Should clinical laboratorians be licensed to practice in each state just as physicians and nurses are? At least one professional organization, the American Society for Clinical Laboratory Science (ASCLS), believes the answer is, “yes,” and has been fighting for that goal since the 1980s.
James T. Griffith, Ph.D., CLS (NCA), a past-president of ASCLS and chairperson of the department of medical laboratory science at the University of Massachusetts, Dartmouth, has played in a key role in the passage of licensure legislation in several states. In his 25 years of advocating for licensure, Griffith has experienced both successes and failures.
The 12 states with licensure today are: California, Hawaii, Florida, North Dakota, Rhode Island, Tennessee, Louisiana, Nevada, West Virginia, Montana and Georgia. Puerto Rico also has licensure. The components of licensure vary from state-to-state, but it usually requires an annual licensing fee, a provision for continuing education and minimum education and professional competency requirements.
“People in the community are shocked when they find out that the people who perform scientific laboratory tests are not licensed,” Griffith said. “Nurses have licenses, taxicab drivers and beauticians have licenses, but a person who is going to cross-match blood has nothing? It does seem ridiculous.”
Although licensure of clinical laboratorians has been a controversial issue for many years, much of the wind has left the sails of those who oppose it. The experience of the 12 states with licensure has allayed some of the most often-mentioned fears. One argument against it claims it would exacerbate the current staffing shortage crisis. (See story on page 46.)
“But there is no data to prove that,” said Elissa Passiment M.Ed., CLS (NCA), executive vice president of ASCLS. “In California and Florida, where licensure has been in place the longest, the shortage is no more severe than it is in states like Maryland or Virginia where there is no licensure. And if that argument were correct, you’d have to use that same argument for nursing where there is licensure in every state.”
Another argument against licensure says that it will drive up the salary of laboratorians and thus the cost of healthcare. Passiment isn’t buying this one either. “Florida is one of the poorer paying states in the country, and as far as laboratorians are concerned, they’ve had licensing for years,” she said.
“We’re committed to licensure for clinical laboratory scientists because we believe it will do two things,” Passiment said. “It will elevate the profession so it is recognized as a profession by the licensing and medical boards of the states, and it protects the public by requiring that practitioners have the proper education and training, as determined by each state. It also is an opportunity to do what every other medical practice has done and that is define the scope of their practice and then define the criteria for practicing in that profession.”
Not every clinical laboratory organization shares ASCLS’ passion for licensure. “When it comes to licensure, the CLMA executive office or national CLMA is neutral,” according to Katharine Ayres, director of healthcare policy at CLMA. “We are now in the process of developing our position on that issue. It was raised at the panel discussion of our staffing shortage forum in March.”
State and regional chapters of CLMA have been approached to help other organizations drive licensure efforts in various states and that has met with different responses in different states. “That’s why it’s important for us to have a consistent response to this issue and a consistent way in which we are either willing to support or not support it. Our panel discussion helped us understand that it’s important for us to do that,” Ayres said.
Ayres sees CLMA’s role as educational. “Apparently there are people out there who fear licensure because they don’t really know what it means,” she said. “I was a practitioner in the industry, and I never saw it as bad. It builds a professional image for us, and it gives us some clout. Because we are a behind-the-scenes profession, the public and even our fellow healthcare workers do not realize what we do. It would give us stature and help us get legislative and public awareness of how critical and important our staffing shortage is and how important we are to patient healthcare.”
For a long time, the American Society of Clinical Pathologists (ASCP) did not support licensure of laboratorians because it was uncomfortable with the title “clinical laboratory scientist,” which was used in most legislation. Since that language has been replaced with the dual title, “medical technologist/clinical laboratory scientist,” ASCP has not opposed licensure in states where it has been proposed. This is good news for ASCLS, but opposition does still exist.
In most states, the two most vocal opponents to licensure of clinical laboratory scientists have been the state medical societies, which represent physicians, and the American Hospital Association (AHA). Griffith notes that, in general, physicians want to be able to hire whomever they want to do their lab work, and the AHA believes there should be institutional certification that allows the management of each hospital to determine who works there.
An inquiry to the American Medical Association in Chicago turned up no written policy against the licensure of clinical laboratorians. The Rhode Island Medical Society referred me to Scott Wang, MD, FCAP, director of pathology at Newport Hospital in Newport, RI, who is the group’s state issue advisor. Wang said that he personally supported licensure of laboratorians but that the official position of the RI doctor’s group is that they support it in principle, but have problems with licensure because of the current staffing shortage. “With Rhode Island so close to Massachusetts and Connecticut, we can easily lose people to other states that don’t have licensure,” Wang said. Legislation is currently pending in Massachusetts, and Connecticut does not have licensure.
Where do you stand on the licensure of clinical laboratory scientists/medical technologists? If you belong to a professional organization such as ASCLS or CLMA, you may already have a forum for your opinions, but those without an affiliation can be heard here. Send me an e-mail with your thoughts about licensure at [email protected]. I’ll report on your comments in a future column. With less than half the 200,000-plus practicing laboratorians in this country represented by a professional organization, it would be fascinating to know where laboratorians stand on this issue. Of course, I’m also interested in ideas from members of professional organizations.
Right now licensure legislation for clinical laboratorians is pending in the states of Massachusetts, New York, Vermont, Michigan and Minnesota. If you live in one of these states and feel strongly about this issue, now is the time to find out the name, phone number and e-mail address of your state representative and tell him or her what you think. If you copy me on those e-mails, I’ll add those into my forthcoming Editor’s Notebook on the topic.
In the past some clinical laboratorians didn’t like the idea of licensure, Griffith said, because they didn’t want to be thought of as unionized. That attitude has changed. “I think that when most clinical laboratory professionals understand what licensure does for them, they’re not just in favor of it, they’re significantly in favor of it to a point where they’re wildly enthusiastic.”