The Complete Guide To Becoming An Immunology (Including Allergy) Doctor

 

The Role Of An Immunology Doctor:

Immunology doctors are often referred to as clinical immunologists who study the immune system and treat patients with immune disorders. Clinical immunologists are involved in diagnosing and managing conditions such as severe infections, HIV and multiple sclerosis.

Their work consists of both clinical and laboratory work. Most of the clinical work is outpatient based although they see inpatients occasionally. 

Immunology doctors have clinics for patients with primary immunodeficiencies, allergies, autoimmune disorders. They also carry out paediatric clinics with a paediatrician for children with immunodeficiency and immunoglobulin infusion clinics. 

Immunology doctors use the laboratory to diagnose and monitor diseases. They must ensure validity and correct interpretation of laboratory results, bridge the gap between patients’ laboratory results and clinical action. They are also responsible for monitoring the quality of laboratory assays. 

For those interested, it is possible to be involved in the laboratory work to limit rejection in organ transplants. Currently, less than 10% of clinical immunologists are involved in this laboratory path (1). 

According to the 2014-2015 census, in 2014, there were 68 immunology consultants, 26 of them were female (2). 

As with any medical speciality, multi-disciplinary work is vital. Immunology doctors work with specialist nurses, medical secretaries, GPs, pathologists, paediatricians and infectious disease doctors. 

Clinical immunologists must have a logical mind and be detailed oriented. Communication, teamwork and leadership skills are key in everyday working life. Clinical immunology is a challenging but rewarding job as immune disorders can often have serious effects on patients’ lives. Clinicians also get the opportunity to work with patients of all ages. 

The world of immunology is constantly advancing due to breakthroughs in novel immunomodulatory treatment modalities and the use of monoclonal antibody therapies. Research is constantly ongoing in this field, making immunology attractive to those interested in the science and teaching aspects of this speciality.

 

A Typical Week:

A standard contract for a full time NHS consultant is 10 programmed activities (PAs) per week. This is typically divided into 7.5 PAs for direct patient care and 2.5 SPAs (supporting activities) which are tailored to each doctors’ interest. 

PAs includes direct patient contact such as ward rounds and outpatient clinics. SPAs can include teaching, appraisal, audit and research. 

Immunologists often focus on one area of sub-specialist interest and will have multiple clinics as the majority of patients are outpatients. The working week will differ depending on the ratio of clinical, laboratory and research work that each doctor tailors to their own interest. 

A typical day as an immunologist:

09:00-12:00:	Immunodeficiency outpatient clinic
12:30-14:00:	Checking patients’ laboratory results and deciding on diagnosis and management.
14:00-17:00:	Allergy outpatient clinic

 

Due to the outpatient nature of immunology, the speciality provides a good life-balance. Typically, their working week is Monday to Friday nine till five. Flexible working hours are already established in the speciality.

Specialists are not usually expected to provide out of hours services to hospitals but due to increasing demand, irregular working hours may become more routine. Currently, immunologists provide out of hour telephone consultations to doctors. 

 

The Route To Becoming An Immunology Doctor:

Entry to clinical immunology is possible following the completion of two foundation years training and core medical training. Core training may be completed via CMT (Core Medical Training), ACCS (Acute Care Common Stem) or paediatrics level 1 training. While all of these routes allow for immunology speciality training, it should be noted that the CMT route is 2 years while ACCS/paediatrics level 1 are 3 years. 

After the completion of core training, trainees sit the Membership of the Royal College of Paediatrics and Child Health (MRPCH) exam and begin immunology speciality training. Speciality training is 5 years, following which candidates will receive a Certificate of Completion of Training (CCT) allowing them to apply for consultant positions. 

During speciality training, there are two exams candidates must pass before completion. The first is completed after the third year of speciality training- the Fellowship of the Royal College of Pathologists Part I exam (FRCPath). This written exam tests trainees’ immunology level and their ability to apply that knowledge onto clinical and laboratory settings. 

Part II of the examination is a practical exam performed at the end of speciality training. Successful completion of FRCPath Part II shows that candidates can independently practice as consultants.

  

Clinical immunology is a competitive speciality. In 2018, there were 19 applications for 9 ST3 posts making the competition ratio 2.11 (4). 

As with any speciality, showing interest is key when applying for positions. At the medical student level, this can be done by joining or founding the university immunology society and by undertaking electives/student selected components in immunology. 

At the junior doctor level, this can be done by attending immunology clinics and taking part in audits and research with senior staff. 

University Hospital Southampton’s asthma, allergy and immunology service is a world centre of excellence that houses one of largest centres of its kind as well as multiple research programmes. The University of Oxford has the highest number of active immunology researchers in the world. 

 

Sub-specialties:

Clinical immunology is one of the specialities that allows time for academic development, research and critical appraisal. Most consultants sub-specialise in one of the following areas: 

• Rheumatology 

• HIV medicine 

• Transplantation 

There are ample research and academic opportunities for those interested as the field of immunology is constantly evolving through new scientific breakthroughs.  

 

Earnings: 

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.  Salaries can be further enhanced with NHS excellence awards. 

As with any speciality, there is the potential to enhance NHS earnings via private practice. JRSM reported in 2008 that the total income for immunology consultants was £89,937 with NHS income making up £76,173 and private earnings making up £13,763 making the ratio 0.18.

This ratio is on par with paediatric surgery and higher than intensive care medicine (0.16) and paediatrics (0.16) but is lower than general psychiatry (0.20) and paediatric cardiology (0.23) (5). 

For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.

 

Resources:

The British Society for Immunology is the largest immunology society in Europe. It is dedicated to immunological research and publishes three journals. Clinical & Experimental Immunology (CEI) publishes research papers and reviews articles about how the science behind immunology can be applied in clinical practice. 

Immunology is a leading journal for new findings in cellular and molecular immunology. Immunotherapy Advances is a peer reviewed journal that focuses on research where the immune system is changed to alleviate disease and immunotherapeutic interventions. 

 

Related Job Sources With BMJ Careers

• GP Jobs
• Hospital Jobs
• Psychiatry Jobs
• Public Health Jobs
• Research Jobs
• NHS Jobs in England
• NHS Jobs in Northern Ireland
• NHS Jobs in Scotland
• NHS Jobs in Wales

 

Other Complete Guides By BMJ Careers

• How To Become A Clinical Scientist
• How To Become A Diabetologist or Endocrinologist
• How To Become A Gastroenterologist
• How To Become A Neurophysiologist
• How To Become A Obstetrician and Gynaecologist

 

References:

1. Immunology [Internet]. Health Careers. 2020 [cited 4 September 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/immunology 

2. 2014–15 census (UK consultants and higher specialty trainees) [Internet]. RCP London. 2020 [cited 5 September 2020]. Available from: https://www.rcplondon.ac.uk/projects/outputs/2014-15-census-uk-consultants-and-higher-specialty-trainees 

3. Immunology curriculum [Internet]. Gmc-uk.org. 2020 [cited 4 September 2020]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/curricula/immunology-curriculum 

4. 2018 Competition Ratios [Internet]. 2020 [cited 5 September 2020]. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Content/Resource%20Bank/Competition%20Ratio%27s/Competition%20Ratios%202018.pdf

5. 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.