The estimated number of laboratory personnel in the United States currently is at least 400,000 (see Table 6). Baccalaureate-level clinical laboratory scientists comprise a majority of the staffs of clinical laboratories in traditional health care settings.
In order to define the major players and their jobs in clinical lab oratories, the following summary descriptions are provided. These summaries are taken in part from the 2001-2002 edition of the Health Professions Career and Education Directory published by the American Medical Association, 515 North State Street, Chicago, IL 60610, and Figure 2 also provides an overview of the routes to various laboratory careers.
Kinds of Laboratory Personnel
Pathologist
Job Description
The majority of laboratory directors in the United States are pathologists, i.e., physicians with advanced training in the study of the nature, structure, and functional changes produced by diseases. There are two branches of pathology: anatomic pathology
AP and clinical pathology (CP): Anatomic pathologists are those physician specialists who examine tissues from biopsies, surgeries, and autopsies both "macroscopically" (by eye) and microscopically. They determine whether the tissues are normal, infected, malignant, inflammatory, necrotic, or with other cellular changes. Pathologists may advise other physicians whether and how to treat those patients whose tissues they have examined.
The other branch of pathology is clinical pathology, sometimes called laboratory medicine. Clinical pathologists are responsible for directing the clinical laboratory or its sections and providing consultation to other physicians regarding test selection, interpretation of results, and diseases associated with various laboratory values. Clinical pathologists head research and development (R & D) efforts concerning new tests, methodologies, and instrumentation; they also teach residents, fellows, and other students. Salaries of pathologists vary. When in a residency program, their income is about $30,000 per year, and once in practice, salaries are usually in excess of $150,000 per year.
Employment Characteristics
Most pathologists are employed in hospital and medical center lab oratories. Others are employed in private laboratories, large clinics or HMOs, forensic laboratories, and industry.
Educational Programs
To become a pathologist (anatomic or clinical) requires graduation from medical school plus a five-year residency program. Thus the usual number of years of schooling totals thirteen; four years in pre-medicine, four years of medical school, and five years in a residency program. Following this, most pathologists take a certification exam provided by the American Board of Pathology to certify them as "AP" or "CP" Some pathologists may choose to further their inquiry into a pathology subspecialty such as hemato-pathology or chemical pathology. In these cases, a one- or two-year fellowship is completed following the residency training, making the total educational experience fourteen or fifteen years.
Clinical Laboratory Scientist (Medical Technologist)
Clinical laboratory professionals (scientists educated at the baccalaureate level) perform analytic tests in clinical chemistry, micro-biology, hematology, immunology, and other biological sciences. They provide data on blood, tissues, and fluids in the human body by using basic procedures as well as those requiring sophisticated instruments and complicated methodologies.
Job Description
Clinical laboratory scientists (technologists) perform many and varied analyses and use fine line discrimination in determining the correctness of results. They are able to recognize the interdependency of tests and have knowledge of physiologic and pathologic conditions affecting results in order to validate them. In most health care settings, they develop data that are used by physicians in determining the presence, extent, and, as far as possible, the causes of disease.
Clinical laboratory scientists assume responsibility for, and are held accountable for, accurate and timely results. They establish and monitor quality control programs and design or modify procedures as necessary.
Tests and procedures are performed or supervised by laboratory technologists in the clinical laboratory center in the major areas of hematology, coagulation, microbiology, immune-hematology, immunology, clinical chemistry, and urinalysis. Subspecialty areas in which laboratorians work include such fields as molecular diagnostics, cytogenetics, fertility testing, flow cytometry, tissue typing, bone and skin banks, forensics, infection control, and others.
Employment Characteristics
The majority of clinical laboratory scientists are employed in hospital laboratories. Others are employed in commercial laboratories and clinics; HMOs; in the armed forces; in city, state, and federal health agencies; in industrial medical laboratories; in pharmaceutical houses; in public and private research programs; and as faculty of programs educating medical laboratory personnel. Salaries vary depending on the employer and geographic location. According to a 1999 survey published in Laboratory Medicine, the average entry-level salary for clinical laboratory scientists was $29,000, and the average manager’s salary was $54,000.
The job market for baccalaureate-level laboratory technologists is more competitive, but it is projected to be good through the year 2006. More and more employers are realizing the importance of their backgrounds, scientific and technical skills, and sound judgment, together with their flexibility in being able to work in more than just one area.
Educational Programs
Clinical laboratory scientists (technologists) are graduates of baccalaureate programs that include a pre-professional component of two to four years and a professional component of one to two years. In colleges and universities that offer the pre-professional curriculum, but are not themselves accredited in laboratory science, students usually complete three years of school in a curriculum that is close to that of a premedical student or pre-pharmacy student. Prerequisite courses include general chemistry, general biology, organic and/or biochemistry, mathematics, microbiology, immunology, and perhaps computer science. Optional courses may include physics and statistics. Students then spend one year in an accredited "school" of medical technology, usually located in a hospital. This is often called a 3 + 1 program. In the final one-year portion, instruction and laboratory experiences are provided in the major laboratory areas.
In California the majority of medical technology programs are of the 4 + 1 model: 4 years in college and including a baccalaureate degree, followed by a 1-year clinical internship.
In colleges, universities, and medical centers that are themselves accredited in clinical laboratory science or medical technology, students usually spend two years in a pre-professional program and two years in a professional program. The first two years are spent in completing prerequisites in general chemistry, general biology, organic chemistry, mathematics, and microbiology. Again, the curriculum resembles that of a premedical or pre-pharmacy student.
During the third year, students complete course work in immunology, anatomy, and physiology and may begin taking preclinical (introductory) laboratory courses in clinical chemistry, hematology, microbiology, and immuno-hematology. These introductory courses are usually conducted in student laboratories. Further courses in patho-physiology, management, and education may be provided, and in the final (fourth) year the actual hospital experience is shortened, for example, to fifteen to thirty weeks. In this 2 + 2 model, students start their laboratory work in year three, and the pre-professional and professional course work is integrated. This type of program is usually found in academic health science centers and medical schools.
Upon meeting specified qualifications and passing a national certification examination, these laboratory scientists (technologists) may be certified by one or more voluntary certifying agencies as "generalists," those who can perform in all of the major areas of clinical laboratories. Individuals are usually certified by the National Credentialing Agency for Laboratory Personnel (NCA) or the Board of Registry of the American Society of Clinical Pathologists (ASCP).
Cytotechnologist
Cytology is the study of the structure and the function of cells; Cytotechnologists are trained laboratory technologists who work with pathologists to detect changes in body cells that are important in the early diagnosis of cancer. Their work is done primarily with the microscope, and they screen slide preparations of body cells for abnormalities in structure, indicating either benign (non cancerous) or malignant (cancerous) conditions.
Job Description
Using special techniques, cytotechnologists prepare cellular samples for study under the microscope and assist in the diagnosis of disease by the examination of these samples. Cell specimens may be obtained from various body sites, such as the female reproductive tract (Pap smears), the oral cavity, the lung, or anybody cavity shedding cells. Examination is made of abdominal fluids, thoracic fluids, central nervous system fluids, urine, sputum, and cells obtained by brushing the surfaces of various organs. Using the findings of cytotechnologists, the physician is able, in many instances, to diagnose cancer long before it can be detected by other methods. Cytologic techniques also are used to detect diseases involving hormonal abnormalities and other pathological disease processes. In recent years fine needle aspirations have been used to locate and identify tumors deeply seated in the body.
Employment Characteristics
Most cytotechnologists work in hospitals or in private laboratories, while others prefer to work on research projects or to teach. Employment opportunities are excellent, as the demand for trained cytotechnologists is high and is projected to remain high.
According to the "ASCP Salary Survey," published in the CP Journal of Cytotechnology (vol. 2, no. 3, 1997), the average hourly pay for cytotechnologists was $21.06 in 1997.
Educational Programs
The length of the cytotechnology program depends significantly on its organizational structure. In general, after completion of three years of prerequisite course work, at least one calendar year of structured professional instruction in cytotechnology is necessary to establish entry-level competencies,
Applicants should be well grounded in the biological sciences and in basic chemistry. This usually entails successful completion of at least twenty semester (thirty quarter) hours in the biological sciences, chemistry courses equaling or exceeding eight semester hours, and some mathematics.
The curriculum includes the historical background of cytology, cytology as applied in clinical medicine, cytology in the screening of exfoliate tumor cells, and areas of anatomy, histology, embryology, cytochemistry, cytophysiology, endocrinology, and inflammatory diseases.
Like in medical technology, some schools provide 2 + 2 curricula in cytotechnology, once again providing preclinical cytology courses in year three, and offering in-depth instruction in cell identification and fine needle biopsy examination.
Medical (Clinical) Laboratory Technician
Medical laboratory technicians (associate or certificate) perform many standardized procedures in the clinical laboratory under the direction of a qualified physician and/or clinical laboratory scientist.
Job Description
Medical laboratory technicians perform routine, uncomplicated procedures in the areas of hematology, serology, blood banking, urinalysis, microbiology, and clinical chemistry. These procedures involve the use of common laboratory instruments in processes where discrimination is clear, errors are few and easily corrected, and results of the procedures can be confirmed with a reference test or source within the working area. The technician has knowledge of specific techniques and instruments and is able to recognize factors that directly affect procedures and results. The technician also monitors quality control programs that have pre determined parameters,
Employment Characteristics
Some clinical laboratory technicians (CLTs) work in hospital lab oratories, averaging a forty-hour week; many more technicians work in HMOs, clinics, and physician office laboratories. Based on a 1999 survey published in Laboratory Medicincy the average entry-level salary was $22,000, and the average salary of technicians was $27,000 per year.
Educational Programs
Clinical laboratory technicians have two routes to choose in completing a CLT program. The first is the certificate program, which is usually twelve to fifteen months in length and often located at a vocational or technical institute or college. Here the curriculum includes areas of medical ethics and conduct, medical terminology, basic laboratory solutions and media, basic elements of quality control, blood collecting techniques, basic microbiology, hematology, serology, and immune-hematology. A clinical practicum in a hospital or clinic laboratory concludes the certificate program.
The second route to becoming a clinical laboratory technician involves completion of an associate degree (CLT-AD) usually at a junior or community college. The period of education is usually two academic years. Courses are taught on campus and in affiliated hospital(s). The teaching laboratory on campus focuses on general knowledge and basic skills, understanding principles, and mastering procedures of laboratory testing. The clinical (hospital) courses include application of basic principles commonly used in the diagnostic laboratory. Technical instruction includes procedures in hematology, chemistry, microbiology, immuno-hematology, and immunology.
If one is planning to become a laboratory technician first and then take additional course work to become a medical technologist, it is recommended that the associate-level route be chosen. It may be difficult to transfer credits from a vocational or technical school to a college or university, whereas transfer of credits from a community or junior college can more easily be accomplished.
In addition, due to regulations specified by the Clinical Laboratory Improvement Act of 1988, only associate-level CLTs may perform highly complex laboratory tasks. Thus, some certificate-level programs are converting to associate degree programs, or they are closing.
The "medical laboratory technician" title may also be designated for those who have graduated as Medical Laboratory Specialists in the armed forces (see Chapter 8).
Specialist in Blood Bank Technology
Job Description
Specialists in blood bank technology (SBB) demonstrate a superior level of technical proficiency and problem-solving ability in such areas as: (1) testing for blood group antigens, compatibility, and anti body identification; (2) investigating abnormalities such as hemolytic disease of the newborn, hemolytic anemia’s, and adverse responses to transfusion; (3) supporting physicians in transfusion therapy, including patients with coagulopathies or candidates for homologous organ transplant; (4) blood collection and processing, including selecting donors, drawing and typing blood, and performing pre-transfusion tests to ensure the safety of the patient. Supervision, management, and/or teaching comprise a considerable part of the responsibilities of the specialist in blood bank technology.
Employment Characteristics
Specialists in blood banking work in many types of facilities, including community blood centers, hospital blood banks, university affiliated blood banks, transfusion services, and independent laboratories. They also may be a part of a university faculty. Qualified specialists may advance to supervisory or administrative positions, or move into teaching or research activities.
According to the American Medical Associations 2000-2001 edition of the Health Professions Career and Education Directory, entry-level salaries for blood banking specialists average between $32,000 and $42,000 per year.
Educational Programs
The minimum length of the SBB educational program is twelve consecutive months. Applicants must be certified in clinical laboratory science/medical technology and hold a baccalaureate degree from a regionally accredited college or university. If applicants are not certified in clinical laboratory science, they must possess a baccalaureate degree from a regionally accredited college or university with a major in one of the biological or physical sciences.
Each SBB educational program defines its own criteria for measurement of student achievement. The sequence of instruction meets the standards of the medical director and program director. The educational model and environment are designed to develop competence in all technical areas of the modern blood bank and transfusion services.
Nuclear Medicine Technologist
Nuclear medicine is the medical specialty that utilizes the nuclear properties of radioactive and stable nuclides to make diagnostic evaluations of the anatomic or physiologic conditions of the body and to provide therapy with unsealed radioactive sources.
Job Description
Nuclear medicine technologists (NMTs) perform in vivo and in vitro diagnostic procedures and utilize quality control techniques as part of a quality assurance program covering all procedures and products in the laboratory. They also apply their knowledge of radiation physics and safety regulations to limit radiation expo sure, prepare and administer radiopharmaceuticals, and use radiation detection devices and other kinds of laboratory equipment that measure the quantity and distribution of radionuclides deposited in the patient or in a patient specimen.
Administrative functions may include supervising other nuclear medicine technologists, students, laboratory assistants, and various personnel; participating in ordering supplies and equipment; documenting laboratory operations; participating in departmental inspections conducted by various licensing, regulatory, and accrediting agencies; and scheduling patient examinations.
Employment Characteristics
The employment outlook in nuclear medicine technology is good. Opportunities may be found both in major medical centers and in smaller hospitals and independent imaging centers. Opportunities are also available for obtaining positions in clinical research, education, and administration.
According to a survey of the American Society of Radiologic Technologists, a staff nuclear medicine technologist averaged $45,000 each year and an administrator made $55,000 per year.
Educational Programs
The technical portion of a nuclear medicine program is one year in length. Institutions offering accredited programs may provide an integrated educational sequence leading to an associate or baccalaureate degree over a period of two or four years.
The curriculum includes patient care, nuclear physics, instrumentation and statistics, health physics, biochemistry, immunology, radio-pharmacology, administration, radiation biology, clinical nuclear medicine, radionuclide therapy, and computer applications.
Histology Technician/Technologist
The responsibility of the histologic technician/technologist is to prepare sections of body tissue for examination by a pathologist.
This includes the preparation of tissue specimens of human and animal origin for diagnostic, research, or teaching purposes.
Job Description
Histotechnicians and histotechnologists process sections of body tissue by fixation, dehydration, embedding, sectioning, decalcification, micro-incineration, mounting, and routine and special staining. Histotechnologists are trained to perform all the functions of the histotechnician and in addition perform the more complex procedures for processing tissues. They identify tissue structures, cell components, and their staining characteristics and relate them to physiological functions; implement and test new techniques and procedures; make judgments concerning the results of quality control measures; and institute proper procedures to maintain accuracy and precision. Histotechnologists apply management and supervision principles when they function as supervisors and educational principles when they teach and supervise students.
Employment Characteristics
Most histologic technicians/technologists work in hospital and medical center laboratories, averaging a forty-hour week. The median entry-level salary for histologic technologists is about $25,000 per year.
Educational Program
For histotechnicians, the program is twelve months. For the histotechnologist, a baccalaureate degree program of four years is required. This curriculum includes both instruction and practical experience in medical ethics, medical terminology, chemistry, anatomy, histology, histochemistry, quality control, instrumentation, microscopy, processing techniques, preparation of museum specimens, and record and administration procedures,
For the histologic technician level, the curriculum should be an integral part of a community college program culminating in an associate degree, and with courses including chemistry, biology, and mathematics. The baccalaureate-level program includes course work designed to prepare researchers, supervisors, and instructors with advanced capabilities.
Clinical Laboratory Specialist in Cytogenetics'
Cytogenetics is the study of heredity at the cellular level. Chromosomes, the condensed form of genetic material, are visible only during cell division. The standard representation of a single cells chromosome, paired and arranged in order and size, is called a "karyotype." By comparing the chromosomes from a sample of blood, fibroblasts, bone marrow, amniocytes, or other tissue to a standard pattern, the cytogenetic technologist establishes a karyotype and determines a cytogenetic diagnosis. This diagnosis is crucial for patient care and also may provide an indication that genetic counseling is required for family members.
Job Description
Clinical cytogenetics is the specialty devoted to the study of relationships among human diseases and chromosome alterations. At birth, chromosome changes can cause mental retardation and physical deformities. An example is Down's syndrome, in which an individual has an extra number 21 chromosome in each of his/her cells.
Other chromosome changes, such as those found in the bone mar row cells of patients with leukemia, are acquired later in life and are found only in cells that are involved in the disease. An increasing number of diseases are being recognized as having a genetic component. Cytogenetic technologies therefore perform the tests that are essential for the diagnosis and treatment of chromosomal disorders.
Molecular biology uses a rapidly expanding group of technologies to explore the relationships among chromosomes, genes, and DNA. These areas include molecular biology, recombinant DNA and gene mapping techniques, gene product studies, and detection of gene rearrangements. Diseases diagnosed by molecular biology include cystic fibrosis, Duchene's muscular dystrophy, Huntingtons disease, and myotonic dystrophy. Specific kinds of techniques include the polymerase chain reaction (PGR); Western, Northern, and Southern blots; heteroduplexing; and others. Technologists in this field use these tools to identify and localize the genes related to specific diseases in anticipation of possible treatments and even cures for some genetic disorders.
Employment Characteristics
Most cytogenetic technologists work in medical centers and academic health centers, averaging a forty-hour week. Entry-level salaries vary, but average $30,000 per year. A recent Web search showed some employers posting $1,000 signing bonuses. Competition for qualified personnel is very strong.
Educational Program
Entry into the field of cytogenetic technology requires a baccalaureate degree in clinical laboratory science/medical technology or in the biological sciences such as genetics, cytogenetic technology, or biology, as well as clinical experience, preferably with formal cytogenetic technology training.
Course work usually involves three to six months of formal course work including lecture and laboratory courses in medical cytogenetics, photography, and cytopreparatory techniques, followed by a six-month clinical internship.
Certification is accomplished by the National Credentialing Agency (NCA) as a Clinical Laboratory Specialist in Cytogenetics, or by the Canadian Society of Laboratory Technologists as a Registered Technologist in Cytogenetics. These credentials are internationally recognized standards of competence in the field.
Phlebotomist
Phlebotomists are those individuals who draw blood by venipuncture or micropuncture from patients for the purpose of chemical or cellular analysis. Most blood is obtained by venipuncture (blood withdrawn from a vein, usually in the arm), although tiny amounts of capillary blood from fingers or babies' heels can be used. In the past many phlebotomists were trained on the job (OJTs); now, short courses of four to ten weeks are provided in hospitals, community colleges, or technical and vocational schools.
Many phlebotomists work in hospitals, but others work in large clinics and HMOs. Often phlebotomists are the laboratory personnel who convey to patients the image of the laboratory; therefore it is important that they be highly professional in appearance and manner.
In 2000, entry-level phlebotomist salaries averaged $8.10 per hour ($16,000 annually), and the average salary for a phlebotomist was $11.80 per hour or $24,000 annually.
A high school diploma or equivalent is usually required to complete a phlebotomy program. Course work and/or training includes basic anatomy and physiology; medical terminology; specimen collection; anticoagulants; patient preparation; techniques; equipment; specimen processing and handling (specimen types, labeling, transport, and storage); safety; quality control; infection control; interpersonal relations; and professional ethics.
Generally a phlebotomy program includes at least 40 hours of didactic training followed by 120 clinical hours with a minimum performance of 100 successful venipunctures, 25 successful skin punctures, observation of 5 arterial punctures, and 8 hours of orientation in a full service laboratory.
Other Specialists
In addition to the previously mentioned laboratory personnel, there are other scientists and specialists who work in laboratories. These include clinical chemists, microbiologists, immunologists, and pathobiologists (Ph.D. level); masters-level personnel in these areas; and other specialists. These individuals are responsible for administering a laboratory section, performing research, and teaching. They may be clinical laboratory scientists with advanced degrees, or they may have biology, chemistry, or microbiology backgrounds with specialized training and education. They usually are employed in large hospitals, medical centers, and universities. Entry-level salaries vary by degree and experience, but may begin at $32,000 to $40,000 per year.
Others employed in laboratories include specialists who have advanced by way of holding a clinical laboratory science baccalaureate degree, with additional course work and experience. This group includes specialists in hematology, coagulation, chemistry, microbiology, immuno-hematology (blood banking), or immunology.
Other specialists are those who work in much defined areas such as molecular diagnostics, flow cytometry, cardiac catheterization, pulmonary function, and the like. They often receive their expertise by learning on the job following completion of a baccalaureate degree in clinical laboratory science. (See Chapter 4)
Yet another group, whose name is similar but whose educational preparation is different from cyto or histotechnologists, is the histocompatibility technologist employed in organ donor and transplant centers. This individual determines maximum odds for transplanting donor tissues or organs successfully to recipients in need of skin, kidney, heart, lung, liver, pancreas, or other tissues and organs.
Practitioner Attributes
The following personal qualifications are similar for all practitioners in laboratory science. Additional aptitudes and abilities may be required for administrators, teachers, or researchers.
Intellectual Requirements
This science-based, investigative profession of laboratory science requires intelligence and sound problem-solving abilities. Interest and aptitude in science are essential, and competence in biology, mathematics, and basic chemistry are necessary. For the typical baccalaureate-level graduate, a clinical laboratory science major requires successful completion of courses in biology, anatomy, physiology, biochemistry, microbiology, and pathophysiology.
For supervisors, managers, and directors, requirements often include business and economics. Demands for cost containment and productivity and increased computerization have added human and fiscal management, computer science, and marketing to the knowledge base for laboratory administrators. And as health care competition and technology, together with new opportunities, extend the laboratory’s reach beyond the hospital to very diverse care settings, good communications and interactive skills are essential.
Emotional Requirements
Clinical laboratory practitioners perform exacting laboratory procedures under considerable pressure; life-and-death situations join productivity demands to escalate the pressures under which they perform. Practitioners also must have an extremely high level of integrity and personal responsibility; patients’ lives depend on their commitment to provide the highest quality of service.
Additional Requirements for Successful Practice
Recent accreditation standards by the National Accrediting Agency for Clinical Laboratory Sciences require that prospective students understand the "essential functions" required for a laboratory professional. Examples of some of these functions follow:
- Communication Skills: Must be able to communicate effectively in written and spoken English; comprehend and respond to both formal and colloquial English-person-to-person, by telephone, and in writing; and assess nonverbal as well as verbal communication.
- Locomotion: Must be able to move freely from one location to another in physical settings such as the clinical laboratory, patient areas, corridors, and elevators.
- Small Motor Skills: Must have sufficient eye-motor coordination to allow delicate manipulations of specimens, instruments, and tools; must be able to grasp and release small objects (test tubes, microscope slides); twist and turn dials/knobs (for a microscope, balance, spectrophotometer); and manipulate other laboratory materials (reagents and pipettes) in order to complete tasks,
- Other Physical Requirements: Must have the ability to lift and move objects of at least twenty pounds and have a sense of touch and temperature discrimination.
- Visual Acuity: Must be able to identify and distinguish objects macroscopically and microscopically and read charts, graphs, and instrument scales.
- Safety: Must be able to work safely with potential chemical, radiologic, and biologic hazards (to include the use of universal precautions) and to follow prescribed guidelines for working with potential mechanical or electrical hazards.
- Professional Skills: Must be able to follow directions and work independently and with others and under time constraints; prioritize requests and work concurrently on at least two different tasks; and maintain alertness and concentration during a normal work period.
- Stability: Must possess the psychological health required for full utilization of abilities and be able to recognize emergency situations and take appropriate actions.
- Affective (Valuing) Skills: Must show respect for self and others and project an image of professionalism, including appearance, dress, and confidence.
- Application Skills: Must be able to apply knowledge, skills, and values learned from previous course work and life experiences to new situations.
