Clinical laboratory science, or medical technology, takes its practitioners on a fascinating journey to the very center of life, to the essence of age-old mysteries of disease and good health. Perhaps the first clinical chemistry report ever recorded was published by Sasruta, a Hindu physician writing around 600 B.C. He noted the sweet taste of diabetic urine. In ancient Greece, Hippocrates taught his students to base diagnoses on the appearance of urine.
As time went on, testing became somewhat less reliant on the doc tor's senses and more reliant on advances in technology. When the number of patients a doctor treated was very small, clinical testing was performed directly by the doctor. However, advances in medical knowledge, specialized technology, and testing procedures became the domain of specialists, thus freeing doctors to take the time needed to treat patients. Today these specialists are known by a number of titles including laboratory technologists, clinical or medical laboratory technicians, clinical laboratory scientists, and medical technologists.
The profession is now a rapidly evolving industry of major proportions. In the United States we spend some billions of dollars each year for tests performed in more than 170,000 clinical laboratories. Typically, through detailed microscopic, chemical, or visual analysis of specimens taken from body substances, clinical laboratory scientists identify, quantify, verify, and report the presence or absence of chemicals, microorganisms, enzymes, proteins, and other substances, and the composition and function of cells, tissues, and organs. The ten billion or more tests they perform each year help physicians screen for illnesses, diagnose diseases, deter mine their causes, prescribe correct treatment, prevent unwelcome drug interactions, discover substance abuse, and perhaps most important, promote good health.
Clinical laboratory scientists and other laboratory practitioners are found throughout the health care delivery system, as well as in numerous other settings. Those who work in a clinical laboratory may practice in hospitals, independent commercial laboratories, clinics, physician offices, blood banks, public health departments, ambulatory care centers, industry, and other settings. Some clinical laboratory professionals work abroad, in the Peace Corps or Project HOPE, or in private or government facilities in other countries.
Many practitioners work in clinical laboratories performing the analytical procedures just described. Many others, however, provide specialized services in a variety of essential health care roles, often in hospitals but also in other health care delivery settings. Some, for example, ensure the quality and safety of the nations supply of blood and blood products used for transfusions in surgery, postoperatively, and for other needs. Others perform tissue and cell analyses essential for bone marrow, kidney, heart, skin, liver, and other organ transplants.
Some clinical scientists put their skills to work for in vitro fertilization laboratories where human sperm and ova are joined in an environment outside the living body, and then implanted (as an embryo) in a woman’s uterus. Others work as researchers in public health departments where they help epidemiologists trace the origin and spread of infectious diseases. And some go on to other roles, serving as hospital infection control officers and as managers in the upper echelons of health care administration.
These are just a few of the options open to the qualified clinical laboratory professional. Consider also the array of roles outside the health care mainstream such as biogenetics; occupational health; environmental health; independent consulting; education and higher education administration; industrial research; product development, marketing, and sales; veterinary science; and forensics (criminology). Few other fields offer graduates a basic preparation for so many possible career paths.
For those students attracted to biology, chemistry, problem solving, and helping people, this profession offers many satisfying career options.
Defining the Field
Probably no other profession is both so important to health care, and yet so little known. Because clinical laboratory professionals historically have had somewhat limited contact with patients, most people know less about them than about other health care workers with whom they have contact. And yet, the information the clinical laboratory professional provides is largely responsible for the appropriateness of the care provided by physicians, pharmacists, nurses, therapists, and other health professionals. They all rely on laboratory data to make a diagnosis or implement a course of treatment that is appropriate for each patient.
Few fields in all of health care are as confusing for those outside the profession. There are many reasons for the confusion. First, clinical laboratory practitioners (the term used here for all levels of practice) are known by a bewildering number of professional titles. Second, they work in a large number and variety of settings. Third, there are differences even within the profession about what various clinical laboratory practitioners should be called, and what their roles should be.
Clinical laboratory technologists held about 350,000 to 700,000 jobs for all subsets of the field. See Table 1 for a comparison of various health care providers.
A Multifaceted Profession
To begin to understand this complex field, it helps to remember that clinical laboratory practitioners assume many roles within and outside of the health service delivery system.
It might also be helpful to remember that because the field is constantly changing (in response to new technologies, health care cost-containment pressures, variations in health care needs, and even new illnesses), new roles are being created every year. The American Society for Clinical Laboratory Science (ASCLS), the oldest of the professional societies devoted exclusively to the profession, summarizes the scope of practice as follows in Table 1:
The Scope of Practice of the Clinical Laboratory Sciences
The ASCLS defines the profession of clinical laboratory science as encompassing the design, performance, evaluation, reporting, interpreting, and clinical correlation of clinical laboratory testing and the management of all aspects of these services. Clinical laboratory tests are utilized for the purpose of diagnosis, treatment monitoring, and prevention of disease. The profession includes generalists as well as individuals qualified in a number of specialized areas of expertise, including microbiology/virology, hematology, immunology, transfusion medicine, clinical chemistry, endocrinology, toxicology, cytogenetic, and molecular diagnostics. Integral features of each of the specialties may include research, consultation, education, information management, marketing, and administration. The profession has a code of ethics that sets forth the principles and standards by which clinical laboratory professionals practice.
Description of Scope of Practice
Clinical laboratory personnel, as members of the health care delivery team, are responsible for ensuring reliable and accurate laboratory test results that contribute to the diagnosis, treatment, prognosis, and prevention of physiological and pathological conditions in humans.
The hallmarks of quality clinical laboratory testing are; per forming the correct test, on the right person, at the right time, producing accurate test results, with the best outcome, in the most cost-effective manner. This is accomplished by:
A. Assessing, designing, evaluating, and implementing new lab oratory test methods.
B. Evaluating the appropriateness of existing and new laboratory methods for clinical utility, cost-effectiveness, and cost-benefit analysis.
C. Developing, implementing, and reporting results of clinical laboratory services research (i.e., within the context of cost, quality, and access).
D. Designing and implementing cost-effective delivery models for clinical laboratories, including their services and personnel. The Scope and Practice of Clinical Laboratory Science 7
E. Developing and implementing a comprehensive Quality Management System to include:
- Quality control and assurance of clinical laboratory testing services;
- Competency assessment of personnel;
- Integration with other aspects of the health care delivery system for ensuring appropriate utilization of clinical lab oratory testing services;
- Continuous process improvement activities to maximize human resources.
G. Promoting awareness and understanding of the use of clinical laboratory testing services to the health care consumer, physician, other health care personnel, health care administrators, and policy makers.
{Source: "Scope of Practice Position Paper." Approved August 2, 2001, by the American Society for Clinical Laboratory Science House of Delegates)
Although many definitions exist, in the simplest terms, this profession is concerned with providing information based on the performance of analytical tests upon body substances to detect evidence of or to prevent disease or impairment, and to promote and monitor good health.
Among the thousands of routine and complex tests available, those are well known to most people. Almost everyone has had at least one complete blood count (CBC performed to detect blood disorders such as anemia or leukemia, or a urinalysis used to screen for kidney or other conditions. Most of us have had our blood typed and tested for compatibility, so that when we donate or receive blood, we and others are ensured of a safe, effective trans fusion, More and more of us are having cholesterol levels checked, to lessen the risk of heart disease. Some monitor their own blood sugar levels to correct conditions like diabetes. Other well-known clinical laboratory tests include antibody tests for viral or immunological diseases, throat or blood cultures for microbiologic infections, tests for alcohol or drug levels, and coagulation tests for clotting disorders.
Since its origins, the field of clinical laboratory science has grown in complexity and responsibility from a helping occupation limited to elementary functions, to its status today as a multifaceted profession that includes many other roles as well, a current definition, then, might read as follows:
Clinical laboratory professionals assume many roles within and outside health services delivery. In traditional laboratory services they provide essential clinical information based on performing and ensuring the quality of tests of human body tissues, blood, fluids, and other substances. Integral parts of their responsibility are verifying, interpreting, and reporting the results of these tests to attending physicians. Many laboratory practitioners assist physicians in correlating test results with patient data and recommend tests and test sequences in light of known clinical considerations. They also perform a wide range of management and supervisory roles, including serving as clinical laboratory directors, managers of laboratory sections, and supervisors of other technologists, technicians, and phlebotomists.
Laboratory professionals are expected to contribute to the body of knowledge comprising the profession. Their services are essential for preventing, detecting, and diagnosing disease and impairment, and for promoting good health.
Clinical laboratory scientists may also choose among many other roles within the health service delivery system but outside the traditional laboratory, including critical research roles; health care management and administration roles; independent consulting; and positions in infection control, public health, and epidemiology, to name a few. Those who do not choose careers in health care may choose among education and higher education administration; diagnostic equipment, pharmaceutical, and other types of industrial research and product development, marketing, sales, or product representation; veterinary science; forensics; environmental or occupational safety and health; and other career paths.
Changes in the Field
Few fields are undergoing change as quickly as clinical laboratory science. A definition showing the scope of this profession and hinting at this change was offered in Shaping the Future of Clinical Laboratory Practice: Proceedings of the Conference over a decade ago:
The laboratory profession does not refer to the hospital alone. Even within the hospital it does not refer to the physical space that the lab oratory occupies. The laboratory profession encompasses those activities of performing, reporting, interpreting and correlating laboratory tests designed for the promotion of health [and the] prevention and treatment of disease through the application of scientific principles of biology, chemistry, and physics as they relate to [human] physiologic and biochemical processes. The laboratory profession includes a number of defined, specialized areas of competence and also incorporates social science to serve its primary purpose. Further, research, consultation, education and administration are integral features of the profession.
This comment that the profession is not bound by the four walls of the laboratory is very important. The reference, of course, is to the very rapid changes the profession is experiencing, even now, as a consequence of new developments in technology and health care economics.
Several technological developments have changed the profession radically. First, refinements in computers have made it possible to process, transfer, and store huge amounts of information. Second, the perfection of dry reagents used in clinical analysis have extended the shelf life of these chemicals, improved their portability, and made them easier to use. Third, the discovery of the monoclonal antibody has allowed clinical laboratory scientists to detect even minute quantities of a specific substance contained in a body specimen. Fourth, new laboratory subspecialty areas have emerged.
Some examples follow: Molecular diagnostics involves the use, for example, of the polymerase chain reaction (PGR) to identify small regions of nucleic acids in diseases such as cystic fibrosis or Huntington disease. Flow cytometry utilizes differences in density gradients and monoclonal antibodies to distinguish mononuclear cells, thus aiding in the diagnosis of various leukemias or lymphomas.
Cytogenetics uses the analysis of chromosome number and structure to diagnose diseases such as Down’s syndrome, Klinefelters syndrome, or Turners syndrome. The mapping of the Human Genome Project has been a huge effort to unravel the mysteries of human genetics. Completed in June 2001, it has already begun to change the ways genetic illnesses are diagnosed and treated. Electron microscopy involves the magnification of cells 100,000 times to study their ultra-structure whether normal, inflammatory, or neo-plastic (cancerous). All of these new specialty areas utilize advanced scientific biotechnology, and they may require advanced (often on-the-job and post-baccalaureate degree) training. These new areas also enhance employment possibilities.
Some of these advances have propelled the manufacture of small desk-top testing instruments and even smaller test kits, such as those used in pregnancy testing. In turn, these instruments and kits have made it possible to perform some common tests in doctors' offices and ambulatory care centers, at hospital stations, and even at home, rather than in traditional laboratory settings.
New test kits, new procedures, new instruments (some large, some small), and other technological advancements are changing the nature and expanding the boundaries of traditional laboratory practice. They are sparking new ideas among educators and managers about the roles the profession should and must take on in tomorrow's laboratory, with and without walls. It may be early to say exactly what effects those changes will have on test menus, employment patterns, and health services delivery. But change always brings opportunity, and the profession is already anticipating what new opportunities the future holds.
Principal Practice Areas within the Field
The following major practice areas within the field are adapted from brief descriptions provided in Medical Technology Program, a pamphlet prepared by the Medical Technology Program of the Michigan State University, East Lansing, Michigan:
Clinical Chemistry: Analysis of bodily fluids for chemical constituents including glucose, protein, cholesterol, and electrolytes to detect diseases such as diabetes, heart attacks, or kidney failure.
Hematology: Evaluation of red blood cells, white blood cells, and platelets for diseases like anemia and leukemia.
Hemostasis: Evaluation of blood clotting to detect diseases like hemophilia or disseminated intravascular coagulation (DIC).
Microbiology: Identification of bacteria, viruses, fungi, and parasites that cause infections, as well as of the antibiotics that may be effective in treatment.
Urinalysis: Physical, chemical, and microscopic analysis of urine, which can indicate disease within the urinary tract or other body systems,
Immunohematology: Blood typing, antibody screening and identification, and other tests to provide safe and compatible blood for transfusion; also called blood banking.
Immunology: Evaluation of the body's immune system to detect diseases of impaired immune function and to ensure the compatibility of tissues and organs for transplantation.
Job Outlook
According to the 2000-2001 Occupational Outlook Handbook, there were 313,000 clinical laboratory technologists and technicians in 1998. Employment of clinical laboratory workers is expected to grow as fast as the average for all occupations through the year 2008. The volume of laboratory tests will continue to grow with the increase in population and the development of new types of tests. On the other hand, many employers such as hospitals and independent laboratories have recently undergone consolidation and restructuring. These changes have increased productivity and allowed the same number of personnel to perform a greater number of tests.
There is a strong need for new people to enter the field because many openings will be created as current workers transfer to related fields, retire, or stop working for some other reason. In fact in June 2000 almost twenty groups (most of which were professional laboratory science societies) came together at a meeting entitled "Summit on the Shortage of Clinical Laboratory Personnel."
The summary of the meeting leaves no doubt that the baby boom generation is entering retirement age and that the people inside the field-those who are actually responsible for staffing labs-see a serious need for new professionals. These societies are working together to find ways to attract bright and talented people to the field.
Currently there are many cities and rural areas in the United States reporting shortages of clinical laboratory personnel. Pockets with a strong need for staff offer attractive starting salary and benefit packages for those willing to relocate. The American Hospital Association reported a shortage of laboratory technologists in June 2001, listing a hospital vacancy rate of 12 percent. The journal Clinical Laboratory Science led its 2001 summer edition with an article about shortages in laboratory personnel. The American Association of Clinical Pathologists offers reprints from a fifteen-page scholarly article detailing shortages in laboratory personnel and associated increases in salaries on its website.
Clearly there is a great need for qualified people to enter this field in the coming years. Since the need for workers in any industry can fluctuate, a visit to industry Web pages will be helpful in gaining an up-to-date understanding of the market in your area. Local librarians are often excellent at helping find sources of current information on areas of interest to their patrons.
Factors Affecting Allied Health Employment Predictions
Allied health professionals comprise more than one hundred occupations other than medicine, dentistry, pharmacy, and nursing, and they are not always direct care givers. Employment outlooks for most allied health fields, including clinical laboratory science, vary from forecaster to forecaster. This is partly due to radical changes in health care economics initiated in the 1980s and thereafter. For example, in 1983 the government implemented the Prospective Payment System (PPS), which essentially paid for much of the care of Medicare patients according to their diagnosis, not by numbers of tests needed or diagnostic procedures performed.
This practice was intended to reduce laboratory and X-ray utilization, since hospitals would lose money if excessive testing was performed. The effects of the PPS on laboratory testing were not as profound as in the mergers and closures that occurred in some institutions. Many hospitals merged into "health care systems" to reduce costs and attract patients. Others were left to fend for themselves and some-especially in inner cities or in rural areas-could not survive, and closed.
In 1988 the federal government also enacted "CLIA-88," the Clinical Laboratory Improvement Act of 1988. Its intent and emphasis was to regulate all laboratories-whether in small physician offices or in academic medical centers. By 2001 more than 170,000 laboratories were identified and ensuing regulation was attempted using "test complexity," i.e. laboratories performing very simple tests could be registered but not inspected. Those laboratories performing highly complex testing, however, were to engage in proficiency testing and expect on-site inspections.
In addition in the early 1990s "managed care" became a profound movement in the United States. This involved the growth and expansion of health maintenance organizations (HMOs). (An HMO is a prepaid and organized health care system that serves a defined population. The enrolled population enters into a contract with the organization, agreeing to pay, or have paid on their behalf, a fixed sum, in return for which the HMO makes available the health care personnel, facilities, and services that the population may require.)
Persons enrolled in managed care tend to have fewer tests per formed. As a result laboratory personnel needed to staff HMO laboratories are thought to be fewer in number. HMO laboratories may be organized differently from hospital laboratories. Many have satellite laboratories for routine and simple tests, and a central laboratory where complex, unusual, or difficult tests are per formed. The satellite laboratories may be staffed by lesser trained personnel; the central, by baccalaureate-level practitioners.
Then in the 1990s the federal government initiated strong measures to contain and reduce health care costs, which in 2000 exceeded $1.2 trillion, or 14 percent of the gross domestic product. Both the Democrats and Republicans brought forth health care plans intended to cut Medicare reimbursements for physicians, hospitals, outpatient settings, clinics, ambulatory care set tings, and laboratories. Their efforts were to reduce reimbursement to clinical laboratories. As reimbursement decreased, some laboratories reorganized and downsized, resulting in fewer personnel being employed.
Another problem is seen in the slim amount of data available about the allied health professions as compared with the wealth of information concerning medicine. Lesser public interest in the allied health professions may be due partly to the fact that women pre-dominate in many of them. Others note that many of these fields, Hke laboratory science, are difficult to define. They point to the numerous, often overlapping titles, and to the fact that some health fields, including laboratory science, are not uniformly licensed and thus lack the usual "scope of practice" definitions found in licensure laws for fields like nursing, pharmacy, or medicine.
One thing that seems certain whether ill or healthy, people will always require medical information. Technological changes create new opportunities. Changes in the way we travel and do business globally mean that humans are exposed to an ever-widening array of diseases. Global climate change even gets into the act: In North America, as average temperatures have increased, insect-borne illnesses, such as malaria that were once thought of as equatorial illnesses are now being discovered and treated in northern cities across the United States. Clinical laboratory personnel will always be needed to help create, perform, and interpret the tests that help physicians care for people.
Most national organizations representing laboratory practitioners remain optimistic about employment. These organizations collect information about their personnel and monitor changes the profession is experiencing. Because they are closer than other observers to the day-to-day realities of practice, and because they have so much at stake when occupational forecasts are mistaken, they often detect important demographic currents earlier and more accurately.
Supply Factors
The supply of qualified personnel has a great deal to do with whether job outlooks are vigorous or not. When supply does not keep up with demand, the employment outlook, of course, favors the job seeker.
Investigations conducted by the American Society for Medical Technology (ASMT-now the American Society for Clinical Lab oratory Science, ASCLS) and by the American Society of Clinical Pathologists (ASCP) and its Board of Registry suggest that the shortages of clinical laboratory science practitioners are increasing. The American Society of Clinical Pathologists has reported vacancies as well. These are seen in Table 2.
Although the predicted shortage in new laboratory personnel hasn't become quite as serious as expected, many inside the field still worry there could be a shortage of clinical laboratory workers. There are several reasons for the concern, and they include some simple demographic facts. The generation sometimes referred to as "Generation X" that follows the "baby boomers" (those born between 1946 and 1964) is smaller and thus there is increased competition across all professions for the smaller number of high school and college graduates. Women who might have been drawn to an allied health field now have more choice in career area and are increasingly choosing careers not traditionally seen as female. Witness the fact that many medical schools are reporting that their class numbers are more than half female. In addition, salary "compression" in allied health fields may make other careers more attractive to those of either sex.
Supply of future workers is affected by what people observe in the news and in their own lives. Many clinical laboratory professionals point to the fact that laboratory workers are less visible than people working in nursing or other fields of health care. News stories can create unrealistic fears that might keep students from wanting laboratory work. Although labs are safer now than ever, some people may hear stories of AIDS or hepatitis and fear risk of exposure to these or other diseases. The risk of accidental exposure in the rigorously controlled laboratory setting is truly miniscule, but that may not be known among students considering their long-term career options.
These developments may be expected to continue to influence the supply pool of future allied health practitioners, including those in clinical laboratory science. To the extent that demand and supply influence how the marketplace sets compensation packages (salaries and benefits), and to the extent that current conditions prevail, these factors are expected to increase the likelihood of a favorable employment outlook for clinical laboratory science graduates.
Demand
Major factors affecting demand for medical technological services of course also escalate demand for qualified practitioners. These include general population demographics, technological developments, and social developments. Even the effect of climate change on infectious diseases will increase the need for testing. According to the Bureau of Labor Statistics:
Continued expansion of the clinical laboratory field is foreseen for three fundamental reasons. First is the increase in disease and disability that will accompany rapid growth of the middle-aged and older population. Second is the probability of new, more powerful diagnostic tests. Advances in biotechnology have already changed testing methods through the use of monoclonal antibodies and other advanced technologies that permit rapid, simple and accurate testing. As further advances occur, they are likely to spur more testing. And lastly, research laboratories that work to find the cause, treatment and cure for diseases such as acquired immune deficiency syndrome (AIDS) are expanding dramatically in response to increased funding from public and private sources.
The size and composition of the population as a whole has a major effect on demand for health care, and thus the potential to affect the employment outlook significantly. As the baby boom generation ages there is a corresponding increase in demand for and intensity of consumption of health care resources.
Other population factors will have an as yet uncertain effect on demand. For instance, the proportion of minorities in the U.S. population will increase by the year 2008. Factors such as diminished financial and geographic access to health care among minorities will have an impact on demand; the higher prevalence among some minorities of chronic diseases (such as diabetes, cancer, and heart disease) also will affect demand.
Technological change-driven by advances discussed earlier and soft technologies such as genetic engineering-is revolutionizing clinical laboratory science. One prediction states:
Implanted biosensors will give "real-time" health status reports and diminish the lag in results for many tests. Nuclear magnetic resonance will help identify the chemical makeup of tissues; DNA probes and molecular biology will transform how and when diseases and organisms are identified; robots will handle bio-hazardous mate rails and repetitive work alike; bar codes will simplify specimen handling from the bedside throughout the laboratory.
Pill-sized sensors are already being used to help diagnose illness. Tiny cameras report images to computer enhanced graphics screens allowing doctors to "see" inside without resorting to surgery.) These and other expected advancements not only will expand the variety of tests available, but probably will also increase the number of tests performed. Technology will have different effects on demand for practitioners at different levels. But if history is any guide, as many jobs will be created as will be taken away by automation.
Social developments also have increased demand and, interacting with new technologies, will continue to do so. For instance, changes in attitudes toward drugs and other substances, combined with technological advancements, have helped turn testing for drug use from a relatively minor field into a multimillion dollar industry. More growth is anticipated as legal and ethical questions are resolved. Similarly, the identification of human immunodeficiency virus (HIV) coupled with medical, epidemiological, legal, political, ethical, and other evaluations of its priority, have made the phrase "AIDS diagnostic tests" a household expression. Thanks to advancements in biogenetics and bioengineering, other developments like these will occur with increased demand for laboratory services and qualified practitioners.
Outlook for Technologists (Scientists) and Technicians
Clinical laboratory scientists usually hold a bachelors degree or above, while technicians are likely to have attended a technical school or community college. Regarding employment outlooks for laboratory personnel, the Bureau of Labor Statistics notes:
Employers' preferences vary so much chat it is hard to generalize about future prospects for the different levels of clinical laboratory personnel. On the one hand, demand for technologists is likely to be sustained by the complexity of much clinical testing; the need for in-depth knowledge and independent judgment to verify test results and advise physicians; expansion of research laboratory facilities; and technologists' greater versatility. . . . On the other hand, advances in laboratory automation will continue to routines certain tests, which may be favorable for technicians. . . . Like other areas of health care, the clinical laboratory is undergoing change on a scale that makes it extremely difficult to project future trends. For both technologists and technicians, demand will vary among employment settings, and job prospects will be affected by diverse factors including economic conditions; structure of the clinical lab oratory market; strategies by health care providers seeking to enter the market; third-party reimbursement policy and other profit considerations; and changes in laboratory [personnel] licensure and staffing regulations.
Most experts within the profession would agree that caution is warranted in predicting how key questions will affect the outlook for the practitioner levels of scientist and technician. Managers will always have to weigh the pros and cons of hiring a clinical laboratory scientist versus a technician. Many jobs require the versatility, productivity, and judgment of a person with a college degree. However, these skills come with a higher salary. Techno logical changes will clearly affect the need for workers of all types in the industry. New laws and regulations also can affect demand for clinical laboratory scientists or technicians. And finally, there is the question of the ever increasing number of user friendly tests. Will these tests mean changes in the way laboratories around the country work?
Salaries Outlook
Results of several recent studies show that salaries and benefits are rising across all categories and levels of laboratory practice. In some areas, employers are offering tuition payments, relocation expenses, and one-time, lump-sum payments for initial employment. In fact, working teams composed of all the major professional groups meeting at the "Summit on the Shortage of Clinical Laboratory Personnel" suggested that the societies themselves could improve recruitment of students. Suggestions included: offering educational outreach and mentoring programs to less-well-served areas like inner cities and rural schools, special loan programs, and opportunities for work in laboratories while still in school.
The Bureau of Labor Statistics, which is an arm of the U.S. Department of Labor, projects a 10 to 20 percent increase in the employment of clinical laboratory scientists and technicians through the year 2008. Some journals such as the Jobs Rated Almanac give clinical laboratory science an even higher projected growth rate. The American Society for Clinical Laboratory Science gives starting salaries ranging from $30,000 up to $50,000 annually. The range reflects the difference factors like geographic location will make on how much a new person can expect to earn.
Because employers have to compete for applicants in some areas, those searching for jobs in areas currently experiencing a shortage can demand and receive much higher starting salaries. Of course, educational level impacts starting salaries as well. Table 3 can help clarify some of the career levels possible to attain, based on years and type of education.
Most profession leaders predict rising salaries and an increased demand for services. (Currently most laboratory workers are not unionized.)
Recalling that 75 percent of laboratory personnel are female, experts predict that the number of women in the labor force will increase more than the number of men-already women constitute half of the workforce. As a result the U.S. economy will be more dependent on college-educated women than at any time in the past. Science-based technical fields especially will be more competitive with each other for fewer qualified graduates. That will increase pressures on traditionally female, science-based fields like clinical laboratory science and other allied health professions to make their salaries more attractive.
Even in the best of times, salary levels vary from locale to locale, and even from employer to employer according to regional supply and demand and underlying economic forces. Therefore, the figures included here should be taken only as broad indications of salary levels as presented in the early part of the twenty-first century.
Job Satisfaction
Clinical laboratory science is an extremely rewarding profession for bright, science-oriented individuals who wish to apply a rich, broad-based body of scientific knowledge to health care. Built on a curriculum similar to premedicine or prepharmacy, this field integrates several bioscience disciplines as well as physiology, pathology, and increasingly, computer and management sciences. These factors make a degree in this field an excellent springboard for many career options.
Historically, clinical laboratory professionals have looked to themselves for knowledge of a job well done. Few people within, and fewer outside, the health care system understand their demanding roles in the "control room" of health services delivery. Even those many patients whose lives have been saved by a laboratory professional are unlikely to understand the role that the laboratory has played in their care and recovery
Public awareness of the field is increasing, however. The technological abilities that have made testing for substance abuse a multimillion dollar industry, and the AIDS tragedy, symbolically have brought the laboratory from the depths of the hospital to the public’s living room. Errors in Pap screening that brought about some women's deaths have made front-page news. Today most people understand the risks to themselves of a positive blood alcohol or cocaine test, or the implications of a positive HIV test, the public has come to better realize what laboratorians have done to ensure the safety of the nation’s blood supply. That public has also realized the importance of proper tissue "matching"-performed by laboratory technologists-in tissue and organ transplants (e.g., a blood group 'A' heart cannot be transplanted into a blood group O recipient). It has also become more aware of what laboratory professionals can reveal in genetic diseases (e.g., Downs syndrome), biochemical diseases (e.g., phenylketonuria), or age-associated diseases (e.g., heart attacks in persons with high cholesterol and high LDL-low density lipoprotein-levels).
The international concern over "Mad Cow Disease" (bovine spongiform encephalopathy, or BSE) in the 1980s, and the subsequent collapse of the beef markets in many parts of the world, brought new attention to veterinary testing for animal disease. In 1996 British health officials identified a similar disease in humans and suddenly the world started paying very close attention. The disease was named variant Creutzfeldt-Jacob Disease (vCJD). Eating cattle carrying BSE can lead to vCJD in humans. A very slow moving but lethal disease, vCJD can take from five to ten or even more years to emerge,
At the time of this writing, more than one hundred people in Europe have died from vCJD, and because of the mysterious nature of the disease, it is impossible to clearly predict how many new victims will be claimed. Because this disease, and many others like it, is essentially proteins called prions gone awry, there is currently no test for it. Professional laboratory scientists are working very hard to develop a way to test for this serious disease and its variants in animals and humans around the world. This is just one of many veterinary science issues that directly impact food safety and thus human economic and physical health.
Increasingly, thanks to these examples, the public is learning to appreciate the laboratory professional’s knowledge, skills, and dedication. Clinical laboratory science is an exacting, precise profession. It rewards the abilities of the competent practitioner with the knowledge that his or her skills and persistence have saved lives, cracked a stubborn diagnostic puzzle, prevented a lethal transfusion, or discovered the problem whose solution starts the patient on the road to recovery.
The practice of clinical laboratory science brings unique satisfactions. Clinical laboratory scientists are health care investigators who journey to the center of life and see its many mysteries up close. Those who work in large medical center and research laboratories are responsible for utilizing millions of dollars worth of state-of-the-art technology and have the opportunity to work with procedures, techniques, and tools at the forefront of basic and clinical research. This is due to the increasing applicability of advances in molecular biology, electronics, laser technologies, biosensors, and other fields that make the clinical laboratory one of the first arenas for new "soft" and "hard" technologies.
Wherever they work, the skills of laboratory practitioners are required in situations ranging from the long-term discovery of a new test to diagnose a certain disease, to the fast-paced, life-and-death intensity of the emergency room and operating theater. Laboratorians are among the few health care professionals to witness and experience the challenge of the entire range of human disorders, as well as the joys of the full health potential of humans. Medical diagnosis and good health care depend on the clinical laboratory professional’s skills, knowledge, judgment, and integrity. Because it is essential to the mission of the physician, nurse, pharmacist, physical or respiratory therapist, or other member of the health care team, laboratory science can be an extremely demanding field. Much of the laboratory practitioners’ work must be done quickly, and all of it must be accurate. There is no margin for error because mistakes in the laboratory may mean inappropriate medical care, an ensuing serious or debilitating condition, and even death.
Like any other, this profession has some less attractive aspects that have to be balanced with its advantages. Within clinical practice, opportunities for advancement are somewhat modest; as in any hierarchy, there are fewer senior- than entry-level positions. Also, although the rich diversity in the professions knowledge base permits numerous career paths, there may be employment limitations if one wishes to, for example, practice in a certain sought-out geographic area, work days only, or take ten years off to raise a family. Stress, too, is an occupational hazard for professionals in clinical practice. Demands for accurate and timely results come not only from attending physicians and nurses, but also from managers oriented to the bottom line who stress that "time is money."
Image is an issue. Because the public is less aware of this profession than of other health care fields, laboratory practitioners get less credit than they deserve. (Who sends flowers to the immuno-hematology professional providing safe and compatible blood for a newborn during an exchange transfusion?)
Finally, although salaries are rising, and while benefits and other incentives are also improving; many practitioners believe that clinical laboratory salaries lag somewhat behind those of other health care professions such as physical therapists. Reasons often cited include the profession's low public profile; carryover practices permitting entrance into the field via nontraditional routes, such as on-the-job training; blurred job descriptions; and intra-professional disagreements about personnel standards and job descriptions that ultimately make negotiations with health care administrators and other employers difficult.
Certainly one factor not unique to clinical laboratory science is that the majority of its practitioners are women. According to the Institute of Medicine's Allied Health Services: Avoiding Crises, "compensation for the allied health professions should be understood in the context of women's earnings, because women (predominate in) many allied health fields. Occupations in which women represent the majority of workers tend to rank lower in terms of earnings than male dominated occupations." However, recent studies show that the gender gap in earnings is steadily closing.
Although almost everywhere, experts agree, starting salaries are reasonably strong, the Institute of Medicine (lOM) further claims that "increases in earnings over the length of a career are substantially lower in allied health fields than in (selected) other occupations." This "salary compression" is among the issues that employers must address for all allied health professions and for nursing and laboratory science in particular, in order to attract new recruits and prevent experienced and competent professionals from leaving the field.
Summary
Clinical laboratory science represents exciting opportunities for individuals who are interested in science, technology, and helping humankind. Those in the field who enjoy their work state these reasons for job satisfaction:
- pride in the profession and what it brings to health care
- sense of accomplishment in work that is done well
- the nature of the work: challenging, interesting, requiring reasoning and excellent judgment
- use of cutting-edge biotechnologies
- use of problem-solving abilities
- a team effort and esprit de corps among co-workers
- interaction with other health providers
- recognition for being a professional
- a sense of being essential in the detection, diagnosis, monitoring, and cure of disease
- a sense of independence, with httle supervision needed
- good and varied employment opportunities following graduation and thereafter
