Because changes in body fluids, tissues, and cells are often a sign that something is wrong, clinical laboratory testing has come to play a crucial role in the detection and diagnosis of disease. Physicians order laboratory work for a wide variety of reasons, however. Test results may be used to establish values against which future measurements can be compared; to monitor treatment, as with tests for drug levels in the blood that can indicate whether a patient is adhering to a prescribed drug regimen; to reassure patients that a disease is absent or under control; or to assess the status of a patient's health, as with cholesterol measurements.
Although physicians depend heavily on laboratory results, they do not ordinarily perform the tests themselves. That is the job of clinical laboratory personnel. Many clinical laboratories are highly automated, and job duties reflect this. Using computerized instruments that perform a number of tests simultaneously, as well as microscopes, centrifuges, and other kinds of sophisticated laboratory equipment, these workers perform tests, interpret the results, and relay them to the patient's physician.
Depending on the worker's level of skill, he or she may run routine tests or perform complex analyses that require a number of steps to arrive at the information needed by the physician. The types of tests that clinical laboratory personnel perform and the amount of responsibility they assume vary by employment setting, but depend to a large extent on the kind of educational preparation they have.
Medical technologists have a bachelor's degree in medical technology or in one of the sciences, as a rule. They perform complicated chemical, biological, hematological, immunologic, microscopic, and bacteriological tests. These may include chemical tests to determine blood cholesterol levels or microscopic examinations of blood and other substances to detect the presence of diseases such as leukemia. Technologists microscopically examine other body constituents; make cultures of body fluid or tissue samples to determine the presence of bacteria, fungi, parasites, or other micro-organisms; and analyze samples for chemical content or reaction. They also type and cross-match blood samples for transfusions.
The exact procedure depends on the test being performed. Most blood chemistry tests, for example, are highly automated. The technologist or technician calibrates an instrument known as a chemical analyzer, loads it with the specimens to be tested, selected the appropriate test code, and monitors the instrument to make sure it does not malfunction. Once the results are ready, the technologist verifies them for accuracy and sends them out or reports them to the attending physician. If a test requires the identification of cell types, such as in leukemia, the procedures are very different. In addition to identifying the cells on a stained blood film or from bone marrow, special stains may be required, cell markers performed, and chromosome studies completed.
Technologists in small laboratories perform many types of tests, while those in large laboratories usually specialize. Among the areas in which they can specialize are clinical chemistry (the chemical analysis of body fluids), blood bank technology (the collection and preparation of blood products for transfusion), cytotechnology (the study of blood cells), histology (the study of human tissue), microbiology (the study of bacteria and other micro- organisms), and immunology (the study of the human immune system).
Most medical technologists perform tests ordered by physicians for their patients. Others conduct research, develop laboratory techniques, teach, or assume laboratory management and administrative duties. Some technologists work as independent consultants, advising physicians on how to set up and operate office laboratories. Others work in product development and sales.
Medical laboratory technicians generally have an associate degree from a community or junior college, or a diploma or certificate from a trade or technical school. They are mid level laboratory workers who function under the supervision of a medical technologist or laboratory supervisor. They perform a wide range of routine tests and laboratory procedures. Technicians may prepare specimens and operate automatic analyzers, for example, or they may perform manual tests following detailed instructions. Like technologists, they may work in several different areas of the clinical laboratory or specialize in just one.
Hours and other working conditions vary according to the size and type of employment setting. In large hospitals or in commercial laboratories that operate continuously, workers are hired specifically for the day, evening, or night shift. Weekend or holiday work may be required since these laboratories operate 365 days a year. Some smaller laboratories also operate 24 hours a day. Laboratory personnel in small facilities are likely to work on rotating shifts rather than on a regular shift, however. That is, they may work the evening or weekend shift one week, and the day shift the following week. In some facilities, laboratory personnel are required to be on call (available in case of emergency) several nights a week.
Clinical laboratory personnel are trained to work with infectious specimens. It is of the utmost importance that specimens be handled properly to ensure that neither staff nor other test specimens become contaminated by disease-causing organisms. When proper methods of control and sterilization are followed, few hazards of infection exist.
Laboratories generally are well lighted and clean. At times, unpleasant odors may be present.
Laboratory workers may spend a great deal of time on their feet. The work can create emotional as well as physical stress, inasmuch as treatment options often depend on quick and accurate analysis of laboratory specimens.
Clinical laboratory technologists and technicians held about 246,000 jobs in 1990. About 3 out of 5 worked in hospitals. Others worked in independent laboratories, physicians offices, clinics, health maintenance organizations (HMO's), public health agencies, pharmaceutical firms, and research institutions.
About 1 laboratory worker in 6 holds a part-time job.
In 1990, Veterans Administration hospitals and laboratories employed about 4,000 medical technologists and about 2,000 medical laboratory technicians. Others employed by the Federal Government worked for the U.S. Public Health Service.
Training, Other Qualifications, and Advancement
The usual requirement for a beginning job as a medical technologist is a bachelor's degree with a major in medical technology or in one of the life sciences. It is also possible to qualify through on-the-job experience, specialized training, or a combination of these.
Bachelor's degree programs in medical technology include substantial course work in chemistry, biological sciences, microbiology, and mathematics, with the final component of course work devoted to acquiring the knowledge and skills used in the clinical laboratory. In addition to basic science, many programs offer or require course work in management, career, and computer applications.
Programs in medical technology are offered by colleges and universities as well as by hospitals. Hospital programs generally are affiliated with colleges and universities and lead to a bachelor's degree, although a few hospital programs require a bachelor's degree for entry.
Many universities offer advanced degrees in medical technology and related clinical laboratory sciences for technologists who plan to specialize in certain area of laboratory work or in teaching, administration, or research.
Medical laboratory technicians acquire their training in a variety of ways, including community and junior colleges, hospitals, and vocational and technical schools. Many programs last 2 years and lead to an associate degree. Some medical laboratory technicians are trained in the Armed Forces.
Persons interested in a clinical laboratory career should be careful about selecting an educational program. Prospective employers--hospitals and independent laboratories-- may have preferences as to program accreditation. (Accreditation indicates that an educational program meets established standards.) Educational programs should be able to provide information about the kinds of jobs obtained by graduates, educational costs, the length of time the educational program has been in operation, instructional facilities, and faculty qualifications.
Nationally recognized accrediting agencies in the allied health field include the Committee on Allied Health Education and Accreditation (CAHEA) in cooperation with the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS), and the Accrediting Bureau of Health Education Schools (ABHES). CAHEA accredits programs that provide education for 26 allied health occupations including medical technologists, cytotechnologists, histologic technicians, specialists in blood bank technology, and medical laboratory technicians. ABHES accredits training programs for medical laboratory technicians and medical assistants.
Licensure and certification are well established in the health field as methods of assuring the skill and competence of personnel. Licensure refers to the process by which a government agency authorizes individuals to engage in a given occupation and use a particular job title. California, Florida, Hawaii, Nevada, Tennessee, and New York City require medical technologists and technicians to be licensed. Some States, such as Georgia, require registration. More information is available from State departments of health, boards of occupational licensing, or occupations information coordinating committees.
Certification is a voluntary process by which a nongovernmental organization such as a professional society grants recognition to an individual whose professional competence meets prescribed standards. Widely adapted by employers in the health industry, certification is a prerequisite for some jobs and often is necessary for career advancement. Agencies that certify medical laboratory technologists and technicians include the Board of Registry and the American Society of Clinical Pathologists in conjunction with the American Association of Blood Banks, the American Medical Technologists, the National Certification Agency for Medical Laboratory Personnel, and the Credentialing Commission of the International Society of Clinical Laboratory Technology. These agencies have different requirements for certification and different organizational sponsors.
Accuracy, dependability, and the ability to work under pressure are important personal characteristics for clinical laboratory personnel. Close attention to detail is essential because small differences or changes in tests substances or numerical readouts can be critically important for patient care. Manual dexterity and normal color vision are highly desirable. With the widespread use of automated laboratory equipment, mechanical, electronic, and computer skills are gaining in importance. In addition, technologists in particular are expected to be good at problem solving and to have strong interpersonal and communications skills.
Technologists may advance to supervisory positions in certain areas of laboratory work and, after several years experience, to positions such as chief medical technologist or laboratory manager in a large hospital. Manufacturers of home diagnostic testing kits and laboratory equipment and supplies seek experienced technologists to assist in product development or to work in marketing and sales. Manufacturers value the knowledge and hands-on experience that medical technologists bring to the firm, and the shift out of the laboratory to product sales and development offers excellent opportunities for career advancement.
Graduate education in one of the biological sciences, chemistry, management, or education usually speeds advancement. Technicians can advance to positions as technologists through additional education and experience.
Employment of clinical laboratory workers is expected to grow about as fast as the average for all occupations through the year 2000 because of the increased volume of testing. Continued expansion of the clinical laboratory field is foreseen for three fundamental reasons. First is the increase in disease and disability that will accompany rapid growth of the middle-aged and older populations. Second is the probability of new, more powerful diagnostic tests. Advances in bio technology have already changed testing methods through the use of monoclonal antibodies and another advanced technologies that permit rapid, simple, and accurate testing. As further advances occur, they are likely to spur more testing. And lastly, research laboratories that work to find the cause, treatment, and cure for diseases such as acquired immune deficiency syndrome (AIDS) are expanding dramatically in response to increased funding from public and private sources.
Employment would grow even faster were it not for advances in laboratory automation that are expected to make it possible for fewer people to perform more tests. Research and development efforts are targeted at simplifying routine testing procedures so that non laboratory personnel--physicians and patents in particular--can perform some of the basic tests that currently must be sent to a clinical laboratory for analysis.
Traditionally, most clinical testing has been done in hospitals. This is changing, however. Ongoing restructuring of the health services industry has led to a shift in testing from hospitals to physicians offices and commercial laboratories. As hospitals examine the cost-effectiveness of their laboratory operations, they are becoming more selective about the tests they perform in-house. Routine laboratory work is likely to be retained, while unusual, rarely performed tests may be sent for processing to a commercial laboratory. At the same time, some hospitals are expanding the scope of their operations through aggressive marketing, and others are setting up regional centers much like commercial laboratories.
Hospital jobs are expected to provide about one-fifth of the new jobs for clinical laboratory personnel. Many additional openings will occur in the hospital sector, however, due to replacement needs. Turnover is an important source of openings in this occupation since career advancement often means leaving a job as a technologists in order to become a sales representative, consultant, or educator.
The increased volume of testing in physicians offices is likely to lead to more jobs for clinical laboratory personnel. Some practices will hire full-time technologists or technicians, while others will employ part-time personnel to run tests at the end of the day. Demand for clinical laboratory personnel, though strong, is not expected to keep pace with the increased volume of tests performed in physicians offices, however. In the absence of regulatory changes, small medical practices will probably continue to have in-house laboratory work done by nurses or medical assistants, thereby avoiding the expense of hiring laboratory personnel.
Employers preferences vary so much that it is hard to generalize about future prospects for the different levels of clinical laboratory personnel. On the one hand, demand for technologists is likely to be sustained by the complexity of much clinical testing; the need for in-depth knowledge and independent judgment to verify test results and advise physicians; expansion of research laboratory facilities; and technologists greater versatility. On the other hand, advances in laboratory automation will continue to routinize certain tests, which may be favorable for technicians. Already, commercial laboratories and hospital laboratories that are large enough to support the investment in highly automated equipment employ more technicians than smaller facilities, where there is more custom work and greater use of methods requiring a technologist's expertise. As user-friendly laboratory equipment becomes more widely available, technicians are likely to be hired by medical groups and clinics for on-site testing of specimens previously sent to a large laboratory. This would heighten demand for technicians in such settings.
Like other areas of health care, the clinical laboratory is undergoing change on a scale that makes it extremely difficult to project future trends. For both technologists and technicians, demand will vary among employment settings, and job prospects will be affected by diverse factors including economic conditions; structure of the clinical laboratory market; strategies by health care providers seeking to enter that market; third-party reimbursement policy and other profit considerations; and changes in laboratory licensure and staffing regulations.
Opportunities for job seekers depend upon supply as well as demand, and the supply of qualified applicants may vary from one community to another. Nonetheless, overall prospects are very good, for enrollments in clinical laboratory training programs have leveled off in recent years, and little change in the supply of newly trained laboratory personnel is expected through the year 2000.
Salaries of clinical laboratory personnel vary depending on the employer and geographic location. In general, those in large cities receive the highest salaries.
Starting salaries for medical technologists employed by hospitals, medical schools, and medical centers averaged about $21,630 a year in 1990, according to a survey conducted by the University of Texas Medical Branch. Beginning salaries for cytotechnologists averaged about $20,800; for histology technicians, about $17,500; and for medical laboratory technicians, about $17,500. According to the same survey, experienced medical technologists working in hospitals, medical schools, and medical centers averaged about $30,150 a year in 1990; cytotechnologists, about $27,050; histology technicians, about $22,675; and medical laboratory technicians, about $23,400.
Medical technologists in the Federal Government averaged about $27,950 in 1990, and medical laboratory technicians, about $20,325 a year in 1990.
Clinical laboratory technologists and technicians perform a wide variety of tests to help physicians diagnose and treat disease. Their principal activity is the analysis and identification of substances. Other workers who perform laboratory tests include biology specimen technicians, criminalities, food testers, sample testers, veterinary laboratory technicians, and water purification chemists.
Sources of Additional Information
Career information is available from:
American Society of Clinical Pathologists, Board of Registry, P.O. Box 12270, Chicago, IL 60612.
American Society for Medical Technology, 2021 L St. NW., Suite 400, Washington, D.C. 20036.
American Medical Technologists, 710 Higgins Rd., Park Ridge, IL 60068.
American Association of Blood Banks, Suite 600, 1117 N. 19th St., Arlington, VA 22209.
American Association for Clinical Chemistry, 1725 K St., NW., Suite 1010, Washington, D.C. 20006.
American Society of Cytology, 1015 Chestnut St., Suite 1518, Philadelphia, PA 19107.
Accrediting Bureau of health Education Schools, Oak Manor Office, 29089 U.S. 20 West, Elkert, IN 46514.
National Certification Agency for Medical Laboratory Personnel, 1725 DeSalles St., NW., Suite 403, Washington, D.C. 20036.
International Society for Clinical Laboratory Technology, 818 Olive St., St. Louis, MO 63101.
For a list of CAHEA-accredited educational programs for clinical laboratory personnel, write:
Committee on Allied Health Education and Accreditation, 535 N. Dearborn St., Chicago, IL 60610.
For a list of training programs for medical laboratory technicians accredited by the Accrediting Bureau of Health Education Schools, Write:
Secretary-ABHES, 29089 U.S. 20 West, Elkhart, IN 46514.
For information about employment opportunities in a Veterans Administration medical center, contact the personnel office of that center.
Information about employment opportunities with the National Institutes of Health is available from the Clinical Center, National Institutes of health, Bethesda, MD 20892.