If you're keen to learn about the science behind disease, a career as a pathologist could be for you

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

There are varying amounts of laboratory work involved in pathology, depending on the specialty and the role itself. Some pathologists don't tend to have any patient contact, whereas others combine lab work with clinical, direct 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. Pathology is involved in over 70% of all diagnoses in 'live' patients.

Types of pathology

There are four distinct specialties within pathology:

  • Chemical pathology/metabolic medicine - 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 where the chemical processes in the body do not 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 - you'll diagnose, treat and manage prevention of infection in hospitals and the community. You'll oversee the medical laboratory and provide a bridge between the lab and clinicians.

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

Responsibilities

As a pathologist, you'll work within the medical laboratory of a hospital. You may provide clinical support for the lab or oversee its management. 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 healthcare 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
  • conduct ward rounds and outpatient clinics (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)  
  • 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 level is £26,614 in the first year, rising to £30,805 in the second year. As a trainee at specialty level you can earn between £36,100 and £45,750.
  • Salaries for specialty doctors (staff grade) range from £37,923 to £70,018.
  • The salary for newly qualified consultants starts at £76,761, rising to £103,490 depending on the length of service.

Allowances are paid for working nights, weekends and being on call. You will automatically be enrolled in the NHS pension scheme.

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

Figures relate to the pay and conditions of medical doctors within the NHS, which is 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. Hours are 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 (where you're available to work, usually outside normal working hours). 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 will usually be employed on short-term contracts.

What to expect

  • You'll work closely with healthcare scientists in the medical laboratory. You'll also attend clinical meetings with a range of 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 have become a consultant.
  • Most pathology specialties have patient contact, e.g. outpatient clinics and ward rounds. Within histopathology patient contact is limited, although you may have joint specialist clinics with surgeons.

Qualifications

The only way to get into pathology is with a degree in medicine recognised by the General Medical Council (GMC). This usually takes five years to complete, although if you've already got a degree in a subject other than medicine (usually a 2:1 or above), you can apply for a four-year accelerated medical graduate entry programme (GEP). Some medical schools accept degrees that are not necessarily in a science-related subject. There are also 'foundation' or 'gateway' degrees that add a preliminary year to your medical degree. These have been brought in to help widen access to medicine. For more information see health careers.

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. On successful completion you'll be awarded a Foundation Programme Certificate of Completion (FPCC).

Following foundation training, you'll undergo further study in one of the four pathology specialities:

  • Chemical pathology/metabolic medicine - you can apply competitively to chemical pathology, and training typically takes five years. However, the most common route is via metabolic medicine, which involves two years of core medical training and then six years of further training.
  • Haematology - you can apply competitively to two years of core medical training and then a further five years of higher specialty training.
  • Histopathology - you can apply directly to histopathology. Training typically takes five and a half years.
  • Medical microbiology and virology - you apply competitively to two years of core medical training, followed by two years of combined infection and then two years in microbiology/virology training.

See hospital doctor for full details on the qualifications and training required to be a doctor.

Skills

You will 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 you could consider becoming an undergraduate member of:

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 and/or arrange a 'taster' in a pathology specialty. This will give you a good insight into the work.

Employers

There are currently plenty of opportunities available for pathologists. The NHS is the largest employer of pathologists in the UK, you can also work in the private sector.

Look for job vacancies at:

Look for training posts at:

  • NHS specialty training - medical and dental recruitment and selection.
  • Oriel - the portal to make applications to medical, dental, public health and healthcare science training programmes.
  • BMJ Careers

For more information on where to look for jobs and training posts, see the Royal College of Pathologists Recruitment into Pathology.

Professional development

While you undergo your training in pathology, you'll need to study for your exams so that you can become a fellow of the Royal College of Pathology.

As a pathologist you will 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.

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 for postgraduate courses.

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 will 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.

There's been a huge change in medicine generally towards genetic testing and so the role of the medical laboratory is going to expand.