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| Should the CLS/MT Education Entry Level be the Masters Degree? |
The dynamic economic, regulatory, and technological changes in health care have stimulated many challenging debates among health care educators, practitioners, and employers. One of the most controversial and potentially auspicious has centered on the educational standards required to enter a professional field of practice. Some professions have become recognized leaders willing to take the risks, deal with the issues, and strategize the future to advance their professions and solidify their unique roles as essential contributors to quality and cost effective health care.
While all professions began as task oriented disciplines in which on the job training provided the knowledge and skills to perform, most have evolved into professions with defined scopes of practice, mandatory degrees and credentials and dramatically changing roles. Some suggest the changing roles have directed the need for advanced degrees and others believe requirements for advanced degrees result in advancing roles. In either case, mandatory advanced degrees have been an integral component of the growth of all professions. This is the ideal time for Clinical Laboratory Science to enter into a thorough and comprehensive debate. The current expansion of laboratory testing requires an increase in knowledge and time to teach it. New technologies have freed practitioners to become consultants, troubleshooters, problem solvers, critical thinkers, and administrators during a time in which the health care system desperately needs practitioners with these skills. Skills in these nonscientific areas also need to be taught so that practitioners can effectively make and influence the laboratory-based decisions that impact patient diagnosis, prognosis and treatment.
For older professions, such as pharmacy, nursing, and clinical laboratory science, the evolution has occurred over 70+ years. For other professions, such as physician assisting, occupational therapy, and physical therapy, the evolutionary periods have been much shorter. It is interesting to note that the younger professions seem to have advanced their professions, increased their practitioner salaries, and elevated their roles more quickly than those professions whose beginnings were before 1960’s.
To effectively debate the question as to whether or not the educational standard for becoming a Clinical Laboratory Scientist should become a Master’s Degree, we should look at what is and has been happening in other health care professions.
The Pharmacy profession began in the late 1800’s. In 1960, the Baccalaureate Degree became the standard of entry into the profession and in the mid 1960’s, the concept of a Clinical Pharmacist was conceived. It was a time when “.. the profession seemed locked on a slow but certain course to extinction. Additionally, the profession was deeply infected with apathy, an inferiority complex, and competition that was beginning to sever its most established and economic roots. As a net result, it was politically impotent and it was ignored not only by other health professions, but the federal policy setters who were making decisions that would drastically and adversely affect its future.”1 Educational programs had, for years, discussed new roles for pharmacists that would include the pharmacist in the drug prescribing process, but there was little agreement as to what the new practitioner would do or how they should be educated. Through the results of a demonstration project, the role of the Clinical pharmacist was established and the idea of a Doctor of Pharmacy Degree (PharmD) was proposed.2 The PharmD degree became the profession’s standard in 1997. After 2005, there will be no more accredited B.S. programs. Shortages in Pharmacists were reported during the late 1980’s and have continued through today. The shortages have been attributed to the development of new drugs, increased vacancy rates, difficulties in hiring, increased use of prescriptions, market growth and competition among retail pharmacies, movement of pharmacists to research, industrial, and consultative settings.3 Whatever the reasons, the shortages did not halt the progression toward the PharmD.
The United States Congress directed the Public Health Service to study the pharmacy workforce shortage as part of the Health Care Research and Quality Act of 1999(Pub.L.106-129). The December 2000 Report To Congress, The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists generated by the Health Resources and Services Administration and the Bureau of Health Professions documents the rationale and supports the movement for mandating the PharmD for entry into the profession of Pharmacy. It discusses the expanding roles which include counseling patients, drug monitoring, disease management, participating in multidisciplinary clinical care teams, consulting in drug utilization programs, supporting research on outcomes of care, providing drug information, patient education and furthering public health initiatives such as smoking cessation programs, diabetes education, and immunizations.4
In Chapter 4: The Supply of Pharmacist and Pharmacy Education, “The education of Pharmacists has been changing to emphasize the optimal use of medications in the care of patients. Related to this, there has been a nationwide conversion from the Bachelor of Science in Pharmacy to the Doctor of Pharmacy…”4
The American College of Pharmacy predicts in a May 2000 white paper, “Pharmacy, will, within the next decade transform itself from a primarily product-centered profession to a patient-care oriented profession.” They also saw technology increasingly deployed to dispense most prescriptions and provide drug information to patients.5
The National Association of Boards of Pharmacy charged a Task Force on Manpower Shortage to assess the impact on the public health of the pharmacist shortage and to examine regulatory changes that could help the situation. One of the recommendations was to eliminate state mandated pharmacist –to-technician ratios and delegate all dispensing functions, with the exception of the final check, to technicians. Pharmacists should retain all clinical and judgmental functions.5
Another joint white paper of The National Association of Chain Drug Stores, American Pharmaceutical Association and The National Community Pharmacists Association....emphasizes the need for augmenting the pharmacist’s resources through the appropriate use of pharmacy technicians and the enhanced use of technology (automation, robotics, electronic transmission of prescriptions).”5
Pharmacy has many parallels with Clinical Laboratory Science. It utilizes technician level personnel; traditional functions are being done more efficiently and cost effectively by automated systems; it has multiple professional associations that represent and set policy for the profession; it’s scope of practice has been historically limited; it has been experiencing a workforce shortage for several years; and its practitioners have left traditional pharmacy environments to work as researchers, consultants, and/or apply their skills to nontraditional arenas. There has also been an explosion of new available drugs just as there has been a comparable explosion of new available laboratory tests. Just as Pharmacists are the experts who should be consulted in the best use of the new drugs, Clinical Laboratory Scientists are the experts who should be consulted on the performance, application, and interpretation of new laboratory tests. If you were to substitute, “Clinical Laboratory Science,” “Clinical Laboratory Scientist, and/or “laboratory tests/testing” throughout the previous paragraphs, you will note that they fit very well within the context of what is written about Pharmacy and Pharmacists. Pharmacists have now successfully, but inappropriately, expanded their role to include laboratory testing even though it has not been within their Scope of Practice
The first Occupational Therapy programs, established in 1918, were hospital based training programs. The first mention of mandating a Master’s Degree for Occupation Therapy practice was in a 1958 issue of the American Journal of Occupational Therapy. 6 A decision to move formally toward a Master’s Degree didn’t occur until 1987.7 Beginning in 2008, all Occupation Therapy programs will be Master’s Degree programs.
The decision to mandate a Master’s Degree was preceded by a comprehensive study that projected the effects of moving from a Baccalaureate Degree to a Master’s Degree based upon the experiences of other professions including nursing, social work, speech pathology, audiology, and physical therapy.8 It looked at 25 areas and specific factors including curriculum, applicant pool, costs, faculty, doctoral programs for Occupational Therapists, knowledge base, employment, student costs, practice skills, consumer attitudes, professionalism, credibility, autonomy, role delineation and others. There are conflicting arguments about each of these areas, but each was resolved and the profession continues moving forward. Some of the conclusions in this study were similar to the Pharmacy conclusions. If a Master’ Degree is mandated, the role of the Occupational Therapy Assistant would take on some of the lower level functions of Occupational Therapists. The work responsibilities of the master’s level Occupational Therapist would include more administrative, research and clinical specialty time. The curriculum would be expanded to include more extensive preparation in human behavior, interpersonal skills, health policy, reimbursement, management and supervision and ethics. There will be more emphasis on critical thinking, problem solving, and strategic planning.
Other studies suggest that higher educational levels lead to greater professionalism, credibility, and autonomy. Most of the studies raised concerns about the need for advanced degrees in Occupational Therapy, the already existing shortage of Occupational Therapists and increased costs to students, which are the same concerns raised in discussions about a mandated Master’s Degree in Clinical Laboratory Science. While these concerns were projected, none obstructed the adoption of the Master’s Degree requirement for Occupational Therapy practice.
This article has offered models of how two healthcare professions have made the transition to a mandatory Master’s Degree for entry into practice. There are many more that can serve as models and examples of having furthered their practice and their profession in today’s changing world. They include physical therapy, physician assisting, podiatry, and nursing. While their roles are very different, they all have these common denominators:
- The professions directed the movement by redefining workplace roles for each
practitioner level (technicians, assistants, etc).
- No one outside the profession initially saw the benefits of requiring advanced
degrees.
- Most practitioners within the profession initially saw only roadblocks and
minimal benefits.
- All of the professions were experiencing workforce shortages and resulting
secondary problems.
- All of the curricula expanded to include, management/supervision, business
related courses, and strategic planning.
- All became more global in their Scopes of Practice and moved from “product or
service oriented” to “comprehensive patient care oriented.”
- None recognized immediate increases in salaries, but salaries and recognition
improved significantly over time.
- Transition time, in most cases was at least 10 years from initial discussion.
- All were initially met with great resistance from their own practitioner’s
administrative personnel, and employers.
Could advancing the entry level of the Clinical Laboratory Scientist to a Master’s Degree benefit Clinical Laboratory Science, its practitioners and patients? It is clear that others have advanced their professions by raising educational standards. While the topic has been superficially discussed over many years, the time to answer this question through a comprehensive study and analysis of all the issues is now, because of all that is happening in health care. While the temptation to answer the question before such a study is completed is strong, because of our long standing traditional views and experiences, it is critical that we withhold our answer and objectively examine and assess the current environment and the status of the Clinical Laboratory Science Profession within it. Let the debate continue…
At The University of California SanFrancisco. DICP, The Annals
of Pharmacology. 1991; 25: 308
2 Day Robert L, Goyan JE, Herfindal ET, and Sorby DL. The Origins Of The
Clinical Pharmacy Program At The University of California SanFrancisco. DICP,
The Annals of Pharmacology. 1991; 25: 309-313.
3 Report To Congress, The Pharmacist Workforce: A Study of the Supply and Demand
for Pharmacists. Department of Health and Human Services, Health Resources and
Services Administration, Bureau of 1 Day Robert L, Goyan JE, Herfindal ET, and
Sorby DL. The Origins of The Clinical Pharmacy Program Health Professions.
December 2000; i-ii.
4 Report To Congress, The Pharmacist Workforce: A Study of the Supply and Demand
for Pharmacists. Department of Health and Human Services, Health Resources and
Services Administration, Bureau of Health Professions. December 2000; iii-iv.
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Copyright © 2008 National Accrediting Agency for Clinical Laboratory Sciences. All rights reserved. Comments or suggestions to the site editor. |
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