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Press Start: Lead an Empowered Life as a Clinical Laboratorian

CAP Slightly Shifts Position

Published February 5, 2009 11:23 AM by Glen McDaniel

I have long advocated personnel licensure for clinical laboratory professionals because I believe licensure protects our scope of practice as well as protects the public welfare.

If you think about the people who are licensed--barbers, drivers, attorneys and almost every healthcare professional--you will see it is important to ensure only "qualified" individuals practice a profession.

Organizations such as the American Society for Clinical Laboratory Science (ASCLS) have supported model personnel licensure bills in many states, almost always to the strong opposition of the College of American Pathologists (CAP).

The official reasoning for nonsupport of the CAP--sometimes joined by ASCP and state pathology associations (at the urging of CAP, usually) --is licensure would exacerbate the clinical personnel shortage.

Actually, every independent survey shows this not to be true. In fact, there is some evidence professionals would be more attracted to the profession and would not leave due to burnout--more pay, more prestige, a protected scope. Without licensure, unscrupulous employers can hire non-certified individuals and pay them less to work side by side with certified laboratorians. Talk about a morale buster for everyone!

In some states, other professionals have seized on the non-licensure of laboratorians, encroached on our scope without the unique body of knowledge laboratorians have. Pharmacists and dietitians often order lab tests; pharmacists perform glucose testing, pregnancy tests and so on in pharmacies. Some practice acts have been rewritten to expand other health professionals' scope (nurses, respiratory therapists, etc.) to include "order and/or perform laboratory testing."  In California, pharmacists lobbied to be included on the list of those eligible to be clinical lab directors. Licensure would restrict or clarify such rights and help to protect both our profession and patients.

Recently CAP has revised its position on universal opposition to laboratory personnel licensure.

CAP will now support bills that:

  • make it clear the pathologist-director is in charge of all laboratory personnel;
  • do not create conflict between scope of practice of the pathologist and non-MD laboratorian. An added benefit is they can continue to bill for reviewing and overseeing procedures;
  • allow on-the-job training as a route for becoming a clinical laboratorian; and
  • ensure state laboratory licensure boards mirror CAP's position.

This is a step in the right direction, but is certainly not ideal. The CAP is all about protection of the scope of practice of the pathologist and protecting their economic welfare.

Pathologists feel others should not be allowed to encroach on their scope of practice and I certainly understand and support that desire. However, I think non-physician clinical laboratorians also deserve the same logic.


Over the years I have written many articles about clinical laboratory personnel licensure, including

January 13, 2011 2:59 PM

The  excellent comments made so far in various ways bring up 3 points that I'd like to touch on some more.

Well, let me address them by asking some questions.

First, is the cost of licensure. No one likes to fork over money. Like taxes we all wish everything cost less than they do. However wouldn't you rather pay a fee to get YOUR driver's license if it meant everyone else had to pass a driving test before they were allowed to drive?

In states with laboratory licensure, at least nurses, pharmacists, secretaries and assorted folks cannot legally work as clinical laboratorians. Doesn't that restriction protect the CLS profession as well as the public?

Second is the actual cost of licensure. I agree that the fees tend to be absolutely too much. Part of the reason for that is that the bureaucracy is so clumsy and cumbersome that it costs money to maintain. Why is all that bureaucracy necessary, especially when a clerk or 2 can maintain records easily in this age of computerized databases?

That brings me to the third point actually. Why are states still having their own licensure exams now? That is duplicative and expensive. Nurses pass ONE state board exam and then it is generally accepted in every other state. If they move to a new state al it takes is a short application and checking their record in the state of origin. In the meantime they will usually get a temporary licence to work in their new state of residence.

There is even a "nursing compact" among some states so nurses don't even have to go through a formal application for licensure if they move from State A that has a compact  with State B- they are automatically licensed in State B from day 1.

Attorneys pass one bar exam and it is usually accepted by other states as  well- a process called "waiving". Most nurses or attorneys have to sit just one exam in ONE state, which is honored if they move from state to state.

Why cannot laboratory Boards accept national certification (NCA or ASCP or AMT for example) as proof of competency and grant licensure on that basis? Why doesn't a licensed CLS not get licensure automatically in another state which requires licensure?

I think licensure has many advantages, but as currently managed, states make it painful to obtain and maintain.

Oh, and for those who travel with staffing agencies, many nursing agencies routinely pay the state licensure fee for their traveling nurses as a perk.

Glen McDaniel February 20, 2009 9:06 AM

The bureaucracy must not be nearly as "clumsy" or "cumbersome" in West Virginia, which does have state licensure, but accepts ASCP certification without requiring another exam - and ONLY charges $25! (Oh my God!)

If other "licensure" states care about actually alleviating the severe shortage of us laboratory professionals, they'll either do away with the $300-400-something crap and lower the fees to something more realistic (i.e. less than 100 dollars!) OR advocate with hospitals to increase our salaries to at least that of registered nurses with ASSOCIATE'S DEGREES!

(At some hospitals, it seems like lab technologists/technicians get about 25% or so of the patient contact involved in a nurses's job when they stick several patients in the ER during morning run - so that line about "being 'worth' more due to much more patient contact involved with the job" will never work with me!)

Stephanie Mathis, MT(ASCP), Generalist - Clinical Laboratory Scientist, Danville Regional Medical Center February 20, 2009 12:39 AM
Danville VA

The laboratory is all about standardization to ensure accuracy and quality.  This is by far not the case regarding those individuals that have been educated, trained and reviewed to maintain this institution.  The haphazzard licensure and association requirements make it clear that this is not about qualifications.  Laboratory professionals need some active and solid representation in order to prevent the system from continuing to victimize them.  I have been in this field for 30+ years and have not seen things change regarding this critical topic.  Over the years I have had to obtain NYC licensing and now CA licensing despite being ASCP certified.  In order to fulfill my most recent requirement I need to invest an additional $400 plus.  Who is benefitting from this arrangement?

Grace Haviland February 14, 2009 9:39 PM
Oceanside CA

As an unemployed AMT Certified Medical Laboratory Technician I too support the notion that CAP ought to specify that NATIONAL certifications such as MT(ASCP), CLS(NCA), and whatever other certifications it deems acceptable should suffice for purposes of earning licensure in ANY state so that laboratorians do not have to take more than one test - AND a $100 limit should be placed on licensure fees!

AMT,ASCP and NCA certifications should be suitable to satisfy any state licensure requirement. It's not easy to acquire certification from any of these certification agencies.I believe that on the job training should be available to certified entry level laboratorians. In fact, the certification agencies mentioned are accredited national certification agencies. There are certainly a lot of other serious issues hampering uniformity and security of our industry but if CAP were able to dissolve the issues mentioned then this would be a start.It would definitely help with the shortage of clinical laboratory personnel, not to mention the morale of certified laboratorians trying to find employment.

Richard Covington, mlt February 10, 2009 7:26 PM
Miami FL

A few years back the state of Florida decided to drop its own testing for laboratory personnel.  They decided to adopt ASCP as the preferred organization although they do accept others.  Now for those licensed by the state of Florida only, it seems very difficult to get the recognition that they earned, while those licensed by ASCP are "given" a state license just by paying a fee.  I feel that those licensed by the state before ASCP was brought in should be given the same opportunity to be licensed by ASCP.  This may bring others to Florida but it has caused a great in-justice to those who have been here all along.

Dan February 10, 2009 5:19 PM

I started traveling through Medical Staffing Network in October 2007, and may have accepted an assignment in upstate NY so that I could hop a ferry to Vermont and see my mother (who lives near Burlington) during those 3-6 months or whatever.

Although my employer would have reimbursed me for any state licensure fees, the psychological impact of parting with that RIDICULOUSLY large amount of $ for any amount of time was unacceptable to me, so I went to Lafayette, IN, Bluefield, WV, and Bryan, TX instead before settling down to an "8 on/6 off" night position in Danville, VA (which is much closer to my 7-year-old first-grade daughter and has a much more realistic COST OF LIVING). :)

Stephanie Mathis, MT(ASCP), Generalist - Clinical Laboratory Scientist, Danville Regional Medical Center February 7, 2009 12:33 AM
Danville VA

Umm yeah..   Dont forget that we (NYS) are one of the most heavily taxed states in the country and this is another way that they can tax, err.... fee us to death here.  

You should have seen it in 2007 when they decided to make licensure mandatory and the short amount of time that they gave us to get all educational materials, diplomas, certificates, et al. together along with the fat $350 check to send to them...  Wasnt pretty, plus how confusing they continually made it with all of the changes they ket making during the early Aug - Sept 30 deadline time period.

Ryan February 6, 2009 10:17 AM
Buffalo NY

Does anyone out there other than me suspect that 345 DOLLARS for New York state licensure may possibly exacerbate the clinical laboratory personnel shortage in that fine state?!

Also, CAP ought to specify that NATIONAL certifications such as MT(ASCP), CLS(NCA), and whatever other certifications it deems acceptable should suffice for purposes of earning licensure in ANY state so that laboratorians do not have to take more than one test - AND a $100 limit should be placed on licensure fees!

Does anyone see either of those guidelines being added in the near future, by any chance?

Stephanie Mathis, MT(ASCP), Generalist - Clinical Laboratory Scientist, Danville Regional Medical Center February 6, 2009 9:03 AM
Danville VA

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