Educational pathway for clinical chemistry?

[AnalyticalChem]

Hi all,

First of all, I've just joined this community and it seems like a really great place!

Here's my situation: I just graduated from college with a bachelor's in chemistry and I'm interested in going into a career as a clinical pathologist, ideally a clinical chemist. I'm really interested in both diagnostics and chemistry (analytical and bioanalytical) so the idea of using chemistry or molecular biology techniques to diagnose patients seems like a perfect choice for me.

Given all that, my main question is: what is the best educational path for someone who wants to go into clinical chemistry? It seems like most of the fellowships available are open to either PhD's or MD's, but does having one or the other make a difference in terms of future employment? I would like to do some amount of research but my primary interest is in actual diagnosis of actual patients, so would an MD be a better route than a PhD? And given that, would it be better to do CP/AP both or just CP? Also, given that I have an interest in clinical pathology in general, is it possible to be someone who does an MD, a residency in pathology, and then works in a general capacity across all of a hospital's or practice's labs?

Any advice or information of any sort is appreciated. I've spent most of my life intending to get a PhD in analytical chemistry and go into academia and pure research, so I'm pretty new to the game and really just trying to learn all I can about pathology as a field and career path.

Thanks so much!
Kerry

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[KCShaw]

Much of running a clinical chemistry lab does not involve diagnostic interpretation, it's making sure the techs are making sure the instruments are running smoothly, your QC/QA is in line, getting occasional new tests up and running, and occasionally answering physician questions about results (sometimes diagnostic related, but often more like troubleshooting -- "I was expecting X but got Y, what could have caused that discrepancy?" or somesuch). Molecular diagnostics is similar, though a different subspecialty on the pathology side; I'm not sure you can do both with only a PhD in one(?), although a CP pathologist with a fellowship in only one could.

IMO, in an ideal world the chem & molecular lab directors would all be CP pathologists, with not only a better foundation in assisting with diagnostic issues, but also a better foundation for standing up for the lab, as well as patient care, in clinical and administrative meetings -- clinicians are still generally more likely to fall prey to marketers trying to sell the latest cool, expensive, but sometimes pointless or at least non-cost-effective test, and will simply expect the lab to pick it up (which includes absorbing the cost). However, in the real world lab directors are often replaced by PhD's; the salary may be lower, but the time and cost it takes to become qualified as a PhD, compared to a CP boarded MD pathologist, is worlds apart. Yeah, somewhere up the line there does have to be an MD medical director overseeing the "lab" as a whole, but individual departments (like clinical chemistry) need be no more than a PhD. If you throw in some grant money for research while also being the clin-chem director, then you pretty effectively trump the average MD without said grant for the same job.

Frankly, though sadly, if you have such a very narrow field of interest and don't have much interest in other aspects of CP, much less AP, much less medicine in general, then I find it very difficult to recommend the average ~$150,000 debt plus minimum of 8 years (med school, 3 yrs CP, 1 yr clin-chem -or- molecular fellowship) it would take to go the MD pathologist route, particularly when you might dislike the other aspects so much you drop out or can't bring yourself to study enough to pass all the other requirements, when a PhD would likely do just fine.

 

[tarotaro]

Much of running a clinical chemistry lab does not involve diagnostic interpretation, it's making sure the techs are making sure the instruments are running smoothly, your QC/QA is in line, getting occasional new tests up and running, and occasionally answering physician questions about results (sometimes diagnostic related, but often more like troubleshooting -- "I was expecting X but got Y, what could have caused that discrepancy?" or somesuch).

Would you happen to know if this is also true of medical microbiology lab directors?

Thanks!

 

[KCShaw]

More or less. Every lab/hospital system is a little different, and it's possible to generate your own local culture. But, most hospital systems have either infectious disease specialists or some clinicians who effectively act as such, who tend to pull together the laboratory results with the clinical findings and history to reach a diagnosis and/or treatment plan. This may include discussions with the lab. The microbiology lab director isn't exactly left with nothing to do, as there can be some complexity with subsets of patients, new antibiotics, new strains of bugs, outbreaks, etc., to be involved with.

At least, that's the word on the street.

 

[Ombret]

AnalyticalChem, I don't think there is any right or wrong answer. In the clinical labs, the distinctions between MD and PhD staff are pretty blurred, almost to the extent of disintermediating the physicians. The MD route is going to be a tougher row to hoe: more hurdles to jump over and they are higher. In contrast it seems like PhD training might be a more natural next step given your training to date--and would still let you get into the kind of career you desire. I have not yet seen anyone make a compelling case that MD-trained clinical pathology lab directors are more astute diagnosticians than those with PhD training. If you look at the ecology of this little part of the health care system, the fact that PhDs predominate in clinical chemistry and microbiology fellowships has got to tell you something.

 

[pathstudent]

Clinical Chemistry might be one of the best kept secrets. Must of us MDs and Pathology Residents think "who would ever want to do that", but on this website that lists salaries for all State Employee from California http://www.sacbee.com/statepay/

The Head of Clinical CHemistry from UCSF makes 300k a year and the one from UCLA makes 350k a year. The one from UCI makes 200k a year. Not bad and better than what a lot of the people on the AP side make.

 

[KCShaw]

Re: Ombret
There's a lot of truth to that. I may have an opinion and argument that appropriately trained MDs are the better option (for patient care), but so long as Phds are cheaper to hire, MDs aren't required by regulation, and clinical staff don't care, then it's a highly unlikely trend to change.

 

[pathstudent]

Re: Ombret
There's a lot of truth to that. I may have an opinion and argument that appropriately trained MDs are the better option (for patient care), but so long as Phds are cheaper to hire, MDs aren't required by regulation, and clinical staff don't care, then it's a highly unlikely trend to change.

Those PhDs above are pulling 300-350k a year. They are not that cheap to hire.

THe one making 200k is an MD.