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Technician or technologist? Sorting out overelapping roles in the lab.

Technicians may do technologist-level work but seldom receive the same pay. Here are four ways to avoid inequity and ill feeling.

An essential aspect of successful management is to match the employee with the job. In the clinical laboratory, a fine distinction must often be made between the roles of technologist and technician. The subject has become an increasingly strong concern since the final rules of CLIA '88 were published.

Some routine tasks can be performed by either a medical laboratory technician (MLT) or medical technologist (MT).[1-3] MTs receive higher salaries because they have more advanced education and training and, in most institutions, are responsible for more complex procedures. When roles become unclear, however, and MLTs do the work of MTs but for less pay, discontent may prevail.

* Cautionary tales. Lab managers have handled this problem in various ways and with varying degrees of success, as described in the real-life examples below.

[unkeyable] Ohio. A group of MLTs working in a hematology lab in Ohio repeatedly tried to convince their supervisor that because they did the same work as MTs, they should receive the same pay. Their supervisor justified the relatively small pay differential on the basis of educational preparation and job descriptions. The technicians remain unmollified and unhappy.

[unkeyable] Pennsylvania. Technicians in the clinical chemistry section of a Pennsylvania hospital lab presented a grievance to administration, claiming that the pay system was unfair. The MLTs admitted that they had had less formal education than the technologists but asserted that in their highly automated area, they all did the same work. After a lengthy investigation that bruised the relationships between technicians and technologists and between the technicians and laboratory management, hospital administration concluded that the pay differential was justified. Lab administration subsequently began to upgrade technician positions to technologist positions as they became vacant. Why, the manager asked, should the lab promote grumbling and strife when the salary difference was negligible?

Today fewer unhappy chemistry technicians work in this laboratory because fewer technicians work there. Technologists do the bulk of the testing.

[unkeyable] Michigan. In Michigan, a technician claimed to be doing the same work as technologists in the same section of a clinical lab but for lower pay. Again, an investigation ensued. In this case, however, the decision was made in the technician's favor. During a brief period when the laboratory was having difficulty recruiting technologists to fill vacant positions, management had filled some technologist positions with technicians. The technicians gradually learned the skills necessary to perform the jobs assigned to them. The result has been costly for the lab: The technician who complained received a monetary award to compensate retroactively for the differences in pay over several years. Other MLTs in the lab have now filed similar actions.

[unkeyable] Indiana. Technicians and technologists in a hospital laboratory in Indiana are expected to do the same work at the same rate of pay. One result is that most staff members are MLTs. It has become increasingly difficult to recruit technologists.

* Difference in theory. The examples above are neither isolated nor rare. It is true that MLTs and MTs enter the workforce with clearly different educational backgrounds. It is also true that most labs apply separate wage schedules for technicians and technologists. Sometimes the gap is relatively small: In Indiana, for instance, according to a personal communication with the state hospital association, the average starting salary was $17,500 for MLTs and $20,900 for MTs in 1990. (Since many institutions now pay technologists a sign-on bonus of $2,000 to $3,000, the $3,400 difference, representing only 16% of the MT salary, is relatively small considering the expanded capabilities of MTs versus MLTs.)

Because educational programs for both technicians and technologists prepare graduates to perform routine testing, such tasks may be done by either. Technologists' more extensive formal education, however, is expected to enable them to do more specialized testing and problem solving. One result of this expectation, which has been compounded by tradition and personal preference, is that some labs employ technicians almost exclusively and others hire mostly technologists.

Advances in sophisticated automation and other technology confuse roles further. Efforts at cost containment that prompted institutions to make the most of their work forces have also contributed to the blurring of job descriptions. A certain amount of expansion makes good managerial sense. For instance, technicians can be taught to handle more sophisticated instrumentation; technologists can develop their skills for decision making and problem solving.

In light of these changes, it is helpful to step back and clarify from an educational perspective the specific roles that technicians and technologists are prepared to handle in practice. These roles were dilineated in 1973 and most recently in 1989 by the American Society for Medical Technology (ASMT)[4,5] and in April 1992 by the American Society of Clinical Pathologists (ASCP) (see "ASCP redefines roles of technicians and technologists," page 39).

In general, the medical technician has the knowledge and practical experience to perform all high-volume, routine laboratory procedures using prescribed strategies for error identification and problem solving. The medical technologist, by contrast, has the knowledge and practical experience to perform not only routine procedures but also complex, specialized laboratory analyses requiring advanced skills and technical expertise. The technologist has the designated responsibility for exercising independent judgment in error identification and problem solving.[6]

* Equal pay. The doctrine of equal pay for equal work is drawn from the Equal Pay Act of 1963 (29 U.S.C. [unkeyable]206, June 10, 1963), which mandates paying workers the same for jobs that require "equal skill, effort, and responsibility, and which are performed under similar working conditions." Enacted to insure pay parity for men and women, the Federal statute enables employers to establish different pay rates based on seniority, merit, the measurement of earnings by quantity or quality of production, or another system based on a factor other than gender. Consequently, the Equal Pay Act does permit dissimilar pay when an employer has a clearly established, gender-blind hierarchy of job classifications.

* Overlapping roles. A laboratory manager should take four steps to delineate the responsibilities of MTs and MLTs: establish a job hierarchy, clarify differences in position descriptions, identify actual differences in practice, and clarify steps for advancement in the laboratory.

1. Establish a job hierarchy. Most human resources departments in large health care institutions have an established job hierarchy and compensation system that crosses departmental boundaries. Such hierarchies are typically the result of compensable factor-based job evaluations. Positions are classified on the basis of complexity, education credentials, scope, physical demands, extent of supervisory power, and work environment.(5) The web of professional interactions--what other positions are reported to, supervised, or interacted with--is also a factor. For each job, components are described and weighted so that they can be placed on a continuum (hierachy) of jobs. The institution's pay structure is then created to match the factors of each job in the hierarchy.

One resource the laboratory manager will find helpful in working with the human resources department to clarify job hierarchies in the Levels of Practice document from the American Society for Medical Technology.[5] This resource identifies four levels of laboratory practioner: generalist 1 (associate degree, MLT), generalist II (baccalaureate, MT), specialist III (master's or baccalaureate plus specialty credential), and specialist IV (doctoral degree). Of particular value are the comprehensive categories of information provided for each level of personnel. These include position duties, responsibilities and extent of authority, education credentials, experience, physical demands, special demands, and appropriate tasks. This consensus document can serve as the basis for establishing the job hierarchy within the lab.

2. Review job descriptions. Most clinical laboratories have job descriptions that outline general differences for medical laboratory technicians and medical technologists. It may be appropriate to review these descriptions and clarify specific differences in the levels of authority and responsibility expected of each. "Performance Standards for Laboratory Personnel" by Umiker and Yohe contains sample job descriptions for several areas of the lab.[7] Of particular value is the discussion of components related to personal contacts. The authors suggest that each position description include an entry describing whom the individual reports to, whom the individual supervises (if anyone), and with whom the workload is otherwise shared. Also of value is the section entitled "Limits of Authority," which specifies what the employee is permitted to do.

3. Examine actual work. The lab manager must insure that the decision-making and problem-solving steps listed in procedure manuals reflect the authority and responsibility specified in job descriptions. One of the lessons learned from the grievances described earlier was that the actual work done by a person should from the basis of compensation regardless of what is stated in the person's position description. Managers are cautioned not to be caught in the trap of compensating based on the job description while expecting work based on a higher level of responsibility and authority.

How does this policy work? In one hematology lab, both technicians and technologists performed leukocyte differentials and recorded cell morphology from blood smears. All could identify abnormal morphology. Certain smears, however, required review by a technologist, the supervisor, or a pathologist before results were reported. Such findings suggested a disease process for which judgement was to be rendered by someone with more understanding than technicians could provide concerning the pathophysiology of the condition.

Another time the line between job levels is crossed concerns a technologist's review of critical values. Such a review typically leads to an immediate change in direct patient care--initiating platelet infusion, for example. In yet other instances, adjustments to instrumentation should be authorized by a technologist. The lab manager must match the complexity of the task and the need for a relatively high level of decision making with the educational preparation and experience of the individual responsible for reporting the result.

One problem with delineating the roles of MLTs and MTs is that tasks and technical personnel are quickly changing. When a new analyzer is put into service, for example, consider the scope of authority and responsibility of the operators. Who can make adjustments or troubleshoot? Who may report abnormal results to physicians or nurses?

4. Clarify opportunities. The skills and abilities of technical staff overall are evolving as well. Most MLTs, given experience and the chance to develop new skills and knowledge, can handle increasing responsibility in the laboratory. For example, a chemistry technician can develop the knowledge and skills necessary to judge quality control data for an automated analyzer, making appropriate adjustments in calibration to correct for accuracy and precision. Also, a hematology technician can learn how to perform and report results for specialized procedures that require judgement and the ability to answer questions about test results and methodology. Laboratory managers should create a system specifying criteria enabling a technician to advance in practice. Recent reports about career ladders in the clinical laboratory suggest that many laboratories are making the effort.[8,9]

* Results. If your laboratory is plagued by obscure distinctions between the roles of medical laboratory technicians and medical technologists, consider taking one or more of the aforementioned steps. Clarifying roles should reduce perceived inequities that result in job dissatisfaction, reduced performance, and increased absenteeism and turnover. Correcting pay inequities may also help prevent the kind of exhausting and expensive litigation that calls for retroactive adjustments.

1. Hedrick, W, and Fiene, M.A. Task oriented job restructuring and curriculum development. Am. J. Med. Technol. 41: 50-55, 1975.

2. Reynolds, S.D.; Love B.F.; and Krall, J.M. Job analysis in the clinical laboratory. Am. J. Med. Technol. 42: 166-171, 1976.

3. Drewry, S., and Fiene, M.A. Cost-effective curriculum planning in health education. J. Allied Health 17: 27-36, 1985.

4. American society for Medical Technology. ASMT position paper: Differentiation among MT, MLT, and CLA expected capabilities at career entry. Am. J. Med. Technol. 39: 362-364, 1973.

5. American Society for Medical Technology. "Clinical Laboratory Sciences: Levels of Practice." Washington, D.C., ASMT, 1989.

7. Umiker, W.O., and Yohe, S.M. "Performance Standards for Laboratory Personnel." Oradell, N.J., Medical Economics Books, 1984.

8. Warren, J. Building a career ladder for the upward climb. MLO 15(1): 72-82, January 1983.

9. Stevenson, J.W. A career ladder for MT growth. MLO 21(6): 43-46, June 1989.
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Title Annotation:includes related article; clinical laboratory personnel
Author:Snyder, John R.; Jahn, Mike
Publication:Medical Laboratory Observer
Date:Jun 1, 1992
Previous Article:Parenthood, harassment, and other workplace distractions.
Next Article:Compiling employee safety records that will satisfy OSHA.

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