One National Certification, Finally?

The Coordinating Council on the Clinical Laboratory Workforce (CCCLW) recently posted an article addressing efforts to resolve the serious clinical laboratory workforce, which was included in the May 15, 2008 ASCP e-Policy News.  It mentions the need to "improve the professional profile of laboratory professionals by expanding their role on the health care team" and "align the scope of practice by STANDARDIZING CREDENTIALS and aligning curriculum." See http://www.ascp.org/pdf/CCCLW.aspx

The  latest edition of the Credentialing Connection published by NCA, contains  an article dealing with the possible merger between NCA and ASCP

http://www.nca-info.org/news/nca-0208.html

The good news is that the  talks are still ongoing. Because of differences of philosophies, alliance, history (and even loyalty)  this is a delicate negotiation. The temptation might be to walk away and abandon the project at the slightest hint of an impasse. But I hope both organizations will hang in there and come to a mutually agreeable joint venture for the benefit of the profesion as a whole.

ASCP was mainly founded to give pathology more recognition as an important specialty of medicine.  This agency's certification of medical laboratory professionals included a code of ethics that still applies today: they agree to work under the supervision of a physician, not to make written or oral diagnoses, and not to advise physicians on treatment options without the supervision of a physician or a pathologist.

ASCLS was founded by groups of medical laboratory professionals who sought increased professional recognition, since pathologists prevented nonphysician clinical laboratory scientists from becoming an autonomous profession through the above-mentioned code of ethics.

I'm not sure that NCA was created "just for fun;" the founding of this agency was more likely as a reaction to ASCP not requiring continuing education of their certified technologists/technicians until a few short years ago (2004, the year I became certified by them) - and their wish to be certified through examinations developed and evaluated by their lab professional peers rather than by pathologists.

There's another professional agency here in the United States that I forgot to mention, ASCLS (American Society for Clinical Laboratory Science) - initially founded some time in the 1940s as ASMT (American Society of Medical Technology), a subgroup of ASCP.  In 1947, ASCLS held its first annual meeting independent of ASCP.  This agency was created to certify MTs who have specialized laboratory experience, but as far as I know, they do not certify clinical laboratory professionals today.  See www.ascls.org.

The Clinical Laboratory Improvement Act of 1967 only covered the small number of laboratories that did business across state lines.  Lawmakers realized that there was a need for regulation of ALL laboratories which test human specimens, especially testing funded by Medicare and Medicaid (established in 1965).  During the 1970s, many amendments to CLIA '67 were proposed, including requirements for laboratory inspections to ensure accuracy, personnel competency, and appropriate quality control.  

In 1978, HEW started requiring medical laboratory personnel to either hold a bachelor's degree (or "equivalent") - or pass their proficiency exam, for which they did not accept certification by any private agency as a substitute.  The HEW exam was the closest that the United States has come to "one" national certfication standard for clinical laboratory professionals.

CLIA '88 lowered education requirements for laboratory personnel performing "high complexity" tests and leaves considerable room for interpretation of competency standards. See www.aacc.org/AACC/resources/resource_topics/clia88/ or  www.cola.org.  This may be why individuals holding "general science" degrees are employed by the laboratory of your hospital, assuming they have not also become certified by one of our many agencies.  

I have a BS degree in Biology with a concentration in Microbiology and Cell Biology; after staying home with my daughter for 18 months, I completed a one-year MT program for either those who have taken three years of science/math/etc. prerequisites or those who already have a bachelor's degree in a scientific field - and became certified by ASCP shortly thereafter.

Thanks for the info Stephanie, but then, that poses a lot of question for me. Was ASCP not enough to validate our "authenticity"? Was AMT an ASCP disbanded group? Was HEW catering government entities? Was NCA created just out of fun?....etc....etc...etc.... I'm just thinking one right word divided, divided, divided we are.... do you guys think we will stand?

At the 150-bed West Virginia hospital where I am currently working as a MT in a travel assignment, one of our part-time techs has "ASCP," not "MT(ASCP)," printed after his name on his ID badge. LOL  Also, the school in which he trained as a MT evidently did not make him aware of ASCP's CE requirement for certification maintenance; he became certified two years ago, but was surprised to find this out when I recently mentioned it.

ASCP was founded in 1922 by physicians who wanted to increase awareness and recognition of pathology as an important specialty of medicine - and of the importance of laboratories in medicine. (See the "History" link under www.ascp.org.)

AMT was created in 1939; for more information, see www.amt1.com.

When I did a MSN search for "HEW," the most possibly relevant link I found was en.wikipedia.org/wiki/HEW.  It stands for the United States Department of Health, Education, and Welfare, a cabinet-level department of the US government between 1953 and 1979.  Today, it exists as two separate departments - the Department of Education and the Department of Health and Human Services.

Glen briefly mentioned the history of NCA (founded in 1978) in his initial posting under this topic.  See www.nca-info.org.

I hope this helps! :)

To Efren and others. I  have received a few emails indicating the link I provided a few posts down regarding the Pharmacist Shortage situation is a dead link. I apologize. I am a subscriber to Medscape so I have automatic access, and I suspect the site is nonsubscribers to register before allowing them to see the article. Sneaky!

Anyway here are a few more sites that you might find useful. They give different perspectives over several years, but all come to the same conclusion-the shortage of pharmacists is significant and sustained.

http://www.pbs.org/nbr/site/onair/transcripts/080327c/

http://www.msnbc.msn.com/id/9956386/

http://www.medicalnewstoday.com/articles/29298.php

http://www.afpenet.org/news_facts_at_a_glance.htm

Thank you Glen, I stand corrected with my non-demand assumption on pharmacists. Anyways, I have a question to the rest of the bloggers, this might be irrelevant but I'm just curious... does anybodyhave any hint of history why there are more than one certifying bodyhere in the US? I presume ASCP were the pioneers. Was there some personal clashes and political brouhaha that's why there are  many tentacles after that? I know I'm probably squeezing an old wound, a very touchy subject. Assuming if that's really the case, we can make comments all we want nothing's gonna happen. Hopefully I will be wrong again with that judgment. But am telling you guys venting yourself out is a good cardio work out you know. LOL! I'm still keeping an eye though with what ASCP and NCA are doing after all I'm good at paying my annual dues. So they still need my money down the road. Come on guys with a concerted effort I know we can do better! Gosh, we'll prove it to the world that we have more than a cent WORTH!

Stephanie:

Thanks for all your posts. You make a good point: there really is a shortage of clinical laboratorians and it's bound to get even worse. It is important that respect, pay, prestige (all the things we seek) require more than high demand. Again, using pharmacists (or even nursing) as an example, employers will  hire ONLY licensed professionals to meet the demand. So if there't enough licensed personnel, employes seek them out, pay more, treat them well and so on.

Employers of clinical laboratorians on the other hand will 1. use OJT personnel 2. allow laboratorians to perform outside their scope or certification level 3. work short 4. create ungodly schedules and workloads and basically 5. whine, complain and make do. No nurse or pharmacist would tolerate that. If they do, the professional organizations and regulatory agencies would step in very quickly.

Other professionals control their profession, restrict practice, also sell themselves to other members of the healthcare team and to "customers" so their value rises.

It says a lot about the way we view and market ourselves that even in a high demand/low supply market we STILL cannot demand what we deserve.

I enjoy your posts, keep them coming!

Is "supply low enough in relation to demand" for medical laboratory professionals today when two of them graduate for every seven that retire?!

Ironically, I interviewed for a pharmacy technician position not long before I started medical technology school in 2003.  I studied toward a PhD in Physiology and Pharmacology at Wake Forest University School of Medicine three years before that, immediately after graduating with my BS degree in Biology with a concentration in Microbiology/Cell Biology (and minors in psychology and chemistry!) from Methodist University, also in North Carolina.

I suspect my ex-husband was looking for the same type of pay scale in a wife as that of pharmacists or research pharmacologists; I can understand how upset he must have been when I decided not to continue with the PhD program not long after I met him and became pregnant with our child - then to find out that people on the clinical side of labs in the hospital make significantly less $ than nurses or pharmacists, not quite enough to afford all the lawn furniture and ornaments he "had to have" while our six-year-old daughter was still an infant.

Good to see Brian, Efren and others continuing the dialogue on this important issue.

Efren: with regards to your comment about whether or not there is a shortage of pharmacists, trust me, there is a HUGE shortage of pharmacists.

See this link for example:

http://www.medscape.com/viewarticle/521115

The shortage is due to several things such as

1. Need for licensure.  Pharmacies will only hire licensed pharmacists, not unlicensed personnel. Pharmacy techs are not legal substitutes for pharmacists although they can be trained to do a LOT. Contrast this situation with what happens in clinical labs.

2. Pharmacists have controlled entry to the profession so that only a certain percent of applicants get accepted into pharmacy programs each year. Many, many qualified applicants are rejected each year. This keeps supply low in realtion to demand.

3. The aging chronically ill population needing lots of prescriptions filled-some estimate approximately 8 billion prescriptions annually by 2020

4. Expanded role for pharmacists in healthcare.  In many hospitals doctors have ceded management of therapeutic drugs like antibiotics, heparin and the like to clinical pharmacists.

This shortage has increased pharmacy salaries tremendously

http://findarticles.com/p/articles/mi_m3374/is_9_26/ai_n6122103

In my last hospital, some staff pharmacists were the highest paid employees in the entire hospital, and the Pharmacy Director's base pay was actually higher than mine as the COO.

Local retail pharmacies would try to attract pharmacists by entering all new staff pharmacists in a  raffle for a new BMW every 3 months. So joining the staff  as a pharmacist immediately put you in the running for new car. Business folks dont just do that sort of thing unless staff is considered valuable and hard to come by!

North Carolina, where I graduated from Medical Technology school, does not require state licensure; ASCP, CLS, HEW, or AMT certification is enough to qualify for medical laboratory positions there.  I just started traveling last year in Indiana, which also does not extort money from already underpaid laboratory "professionals" through state licensure programs.

West Virginia is the first state to which I traveled (earlier this year) with state licensure, only charging $25 and requiring faxed copies of one's high school diploma, MT graduation certificate, and national certificate (ASCP or whatever).  I was very relieved to find out my misconception about having to take another exam was not reality there in WV.

However, my eyes darn near bugged out of my head when I considered looking into a traveling opportunity in New York to stay near my mother in Vermont this summer and found out that the NY licensure fee for clinical laboratory professionals is $345!

(My staffing coordinator thought it was only $100, LOL)  I have debts associated with my recent separation/divorce that need to be paid down with that kind of money!

We have the same sentiments Brian, I'm disappointed myself... I think we are a minority about these issues that plague the profession. I don't agree about the "supply and demand" thingy. Look at the pharmacists, they are not really in demand ( I might be wrong though) but look at their pay scale. I should have been a chiropractor, a PA, an anesthetist etc. or a pharmacist or even go to medical school if somebody will pay me to go study. LOL!

I THINK THAT THIS IS A VERY GOOD DISCUSSION.  I ALSO THINK THAT ALL OF THESE RESPONSES ARE NECESSARY, HOWEVER, I'M SURPRISED TO SEE THAT ONLY 6 PEOPLE RESPONDED.  YOU WOULD THINK THAT MORE TECHS WOULD BE INTERESTED IN SOME TYPE OF UNIFICATION AMONG NATIONAL CERTIFYING AGENCIES, AT LEAST ENOUGH TO VOICE THEIR OPINION ON THE SUBJECT MATTER. EFREN I SHARE YOUR CONCERNS.  TECHS IN CALI., WITH ALL DUE RESPECT, ARE NO DIFFERENT FROM THOSE IN TENNESSEE OR ANYWHERE ELSE.  PERSONALLY, I THINK MOST STATES REQUIRE STATE LICENSURE AS A MEANS TO GENERATE REVENUE. I TRAVEL QUITE OFTEN AS A TECH.  ITS AMAZING TO SEE HOW THOSE STATES THAT DO REQUIRE LICENSURE PRICES VARY FROM ONE STATE TO ANOTHER.  ONE VOICE, ONE PROFESSION, ONE AGENCY.  WE MUST UNITE TO ADDRESS SUCH ISSUES AS THOSE MENTIONED IN THIS BLOG AND LABS THROUGHOUT THE WORLD.  

There used to be a forum in MedHunters about this issue 7 years ago. If my memory serves me right, there was a guy there by the name of Doug who was so passionate about this topic, who was from Montana. I hope Glen can get ahold of that guy.  Another thing too that I hate with every hospital organizational structure is that we are put under ancillary services where usually the "head" know nothing about how we function. Pathologist should just be a consultant with our organization academic wise but making by-laws, we should be able to do that ourselves as we are all known as independent thinkers within our circles. And one last thing, the "infection control people" in every hospital should be a medical technologist not anybody else! Agree or disagree?

Glen,

This is a good topic.  I will defiantly be back to respond.  I'm contacting all of my M.T. friends. We need to prolong this converstion.

Aside from certification ever raising our wages to the levels that are comparable to other healthcare professions --

Is it the fact that we are classified as "Technical Staff" versus "Professionals" that our wages are kept lower?  Would merely changing the classification heading of our jobs help bring in higher wages?

I have seen postings in the newspaper and workplace that are classified as 'Professional' and have comparable if not higher wages for MUCH, much simpler positions than for what we hold.  Are technical staff any different from the professional staff in a workplace?  

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We were recently licensed in New York state.  We have been continually told that being licensed should help bring our wages up and that this should also create more of a demand for techs that are now licensed.  (supply and demand)  

I am still waiting.  I don't count our (possible) yearly COLA raise as an increase in wages.

We even have co-workers here with degrees in Biology, General Sciences and who knows what? We don't even have any control on who are suppose to work in our field. What's next after that?

I don't think ASCP or any other certification even matters anymore. You only get maybe one or two more dollars per hour. I was surprised to find out a lot of my co-workers are not certified anywhere. I have a BS degree and am ASCP certfied(since 1979) but that and a $1.50 will buy you a cup of coffee.

 I'm sorry guys, I know I've been yacking your ears too much BUT I've got to ask this. Can somebody shed light on this issue? Why in the world I have to be scrutinized again in some other states? Certification, licensure, etc. whatever you call it, is just an outright insult, so demeaning with my professional capabilities. I don't give a second class performance wherever I go. So, the technologists from California is way farrrrrrrrrrrrrrrrrrr better than the ones from Oklahoma eh? Dang! There textbooks must be coming from Mars and mine from Venus. LOL!

ERRATUM: March 4, 2008 posting @0935pm

It should read:

    After you graduate with the program in Canada, you can function right away as a full-fledged technologist. Passing the certification exam will just give you more pride sealing the deal and maybe almost a buck more added to your salary.

There is so much apathy on this issue that people don't care anymore. Glen, if you have that "bulldog" will, go ahead and spearhead it man. Get signatures through out the country for a support base. I know it's easier said than done but unless somebody is willing to do this, to bring unity to our profession, nothing in our lifetime will happen. I just don't get it here in the US. I'm certified in three countries, the Philippines, Canada and the USA. Both the Philippines and Canada has one national certification that is recognized all of the country's respective provinces. Yes, these organizations is united in every way and Canada even have a union that works. It so mind-boggling for me when this country is flagrantly hoisting the banner of "patriotism" but it seems hard to be a good compatriot with your colleagues in the field of work. I've been through 16 laboratories- general hospital labs, trauma center, health sciences center, university hospital, reference lab, municipal, provincial labs, clinics, public health, state, etc.- in my career and still have good relationships with all of them and yet I still have to meet a dumb technologist. You have to be above average IQ before you can finish a med. lab degree. I don't have a life when I did mine, sleepless nights, 6-8 major exams in a day for 3 days and rigid deliberations before you can get to internship. It will blow your mind away! And you know what, the CanadianOrganization just got it right. After you graduate in Canada you can function right away as a full-fledged technologist. The certification exam will just give you pride to seal the deal and maybe almost a buck for your pay. Your registry is just an icing on your cake and I love to eat both- it will make you fat but I don't care it's still goooood! The idea might not be parallel, but you know what I mean people (for heaven's sake)- just have a one and unified certifying body! I don't care if it's NCA, HEW, ASCP, AMT, ABCDE, EFGH, IJKL or Hill&Billy's Association of Clinical Scientist... I just don't care. I've meet bunches of people with different certification but their technical skills is still archaic. Our field is evolving, we are ethically responsible to stay abreast with what's goin' on in our camp and that has nothing to do with certification. Some techs are just plain old lazy but yeah, I can't deny that these are smart people. We all know the reason why, promotion will take ages to get one, pay scale (the biggest issue), a hard-to-reach recognition...you name it! What would inspire us to do better aside from our innate ability to look after the welfare of the people we serve? Nothing! If you have one, good for you!

    I've read an article just a week ago released through the media about MRSA's , RSV's, flu's and there's nowhere the "lab" people being mentioned in there. In other words, article is implying that oh the doctors and the nurses can just take a look at me for few minutes and be back after and viola you have a flu, magic! After 2 days, hey dude you have a MRSA. Whoah! What a brainiac!

    Figure this out guys. One governing body? The annual dues we pay? Pay a time slot with CNN, NBC or SPIKE network, I don't care...promote the profession. Design an up-to-date curricula in universities and teaching labs. Patterned pay scale all over the country... you guys can add more.... Then and only then, we can be a big happy family dancing in the lalala land! Is that really a very hard thing to do?

    One last thing, our lab just hired travelling techs, I'm so proud of these guys $28,000.00 for 12 weeks and the admin had no hesitation whatsoever to pay this amount. They deserve it but the problem is we deserve that too! We just had a meeting and everbody is flaming and just about to explode! We'll see what will be the outcome with that.

     And one last last thing. My ex-roomate in Canada just called me lately. We normally don't hire US graduates for some reason but there are some independent clinics down there right now who are hiring US graduates. And from the province where I came from they are paying students to go to school and just commit couple of years to work in that institution. And probably the next time I get a call, Canada is already venturing the travelling tech thing. Guys you should go for it. Vancouver, Quebec, the Rockies, the Praire.... travel the north for free with big bucks! We deserve it guys! Dreaming is not a crime you know!

I do not understand how we can expect to be treated as profesionals when there are multiple groups touting their memberships.  I once was proud to be a MT.  Now adays I am ashame to say I work in the Laboratory.  We have little pride in our work.  We are always considered to be the problem, not part of the team.  Results that are (at least to me) diluted or contaminated are reported out and the physician determines what to do.  Why do I need to be trained and certified?  Anybody can put out numbers.  Directors, mangagers etc only want fast turn around times with high output - not quality.

Thank you, Glen, for seeing the big picture. I was thrilled to hear that ASCP and NCA were "talking". I became certified through ASCP immediately after school but when NCA came along I grandfathered in because I wanted to be certified by an organization that saw the importance of continuing education. Then I realized that paying ASCP a fee every year for a journal that I could read in the break room at work wasn't worth it. I'm glad that ASCP now requires CE and I would love to see one unified certification for my profession. I woul hope that it would also be accepted by all states for licensure. I became a traveler a year ago to help fight the tech shortage but the states that require exams for licensure will have to do without my help until they see the light. My 33 years of experience will be put to use in states that accept NCA or ASCP certification.

Robert and Efren, thanks for your comments.

Efren is correct: Lack of unity may not be the total cause of dissatisfaction in the profession, but it sure adds to lack of recognition and speaking with one, strong voice. Other perks like recognition and better pay are more likely to become a reality if the profession speaks with one unified voice. The other issue is that others outside the profession are confused when laboratorians themselves use words like licensure and certification interchangeably, or ask for one certification exclusively, when several exist.

Robert, a national license would certainly simplify things, but licensure (the right to legally undertake an activity or practice a profession) is usually a state function, not a federal activity.

One simple way in which licensure could work for laboratory professionals is if states granted automatic licensure (to practice in that state) to anyone who passes a national certification exam. That would reduce cost and prevent excessive multiple test-taking for laboratorians who move from one state to another.

It's sometimes helpful to look at other professions. A new nurse will take a single state board in California, for example. If he/she moves to New Mexico that state will grant them a license to practice in NM based on their California license. This type of reciprocity is common in licensing health care professionals. In fact, many states now have what's called a Nursing Compact which is a inter-state agreement so nurses with one state license can work in several states in addition to with what's called a "home state". They dont need multiple licenses to work in any (or all) of the Compact states.

Attorneys pass the Bar examination in one state and become "waived into" other states in a similar way. So they do not have to sit a different exams for each state they practice in.

A similar approach could be used very effectively for clinical laboratorians, I think. A few states that licence clinical laboratorians (eg Florida and California) require passing state exams to practice in the state. Redundancy and cost could be reduced by adopting automatic licensure based on national certification.

One nationwide license will suffice. We have being putting to much emphasis on many letters of certifying agencies after our last names. What is important is our professional performance and knowledge.

Why would we expect a respect from the public when we ourselves don't respect each other? I've never seen such a fragmented professional organization like us. In reality, such divisiveness is a blatant form of unprofessionalism- take it or leave it! Who can tell me 100 years from now that this profession is not a lost cause anymore? I dare you all!