Careers in Clinical Pathology

The advantage to the MD or MD-PhD physician-scientist of pursuing a career in Laboratory Medicine is that clinical work melds very well with bench investigative work. Although emergencies occasionally arise, the majority of one's clinical activities can be planned in advance so that time devoted to bench work can be optimized and carried out without disturbance. Many of the clinical laboratory issues that arise also directly relate to the work done at the research bench (optimization of a PCR-based assay, understanding "false positives," image analysis interpretation, and so forth).  Similarly, much of the consultative and interpretive work in Laboratory Medicine is rooted in an appreciation of basic scientific principles. During residency training, it is often possible to complete the core clinical training in an 18-24 month block and devote a significant portion of one's additional residency time to begin (or continue) scientific investigations. This is possible because the body of knowledge needed to be a clinical pathologist physician overlaps significantly with that needed to be a scientist (including both an understanding of the scientific basis of disease but also, for better or worse, administrative skills in running a laboratory.)  In many medical disciplines, the universe of knowledge needed for state-of-the-art clinical care is growing substantially independently of the expanding universe of bench research, but in pathology, the life of the physician and the life of the scientist remain very closely juxtaposed.

It should also be noted that for individuals who have obtained their MD (but not a PhD) and who wish to pursue a physician-scientist career, there are two broad approaches. One is to begin post-doctoral research experiences either pre- or, most often, post-residency. This has been a traditionally successful route for many physician-scientists. Another alternative, however, is to obtain some of that research experience while working toward a PhD degree. At Yale, a new program has been initiated which allows someone with an MD degree to subsequently obtain a PhD degree in Investigative Medicine.

Another career path in clinical pathology that has recently become progressively more popular is that of Medical Informatics. The explosion in medical information in general, the complex interactions involved in the interpretation of laboratory tests in patients on multiple medications including biologicals, and the ongoing need for improved image analysis processing has made this an area with a great need for more physician-scientists applying their skills. At Yale, it is possible to combine training in Clinical Pathology with Yale's postdoctoral fellowship in medical informatics.

Yet another area of increasing interest for those trained in clinical pathology in recent years has been to use the managerial and medical/bioscience skills obtained during clinical training and apply these to a career in the private corporate sector. This sometimes involves a managerial position in an upstart biotechnology company and sometimes a position in a larger healthcare delivery, diagnostic device R&D, or pharmaceutical firm. At Yale, for example, occasional trainees have been interested in obtaining an MBA degree, whether a Yale MBA or an MBA from another school. Finally, we have also recently seen some interest in the legal implications of expanding diagnostics (especially genetic testing) with courses and/or a degree in law as activities that may be part of an alternate career path.

Other sources of information on Laboratory Medicine are available on the Web. The major site to review is The International Committee on Pathology Information. One can also look at the Yale Laboratory Medicine Portal.