When Dr Ramesh Chandna entered the field, it was not as developed and diversified as it is now. “As a medical student I got my hands on Arthur Hailey’s The Final Diagnosis and was fascinated by the account of pathology and what it could be. It taught me what difference pathology can make in the treatment of various ailments. Even before studying for MBBS, I got an insight into pathology and chose the subject by the time I was doing postgraduation in 1972,” he says.
Many people opt for the clinical side where they have to deal directly with patients. In the non-clinical side, “all the reports or diagnostic services to the clinician come from the pathologist. Without their diagnosis, correct treatment will not be possible,” says Dr Chandna, Director, quality and laboratory services and blood bank, Asian Institute of Medical Sciences, Faridabad.
Dr Om P Manchanda, CEO, Dr Lal Path Labs, New Delhi, says, “Pathology is one of the most critical areas of medical science since 70 per cent of treatment decisions are based on lab tests. This statistic alone proves the importance of a pathologist in a patient’s life.”
There are two main branches of pathology in medical science — anatomical pathology and clinical pathology, and smaller branches such as forensic pathology, veterinary pathology, plant pathology, molecular pathology, surgical pathology, hematopathology, etc. Those wanting to work in this field can become specialists in one of the aforementioned branches. “But they have to remember that a lot of hard work goes in perfecting the skills in a laboratory.
Pathologists also need to regularly upgrade their learning to keep abreast of the developments in the field of medicine,” says Dr Manchanda.
A lot has changed over the years in the profession and in the field. “When I was a student pathology was considered not so great. We did not have tools, radiology was not advanced. Gradually, things have changed and conclusive diagnosis is reached on the basis of a pathologist’s report. A patient wants to know what is happening to him/her, and a pathologist’s report has all the answers. When I was doing my course, the pathologists came to know of a patient’s condition when it was too late – after the autopsy was done. But now things have changed, clinicians send samples and we are supposed to make a diagnosis and give it to them quickly,” says Dr Chandna.
Pathology combines the art of medicine and the science of tissue morphology. Each case presents a challenge to the pathologist, who has to don the hats of both a physician and a scientist. “The thrill of observing DNA precipitate and the challenge of providing remarkably accurate data to clinicians and patients day after day is part and parcel of a pathologist’s professional life. This challenge is best met by devoting many hours of effort in obtaining the necessary knowledge and technical skills for a pathologist,” says Dr Manchanda.
The second major challenge pertains to the overall healthcare industry. The sector is undergoing one of the most massive transformations ever seen in any industry and will entail an escalation of challenges in the next few decades.
“Among these challenges are the proliferation of new technology and clinical information management systems, especially the utilisation of shared electronic health records. Pathology service in combination with sophisticated pathology informatics systems, is one of the major forces driving changes within the medical world through the adaptation of new technology. This factor, in the time to come, will be a major challenge in a pathologist’s professional life,” he says.
For aspiring pathologists, Dr Chandna has good advice. “You must spend the initial years in a good hospital, which has a good faculty. You will then get to deal with numerous samples every day and thus increase your learning experience. So when you come out of the hospital after three-five years you will not only be confident but also full of practical knowledge. Learning and improving is a continuous process.”
What's it about?
A branch of medical science, pathology deals with causes, development and effects of a particular disease. A pathologist examines the organs, tissues and bodily fluids of the patient to deliver a diagnosis
. 6 am: Wake up
. 10 am: Reach hospital or clinic
. 10:30 am: Samples start coming in. Check overnight samples and sort them out
. 11 am: After sorting out, make a report and sign it.
. 1:30 pm: Lunch
. 3 pm: Back to work
. 6 pm: Leave for home
. Senior resident (for three years) Rs 50,000-60,000 per month
. Assistant professor Rs 60,000 per month
. Associate professor (takes around eight years) Rs 75,000 per month
In hospitals or labs
. Assistant consultant Rs 65,000 per month
. Associate or attending Below Rs 1 lakh per month
. Consultant (with seven to eight years’ experience) Rs 1 lakh per month
. Senior consultant (10-11 years’ experience) Above Rs 1 lakh
. You should enjoy anatomy and physiology. For example: as a kid, you played with a toy skeleton instead of a doll or an action figure
. You should prefer to work in a lab behind a microscope instead of interfacing with patients all day
. You should enjoy solving mysteries or finding answers
. You are drawn to the scientific, analytical, technical aspect of medicine
How do i get there?
A number of medical colleges and universities offer courses in pathology. Most of them generally conduct courses at the undergraduate and postgraduate degree levels. At the plus-two level you must have physics, chemistry and biology and then apply for UG courses. After MBBS, you do MD or DNB – both of three years’ duration – and then become a pathologist
Pros & Cons
You have fixed timings and can get time off, unlike other medical personnel
There can be conflict issues with clinicians
Wrong diagnosis can get you into trouble
If you own a lab, then you have to be aware of the market too
A system of referrals could make you insecure about your job as you have to be dependent on other doctors to send you patients
It takes time to earn a reputation in the market
Hospitals, medical labs need you
An industry expert looks at the work scenario for pathologists
Apart from hospitals, where else can a pathologist work?
Pathologists can broadly choose service, teaching or research. The service category offers the option of working in the diagnostic field related to not only hospital-based labs but also standalone independent laboratory services and blood-bank associated labs.
Teaching, on the other hand, can be undertaken at undergraduate as well as postgraduate medical /dental colleges and universities. Besides community and academic practice, career options are available in health regulatory services, such as the FDA.
Research includes work in clinical-trial labs and development of diagnostic aids.
Another important diversification of a pathologist’s role comes in utilising one’s technical skills for marketing and product development of diagnostic aids, reagents and instruments.
With the advent of accreditation processes, quality systems are increasingly becoming an integral component of every laboratory and thus opening avenues for pathologists to diversify their role as quality managers and auditors. They can also play a role as consultants for audit processes for various laboratories which lack experience in this process.
How is the job scenario in India for those with expertise in various fields, including speech, forensic and surgical pathology, etc?
The outlook for pathologists is very good. Take Dr Lal PathLabs, for example. We plan to hire 250 pathologists in the next three years. For the health sector, including standalone pathology enterprises and hospitals, about 3,000 pathologists will find employment in the next three years. There is likely to be competition for teaching work in universities and new jobs for pathologists in research and medical laboratory work.
Considering the increasing demand for highly qualified pathologists in India, several institutes, colleges and universities have included courses in pathology in academic programmes.
Forensic pathology offers a unique opportunity to combine the scientific and academic rigours of histopathology with the ability to practice medicine in its broadest sense in a legal setting. It is challenging and rewarding, aptly suited to the adjective ‘grim glamour’.
Opportunities for those with a Bachelor’s or Master’s degrees in pathology are expected to be better than opportunities for those with doctoral degrees. Jobs will be plentiful in industry, large hospitals, and medical centers. With increased interest in preserving the environment, expanding food supplies, and improving healthcare, private companies are expected to fund research in pathology. There will be a great number of positions in sales, marketing, and research management.
Is there any interesting aspect which makes a pathologist’s career enjoyable?
There are several interesting aspects in pathology. However, only committed pathologists are able to relate to these. For example, the reward may come in the form of gratitude of patients – especially when a timely diagnosis saves people’s lives. Apart from this, unravelling the mysteries of the DNA can be very satisfying for pathology scientists.
Dr Om P Manchanda, CEO, Dr Lal PathLabs