I have to agree with the previous post. Academic medical centers are the most familiar environments for trainees as the accredited training programs mainly take place in these settings. However, different opportunities may present themselves while applying for jobs; therefore I highly suggest exploring every one of them. I will discuss the different activities I encounter as a clinical chemist in a large private physician organization with multiple laboratory locations.

The Large Private Physician Organization

Day-to-day activities are quite similar to other settings; daily quality control reviews and daily rounds are almost a requirement these days given complex operations, high specimen volumes, and high technology instruments in the laboratories. Being responsible for the operation of five different laboratories, I heavily rely on real-time information from managers, supervisors, and technologists regarding the daily issues that arise. Good communication, clear expectations, and an open-door (and open-phone) policy are crucial for successful management of QC and other laboratory issues. It is very important to spend face-to-face time at all locations and be visible and available to the entire operation. Other activities that are similar to other settings include proficiency testing results review and troubleshooting, standard operation procedures update and review, quality assurance activities review and monitoring, and regulatory/compliance issues.

 One of the most challenging (and most rewarding) aspects for a PhD in a physician organization is to become a valuable consulting resource. Physicians may initiate contact to relay a concern or a complaint/observation, and as trust is developed these become consultations. It’s a good idea to remember that many physicians have not had interactions with clinical chemists and may not know what our training, background and experience is. You will find yourself doing some educating in this respect and also getting questions re-directed to the medical director/pathologist. This is probably true in other settings as well, but can be more prevalent in private practices that are historically MD-focused.

The private practice setting is very customer oriented. I usually like to think of “customers” two ways: the patient and the physician, although I personally prefer the term “stakeholder”. Good customer service skills are needed, and once again prompt communication and action are crucial for success. There is also the potential for direct patient interaction in the outpatient setting, especially when the laboratory is co-located with the phlebotomy operation. Patients sometimes encounter situations that require further clarification, discussion or explanation and I have personally found these interactions incredibly rewarding.

A potential challenge that trainees may encounter when they are the only clinical chemist in the organization is that colleagues or mentors are not across the office any more. I have personally found that there are many avenues that facilitate immediate consultation and/or mentoring: some examples include phone calls or emails to former colleagues and mentors, establishing a network with clinical chemists that practice in your geographic area, online forums, attending local events, attending physician rounds, and being involved with nearby academic medical centers.

As an outpatient setting with hours of operation that do not include overnight hours, an on-call schedule is often not required. Some clinics may operate an Urgent Care department that requires extended laboratory operations, and my rule of thumb is to be available at all times for any type of consultation while the laboratories are in operation.

Lastly, one more item I want to mention is the availability of laboratory test results to patients, which is now more prevalent in outpatient settings that operate entirely within electronic health records. This is a complex topic and poses a challenge to the entire health care team. Therefore I suggest you work closely with all the departments involved and have a consistent practice to approach the issue.

Please feel free to ask questions and/or share your experiences in this forum. I intended to discuss some aspects of the job but the list is definitely not complete. And as you already know, there is never a dull day in the lab, which is the reason why many of us are passionate about what we do.