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Realistic qualifications to practice medical technology.

As long as I can remember (and that's a long time), a continuing controversy has raged between the "haves" and the "have nots"-having and not having baccalaureate degrees, that is regarding the following question: Is having a baccalaureate essential to practice medical technology'?

This year the subject has again heated up the profession due to the long-awaited HCFA personnel regulations, which were recently announced, and the CLIA 88 regs, which may override them and were still not final at press time. The question has generated substantial differences of opinion among the professional organizations. * Where people stand. Those who have degrees or are medical technology educators constitute the majority of those who cannot accept any pathways to clinical lab competence besides the baccalaureate. Those who have succeeded professionally without extensive formal education usually vehemently disagree with the "haves." In the middle is a group, including man,,, employers, who can see both sides. They believe more than one path leads to knowledge, technical skills, and competent performance.

Resolving this issue will require give and take on both sides. It will be crucial to recognize the present and future needs of the marketplace and to understand role expectations versus reality. Most important, opposing groups must be willing to look at the issues with an open mind, to disregard their own vested interests, and to approach quality care objectively, free of consideration of their present job positions.

HCFA's final decision on personnel qualifications will not solve the problem, since employers can exceed the regulations if they choose. Individual states have the same option in drafting licensure laws. Now is the time for the profession to analyze all aspects of the question. We must reach a conclusion that will advance the field, as sure high-quality care, and recognize the reality of present-day practice.

Of all non-physician health professions, laboratorians complain most about status, recognition, and low salaries. Could one reason be that we are the most fragmented group'. The lab field is represented by more diverse organizations than I can count. Not surprisingly since all the associations claim t for the profession, no single organization has credibility. The proliferation of spokespersons forces others to make decisions for us. * Questions. Solving these problems demands that we address several questions. Do clear-cut job descriptions exist for the clinical laboratory scientist/medical technologist and clinical/medical licensed technician? Should entry-level requirements be minimal or maximal'? What levels of knowledge and skill are necessary to perform competently! Do the present national and state credentialing exams (of which there are far too many) accurately measure the degree of competence that is essential to good performance? Is a baccalaureate necessary for the CLS and an associate degree for the CLT? Can career mobility tracks help develop individuals as competent as those who pursue more extensive formal education'?

I don't believe any empirical study that would answer these questions has ever been done. Isn't it time we did our homework instead of using subjective, emotional, turf-protecting arguments to justify our demands'? * Varying needs. in my travels, I find that personnel needs vary with the size and location of labs. The larger the lab, the greater the need for several levels of qualified personnel. The smaller the lab, the greater the need for more advanced knowledge and skill.

Cross-training to increase personnel flexibility is on the rise. The concentration on patient outcome measures, off-site testing, and restriction of unnecessary or inappropriate testing has provided opportunities to expand the responsibilities of laboratorians. Adding to these factors the continuing growth of automation makes it clear that the qualifications of lab personnel must keep pace with the changes.

I believe technologists need a broad base of understanding not only of general scientific laboratory principles but also of theory, problem solving, correlating and intergrating patient data, and skills in interaction. The focus should be on what to do rather than on how to do it. Laboratorians can achieve these competencies in other ways than by obtaining a baccalaureate.

Although most laboratory practitioners have completed two- or four-year academic programs, many competent individuals have not. They are proof that alternate routes work. I am a strong proponent of alternatives as long as the following criteria are used:

The benchmark for knowledge and skills should be a baccalaureate for the CLS and an associate degree for the CLT. A clear definition of equivalency should be established for those who achieve their academic-related education in nontraditional ways.

*A structured clinical program, consisting of either a combination of student and hospital clinical experience or a full hospital program, should be completed.

*All practitioners should pass a national certification exam reflecting the above benchmark levels of knowledge and skill. Only one national exam, recognized by every state, should exist.

It is not enough, however, to establish national qualifications. Even after winning their credentials many new laboratorians are not allowed to utilize their hard earned knowledge. Instead, they are placed before machines and told to push buttons. Individuals should not come to this field with unrealistic expectations.

Isn't it time we all put aside our personal biases, vested interests, and political differences to present a united front that will solidify our profession'? Then and only then will we achieve the status and economic parity everyone so eagerly seeks. Once we solve these problems that have become synonymous with the lab profession, we will be able to attract the quality and quantity of individuals needed in the field. And only then will we insure performance and services of the highest caliber. n
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Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Article Type:column
Date:Jun 1, 1990
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