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. The extent of laboratory work in pathology varies depending on your specialty and specific role. Some pathologists work predominantly behind the scenes in laboratories, while others combine lab work with direct, clinical care and patient interaction.

It's a misconception that pathologists only deal with post-mortem examinations - this is only the case with forensic histopathology, a sub-specialty of histopathology, which employs only a very small number of professionals.

Types of pathology

The four most common areas of medical pathology are:

• Chemical pathology - you'll combine laboratory and clinical skills to analyse biochemical test results from blood and other bodily fluids to support the diagnosis and management of a range of conditions. You may work closely with multidisciplinary teams to monitor treatment responses and guide patient management.
• 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. Haematologists often have significant patient-facing roles, especially in hospital settings.
• Histopathology - you'll diagnose and study disease in tissues and organs. Your role is integral to cancer management through the staging and grading of tumours. You'll also perform autopsies to determine cause of death. Histopathology is the largest specialty of pathology. Most histopathology work is lab based, and you won't have direct contact with patients. The sub-specialties of histopathology are cytopathology, diagnostic neuropathology, forensic histopathology, and paediatric and perinatal pathology.
• Medical microbiology and virology - in medical microbiology, you'll identify and advise on the treatment of infections caused by bacteria, fungi and parasites. In virology, your focus will be on viruses such as influenza, HIV and emerging pathogens like SARS-CoV-2. You'll also support infection prevention and control efforts in hospitals and the community and may contribute to public health responses.

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.

Although specific tasks vary according to your specialty, there are some responsibilities common to all specialties, 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 diagnostic tests
• work alongside biomedical scientists, clinical scientists and other laboratory professionals while they perform and analyse tests
• educate clinical colleagues on the appropriate use and limitations of diagnostic investigations
• provide advice and interpretation of test results and the appropriateness of further investigations
• provide expert interpretation of test results and guidance on the clinical significance and any follow-up investigations
• deliver clinical care to patients (depending on the area of pathology you are working in)
• conduct ward rounds and outpatient clinics in certain specialties, such as haematology and chemical pathology
• lead or participate in multidisciplinary team (MDT) meetings, particularly for cancer diagnosis and treatment planning
• undertake managerial responsibilities, including service development, quality assurance, budgeting and workforce planning, especially at more senior levels
• supervise, mentor and teach resident doctors, medical students and laboratory staff
• engage in clinical audit, quality improvement initiatives and adherence to national standards and guidelines
• carry out and publish clinical research and stay up to date with advancements in medical science and technology relevant to your field.

Salary

• The basic salary during foundation training in England is £36,616 to £42,008. Salaries for doctors starting their specialist training range from £49,909 to £70,425.
• As a speciality doctor, you'll earn between £59,175 and £95,400. Salaries for specialist grade doctors range from £96,990 to £107,155.
• Salaries for newly qualified consultants start at £105,504, rising to £139,882 depending on the length of your service.

Resident doctors (formerly known as junior doctors) will earn a basic salary, plus pay for any hours over 40 per week, a pay enhancement for working nights, a weekend allowance and an allowance if you're on call.

High-cost supplements are available to pathologists working in London. You'll automatically be enrolled in the NHS pension scheme, but you can opt out.

Consultants in England and Wales may apply for local Clinical Excellence Awards and national Clinical Impact Awards. You should also be paid more if you take on extra responsibilities in, for example, management or education. In Scotland, you can apply for discretionary points. Consultants 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, which is the largest employer of pathologists in the UK.

Salary bands differ across the four countries of the UK. Pay negotiation happens annually at different times, so salaries will change when each country agrees their new pay award. Check your country's pay scales for doctors for the most up-to-date NHS salary information.

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 and clinical scientists in the medical laboratory. You'll also attend clinical meetings with doctors, nurses and other multi-professional staff.
• The lifelong study of disease, combined with the requirement to diagnose clinical conditions, means that pathology can be a rewarding and intellectually stimulating career.
• Most pathology specialties involve some degree of patient contact, such as outpatient clinics and ward rounds. In histopathology, direct patient interaction is limited, although you may take part in joint specialist clinics with surgeons.
• You'll typically work in NHS hospital laboratories, with opportunities across the UK. Some roles may require regional travel, particularly in smaller specialties where services are delivered across multiple hospital sites or as part of outreach and networked laboratory services.

Qualifications

To qualify as a pathologist, you must complete a series of medical training stages. You'll start by taking a recognised medical degree approved by the General Medical Council (GMC). This usually takes five to six years. However, if you already have a degree in a subject other than medicine (usually a 2:1 or above in a science-related subject), you may be eligible to apply for a four-year accelerated medical graduate entry programme (GEP).

For a list of approved UK medical schools, see the Medical Schools Council.

After your medical degree, you'll apply for the UK Foundation Programme, a paid, two-year general training programme common to all medical graduates. During these two years, you'll develop your clinical and professional skills and will undertake placements across various hospital departments that may include pathology.

After completing the first year (F1), you can apply for full registration as a doctor with the GMC. Successful completion of the second year leads to a Foundation Programme Certificate of Completion (FPCC). You must apply for foundation training through the Oriel recruitment system.

You will then undertake post-foundation core training that typically lasts two to three years. Training at this stage varies depending on the area of pathology you want to work in. Common routes include Internal Medicine Training (IMT) or Acute Care Common Stem (ACCS). These programmes prepare you for entry into pathology specialty training.

Specialty training in your chosen area of pathology typically takes five years to complete. As part of your training, you must pass examinations to gain Fellowship of The Royal College of Pathologists (FRCPath).

On successful completion of your training, you'll receive a Certificate of Completion of Training (CCT), which qualifies you to join the GMC Specialist Register and apply for consultant posts.

Full details on pathology training routes are available from the Royal College of Pathologists.

If you're interested in a clinical academic or research career, see the Clinical Academic Training and Careers Hub (CATCH). They have details on the role of a clinical academic and the training routes available.

Not all doctors become consultants. Some take up roles as specialty and specialist grade doctors (SAS).

There is a non-medical route into pathology as a clinical scientist. Clinical scientists are involved in diagnosing, monitoring and researching disease. You'll usually need to complete the Scientist Training Programme (STP) to become a clinical scientist. To work as a consultant clinical scientist, you will also need to complete the Higher Specialist Scientist Training Programme (HSST).

Skills

You'll need to have:

• clinical expertise in the scientific processes behind changes in the body's cells and tissue, which can cause disease and illness
• strong diagnostic skills to determine the type of disease, its severity and extent
• excellent problem-solving and clinical decision-making skills
• keen observational skills and attention to detail
• the ability to remain calm under pressure and make informed, evidence-based decisions
• the ability to work flexibly and collaboratively as part of a multidisciplinary team
• good time management and organisational skills
• the ability to communicate effectively, both verbally and in writing
• a flexible approach to work with the ability to adapt quickly to changing situations and new challenges
• leadership skills with the ability to organise, influence and motivate others
• the ability to manage clinical complexity and uncertainty
• emotional resilience to work in challenging situations
• knowledge of relevant legal, ethical and professional requirements
• self-motivation, initiative and a commitment to continuous learning
• confidence in using digital tools and laboratory information systems
• an understanding of quality assurance, audit and risk management in clinical laboratories
• research and analytical skills to contribute to innovation and evidence-based practice.

Work experience

Before applying to do a medical degree, you're 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 at medical school, try to choose modules in pathology. You could also consider an elective placement. Contact the pathology lab at your local hospital to see if they can help you organise a student selected clinical placement, elective or clinical audit, for example.

It's a good idea to join and get involved in your university's pathology student society to keep informed about developments in the field. You could also become a student member of the The Royal College of Pathologists and the Pathological Society.

The Royal College of Pathologists also has social media threads that advertise training, opportunities, news and 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 resident doctor, try to get onto a pathology rotation to gain an insight into the work. 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. Make the most of networking opportunities by attending conferences and events.

For free mentoring resources and experiences designed to support aspiring doctors, including virtual work experience that is accepted by medical schools, see Medic Mentor.

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 JobsÌý- 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 and updating your skills and knowledge throughout your career. Continuing professional development (CPD) is essential if you want to remain on the GMC register.

CPD activities can include:

• attending conferences, courses, workshops and clinical meetings
• participating in journal clubs, case discussions and multidisciplinary team (MDT) meetings
• undertaking research, publishing in peer-reviewed journals and reviewing scientific papers
• engaging in clinical audits, quality improvement projects and teaching activities.

The Royal College of Pathologists runs a CPD scheme to help members record and keep track of their activities. Membership of the Pathological Society provides access to research updates and networking opportunities.

Additional postgraduate qualifications may support your development in particular areas but aren't essential. Examples include:

• MMedSci or PGCert in Medical Education - for those involved in teaching or training
• leadership and management qualifications - such as the NHS Leadership Academy programmes
• MSc or PhD - if you want to pursue a more research-intensive or academic career pathway.

ÌýSearch postgraduate courses in medical education.

Career prospects

As a consultant, you'll gradually gain more clinical experience and may take on additional leadership and managerial responsibilities. Career progression within the NHS typically follows a structured path, with opportunities to advance into senior roles such as:

• medical lead - lead consultant for a pathology team
• clinical director - overseeing a hospital department and contributing to service development and strategy
• medical director - holding executive responsibility for clinical governance across an entire NHS trust.

You may need to relocate to progress your career due to the limited availability of posts in some specialties.

If you're interested in academic medicine and research, you'll need to start early - ideally during Foundation Training or specialty training - by pursuing the Specialised Foundation Programme (SFP) or Integrated Academic Training (IAT) Programme, for example. Research roles are competitive and usually involve working in partnership with universities and research institutions.

Pathologists interested in teaching future doctors may take on roles such as educational supervisor, training programme director, director of medical education or even associate dean, helping to shape the training and assessment of resident doctors and pathology trainees.

There are also some opportunities to work:

• in the private sector, particularly in diagnostic laboratories, private hospitals or commercial pathology services
• in public health, through advisory roles in infection control or epidemiology, for example
• for regulatory bodies, such as the GMC or UK Health Security Agency (UKHSA).