Volume 91 - Winter 2005	Download

Clinical Laboratory Science An Historical Perspective - Part II by Lucy J. Randles, MA, CLS/CLDIR President, Health Care Advantage; Member, NAACLS Graduate Task Force

The following historical perspective is provided in order to lay a foundation for the proposed final step in the CLS career ladder, the Clinical Laboratory Practice Doctoral Degree. This is Part II of the article; Part I appeared in NAACLS News, Volume 90 in Fall 2005.

1945-1962
Membership in ASMT grew significantly as it moved to establishing Medical Technology as an independent profession. In 1946-47, ASMT's membership on the Board of Registry (BOR) Advisory Committee was increased to three and, in 1949, ASCP permitted the addition of three ASMT representatives on the BOR. Ten years later, a fourth representative was added so that ASCP appointed six representatives and ASMT appointed four. In 1948, the Board of Schools (BOS), assumed responsibility for the accreditation of educational programs.

In the 1950's, ASMT organized efforts to promote personnel licensure and sought to reclassify MT positions in the Civil Service and armed forces. Pathologists also supported the reclassification. After many years of collaborative efforts among ASMT, ASCP, BOS, BOR, interested pathologists and MT educators, MT's were granted professional status in 1958.

The 1960's brought automation to the laboratory, and this drastically changed how MT's worked. They were required to have fewer technical skills and have more analytical and problem solving skills. Many new laboratory tests were introduced. Knowledge in the areas of management and supervision were required. MT's were required to exercise independent judgment and to supervise others.

In 1962, three years of college were required to become registered. Discussions evolved around a perceived need to stratify the laboratory workforce and to create a new level of personnel, the Laboratory Assistants (LA). In 1962, the BOR certified LA's graduating from recognized programs and, in 1967, developed a certification exam for them.

Also in 1967, the National Health Council and the American Association of Junior Colleges developed guidelines for community colleges that were developing allied health education programs. Inquiries were directed toward ASMT and ASCP about developing education programs at the technician level. However, no such level existed in the laboratory workplace at that time and, therefore, there were no job descriptions, skills or competencies defined. While the first MLT exam was given in 1969 by the BOR, the skills, knowledge and content still were not defined. ASCP established a committee with broad representation to write, "The Essentials for an Approved Program for Associate Degree Medical Laboratory Technicians," which were adopted in 1972. The ASMT House of Delegates approved a position paper defining competencies in 1973.

The birth of the MLT level, gave rise to the concept of a career ladder in Clinical Laboratory Science. It was thought that career mobility allowed workers to move from an assistant to a full fledged practitioner incrementally and presented an attractive career path while providing opportunities for self-improvement and professional advancement. This is viewed as even more important today.

With the integration of the MLT into the workplace, managers and educators were faced with the challenge of differentiating what the MT and MLT did in the workplace as well as the curricula providing them required knowledge and skills. This continues to be a major problem today and has gone unresolved since the inception of the MLT despite the differentiation of accreditation Standards.

Because of United States Department of Justice (USDJ) criticism that ASMT was too passive in not doing all it could to prevent collusion in a major segment of the health care industry, ASMT pursued the issues of the BOR and the Board of Schools (BOS) within the same organization. ASMT thought it appropriate to establish equal representation on the BOR and for the BOR and BOS to be independent of both ASCP and ASMT. Meetings occurred but an impasse was reached. ASMT proposed a third-party arbitrator, but agreement could not be reached and ASCP instead created the "Affiliate Member" category in 1968 to provide opportunities for MT input.

ASMT felt that the only solution was to file suit. The suit was dismissed by the Court, but the United States Department of Education (USDE) and the National Commission on Accrediting became aware of the issue. When the BOS sought continued recognition it was withheld because the BOS was not seen as having an autonomous relationship with ASCP. Consequently, in 1973, the BOS was dissolved, and the National Accrediting Agency (NAACLS) was formed and began accrediting programs in 1973 as an independent accrediting body. ASMT and ASCP were designated as "Sponsoring Organizations."

In 1974, after failed efforts to accomplish its goal of a certification agency independent of both ASCP and ASMT but with equal ASCP and ASMT representation, ASMT withdrew its representatives from the BOR and announced its support for a new certification agency, the National Certification Agency for Medical Laboratory Personnel (NCA).

1997
The importance of laboratory testing was clearly stated in an ASCLS position paper, "The Value of Laboratory Testing," approved by the House of Delegates on August 1, 1997. The paper was developed in response to the application and imple-mentation of Diagnostic Related Groups (DRG's) and managed care organizations for the payment of healthcare costs. Laboratories were transformed from revenue producing centers to cost centers in the eyes of hospital administrators. The consequences included increased automation, test procedures being done by lesser trained personnel, and reduced laboratory utilization. The background preceding the position statement states the value of laboratory testing and still rings true in today's health care environment.

"Data from laboratory tests that are appropriately ordered and accurately performed, reported and interpreted, contribute to early detection and diagnosis. Early diagnosis may present complications, avert unnecessary invasive testing, and shorten hospital length of stay. In short, spending resources on appropriate laboratory testing saves greater long-term expenses, and results in less health care spending and more positive patient outcomes."

This historical summary is excerpted and paraphrased from a six part series written by Virginia R. Kotlarz, PhD, CLS and published in, Clinical Laboratory Science, 1998 Volume 11/Numbers 1-5 and 1999 Volume 12/Number 4-6.

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