Histopathologists are doctors who diagnose and study disease using expert medical interpretation of cells and tissue samples. The specialty determines the cause of death by performing autopsies and is integral to cancer management through staging and grading of tumours.
This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.
Nature of the work
Histopathologists work in the laboratory, both in partnership with laboratory scientists and doctors from other clinical specialties. They have an in-depth knowledge of both pathological and clinical aspects of disease.
The histopathologist is a member of the multidisciplinary team, assessing cancer patients and planning their further investigation and treatment. They also have key responsibilities for cancer screening – currently for breast and cervical cancer but with bowel and prostate cancer screening on the horizon.
In many hospitals, biomedical scientists are undertaking more of the ‘routine’ cut-up of smaller specimens, and in some cases are also conducting microscopic examination and report writing of cytological samples.
With an increasing ability to automate and mechanise laboratory processes, there is the possibility that histopathology departments will no longer be necessary at smaller hospitals, and work may be managed centrally in dedicated histopathology centres with larger throughput capacity.
Some histopathologists have specific clinical roles, such as taking fine-needle aspiration[1] cytology specimens in breast clinics. However, they generally don’t see patients in person. Instead, they deal with specimens sent to the laboratory, or deceased patients in the mortuary.
Patient contact is limited, although they may see a patient to explain how their diagnosis has guided the patient’s treatment, or they may see the family of a deceased patient to explain the cause of death.
“We examine each case systematically to arrive at a diagnosis”. Dr Ayesha Azam, Sandwell and West Birmingham NHS Foundation
examination and dissection of surgical resection specimens, to select the most appropriate samples for microscope slides
microscopic examination of tissues, with subsequent construction of clinical reports
carrying out fine-needle aspirations
carrying out autopsies
Sub-specialties
There are no sub-specialties within histopathology. Instead, there are CCT[3] specialties to which you are appointed during training at ST3 level, after two years of general histopathology training.
This section provides useful information about the pay for junior doctors (doctors in training), specialty doctors, consultants and general practitioners.
NHS employers[12] 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.
There are opportunities within private practice for neurosurgeons.
Read about consultant and non-consultant roles in histopathology, flexible working and about wider opportunities.
Consultant roles
You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training[13] (CCT[3]). You will receive your CCT[3] at the end of your histopathology training.
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[14] 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
There are also opportunities to work at non-consultant level, for example as a SAS (Specialist and Associate Specialist) doctor.
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 Specialty Doctor roles. Find out more about SAS doctors roles.[15]
Other non-training grade roles
These roles include:
trust grade
clinical fellows
Academic pathways
If you have trained on an academic histopathology pathway or are interested in research there are opportunities in academic medicine.
For those with a particular interest in research, you may wish to consider an academic career in histopathology. Whilst not essential, some doctors start their career with an academic foundation post. Entry is highly competitive. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum[16].
Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) at ST1-2 and may progress to a Clinical Lectureship (CL) at ST3 and beyond. Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.
After completion of the academic foundation trainees can then apply for academic core training posts (instead of normal core training). A PhD is often taken, either during core or specialty training.
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.[18]
The Clinical Research Network [19](CRN) actively encourages all doctors to take part in clinical research.
Other opportunities
Histopathologists often undertake research, which includes collaborating with colleagues in the UK and overseas, writing papers and presenting work at conferences.
The opportunities for research within this speciality are good.
There are also opportunities to work in the private sector and overseas.
This page provides useful information about the availability of jobs, how to find vacancies and sources of further information.
Job market information
At present there are 1,161 histopathology consultants and 391 medical registrars in England (NHS Digital, 2016[20])
Histopathology training is open to those who may want to train flexibly on a less than full-time[24] basis (LTFT). You can request and apply for this after you have been offered the job. Restrictions apply.
Registration and applications for histopathology training is online via Oriel[25].
