Medical Laboratory Technology
Medical laboratory technology
Medical laboratory technology is the branch of medical science responsible for performing laboratory investigations relating to the diagnosis, treatment, and prevention of disease.
Laboratory scientists (medical and clinical technologists as well as medical and clinical laboratory technicians) facilitate the diagnosis of diseases, as well as the implementation and monitoring of therapies to treat disease. Laboratory scientists are responsible for examining and analyzing blood , body fluids, tissues, and cells in an effort to help clinicians determine the underlying cause of an illness, the stage of a disease, or the effectiveness of therapy. To accomplish their objectives, laboratory scientists perform a wide variety of laboratory tests, often with the aid of complex, computerized, and automated instrumentation.
Tests performed by laboratory scientists include:
- Microbiology tests that isolate and identify pathogenic bacteria , yeast, fungi , parasites, and viruses and determine antibiotic sensitivity.
- Chemistry tests that measure the chemical content of plasma, body fluids and cells including electrolytes, glucose, lipids , proteins , hormones, enzymes, trace metals, drugs, and toxins.
- Blood banking tests, such as typing, antibody screening, and cross matching, that are used to identify and prepare blood components that are compatible for transfusion.
- Immunology tests that are used to determine a person's ability to resist infections, diagnose autoimmune diseases, allergies , and infectious diseases, and determine tissue compatibility for organ transplantation.
- Hematology tests that count and classify blood cells, diagnose blood diseases, diagnose bleeding disorders , and monitor anticoagulant therapy.
- Histology procedures that prepare specimens for microscopic examination by pathologists.
- Cytology procedures such as the Pap smear test, which identify cancerous changes within cells.
- Cytogenetic procedures which identify abnormal chromosome counts, morphology, and disease genes.
Over the past few decades the proliferation of laboratory automation has significantly decreased the handson nature of the work. Today, many experienced laboratory scientists spend more time analyzing results, developing and modifying procedures, and establishing and monitoring quality control programs than they do performing tests.
An article published in the July 1999 issue of Medical Laboratory Observer reported that "in general, medical technologists and medical laboratory technicians are stable professionally." Laboratory scientists in their study, which was conducted in 1998 and 1999, had been employed at their current lab for 12 years and had been in the lab profession for 21 years. This job stability may be due in part to job flexibility. Because many large hospitals and reference laboratories operate 24 hours a day, seven days a week, they offer opportunities for laboratory scientists to work full or part-time, days, evenings, or nights. However, smaller hospitals with a more limited staff often require their laboratory scientists to rotate shifts, while others place laboratory workers on call several nights a week or on weekends to ensure coverage during an emergency situation. Working an occasional weekend and holiday is also quite common.
Clinical laboratories are well lit and clean, and the work is not physically demanding or particularly dangerous. That said, in a typical day most laboratory scientists will spend a significant portion of their day on their feet and be exposed to odiferous reagents and specimens, some of which will be infectious.
Wages for laboratory personnel are rising and correlate with the level of education and training. According a survey conducted by the American College of Clinical Pathologists, the median annual salary for a staff medical technician in 2000 was $29,120, an increase of 8.5% since 1998. In contrast, the median annual salary for a staff medical technologist in 2000 was $37,232, an increase of 11.9% since 1998. For both technicians and technologists, salaries on the coasts were higher than elsewhere in the United States.
As the MLO article and others have reported, the majority of laboratory scientists work full-time in hospitals, reference and physician office laboratories. However, there are also numerous employment opportunities for laboratory scientists in forensic, environmental and food industry laboratories. In addition, manufacturers of home diagnostic testing kits and laboratory equipment and supplies seek experienced technologists to work in product development, marketing, and sales.
Education and training
The Clinical Laboratory Improvement Act of 1988 (CLIA '88) sets minimum standards for testing personnel who work in clinical laboratories. For labs performing high complexity tests, the minimum requirement for testing personnel is an associate's degree in laboratory science. Persons who hold an associate degree from an accredited training program and certification are referred to as technicians. Persons who hold a bachelor's degree and certification in a clinical laboratory field are referred to as technologists. Certification is a prerequisite for most jobs, and some states require laboratory scientists to be licensed. Those holding a bachelor's degree with a major in medical technology or in one of the life sciences typically earn more money and receive more opportunities for advancement. While both technicians and technologists perform laboratory procedures, the technologist has greater knowledge of scientific principles and problem solving skills, and is responsible for oversight of quality assurance, method evaluation, and laboratory management.
Both bachelor and associate degree programs include courses in general and organic chemistry, general biology, microbiology, and anatomy and physiology. Specialized training includes courses in the specific laboratory disciplines. Baccalaureate programs also include courses in statistics, biochemistry, and immunology. Many four-year programs also offer courses in management, business, and computer technology.
There are several certifications available for laboratory personnel. The two most prominent organizations that certify lab personnel in the United States are the American Society of Clinical Pathologists board of Registry and the National Certification Agency for
Blood banking tests —Typing, antibody screening, and cross matching that are used to identify and prepare blood components that are compatible for transfusion.
Chemistry tests —Those tests for the measurement of electrolytes, glucose, lipids, proteins, hormones, enzymes, trace metals, drugs, and toxins.
Cytogenetic procedures —Techniques for chromosome counting and identification of abnormal chromosomes and disease genes.
Cytology procedures —Staining and examination of tissue samples in order to identify cancerous changes within cells.
Hematology tests —Tests to count and classify blood cells, diagnose blood diseases including coagulation disorders.
Histology procedures —Cutting, staining, and mounting of specimens for microscopic examination by pathologists.
Immunology tests —Tests which are used to determine a person's ability to resist infections, diagnose autoimmune diseases, allergies, and infectious diseases, and determine tissue compatibility for organ transplantation.
Medical laboratory technician —A clinical laboratory worker who may perform all levels of testing including quality control monitoring, specimen processing, and other laboratory operations.
Medical technologist —A clinical laboratory worker who performs all levels of testing, evaluates laboratory methods, verifies results, detects and resolves analytical problems, performs quality assurance, and consults with physicians and allied health professionals regarding laboratory services.
Microbiology tests —Those tests for the isolation and identification of pathogenic bacteria, yeast, fungi, parasites, and viruses and antibiotic sensitivity testing.
Medical Laboratory Personnel. Technicians with general certification by the American Society of Clinical Pathologists Board of Registry are denoted by the letters MLT (ASCP) and technologists with general certification by MT (ASCP). Technicians with general certification by the National Certification Agency for Medical Laboratory Personnel are denoted by the letters CLT (NCA) and technologists with general certification by CLS (NCA).
Advanced education and training
Technicians can become technologists through additional education and experience, which may be covered, partially or fully, by a tuition reimbursement program offered by their current employer. Specialist certification is also available in blood banking, chemistry, cytotechnology, hematology, hemapheresis, immunology, and microbiology. For those desiring supervisor and management responsibilities the U.S. Department of Labor's Occupational Outlook Handbook suggests that a "graduate education in medical technology, one of the biological sciences, chemistry, management, or education usually speeds advancement." CLIA '88 mandates that a laboratory director hold an M.D. or Ph.D. with board certification or prior laboratory experience. Laboratory managers usually hold a bachelor's degree or higher.
According to the 2000 Wage and Vacancy Survey of Medical Laboratories conducted by the American Society of Clinical Pathologists, "the year 2000 marked the highest vacancy rates reported per position over the 12-year comparison period." With 87% of the responding laboratories reporting vacancies in medical technologist and manager positions, it is easy to see why theU.S. Department of Labor expects employment opportunities for laboratory scientists to grow through the year 2008.
These shortages are most profound in the Northeast and East North Central regions of the United States, though no region seems unaffected. While over 65% of all laboratories with a vacancy were having trouble filling at least one shift for a staff medical technologist; cytotechnologists, histological technicians, histotechnologists and phlebotomists vacancies pose the greatest concern. The breadth of the problem is clear as over 70% of laboratories are using some combination of salary, benefits, sign-on bonuses, and tuition reimbursement to attract personnel to their facility.
For those laboratory scientists seeking something new, there are also numerous opportunities outside the laboratory in corporations and other businesses. As previously mentioned, manufacturers of home diagnostic testing kits and laboratory equipment and supplies seek experienced technologists to work in product development, marketing, and sales. In addition, the highly computerized laboratory of today is preparing many laboratory scientists for positions in information technology for the laboratory, the hospital, or any other business. Positions involving quality assurance or performance improvement, remote site testing, safety compliance or infection control , accrediting organizations, employee education, and laboratory consulting represent other avenues of opportunity for laboratory scientists. Better still, an article in the July 1999 issue of Clinical Laboratory News entitled "Where Will You Be Working in 2010?" predicts that "One of the major changes in how laboratorians are employed is that many will be self-employed, performing services for multiple companies and organizations. Furthermore, these changes will allow many laboratorians to work from home."
Regardless of the career path chosen, the key to remaining employable is to continuously strive to gain new skills and to develop a network of contacts from a variety of sources, including co-workers, associations, and vendors.
Frings, C. S. "Answering your questions on alternative careers for laboratorians and necessary credentials for managing a high-complexity POL." Medical Laboratory Observer (Nov. 1999) 31: 20.
Frings, C. S. "Where will you be working in 2010? Novel opportunities for future laboratorians." Clinical Laboratory News 25, no.7 (July 1999): 28-30.
Ward-Cook, K., and S. Tunnar. "2000 Wage and Vacancy Survey of Medical Laboratories." Laboratory Medicine 3, no. 32 (March 2001): 124-138.
American Medical Technologists. 710 Higgins Rd., Park Ridge, IL 60068. <http://www.amt1.com>.
American Society for Clinical Laboratory Science. 7910 Woodmont Ave., Suite 530, Bethesda, MD 20814.
American Society of Clinical Pathologists, Board of Registry. P.O. Box 12277, Chicago, IL 60612. <http://www.ascp.org/bor>.
International Society for Clinical Laboratory Technology. 917 Locust St., Suite 1100, St. Louis, MO 63101-1413.
Occupational Handbook Outlook. U.S. Department of Labor, Bureau of Labor Statistics. <http://stats.bls.gov/oco/ocos096.htm>.
Victoria E. DeMoranville