Metabolic Medicine

Doctors in metabolic medicine treat patients whose chemical processes do not function properly and who may have various health problems as a result.

Your patients will have a wide range of common and rare conditions, for example diabetes, kidney stones, lipid metabolism and inborn errors of metabolism such as phenylketonuria.

Life as a doctor in metabolic medicine

Metabolic medicine is a relatively new specialty (it's a sub-specialty of chemical pathology) and provides excellent opportunities for research.

You could choose to study it together with general internal medicine, but most doctors decide on chemical pathology as their specialty. The clinical work of metabolic medicine complements the laboratory work of chemical pathology. Whatever specialty you choose, you’ll work closely with your hospital’s biochemistry laboratory.

If you decide on chemical pathology as your specialty, you’ll see patients with conditions within specific areas of metabolic medicine, predominately as outpatients.

You’ll have the opportunity to run a hospital biochemistry laboratory where you’ll spend most of your time ensuring high quality laboratory testing, interpreting results and liaising with colleagues in primary and secondary care. Collaboration with colleagues in other specialties is a must.

In a typical week, you’ll hold up to three outpatient clinics for a range of conditions, for example diabetes, cardiovascular risk and renal stone disease

If you choose general medicine as your specialty, you’ll treat patients with inherited diseases.

Common procedures and interventions include:

  • drug treatments such as insulin and lipid-regulating drugs
  • enzyme replacement therapies for inherited metabolic diseases
  • bariatric surgery for obesity, such as gastric bypass surgery – where metabolic medicine physicians will work closely with bariatric surgeons
  • provision of nutritional support via percutaneous gastrostomies (PEG, an endoscopic procedure) or parenteral nutrition (TPN)
  • cardiovascular risk testing, e.g. for patients with high cholesterol
  • use of new biologic treatments for cholesterol disorders
  • dynamic tests or ‘stress tests’ for a wide range of conditions

How much can I earn?

You’ll first earn a salary when you start your foundation training after medical school. The basic salary ranges from £32,398 to £37,303. Once you start your specialty training in the NHS, you can expect to earn a salary of at least £43,923, which can increase to between £93,666 and £126,281 as a consultant.

How about the benefits?

  • make a difference
  • flexible and part-time working
  • high income early in your career
  • work anywhere in the world
  • excellent pension scheme
  • good holiday entitlement
  • NHS discounts in shops and restaurants

Must-have skills

  • excellent communication skills to manage a wide range of relationships with colleagues, and patients and their families
  • emotional resilience, a calm temperament and the ability to work well under pressure
  • teamwork and the capacity to lead multidisciplinary teams
  • problem-solving and diagnostic skills
  • outstanding organisational ability and effective decision-making skills
  • first-class time and resource management for the benefit of patients

In addition, doctors in metabolic medicine need to demonstrate:

  • a strong interest in biochemistry and metabolism
  • a familiarity with research methods and a willingness to keep up to date with research and advances in treatment

Entry requirements

Your first step is medical school. Typically, you’ll need excellent GCSEs and three A or A* passes at A level including chemistry for a five-year undergraduate degree in medicine. Many medical schools also ask for biology and others may require maths or physics.

If you already have a degree, you could study for a four-year postgraduate degree in medicine.

You’ll need to pass an interview and admissions test. You’ll be asked to show how you demonstrate the NHS values such as compassion and respect.

Some medical schools look to recruit a mix of students from different backgrounds and geographical areas, so your educational and economic background and family circumstances could be considered as part of your application.

"The patient contact is the part I enjoy the most. I love my clinics. I also enjoy carrying out research as it means that you can actually drive and develop the treatments that your patients receive in clinic."

Read Jaimini's story

What are my chances of starting a career as a doctor in metabolic medicine?

In 2016, there were 15 consultants in metabolic medicine in the NHS in England. In 2020, there were 23 applications for 12 training places.

How to become a doctor in metabolic medicine

After medical school, you’ll join the paid two-year foundation programme where you’ll work in six placements in different settings.
After your foundation programme, you can apply for paid specialty training to become a doctor in metabolic medicine, which will take a minimum of seven years.

You may be able to train part time, for example for health reasons or if you have family or caring responsibilities.

Where a career as a doctor in metabolic medicine can take you

You could: 
  • specialise or conduct research
  • teach medical students or postgraduate students in training
  • get involved in research at universities, the NHS or private sector

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