Laboratory careers are sort of a hidden profession,” says Louann Lawrence, DrPH, head of the department of clinical laboratory sciences at Louisiana State University Health Sciences Center in New Orleans (currently based in Baton Rouge). Many lab professionals would agree.

Sciences are not emphasized as much as they once were in early education, and students gravitate toward the high-profile, high-paying industries, such as technology. With a few exceptions, such as phlebotomists, patients don’t often see laboratory professionals—not even on television, where physicians are often the ones shown performing tests. As a result, the industry lacks the students and funds needed to support the work.

That lack of support is particularly evident in laboratory-educational programs. If programs happen to have enough students interested, they often do not have the funds or hospital labs with which to properly train students. Claudia Steen, program director of the Yakima Regional CLS Program (Yakima, Wash), has been teaching for 28 years, and she worked in the field for about 10 years before that. “Back then, there were over 600 CLS programs. Now, there are only about 200,” she says.

CSI? How About CLS?
The National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) in Chicago currently lists 226 accredited CLS/MT programs and 200 CLT/MLT programs. “Every NAACLS-approved program has prerequisite courses,” Steen says, noting that they are heavy in the sciences. Most commonly, CLS-level professionals require a bachelor’s degree and CLTs require an associate’s degree.

“But many students don’t know there are bachelor’s-level professionals in the laboratories performing tests,” Lawrence says. They are just not very visible.

 Even in medical school, clinical pathology (CP) does not get much attention. “CP is in the rotation to some degree, but when I ask students about their previous exposure, most say it’s been very little,” says Ann M Gronowski, PhD, associate professor at Washington University School of Medicine in St Louis, and associate medical director at affiliated Barnes-Jewish Hospital. As a result, postdoctoral and residency training programs also suffer from a lack of students.

To alleviate this, the industry needs to increase its visibility, which can be a challenge since professionals are often tucked into a lab. “We need to publicize the laboratory professions more in general so they are known as one of the allied health professions. No one is promoting the lab professions,” Lawrence says.

Nurses, physical therapists, and others on the patient floor get a lot of visibility. “CSI has helped a little bit. Students see the scientists working in the labs,” Lawrence says. She has received more calls related to students interested in forensic science since the shows began airing. But that hasn’t helped clinical lab recruitment as much.

“There is no television show about clinical laboratory professionals,” Lawrence says, noting that even on medical shows, the physicians are often shown performing the tests. And while point-of-care testing is a new trend, it is certainly not the case that physicians are performing these tests as often as television watchers might think.

 Awareness will increase slowly, and only after the profession has organized the publicity. Gronowski, who works with upper-level students and professionals (that is, those seeking doctoral and medical degrees), suggests that individual institutions can increase exposure on their own, with a greater focus on clinical pathology during rotations.

Associations can also undertake efforts. Gronowski notes that the American Association for Clinical Chemistry (AACC) has started a program through its Society for Young Clinical Laboratorians (SYCL) that sends these professionals back to the institutions from which they graduated to give presentations and stimulate interest in the field.

Even if students have an idea about the lab, they do not realize the requirements. “Many science students graduate but aren’t qualified to work in a lab,” Lawrence says.

Staying Current
Steen could not agree more. The Yakima Regional CLS Program recommends an overall GPA of 2.5, with a 2.7 in science coursework. Prerequisites include: general chemistry; organic and/or biochemistry; quantitative analysis; biological science, which includes general biology and bacteriology or microbiology; and immunology. Recommended coursework includes medical microbiology; parasitology; anatomy and physiology; virology; genetics; molecular biotechnology; hematology; college-level mathematics; statistics; computer science; and instrumentation or basic electronics, such as physics.

Steen has found that even students who have completed these courses are often still not prepared. “They don’t know the material when they arrive, so we may still have to teach them the rudiments,” she says.

Laboratory-professional programs aim to teach students so that they can walk into a lab and function with a minimal amount of orientation. “Our students shouldn’t require any on-the-job training, just orientation,” Lawrence says.

To achieve this, programs stay in touch with working professionals to keep their curriculums updated. “NCA [the National Credentialing Agency for Laboratory Personnel Inc in Lenexa, KS] does a job analysis every 5 years to find out which new tests are being performed in the lab. Using a national survey, the organization determines what should be dropped from the content outline and what should be added according to the people actually practicing,” Lawrence says.

 “There is so much information to learn, and it’s challenging to determine what to include in a program, how much to put in, how to test it, and how to evaluate whether the material is training students properly for the field,” Gronowski says. She notes that higher-level programs also stay in touch with current professionals to keep curriculums and certifying exams current.

Many programs train students with a generalist approach, enabling them to work in any lab—chemistry, hematology, microbiology, blood bank, etc. “Students may not know where they are going to end up, and the lines between labs are blurring,” Gronowski says.

So programs provide broad exposure, not just in the sciences and lab specialties but also in people skills. “Our clinical affiliates are not concerned as much about management skills as they are about communication, writing, and presentation skills,” Lawrence says.

Getting a Fair Share
But education does not come cheap. “If a class in a typical university has one professor and 30 to 35 students, the tuition pays for the class. But in the clinical setting, the class size is smaller — teaching is often done one on one — so tuition never covers the costs,” Steen says, noting that her program trains eight students per year.

Laboratory-education programs are also expensive because they re-create laboratories, meaning equipment, reagents, and other supplies must be stocked, according to Lawrence.

Funding issues affect the programs at all levels—students need money to pay tuition, programs need money to pay instructors and provide materials, and affiliated clinical labs need money to train students. And without visibility, funds are difficult to procure.

“Nursing has many more opportunities for scholarships and grants,” Lawrence says. Even within the hospital, nurses have lobbied more successfully for money — their salaries are higher, and their plight is well understood. Labs have the same staffing shortages and significant educational requirements, but not the same support.

Gronowski notes that SYCL’s efforts have increased the number of applicants to postdoctoral clinical chemistry programs that are accredited by the Commission on Accreditation in Clinical Chemistry (ComACC), but these programs require additional resources for the additional trainees.

Hospital budget crunches have also affected laboratory education. Accredited programs require clinical work so they need a hospital affiliate in which students can complete practicums or internships, but these affiliates have been forced to close their doors to students due to lack of resources.

“Due to their own personnel shortages, hospital lab don’t have enough staff to be able to spare someone to train others,” Lawrence says. She adds that the program through Louisiana State University Health Sciences Center had to turn away students because there were no hospital labs in which to place them.

Again, nursing programs have been able to secure hospital funds, whereas the laboratories have not — and that goes for salaries as well. “This generation pays more attention to income, and laboratory salaries are not high enough,” Lawrence says—particularly when one considers the intense coursework and time involved. On the other side, Lawrence notes that the shortage of professionals creates lots of opportunity for job placement and growth.

Wanted: Lab Professionals
The shortage also means, however, that some hospitals, in states where they can do so, may hire degreed but uncredentialed staff to work in their labs, training these employees on the job. While this may help to solve an immediate problem, Lawrence wonders about the long-term effects. These professionals are trained in one area and lack the broad knowledge of certified laboratorians.

Hospitals also balance the staff differently than they might otherwise do if resources were not an issue. “Often, a lab has one CLS in charge, with the rest of the staff holding CLT certifications,” Steen says. Sometimes, the CLS is available only by phone, meaning that a lesser-qualified individual is left judging when to call.

The fact that there are two credentialing bodies adds to the confusion, according to Lawrence. Currently, both the American Society for Clinical Pathology (ASCP) and the NCA offer certification and, until now, have been competing. “Both use different credentials, and it’s confusing to outsiders,” Lawrence says. However, the two organizations are beginning to talk about the creation of one exam.

One main exam will benefit the profession, as would other unified efforts. A larger voice can gain the respect and attention needed for students and funds — taking the laboratory professions out of hiding.

Renee DiIulio is a contributing writer for Clinical Lab Products.

Where Do CLSs Come From?
The National Accrediting Agency for Clinical Laboratory Sciences (NAACLS of Chicago) lists 226 accredited programs for CLS/MTs. Here they are, organized by state. Further information can be found on the Web sites of NAACLS or the individual programs. The programs are:

University of Alaska, Anchorage, Alaska
University of Alabama at Birmingham, Ala
University of South Alabama, Mobile, Ala
Auburn University at Montgomery, Montgomery, Ala
Baptist Medical Center South, Montgomery, Ala
Tuskegee University, Tuskegee, Ala
Baptist Health, Little Rock, Ark
University of Arkansas for Medical Sciences, Little Rock, Ark
Arkansas State University, State University, Ark
Arizona State University, Tempe, Ariz
California State University, Dominguez Hills, Carson, Calif
Loma Linda University, Loma Linda, Calif
University of California Irvine Medical Center, Orange, Calif
Eisenhower Medical Center, Rancho Mirage, Calif
University of California Davis Health System, Sacramento, Calif
San Francisco State University, San Francisco, Calif
San Jose State University, San Jose, Calif
Santa Barbara Cottage Hospital, Santa Barbara, Calif
Centura Penrose Saint Francis Health Service, Colorado Springs, Colo
HealthONE Alliance, Denver, Colo
Parkview Medical Center, Pueblo, Colo
Danbury Hospital, Danbury, Conn
Hartford Hospital, Hartford, Conn
University of Hartford, West Hartford, Conn
George Washington University Medical Center, Washington, DC
Howard University, Washington, DC
Walter Reed Army Medical Center, Washington, DC
Washington Hospital Center, Washington, DC
University of Delaware—Christiana Care Health Services, Newark, Del
Saint Vincent’s Medical Center, Jacksonville, Fla
Shands Jacksonville Medical Center, Jacksonville, Fla
Florida Hospital, Orlando, Fla
University of Central Florida, Orlando, Fla
University of West Florida, Pensacola, Fla
Bayfront Medical Center, St. Petersburg, Fla
Tampa General Hospital, Tampa, Fla
Medical College of Georgia, Augusta, Ga
Armstrong Atlantic State University, Savannah, Ga
University of Hawaii at Manoa, Honolulu, Hawaii
Saint Luke’s Hospital, Cedar Rapids, Iowa
Mercy Medical Center, Des Moines, Iowa
University of Iowa Hospitals and Clinics, Iowa City, Iowa
Mercy Medical Center—Sioux City, Sioux City, Iowa
St Luke’s College Medical Technology Program, Sioux City, Iowa
Idaho State University, Pocatello, Idaho
Saint Elizabeth’s Hospital, Belleville, Ill
Rush University Medical Center, Chicago, Ill
Northern Illinois University, DeKalb, Ill
Evanston Northwestern Healthcare—Evanston Hospital, Evanston, Ill
Edward Hines, Jr, Veterans Affairs Hospital, Hines, Ill
Illinois State University, Normal, Ill
Rosalind Franklin University of Medicine and Science, North Chicago, Ill
OSF Saint Francis Medical Center, Peoria, Ill
OSF Saint Anthony Medical Center, Rockford, Ill
Saint John’s Hospital, Springfield, Ill
University of Illinois at Springfield, Springfield, Ill
Saint Francis Hospital and Health Centers, Beech Grove, Ind
Parkview Hospital, Fort Wayne, Ind
Saint Margaret Mercy Healthcare Center, Hammond, Ind
Clarian Health Partners, Inc, Indianapolis, Ind
Indiana University School of Medicine, Indianapolis, Ind
Ball Memorial Hospital, Muncie, Ind
Good Samaritan Hospital, Vincennes, Ind
University of Kansas Medical Center, Kansas City, Kan
Wichita State University, Wichita, Kan
Saint Elizabeth Medical Center, Edgewood, Ky
University of Kentucky, Lexington, Ky
Bellarmine University, Louisville, Ky
Owensboro Medical Health Systems, Inc, Owensboro, Ky
Eastern Kentucky University, Richmond, Ky
Rapides Regional Medical Center, Alexandria, La
Our Lady of the Lake College, Baton Rouge, La
Lake Charles Memorial Hospital, Lake Charles, La
McNeese State University, Lake Charles, La
Saint Francis Medical Center, Monroe, La
Louisiana State University Health Sciences Center, New Orleans, La
Louisiana State University Health Sciences Center
Shreveport Campus, Shreveport, La
Overton Brooks Veterans Affairs Medical Center, Shreveport, La
Northeastern University, Boston, Mass
University of Massachusetts—Lowell, Lowell, Mass
University of Massachusetts—Dartmouth, N Dartmouth, Mass
Berkshire Medical Center, Pittsfield, Mass
Morgan State University, Baltimore, Md
University of Maryland, Baltimore, Md
Salisbury University, Salisbury, Md
Eastern Maine Medical Center, Bangor, Me
Andrews University, Berrien Springs, Mich
Ferris State University, Big Rapids, Mich
DMC University Laboratories, Detroit, Mich
Wayne State University, Detroit, Mich
Michigan State University, East Lansing, Mich
Hurley Medical Center, Flint, Mich
Grand Valley State University, Grand Rapids, Mich
Saint John Health System, Grosse Pointe Woods, Mich
Northern Michigan University, Marquette, Mich
William Beaumont Hospital, Royal Oak, Mich
Eastern Michigan University, Ypsilanti, Mich
Fairview Health Services Clinical Laboratory Science
Program, Minneapolis, Minn
Hennepin County Medical Center, Minneapolis, Minn
University of Minnesota, Minneapolis, Minn
Southeast Missouri Hospital, Cape Girardeau, Mo
Saint John’s Regional Medical Center, Joplin, Mo
Saint Luke’s Hospital, Kansas City, Mo
North Kansas City Hospital, North Kansas City, Mo
Cox Medical Centers—South, Springfield, Mo
Barnes-Jewish College of Nursing and Allied Health,
St Louis, Mo
Saint John’s Mercy Medical Center, St Louis, Mo
Saint Louis University Health Sciences Center, St Louis, Mo
University of Southern Mississippi, Hattiesburg, Miss
Mississippi Baptist Medical Center, Jackson, Miss
University of Mississippi Medical Center, Jackson, Miss
North Mississippi Medical Center, Tupelo, Miss
Benefis Healthcare West Campus, Great Falls, Mont
University of North Carolina, Chapel Hill, NC
Carolinas College of Health Sciences/Carolinas Medical Center, Charlotte, NC
Western Carolina University, Cullowhee, NC
East Carolina University, Greenville, NC
Wake Forest University Baptist Medical Center, Winston-Salem, NC
Winston-Salem State University, Winston-Salem, NC
MeritCare Health System, Fargo, ND
University of North Dakota, Grand Forks, ND
Nebraska Methodist Hospital, Omaha, Neb
University of Nebraska Medical Center, Omaha, Neb
University of New Hampshire, Durham, NH
Monmouth Medical Center, Long Branch, NJ
Atlantic Health System—Morristown Memorial Hospital,
Morristown, NJ
Jersey Shore University Medical Center/Meridian Health,
Neptune, NJ
University of Medicine and Dentistry of New Jersey, Newark, NJ
Valley Hospital, Ridgewood, NJ
University of New Mexico School of Medicine, Albuquerque, NM
University of Nevada-Las Vegas, Las Vegas, Nev
New York Methodist Hospital, Brooklyn, NY
Long Island University CW Post Campus, Brookville, NY
SUNY at Buffalo, Buffalo, NY
Saint Vincents Catholic Medical Centers of NY-Brooklyn and Queens Region, Fresh Meadows, NY
Woman’s Christian Association Hospital, Jamestown, NY
Saint Vincent’s Catholic Medical Centers of NY—Manhattan Region, New York, NY
Marist College, Poughkeepsie, NY
Rochester General Hospital, Rochester, NY
SUNY at Stony Brook, Stony Brook, NY
SUNY Upstate Medical University, Syracuse, NY
Ohio Northern University, Ada, Ohio
Children’s Hospital Medical Center, Akron, Ohio
Bowling Green State University, Bowling Green, Ohio
University of Cincinnati Medical Center, Cincinnati, Ohio
Ohio State University, Columbus, Ohio
Wright State University, Dayton, Ohio
Southwest General Health Center, Middleburg Heights, Ohio
Mercy Integrated Clinical Laboratory Science Program, Toledo, Ohio
Valley View Regional Hospital, Ada, Okla
Comanche County Memorial Hospital, Lawton, Okla
Muskogee Regional Medical Center, Muskogee, Okla
Saint Francis Hospital, Tulsa, Okla
Oregon Health and Science University/Oregon Inst of Tech, Portland, Ore
Altoona Regional Health System, Altoona, Pa
Saint Vincent Health Center, Erie, Pa
Conemaugh Valley Memorial Hospital, Johnstown, Pa
Lancaster General College of Nursing & Health Sciences, Lancaster, Pa
Graduate Hospital, Philadelphia, Pa
Pennsylvania Hospital, Philadelphia, Pa
Thomas Jefferson University, Philadelphia, Pa
Reading Hospital and Medical Center, Reading, Pa
Robert Packer Hospital, Sayre, Pa
The Williamsport Hospital and Medical Center, Williamsport, Pa
York Hospital, York, Pa
Pontifical Catholic University of Puerto Rico, Ponce, Puerto Rico
Inter-American University, San German, San German,
Puerto Rico
Inter-American University, Metro Campus, San Juan,
Puerto Rico
University of Puerto Rico, San Juan, Puerto Rico
University of the Sacred Heart, San Juan (Santurce),
Puerto Rico
Our Lady of Fatima Hospital, North Providence, RI
Rhode Island Hospital, Providence, RI
Palmetto Health, Columbia, SC
McLeod Regional Medical Center, Florence, SC
Lexington Medical Center, West Columbia, SC
Rapid City Regional Hospital, Rapid City, SD
Sioux Valley Hospital and Health System, Sioux Falls, SD
Austin Peay State University, Clarksville, Tenn
Lincoln Memorial University, Harrogate, Tenn
University of Tennessee Medical Center, Knoxville, Tenn
University of Tennessee Health Sciences Center, Memphis, Tenn
Tennessee State University/Meharry Medical College, Nashville, Tenn
Vanderbilt University Medical Center, Nashville, Tenn
Austin State Hospital, Austin, Tex
CHRISTUS Hospital—Saint Elizabeth, Beaumont, Tex
Texas A&M University—Corpus Christi, Corpus Christi, Tex
University of Texas Southwestern Medical Center, Dallas, Tex
University of Texas—Pan American, Edinburg, Tex
University of Texas El Paso, El Paso, Tex
Tarleton State University, Fort Worth, TX
University of Texas Medical Branch, Galveston, Tex
Texas Southern University, Houston, Tex
The Methodist Hospital, Houston, Tex
University of Texas MD Anderson Cancer Center, Houston, Tex
Texas Tech University Health Science Center, Lubbock, Tex
University of Texas Health Sciences Center at San Antonio, San Antonio, Tex
Texas State University, San Marcos, Tex
Scott and White Hospital, Temple, Tex
Hillcrest Baptist Medical Center, Waco, Tex
United Regional Health Care System, Wichita Falls, Tex
Weber State University, Ogden, Utah
Brigham Young University, Provo, Utah
University of Utah Health Science Center, Salt Lake City, Utah
Inova Fairfax Hospital, Falls Church, Va
Augusta Medical Center, Fishersville, Va
Rockingham Memorial Hospital, Harrisonburg, Va
Norfolk State University, Norfolk, Va
Old Dominion University, Norfolk, Va
Virginia Commonwealth University, Richmond, Va
Carilion Medical Center, Roanoke, Va
University of Vermont, Burlington, Vt
University of Washington, Seattle, Wash
Sacred Heart Medical Center, Spokane, Wash
Yakima Regional CLS Program, Yakima, Wash
Affinity Health System—Saint Elizabeth Hospital, Appleton, Wis
Sacred Heart Hospital, Eau Claire, Wis
University of Wisconsin—Madison, Madison, Wis
Saint Joseph’s Hospital / Marshfield Clinic, Marshfield, Wis
Clement J. Zablocki Veterans Affairs Medical Center,
Milwaukee, Wis
Marquette University, Milwaukee, Wis
University of Wisconsin—Milwaukee, Milwaukee, Wis
University of Wisconsin—Stevens Point, Stevens Point, Wis
Aspirus Wausau Hospital, Wausau, Wis
Marshall University, Huntington, WVa
West Virginia University, Morgantown, WVa
West Liberty State College, West Liberty, WVa