Doctors working in metabolic medicine combine an understanding of biochemistry and metabolism. They deal with adult patients where the chemical processes in the body do not function properly and may cause various health problems.
This page provides useful information on the nature of the work, the common procedures/interventions and other roles that may interest you.
Nature of the work
The work of doctors in metabolic medicine is very varied, but the overall aim is to improve the quality of patients’ lives and treat their metabolic health conditions. This is a relatively new specialty and helps patients both with common and rare diseases. The opportunities for pursuing research interests are excellent.
The range of work in includes treatment of:
- disorders of nutrition - includes patients with obesity and those needing parenteral nutrition (direct administration of nutrition into the bloodstream)
- inborn errors of metabolism (IEM) in adults, such as phenylketonuria
- disorders of lipid metabolism (which may involve cardiovascular risk assessment)
- disorders of calcium metabolism and bone – examples include osteoporosis vitamin D deficiency and kidney stones
- diabetes mellitus
Metabolic medicine is a sub-specialty of chemical pathology and to a much lesser extent general internal medicine. It has its own GMC curriculum, and in this way it’s different from other medical sub-specialties (except stroke medicine). Metabolic medicine training is taken alongside training in either chemical pathology or general internal medicine.
The job varies according to the parent specialty that you decide on, although whichever specialty you chose, you’ll have very close links with the hospital’s biochemistry laboratory. If you choose to combine metabolic medicine with general internal medicine (GIM), you will generally work with patients who have metabolic inherited diseases. You may also pursue particular academic interests within this field.
Where chemical pathology is your chosen parent specialty, you will see patients in specific areas of metabolic medicine, predominantly in the outpatient setting. You’ll also probably lead the hospital’s pathology laboratory, and spend part of your working week ensuring a high-quality laboratory testing service.
Doctors working in metabolic medicine generally deal with adults over the age of 18. Paediatric inherited metabolic medicine is a subspecialty within paediatrics, involving the diagnosis, treatment and follow-up of children with inherited metabolic disorders. About one in every 2500 children born in the UK will have an inherited metabolic disease. Newborn babies are routinely screened for one of seven such diseases via the heel prick blood test. These diseases can often be successfully managed by diet and sometimes drugs with much improved life expectancy and quality of life overall.
There are many different procedures and interventions in metabolic medicine and these 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 parenteral nutrition (TPN) to in-patients who require intravenous feeding
- cardiovascular risk testing, eg for patients with high cholesterol
Want to learn more?
Find out more about:
- the working life of a doctor in metabolic medicine
- the entry requirements and training and development
- two first-hand accounts of life:
- Pay and conditions Expand / Collapse
This section provides useful information about the pay for junior doctors (doctors in training), SAS doctors (specialty doctors and associate specialists) and consultants.
NHS employers provides useful advice and guidance on all NHS pay, contracts terms and conditions.
Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.
- Where the role can lead Expand / Collapse
Read about consultant and non-consultant roles in metabolic medicine, flexible working and about wider opportunities.
There are excellent opportunities to participate in research and metabolic medicine is a rapidly changing field. Because you will normally have had extensive experience of managing the biochemistry laboratory, there are good opportunities to move into more general medical management.
Managerial opportunities for consultants include:
- clinical lead - lead NHS consultant for the team
- clinical director - lead NHS consultant for the department
- medical director - lead NHS consultant for the Trust
Most NHS consultants will be involved with clinical and educational supervision of junior doctors.
Here are some examples of education and training opportunities:
- director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
- training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training programme director. This role will be working within the LETB/deanery
- associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery
SAS doctor roles
SAS doctors (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for SAS roles.
Find out more about the SAS doctor role.
Other non-training grade roles
These roles include:
- trust grade
- clinical fellows
If you have trained on an academic pathway or are interested in research there are opportunities in academic medicine.
If you are interested in an academic career, consider applying for an academic clinical fellowship (ACF), particularly one that provides exposure to CPT. This would enable you to develop skills in research and teaching alongside the basic competences in the foundation curriculum .However, it is not essential to take the academic foundation route if you are interested in pursuing an academic career.
Some trainees use their academic time to prepare an application for funding for a research fellowship leading to a PhD and subsequently apply for an academic clinical lecturer appointment.
Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) and may progress to a Clinical Lectureship (CL). Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.
Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC).
There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine.
The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.
- Job market and vacancies Expand / Collapse
This section provides useful information about the availability of jobs, finding vacancies and where to find out more.
Job market information
Metabolic medicine is a small sub-specialist area of general internal medicine and chemical pathology. There is currently one higher specialist trainees in metabolic medicine and 15 consultants in post in the UK. Women make up 50% of the higher speciality trainee workforce in the UK(RCP Census 2014-5, 2016).
For information regarding Scotland, Wales and Northern Ireland please click on the links below.
Where to look for vacancies
All candidates apply through the online application system Oriel.
In 2016 there will be 15-20 training posts available in metabolic medicine. In the past three years there have been more vacancies than applicants, with an applicant ratio of .5 in 2015.
There is currently a shortage of suitably qualified applicants for metabolic medicine.
Local education and training boards (LETBs) will also have details of training vacancies. Not all LETBs will offer new training posts in all specialties in all years.
All jobs are advertised on the NHS Jobs website.
- Further information Expand / Collapse