One of the questions I had went I was seeking my first professional position in the field of Clinical Chemistry a few years ago was whether I should pursue a position in an academic medical center, a private pathology practice or foundation or a large reference laboratory. For me there were a lot of unknowns about what was expected of a clinical chemist in each of the above general categories. In order to provide the readership of Council Chat with a little of an insight into each type of position over the next three weeks we will have a post from different clinical chemists in each of these types of facilities.

Of course each laboratory within each one of these broad categories will differ but we hope that in general this information will help each of you when you begin looking for your first professional position as well. The first day-to-day summary will focus on the academic medical center and I will be highlighting some of the expectations and challenges that I face in my facility as a model. Stay tuned for the others in weeks to come and I encourage you to ask the authors specific questions about their positions and the pluses an minuses of the different options.

The Academic Medical Center

The academic medical center is perhaps the most familiar environment to most trainees in clinical chemistry/clinical laboratory medicine/clinical pathology as many; if not most training programs are set in this environment.

The most obvious day-to-day activity that occupies much of the time of a clinical chemist in this setting are the quality assurance and regulatory activities associated with a clinical laboratory. It is likely a universal truth that on a daily basis there is some degree of review of quality control data. While this review may not be a scheduled meeting there are frequent opportunities for a technologist or supervisor to bring a QC issue to your attention. In my laboratory we schedule this activity into daily rounds in which the chemistry laboratory management team walk through the various laboratory areas. In this time we review any questionable QC data or non-STAT test results that require review prior to being released into the medical record. While individual QC decisions are made by the typically made prior to rounds by our Technical Specialists, this time presents the whole management team the opportunity to discuss quality concerns in regards to assay performance, sample stability and processing. This time gives me the opportunity to become aware of quality concers prior them being revealed in a periodic review of QC data. It of couse goes without saying that scheduled periodic review of QC data is in your future if you have any interaction with a clinical laboratory.

As a director in the academic clinical lab the clinical chemist is also responsible for the development and/or validation of new assays or testing protocols as the need arises. If you haven’t already discovered this you’ll quickly find that all clinical laboratories, not just academic clnical labs, are highly protocol driven. The many protocols and procedures require constant review and updating as procedural changes occur and updates in procedures are made. While it’s most likely that your laboratory management team will make the physical changes to the documents it is wise to initiate or direct these changes and review the amended documents before they are put into place.

One of the important roles for the clinical chemist in this setting is fielding calls and questions from phlebotomy staff, laboratory technologists and physicians and other providers as they arise. As the academic medical center laboratory is a 24/7 operation, testing issues or provider questions and requests can come at any point during the day or night. Depending on the institution there may be on-call duties associated with the position. In many centers the overnight on-call duties are handled by a Clinical Pathologist but in other hospitals such as the one that employs me, the individual laboratory directors are expected to be available for consultation with the laboratory on technical issues, or with a physician or other care providers regardless of the hour.

As the position in an academic medical center is likely to come with an academic appointment there are likely also expectations that you will contribute to the training and education of pathology residents and possibly fellows. This may take many forms including didactic teaching sessions or technical projects for the residents to carry out. Although these activities may occupy a significant amount of time in your day, pathology residents and fellows can also be an asset to you. A portion of the residents and fellows training should include review of test results or fielding physicians’ questions, concerns and/or requests. The availability of a resident or fellow for these activities can free up a significant portion of your time once they are become properly trained and accustomed to the questions and requests physicians typically make.

As a clinical chemist/laboratorian with an academic appointment there is also likely an expectation for scholarly research and publications. While your academic appointment may not be on the tenure track or have a requirement for externally sponsored research, scholarly publications may be expected or required for academic advancement. Thankfully there are many venues in which to publish as a clinical chemist/laboratorian. Case reports, method validation studies, and original research alone or in collaboration with other laboratorians or basic researchers can all contribute to your academic advancement.

As you can see an appointment in an academic medical center with an academic appointment presents you with a dynamic and challenging environment that can also be quite rewarding. As you enter into laboratory medicine and progress through training you’ll have to decide for yourself what kind of laboratory environment you would prefer to practice in. While the academic medical center model may be the most familiar to you I would challenge you to read the posts in weeks to come from our other contributors. As you’ll see each type of facility comes with its own challenges and rewards.