postgraduate qualifications can be useful but aren't essential. If you wish to integrate more formal teaching into your work, you can take the MMedSci Medical Education. Search postgraduate courses in medical education.

For an academic research career, you'll need to study for a PhD in an area of original research.

Career prospects

As a consultant you'll gradually gain more experience in your clinical duties and take on more responsibilities. You'll have the opportunity to move into managerial roles, initially as a medical lead (a lead consultant for a team), then as a clinical director (a lead consultant for a department) and later on as a medical director (a lead consultant for a hospital trust).

If you wish to take up scientific research and an academic career, you'll need to start early during your Foundation Training, as this field is highly competitive.

Pathologists interested in teaching future doctors may become a director of medical education, training programme director or associate dean in charge of the entire training programme.

There are also opportunities to work in the private sector or to set up your own practice. Depending on your specialty, you may have to be geographically mobile in order to move up to the next level in your career.