After finishing my Ph.D. in cellular physiology at Manchester University in early 1999, I knew I wanted to move out of academic research. I was looking for a career with structure, stability, and clear progression. But I also wanted a job that offered a wide variety of challenges and gave me the opportunity to specialise and to carry out some research and development work.
Until I saw the advert for a Grade A training post based at Nottingham City Hospital, I hadn't heard of clinical biochemistry. Along with other clinical science departments, such as haematology, immunology, microbiology, molecular cytogenetics, histopathology, and medical physics, clinical biochemists carry out the diagnostic services that provide valuable information to doctors and other health care professionals within the National Health Service (NHS). Such departments are staffed by a mixture of clinical scientists, biomedical scientists, and medically qualified staff.
So what is clinical biochemistry? Blood and other body fluids contain thousands of different substances, such as sodium ions, hormones, and drugs, to name just a few. Absolute levels of, or changes in, such molecules can indicate disease (the increase in glucose seen in diabetes mellitus), particular conditions (new hormones produced in pregnancy) or increased risk of a disease (screening cholesterol levels can predict risk of coronary heart disease).
Clinical biochemistry departments provide rapid, high-quality analytical results on samples from patients, interpreting the significance of the data obtained and advising on whether further investigations are needed. Common tests are performed on large, highly sophisticated automated analysers, while more specialised tests are performed using technology such as absorption spectroscopy, electrophoresis, HPLC, GC-MS, and tandem MS, immunoassay, and DNA analysis.
For a career in clinical biochemistry, you will need a good honours degree in biology, biochemistry, chemistry, or a related subject. Having a Ph.D. is an advantage, but it is not essential. Normally, the recruitment of clinical scientists is though a clearinghouse method that begins in January or February of each year. A directory of vacancies and application forms is published by the Clinical Scientist Recruitment Office. Adverts are placed in New Scientist, Nature, and ACB News (the newsletter of the Association of Clinical Biochemists) at the beginning of the year. However, not all NHS regions use this service, so it is advisable to keep an eye out for individual advertisements.
The deadline for completed application forms is the end of February, and short-listed candidates are interviewed in April or May.
As part of the application process, I was offered the chance of an informal look around the department prior to interview. It was then that I found out about the scope of the job and the variety of assays performed by a clinical biochemist. If you take one piece of advice from this article, it should be to visit a lab and find out what really happens. While you are there, you will have the opportunity to speak to people already doing the job, but don't just talk to a top-grade biochemist. If you can, speak to trainees as well. Get their views on the training process, as eventually you will be following in their footsteps.
If you can't visit a hospital that is actually advertising posts, then go and visit your local district general hospital (DGH); it will more than welcoming. This will also highlight the differences in the services provided by a DGH and a large teaching hospital, where most training takes place. If you're currently doing a degree, try to get some work experience during your vacation.
Interview panels are normally made up of a consultant clinical biochemist, consultant chemical pathologist, a regional tutor who is responsible for training in that NHS region, and an external assessor. Apart from asking about your academic career, they will be looking to see if you appreciate the roles performed by a clinical biochemist. If you can, match the skills you have obtained from your degree, especially your research and analytical skills, to the functions of the clinical biochemistry department. The panels will also be looking for a commitment to the training and study involved in the Grade A and early Grade B posts.
The initial Grade A training in clinical biochemistry lasts 3 years. To start with, you will be based in your host laboratory. where you will receive on-the-job training. You will also be seconded to other hospitals to get an overview of how different services are provided, as well as seeing specialist departments, e.g., paediatrics or toxicology. I was based at Nottingham City Hospital before being seconded to the Derbyshire Royal Infirmary and Derby City General Hospital.
The Grade A salary ranges from points 00 to 07 (£14,600 to £19,300). You will be appointed somewhere on this scale, depending upon your qualifications and experience. As part of your training, you will also attend regionally run courses, or an MSc course, in order to get a grounding in clinical biochemistry. These courses cover a variety of topics, including the physiology and pathology of disease, methodology, statistics and audit, and other issues related to the health service. The Association of Clinical Biochemists also runs national day- and week-long training courses. I have enjoyed these, as they offer a great opportunity to meet with trainees from around the country and discuss current issues.
This basic vocational training prepares you for a variety of roles, such as advising clinicians on appropriate diagnostic tests, advising on the scientific approaches to treatment that are likely to be most fruitful, devising scientific solutions to clinicians' problems, developing and troubleshooting analytical methods, developing solutions for a wide range of patients, and becoming an accredited clinical scientist.
After finishing your Grade A training, you will be assessed by a panel similar to the interview panel and will receive a certificate of completion. You will then be able to apply for a Grade B post. This is considered the career grade and is divided into two stages--low Grade Bs (senior biochemists), and high Grade Bs, (principal biochemists). Even as a senior biochemist, your training is not over. These are considered to be higher specialist training posts, and there is the opportunity to develop an interest in an area such as paediatrics, endocrinology, or toxicology. During this time, you will be expected to sit for the Membership of the Royal College of Pathologists (MRCPath) exam. In order to progress to a Principal Grade B post, it is now expected that you will have passed the MRCPath.
In addition, in order to work as clinical scientist in the NHS, you must be state registered. After completing 4 years of training (3 as a Grade A and 1 as a Grade B), you will be eligible to apply for state registration. An important part of this is the Grade A certificate of completion.
The top grade for clinical biochemists is Grade C, and is equivalent to a medical consultant post. The salary for these grades ranges from £20,000 to £37,500 for Grade B posts and up to £60,000 in a consultant post.
From my perspective, the only downsides to this career path are (1) you're expected to be mobile during your early (Grade A) training period, and (2) at this point, the salary is not equal to that of a researcher in academia. However, once you are qualified, the salary improves and there is a lot more stability. In addition, progression in the job is not dependent upon grant applications and multiple publications. Another consideration for some may be antisocial hours, since this is not always a 9 to 5 job. During your Grade A training, you will not work "on call," although there will be opportunities to observe an on-call shift. However, once you become a state registered clinical scientist in a Grade B post, you will be expected to cover some weekend and evening on-call shifts.
Coming from a research background, I have found that the skills I gained while doing my Ph.D. have been very transferable. The training in research that my Ph.D. provided is invaluable to the work of a clinical biochemist. Skills such as interpretive skills, audit and data management, research and development, good communication, time management, attention to detail, and problem solving are all essential for the job.
Communications skills are especially useful--whether you are presenting a clinical case at a ward round, writing a paper for a journal, giving a talk or poster session at a scientific meeting, or just trying to explain an abnormal result to a general practitioner late on a Friday evening.