There are a number of career pathways possible to pursue under the aegis of Clinical Pathology board certification, including opportunities for both academic and community practice.
For clinical pathologists in academic centers or larger community hospitals, practice usually involves running one or more clinical laboratories; e.g., blood bank and apheresis, clinical chemistry, hematology, immunology , microbiology and virology, molecular diagnostics.
In the academic center, research work integrates extraordinarily well with clinical pathology practice (see below), making this career path especially attractive to physician-scientists. 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 entwined.
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. In addition, many clinical laboratory issues often 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 and, for better or worse, administrative skills involved in running a laboratory.)
For individuals who have obtained their MD (but not a PhD) and 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.
While the discipline has historically been especially attractive to those who wish to pursue academic investigative careers (the investigative MD or MD-PhD physician-scientist pathway described in more detail below), many individuals go on to pursue full time clinical work, especially those trained jointly in anatomic and clinical pathology (AP/CP) or jointly in internal medicine and CP.
For example, two-thirds of recent Yale resident graduates who trained in pure CP are in full-time academics, while one-third are now in full-time clinical practice. Of those residents trained jointly in AP-CP, or in internal medicine and CP, approximately two-thirds are in full-time clinical practice and one-third in academics.
Such a career path is more common for clinical pathologists in smaller hospitals, where a single individual may direct multiple laboratories, and may also have additional clinical responsibilities, most frequently in anatomical pathology.
Most of our CP-only graduates who have gone on to full-time practice have taken an additional year of training in a subspecialty area.
An alternate career path involves the combination of internal medicine subspecialty practice with clinical pathology. Common combinations are internal medicine/hematology combined with running a hematology laboratory or a blood bank or apheresis service, or internal medicine/infectious disease practice combined with a microbiology/hospital epidemiology laboratory.
Physicians interested in these possibilities often pursue a CP fellowship either in transfusion medicine, hematology/hematopathology or microbiology following their internal medicine training or sometimes complete a full CP residency after internal medicine training.
The American Board of Pathology recognizes these career options by making it possible to become Board certified in Transfusion Medicine, Microbiology or Hematopathology after primary certification by the American Board of Internal Medicine followed by subspecialty work in these areas, without a need for primary certification in anatomic or clinical pathology.
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.
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.