I read with mixed feelings the column on licensure by Thomas Sodeman,
MD ("Good intentions, bad consequences", September 2006). I understand
the theory about the shortage of laboratorians increasing with a required
license, but what about the quality of work performed with the resulting
values reported to physicians? MLTs and MTs are not robots who put specimens
on the machine and wait for a result. Their education programs are very
complex. To recruit students for such an important profession is difficult
when they can choose to go into another field of study for more money.
And students definitely look at the salary. We have seen other health
professions acquire licensure, and they have seen an increase in salary
as a result. Why is the laboratory different? I realize this is not just
about salary increases, but as a med tech and as a program director for
an MLT program, I would like to see the stature of laboratory personnel
and their salaries improve.
Bonnie Fanning, MS, MT(ASCP), CLS(NCA) MLT/PHL/ECG
Orangeburg-Calhoun Technical College
It is regrettable that New York State is having trouble implementing licensure of its laboratory personnel. The editorial by Thomas Sodeman, MD, assumed that this was going to have bad consequences on patient health in that state and that licensure was unnecessary. I disagree and feel obliged to relate how this process has worked in California.
The California Department of Health Services has been licensing laboratory personnel for 50 years, starting with medical technologists (now called clinical lab scientists, CLS) in 1952; clinical chemists, toxicologists, microbiologists, and bioanalysts in 1972; cytotechnologists in 1999; genetic scientists, histocompatibility scientists, and oral pathologists in 2000; and now phlebotomists. Since 2003, more than 20,000 phlebotomists have been certified in California and more are applying each day. There are more than 25,000 licensed baccalaureate- or doctorate-level clinical laboratorians in California in 22 different license categories, and there is public demand for two more for biochemical geneticists and andrology scientists. Why such a demand for licensure? How has this worked in California?
Licensure of qualified laboratory personnel ultimately is a win-win situation, and I think New York state will find that, too. It benefits patients because they can be assured that their physician, their phlebotomist, and their CLS are all licensed after meeting stringent licensing requirements. Why should it be important that physicians are licensed if the rest of the team is not? Second, it benefits employers because they can be assured that if their applicant is licensed, then he or she meets strict education, training, and examination requirements; has taken annual continuing education; and has no actions taken on his or her license.
Third, it certainly benefits the licensed person. I was sad to read in the September 2006 CAP TODAY the letter from Trudy Darden, who is working as a CLS in Illinois (without licensure, as you stated) and who was so underpaid that she had to work two jobs. We would welcome her to California where the salaries are tops. That is the benefit to licensed clinical lab scientists in our state. They can work as general supervisors, lab managers, or technical supervisors. They are well paid, recognized as lab professionals, and highly sought after. It is true we have a labor shortage in California, with most of our license applicants coming from outside the state or outside the U.S. However, if you ask anyone working with a license in California, they would say it is an indispensable part of maintaining the quality of health care here.
Don’t be discouraged with the licensure process in New York. Give it time because you will appreciate it someday. We hope it goes well.
Karen L. Nickel, PhD, Chief
Laboratory Field Services
California Department of Health Services
Don Patton’s letter, "Putting Lab Professionals
in the Spotlight" (August 2006) was right on the money. I have been
in the microbiology field for almost 40 years, and I can tell you lack
of communication is one major cause of the shortage of professionals.
Getting out there and telling the public what we do is important.
The other important factor is money. Students today are not going to invest in the medical technology field for low-paying jobs, when other health care fields are paying more.
I hope that putting the spotlight on the medical technology field, bringing medical technology back into the colleges, and increasing salaries will give the medical technology profession the professional recognition it truly deserves.
Barbara A. Pettinato
Coney Island Hospital
The letter from Don Patton, Abbott Diagnostics, is incorrect in stating, "… Los Angeles and Miami do not have any medical technologist or medical laboratory technician training programs." UCLA, working with California State University, Dominguez Hills, currently has a training program, and I know of several other institutions in the Los Angeles region similarly providing technologist training approved by the state of California.
Elizabeth A. Wagar, MD
UCLA Clinical Laboratories
I want to voice my support for Trudy Darden and her letter in the September
2006 issue . She is spot-on in her assessment of wage versus altruism
with today’s students. While I enjoy my profession and continue to find
it engaging after 25 years, I can’t blame new graduates for wanting a
job that can pay the bills and allow them a family and maybe a house with
a yard. No longer can anyone count on a guaranteed two incomes. It’s not
unreasonable to expect a four-year degree and registration requirements
to result in a position lucrative enough to support oneself.
Patricia Sather Hartell, MT(ACSP)
Gottlieb Memorial Hospital
Melrose Park, Ill.
The article "New Help in Understanding the
’Proper Work’ of PAs" (September 2006) correctly underscores the significance
of the CAP Policy and Scope of Work documents for pathologists’ assistants
developed with the American Association of Pathologists’ Assistants. As
general documents, they encompass a variety of tasks in pathology practice.
For example, the phrase "gather, screen, and prepare materials…pursuant
to a protocol developed by the pathologist" gives a pathologist unlimited
opportunities to employ highly educated individuals who complete pathologists’
I would like to emphasize an area where PAs can make a substantial difference in assisting the pathologist: grossing. It is indisputably the pathologists’ assistants’ turf.
Actually, pathologists’ assistants do this work in facilities that employ them. However, because of the dramatic increases in the number of biopsies and small specimens, and management’s desire to cut costs, this job is sometimes "outsourced" to less-educated and trained workers. Even some academic institutions do not have a PA position. The grossing technologist position was invented as a substitute. Employing histotechnologists or even morgue attendants to do grossing is common practice, especially in commercial laboratories.
Of course, the phrase "under the supervision and direction of a pathologist" is always used, but everyone knows what it means in practice. The pressure of turnaround time makes systematic supervision difficult. Pathologists are perfectly aware they depend on the technical part of specimen processing during grossing but sometimes prefer to turn a blind eye to their doubts for many practical reasons.
The tasks in the contemporary grossing room are broader than grossing technique itself and sampling decisions. They include, for example, correct accessioning, triage by timing and special procedures, and rational storage and disposal of specimens. Program-trained pathologists’ assistants should be assigned to supervise grossing as a pathologist’s representative at the grossing bench starting with accessioning and finishing with embedding. The Policy and Scope of Work statement ought to reflect PAs’ supervisory responsibilities in the surgical pathology grossing room.
Izak B. Dimenstein, MD, PhD, HT(ASCP)
Clinical Laboratories, Pathology Dept.
Chicago Medical Center