Ray McMahon
Chairman of the Specialty Training Committee in Histopathology
for the North West region.
I am employed by the University of Manchester as a senior lecturer in pathology and hold an honorary contract with Central Manchester Trust as consultant histopathologist at Manchester Royal Infirmary.
I entered pathology in 1981, 2 years after qualification from the National University of Ireland in Galway. After PRHO year, I worked as an SHO in clinical haematology which included a certain amount of laboratory and microscopic work. As the year progressed I realised that I enjoyed the laboratory aspects more than the directly clinical work and decided to try out histopathology for 6 months. I am still here 21 years later. I worked in Galway for 3 years first as an SHO and then as a registrar during which time I passed the old style primary RCPath which involved an MCQ and practical examination, followed by a rather daunting oral examination with some of the great names in pathology at the time. Following this, I transferred to the University of Manchester as a lecturer with honorary senior registrar status. My initial intention was to obtain the final MRCPath and return to Ireland but I discovered that I enjoyed teaching, particularly at undergraduate level and later to postgraduates, and also enjoyed the research aspects of the programme. I passed MRCPath in December 1986 and subsequently worked in the field of lectin histochemistry of the colorectum for my MD which was awarded in 1992. I was appointed consultant histopathologist to Manchester Royal Infirmary in early 1990 and have developed specialist interests in the fields of liver, gastrointestinal and urological pathology, while continuing in general aspects of histopathology and autopsy practice. I decided at an early stage that cytopathology was not for me and my case demonstrates that it is possible to drop particular areas of pathology practice if you discover that you are not particularly suited to them.
My current contract allows for half time as an NHS consultant and the remainder of the time as a clinical academic with activities in teaching and research. Inevitably, in the current shortage of histopathologists, I seem to spend more than half my allocated time for both aspects. In general the working hours are 9 to 5, Monday to Friday, although they are more frequently 8 to 6 or 7, including weekends. There is a variety of work in terms of autopsy and surgical histology practice, interspersed with regular clinicopathological meetings at which interesting and problem cases are discussed with clinicians. There is an opportunity to interact with clinical colleagues and also in the practice of autopsies, especially for HM Coroner. In general, there is no evening or weekend work although an on call service is provided which may involve frozen section diagnosis or providing advice to clinicians and others. Training in pathology is arduous and the examinations are relatively difficult with a need for understanding of basic scientific principles and their application to clinical practice. There is also a need to understand the role of pathology in clinical governance and management of laboratories. However, this can usually be accommodated during the working day, apart from the difficulties encountered at present due to a relative shortage of qualified pathologists, and is increasingly being seen as a suitable career option for persons wishing to train flexibly and to work part-time in their consultant careers. Intellectually, histopathology is a constant challenge with frequent changes of emphasis in terms of autopsies where on a single morning it may be possible to undertake postmortems identifying the commonest cause of sudden death in coronary thrombosis in severe coronary atheroma, a complex post-operative case and a forensic type case such as a road traffic accident, suicide, drug overdose or the proverbial ‘green man’.
When I started in pathology first in 1981 I thought that I would try it for 6 months and was not convinced that it was the career for me. However, having overcome the predictable initial difficulties with the autopsy room, and an apparent inability to focus with both eyes at the same time at microscopy, I have thoroughly enjoyed my time in histopathology. It is an ideal discipline for somebody with an interest in basic scientific principles who wishes to apply them to clinical practice, at one remove from the patient. This does not mean however that there is no verbal communication or clinical contact involved and pathology should not be considered as a career for those with difficulties in communication or interpersonal skills. Histopathology is now a career for dedicated professionals with a good understanding of clinicopathological correlations with an ability to interact with colleagues at all levels. An interest in research and/or teaching are added bonuses.