The Role Of A Haematologist:
As a pathology specialty, haematology is at the interface of clinical and laboratory medicine and comprises holistic involvement in patient care that extends from laboratory examination of haematological tissue to treatment administration. A Haematologists job is to diagnose and treat pathologies of the blood and bone marrow in persons of all ages(1).
In conjunction with direct clinical care of patients with haematological disorders – for example, anaemia, haemophilia and leukaemia – they supervise the operations of diagnostic laboratories.
Haematologists also provide a crucial 24-hour consultancy service to all hospital inpatient and outpatient departments, including emergency and intensive care settings, and community healthcare teams.
Advice requested may relate to interpretation of laboratory results, management of haematological disorders with consideration of treatment complications and management of major haemorrhages including haemostasis and blood transfusions.
Examples of other responsibilities are hematopoietic stem cell transplantations, lumbar punctures and intrathecal chemotherapy.1 Haematologists can request and interpret pioneering diagnostics, for example, immunophenotyping, cytogenetics and genetic sequencing(2).
Organising blood transfusion services is a central role of haematologists. Haematologists construct and implement policies relating to blood transfusion, including blood conservation and transfusion safety(2) They support the blood bank laboratory and provide clinical transfusion advice.
Haematologists work in laboratories, outpatient clinics and hospital wards in multidisciplinary teams of, for example, biomedical scientists, GPs and doctors of other specialties(3).
Extensive medical knowledge, attention to detail, adaptability and empathy are requisite. In 2017, 55% of haematologists were female(4).
A Typical Week:
In a standard week, consultant haematologists divide their time between clinical and laboratory commitments.3 Multidisciplinary meetings with diverse specialists are a regular feature of the job. Haematologists are at the forefront of staff training and many undertake research.
Working hours in haematology are typically unsocial as patients may become critically ill and laboratory services must operate at all times. For example, an on-call rota of 1 in 4 or 1 in 5 may be followed.
On average, haematologists work no more than 48 hours per week, according to ‘Working Time Regulations 1998’.
The Route To Haematology:
The route to haematology commences with the attainment of a medical degree and two years of foundation training. The subsequent three years comprise core medical training.
Trainees choose between Internal Medicine Training (IMT) stage 1, Acute Care Common Stem (ACCS) Acute Medicine and Level 1 Paediatric training.5. IMT features rotations across a selection of medical specialties and is concluded by the Membership of the Royal College of Physicians of the United Kingdom (MRCP (UK)) examination. ACCS is a similar programme but, in the initial two years, greater focus is assigned to acute medicine, emergency medicine, anaesthetics and critical care medicine. ACCS trainees must also pass the MRCP (UK) examination. Level 1 Paediatric training facilitates the acquisition of core skills in general paediatrics, neonatology, public health, community child health and child and adolescent mental health and is assessed by the Membership of the Royal College of Paediatrics and Child Health (MRCPCH) examination.
In 2019, the competition ratios for IMT/ACCS Acute Medicine and Level 1 Paediatric training were 1.43 and 1.18 respectively.6 Subsequently, trainees complete specialty training in haematology. Typically, this has a duration of five years.
In 2019, the competition ratio for haematology ST3 was 1.69.6 The spiral curriculum facilitates acquisition of capabilities in laboratory, liaison, outpatient, day unit, inpatient, emergency and palliative haematology.5 Trainees benefit from consultant supervision in the early years with gradual progress to independent practice as experience is obtained.
The Fellowship of the Royal College of Pathologists (FRCPath) Part 1 examination in Haematology can be taken after eighteen months of specialty training and trainees attempt the FRCPath Part 2 examination in Haematology at the conclusion of specialty training.
Finally, trainees achieve a certificate of completion of training (CCT) that is awarded by the General Medical Council. Consultant posts may be applied for six months prior to attainment of a CCT.
Medical students interested in a career in haematology can attend conferences and choose relevant topics for student selected components. It is possible to join the Royal College of Pathologists (RCPath) as an undergraduate member to avail benefits, for example, access to the members area of the college website, discounted tickets to college conferences and access to science communication training. The RCPath also hosts an annual pathology summer school. Additionally, associate membership of the British Society for Haematology (BSH) is open to students.
Foundation doctors should attempt to secure a full placement in haematology. Alternative modes of acquiring experience in the discipline can be explored by contacting a local haematology department. The RCPath operate taster schemes for foundation doctors and the newly introduced RCPath Foundation Fellowships.
Foundation and core trainees can also join the RCPath. At this stage, it is beneficial to obtain research, teaching and management experiences.
Service provision by haematologists that work in general hospitals may relate to all areas of the discipline. However, more specialised consultant posts are available in larger centres.5 Subspecialist interests in haematology include haemato-oncology, haemostasis and thrombosis, bone marrow transplant, red cell and haemoglobinopathy disorders, transfusion medicine, advanced diagnostics and paediatric haematology.
Experience in areas of specialist interest is acquired through specific training posts in the regional programme, out of programme training or continued development as a consultant.
Opportunities for research in haematology are very good. Research may comprise molecular pathology, translational medicine and extensive clinical trials(2).
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020, the salary bands range from £77,779 to £109,849.7 Salaries can be further enhanced with NHS excellence awards.
It may be possible to work in the private sector. Earnings potential in private practice is limited in comparison to other specialties; earnings equate to a small fraction of the NHS salary.8
The recommended starting salary of accredited consultants in the British Army is similar to that in the NHS. In 2017, this was £80,527.7
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
The primary societies for haematologists are the RCPath, the BSH, the Pathological Society of Great Britain and Ireland and the European Haematology Association (EHA).
Annually, the BSH and EHA host a scientific meeting and congress respectively. Key journals in the field are Blood, Circulation Research and Haematologica.
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Haematology (doctor) [Internet]. Health Careers. [cited 16 August 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/pathology/haematology-doctor
Careers in Haematology [Internet]. British Society for Haematology; 2018 [cited 16 August 2020]. Available from: https://b-s-h.org.uk/media/16203/bsh_careersbooklet-v2.pdf
Working life (haematology) [Internet]. Health Careers. [cited 16 August 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/pathology/haematology-doctor/working-life
NHS Digital. Analysis of the representation of women across the hospital and community health services workforce [Internet]. NHS Digital; 2018 [cited 16 August 2020]. Available from: https://digital.nhs.uk/data-and-information/find-dataand-publications/supplementary-information/2018-supplementaryinformation-files/analysis-of-the-representation-of-women-across-the-hospitaland-community-health-services-workforce
Curriculum for Haematology Training [Internet]. Joint Royal Colleges of Physicians Training Board; 2019 [cited 16 August 2020]. Available from: https://www.jrcptb.org.uk/sites/default/files/Haematology%20Curriculum%20121219_0.pdf
Specialty Recruitment Competition Ratios 2019 [Internet]. Health Education England; 2020 [cited 16 August 2020]. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition%20Ratios%202019_1.pdf
Pay [Internet]. British Medical Association. [cited 16 August 2020]. Available from: https://www.bma.org.uk/advice/employment/pay
Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D et al. Analysis of consultants' NHS and private incomes in England in 2003/4. Journal of the Royal Society of Medicine. 2008;101(7):372-380