CurranThis space is usually devoted to my views, but this time it’s all yours. We received so many thoughtful and passionate reader e-mails in response to last month’s column on professional licensure and article on staffing shortages that they deserve to be heard. Since several also posed additional questions, I passed those on to James T. Griffith, Ph.D., CLS(NCA). Griffith is chancellor professor and chairperson, Department of Medical Laboratory Science at the University of Massachusetts in Dartmouth and a past board president of ASCLS, who has been working on the licensure issue for many years. Our answers and comments appear in italic type and are signed.

I am a CLMA member who feels strongly that laboratorians should be licensed because it will serve as a backdrop for salary issues and also because it puts us in a better position to hire quality individuals and to elevate our professional respectability in the healthcare community. As a Med Tech for almost 20 years, I have always felt that lab personnel are treated as second class citizens and way beneath nurses on the pay and respect scale. I, for one, am tired of the respect discrepancy between the two professions.
Renee Wilson
Methodist Extended Care Hospital
Memphis, Tenn.

I’m totally against [licensure]. Let job descriptions define the skills required. All licensure does is restrict a person’s ability to move freely from state to state. Open competition allows a better choice of candidates. Of course Florida and California want to restrict who can immigrate! They are the “promised lands”!
Walter T. Hayes
Administrative Director of Laboratories /LabCare
Danville Regional Medical Center
Danville, Va.

Up to the point where I read your article, I was not a member of a professional organization. I quickly joined ASCLS. I am a medical technologist in South Carolina and have been in the field for seven years now. My current title is Microbiology Supervisor, and I am totally for licensure. I listen to what’s happening around the country with Med Tech shortages, schools closing and new legislation allowing nurses to perform lab tests, and I quiver with fear. The fear is not only for my job, but as a patient as well. I do not believe that just anybody can perform lab tests. I want licensure in my state, so that schools will have to remain open, salaries will rise and interest in our field will continue. Today the lab loses many potential candidates to radiology and nursing, which incidentally are licensed professions.
     Another concern is the aging of the average laboratorian. I supervise a team of 10 who are all 10 to 30 years my senior. Who will replace these highly seasoned folks? What kind of time and effort will be required to train non-laboratory personnel in microbiology? My department is not automated and the thought of training someone who has no education on the difference between an E. coli and S. aureus is utterly a nightmare.
Marion E. Boatwright, MT (ASCP)
Microbiology Supervisor
Lexington Medical Center
West Columbia, S.C.

I enjoyed your editorial on personnel licensure, but I must make a correction. Georgia does not have personnel licensure; it has facility licensure, which places the responsibility for personnel qualifications on the institution not the employee. I was part of a group of ASCLS/GLCLS members who worked very hard, but unsuccessfully, to get personnel licensure some years ago. The legislature decided to make more stringent requirements for professions seeking licensure and there was division in the laboratory community (mostly along certification lines) that thwarted our efforts.
Sue Osier, MT(ASCP)SH
Supervisor, Hematology
Northside Hospital

I apologize for not making that distinction clear. — Coleen

The Georgia statute is weak in that it requires the “facility” to have the correct personnel rather than requiring that the individual be qualified to perform lab tests or loose that distinction if they fail a statutory requirement. Nonetheless, the Georgia system is better than nothing, which is what most states have. — Jim

The Clinical Laboratory Scientists who are against licensure usually oppose it because they are influenced by an organization such as ASCP. As you note, ASCP has opposed licensure in the past. Perhaps ASCP members have not taken the time to learn about the professional benefits of licensure.
     It’s true that the public is usually amazed to learn that the individuals who do their drug testing and cross-matches are not licensed. Physicians who oppose licensure do so primarily because they want to be able to hire individuals off the street and train them on the job. However, if they truly understood the potential ramifications and liabilities, they might have a different view. Physicians carry some legal liability for office staff including those performing laboratory testing. It is true that unlicensed individuals can be taught to run many laboratory instruments, but there is no requirement that they understand and recognize when the test system has a problem or a result is absurd or not valid. They do not always understand how to read quality control results and over time to detect developing problems.
     I wish laboratory professionals had understood the importance of getting licensed in every state early in the profession’s history as nurses did. It is difficult to get such legislation passed with powerful associations such as the AHA [American Hospital Association] and AMA [American Medical Association] lobbying against it.
     Laboratory professionals should be licensed to protect the public health.
Cheryl R. Caskey, MA, CLS, CLSp(NCA)
Christus Schumpert Health System
Past President, ASCLS
Shreveport, La.

As an MT who enjoyed the early days (1980s) of the licensure effort in Michigan, I am very pro-licensure. Today I’m a Laboratory Manager in Indiana with no qualified applicants for an open position. I believe the shortage in central Indiana will get worse before it gets better. Many MTs work a second job for the extra pay. In fact, I did this for five years. If licensure produces a wage increase for laboratorians, many may be able to quit their second job, and the personnel shortage will be magnified. I wonder how many laboratorians hold down more that one lab-based job. I would be interested in speaking to anyone in Indiana who is seriously interested in starting a licensure effort.
Mark Andrews, MT(ASCP), CLS(NCA)
Laboratory Manager
Major Hospital
Shelbyville, Ind.
[email protected]

If you are working full time (or more) at more than one laboratory, feel free to e-mail Mark or me ([email protected]). We included his e-mail address so anyone working on state licensure in Indiana can reach him, as well as job seekers too. — Coleen

As a past president of ASCLS and current chair of its government affairs committee, licensure is an issue I have followed for many years. I am wondering where the information came from that led you to state that licensure legislation is pending in Minnesota? I am aware that there is a bill before the state legislature regarding the personnel shortage, which would provide student loan forgiveness for laboratorians who agree to work in rural or under-served areas.
     To my knowledge there is no bill currently pending regarding licensure. However, there has been a resurgence of interest in pursuing licensure among the leadership of MNSCLS. The process in Minnesota is difficult because the State Department of Health must first approve the request before it can be introduced as a bill. That department has been an insurmountable barrier in two previous attempts at introducing a bill.
Kathleen L. Hansen
Director, Laboratory Operations
Fairview-University Medical Center

You are correct that there is no actual bill pending in Minnesota at this writing. However, as you note, there has been activity in the state to propose a bill and/or bills. — Jim

This idea that without state licensure there is no control over the qualifications of the person performing your laboratory tests makes absolutely no sense. What about CLIA? I manage a highly complex laboratory in a small rural hospital and CLIA mandates the education levels and qualifications of my hires. In addition, their regular inspections and proficiency testing are already mandated by CLIA. Why would we need another level of bureaucracy (that we would have to pay for) requiring the same things? How would states determine the proper level of education and training any different than CLIA does now? I certainly do not believe in being state licensed. Most of us are already nationally licensed (CAP or NCA or HCFA) and would do anything to “build a professional image” or make people more aware of what we do.
Jane Schilcher
Lab Manager, Grace Cottage Hospital
Townshend, Vermont

CLIA had appropriate personnel standards in its first iteration but those were diminished by M.D. complaints to HCFA during the comment period, and the current very weak standards were put in their place. Those standards allow for 85 percent of all the 27,000 scientific analyses to be done by a person with a high school diploma.
    The regular inspections are, in reality, highly infrequent. After three nationwide rounds of CLIA inspection since 1995, the top four deficiencies cited involve people not being able to follow manufacturers’ instructions, inability to perform quality control, inability to sustain quality assurance and failing at proficiency testing. There is a graphic that helps illustrate this at:
     National licensing of professions is prohibited by the U.S. Constitution (section 8, Preamble) which reserves the power to license for the states. — Jim

Don’t be surprised to hear more from us on the topics of professional licensure and staffing shortage. As a matter of fact, I encourage organizations such as CLMA and ASCLS to host an open-forum panel discussion and/or debate by opinion leaders on both sides of the licensure issue. If such a public forum were held at either group’s annual meeting, it no doubt would be well attended and a great effort toward building solidarity on an issue where laboratorians are sharply divided. Whether professional licensure represents a boon or boondoggle for clinical laboratorians, a thorough grounding in the facts of what it does or does not do for professionals and patients should help immensely.

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Coleen Curran