This, Too, Shall Pass

Below is a copy of a post that has been circulating two different message forums: the forum and the AACC forum. Given the traffic that these posts have received and the notices/messages I have received from them, I only feel it is necessary to respond. This response is for both the original poster and those who think like her. Unfortunately, it again shows that the primary negative viewpoint on the DCLS is from within the laboratory and not outside of it.

Here is the post in italics and my responses are scattered throughout:

Midlevels come to Pathology – and not the kind we want and invite (Pathologist Assistants) – the kind dreamed up by the Association of Clinical Laboratory Scientists because, in their own words, they are tired of producing technicians and want to produce an advanced degree.

It is the American Society for Clinical Laboratory Science and here is a gross misinterpretation of the position paper. I have provided the link here for my readers to read. .

It started here at Rutgers, as has been discussed on this forum once in the past per my search:

Rutgers SHP – CLS – Doctorate in Clinical Laboratory Science

And now the first graduate will finally finish, I believe she went to the program part-time over a period of several years (not sure about that)

Yes, I did go for several years part-time and have the transcripts to prove it. Six graduate credit hours per semester for four years (including some summers) while working one full-time position and two part-time jobs. After completing four degrees and additional graduate level courses taken outside of degree programs, I have 363 completed college credit hours. This includes extensive coursework (that means several courses) in Bio and Clinical Chemistry, Immunology, Microbiology, Parasitology, Mycology, Immunohematology, Hematology, Hemostasis, Epidemiology, Pharmacology, clinical correlation, etc.

Rutgers Trailblazer to Become Nation’s First Doctor of Clinical Lab Science | Rutgers Today

And she also has a blog!

Thanks for the link! I’ve had a lot of traffic from it 😊

Enjoyed this article:

What Do They Ask?

While I appreciated the link to the blog, the very ugly message you sent me via the blog was not. While I understand you are a female pathologist in the glorious state of Texas, reducing yourself to name calling a fellow laboratory professional, even if you do not agree with that professional, is uncalled for. Then hiding behind a computer screen to do it is just shameful. And while I do know who you are, I will not broadcast your information as so many do in today’s social media society. I only wish to educate you and the entire laboratory profession on the benefits of this new practitioner.

And the DCLS degree will now be offered at UTMB Galveston, and a program at MD Anderson is also in the works. CAP Board of Governors will discuss this at their meeting this weekend as this is a scope of practice issue with CP, but there is little they can do if the Board of Regents in these respective states is approving these degrees. Hospitals will love it because they will tout cost savings in the clinical lab – as if CP does not exist already. And MLTs love it bc the starting salaries are apparently $180k range that the sole candidate has been offered in her starting position – she claims she saves the hospital $600k/year. Just like the NP/ DNP degree has caused a brain drain away from bedside nursing to greener pastures and the lure of being called “Doctor” without attending medical school, so will the DCLS degree lure MLTs away from the bench into the role of Clinical Pathologist. Please read the documents linked here carefully – what do you all think?

Does the DCLS bring cost savings? Absolutely! Does it bring a $180k salary? I wish! And the program at UTMB-Galveston has been in existence for two years.

Here is where it your post begins to show exactly how much of the laboratory, and about the people in your laboratory, you truly do not currently understand. Please allow me to break it down for you:

Laboratory Assistant – On the job trained, some have post-high school certificates

MLT (aka Medical Laboratory Technician) – Associate’s degree

MLS (aka Medical Laboratory Scientist) – Bachelor’s degree (has a different board examination than the MLT exam)

You repeatedly mention that MLTs will pursuing this degree. There is no doctoral degree, clinical or otherwise, that will accept a student with strictly an associate’s degree. They must first have the minimum of a bachelor’s degree, and the majority of those pursing the DCLS already have a master’s degree. And the fact that you clearly do not know the difference between the two makes me feel sorry for those laboratory personnel whom you oversee. If you do not understand the differences in the levels of education of your own personnel, how can you truly appreciate them? How can you support the advancement of education and knowledge of your staff if you do not know the basic fundamentals of their education? Are you that paranoid that you do not want your staff to not learn more about their chosen science? Do you see your bench-level staff as nothing more than work-horse button-pushers there to do your bidding?

You also complain about being called “Doctor” without going to medical school. There are many “Doctors” that did not go to medical school and they have been accepted for many years. These include Doctors of Pharmacy, Doctors of Physical Therapy, Doctors of Clinical Nutrition, Doctors of Podiatry, oh and don’t forget the Doctors of Philosophy (PhD). Should you forget, the medical doctorate is also clinical doctorate. If anyone should be upset over the use of “Doctor” outside of their own, it should be the PhD doctorates! However, as in most areas, the other non-medicine clinical doctorates, while we are doctors in our own right, typically relinquish the title of “Doctor” within clinical teams and use our first names instead so as not to confuse who has the MD degree.

For a glimpse into the background thinking that led to the degree, please read this long document (with support from pathologist) from the U Kansas Board of Regents – pathologist supports it bc since slides come out at the same time that CP consults are needed, then the medical director cannot provide the consults, thus we need a midlevel in this role.

Click to access KUMC_Doc-Clinic_Lab_Webpage.pdf

The document specifies that the “DCLS” doctor (former MLT) will answer patient questions about the labs, answer physician questions about lab, interpret results, guide further testing choices, and have full access to the patient EMR, diagnoses and symptoms to integrate all this info together. They will also head up Quality programs in the lab and be the driver of cost savings in the lab.

Again, please learn about the education levels of your staff (see above!). Currently laboratorians have very restricted access to the EMR, diagnoses, and symptoms, and in some facilities, have no access at all. Since you are unaware of the education levels of your staff, I am also assuming that you have no idea about their capabilities as well. Your bench-level scientists have been trained to correlate the patient’s lab results with the patient’s diagnosis and clinical picture. How else could they ensure that correct and quality results are reported? How can a medical laboratory scientist correctly assess a delta check or other significant laboratory test result changes without knowing the patient’s diagnosis or other clinical changes? They don’t. They must take time to contact the nurse or patient’s physician when access to patient’s record would solve this problem. They also cannot tell if the correct test was ordered without access to the patient’s record. Do we not have an ethical duty to identify when the incorrect test was ordered and either notify the ordering physician or correct the order? This cannot be done without access to the patient’s record. The majority of your laboratory staff likely have more college education than the majority of your facility’s nursing staff, yet the laboratory scientists are not trusted with access to the patient medical record? Why is that? Why are the medical laboratory scientists not used to their full potential?

The pathologists I have worked with fully support the DCLS. We are part of the laboratory team. We are not looking to take over the team from the pathologists, we are here to improve test utilization, improve patient care, improve patient outcomes, improve communication and interdisciplinary care, and decrease healthcare costs. I respond to the phone calls, the consultation requests, provide continuing education, and monitor appropriate test utilization which the pathologist is able to keep up with slides, electrophoresis interpretations, molecular interpretation, teaching residents, and medical directorship responsibilities. If I get a patient or physician situation that necessitates the intervention of the pathologist, then I bring the pathologist on board.

Is this good for patient care? Does this sideline the Pathologist / medical director role in the lab? Am I paranoid street corner person?

Yes, this is good for patient care. No, it does not sideline the pathologist nor the medical director role in the lab. Can the DCLS become high-complexity lab director? After passing one of the nine CMS approved board examinations, yes they can, as can any doctor of chemistry, biology, or physical science. Can we replace the medical director? No. The high-complexity lab director qualification is best for those small facilities who do not have on-site pathologists. There are many rural hospitals that currently have anatomic pathologists overseeing clinical laboratories, sometimes from several hundred miles away and they are only on-site a couple of hours once a month or even as little as once a quarter. Would it not be better for laboratory quality and patient care to have an doctoral trained advanced practitioner with extensive experience in medical laboratory testing overseeing these types of labs?

While I believe I have shown your paranoia is certainly misplaced, I suggest you spend less energy on degrading the DCLS, and more energy in learning about your own laboratory staff and their educational background. For you cannot hope to lead a laboratory to be the best it can be if you do not understand and utilize your staff to the best of their abilities.


6 thoughts on “This, Too, Shall Pass

  1. Nice article! This is a new degree and there’s definitely going to be people who are against this idea. Laboratory involvement in clinical decision making is something that needs to happen to improve over all patient care. DCLSs are well trained board certified Medical Laboratory Scientists who are ready to take on the role as a liaison between clinicians and laboratory personnel. The need for DCLSs is so critical that laboratory practitioners will be integrated into the clinical team in no time!

    Liked by 1 person

  2. Dr. Gunsolus,

    The Bureau of Labor Statistics (U.S. BLS, 2016) projects clinical laboratory (MLS and MLT) job growth to increase 13% by 2026, that’s double the ALL jobs growth for any other field. The U.S. Department of Health Resources and Services Administration (HRSA) projects a 22% increase in demand (U.S. HRSA, 2015). These job growths are largely due to the advances in molecular and genetic testing in the pathology worlds, and retirement replacements in the clinical benches. At the same time, 13.76% of the Pathologist workforce is retiring, which includes both CP and AP. Needless to say, there will be PLENTY of work for everyone!!

    The laboratory industry projects an overall workforce retirement of 28.3% in the next five years (Garcia, Kundu, Ali, & Soles, 2018). This is unprecedented! The National Association of Clinical Laboratory Science (NAACLS) accrediting agency estimates 6,347 annual eligible bench graduates (Cearlock, 2018), which is only able to meet about 53% of demand. This crisis is peaking between 2026 – 2030, wither anyone is prepared or not!

    The number one reason that the bench level industry has been unsuccessful in recruitment and retention is years of a flawed job design. A 2017 VHA Office of Inspector General report revealed that of the five critical healthcare professions (doctors, nurses, psychologists, P.A.s and Medical Technologists), all had been able to recover workforce shortages…EXCEPT the lab M.T.! The lack of medical laboratory visibility in patient care, the lack of a demonstrated patient care value, and lack of reimbursement structure on clinical consultation have only ‘dead ended’ the laboratory profession.

    The experienced clinical laboratory supervisor and masters level managers who would like to advance in their career now have an option, making the entire laboratory industry have more job attractiveness. While not everyone will be able to endure the rigors of an advanced practice doctorate, it is truly the best hope for recruitment and retention of medical science professions. Those hoping to move up the career ladder –> Phlebotomist, Medical technician, Medical technologist, Supervisor, Specialist, Manager, and now DCLS. It’s long over due.

    Liked by 1 person

  3. Well articulated and nuanced.
    Part of the problem the profession faces world over, is that there is a gross under-representation of Medical Lab. Scientists and the value they add to overall patient care. This has had negative consequences for career progression and job fulfillment. DCLS is well positioned to change this.

    These are very defining times for the MLS profession world over, and we all must do our bid (including voicing and correcting opinions) to improve the perception and potential of MLSs to contributions to the healthcare continuum. Posterity will thank us for it.


  4. I hope you are proud of yourself and all you are doing for our profession. Keep up the good work. You won’t be alone forever.


  5. If you’re familiar with the history of the medical lab you should know that it was designed as a place to stick women who were interested in medicine to ensure they would be safely walled off from public exposure and clinical practice. This is why the medical lab has historically been staffed mostly by women despite being a highly technical field, and it may be part of why the lab is all-but-excluded from the rest of the care team.

    In addition, you should be aware that the field of pathology is fiercely protective of pathologists’ position and status. CAP is a pathology organization, and they’ve stated their intent to ensure that laboratorians’ scope of practice excludes any kind of consulting or diagnostic role.

    “The College of American Pathologists (CAP) is committed to protecting pathologists’ scope of practice from encroachment from allied health professionals.”

    The answer to your questions (Are you that paranoid that you do not want your staff to not learn more about their chosen science? Do you see your bench-level staff as nothing more than work-horse button-pushers there to do your bidding?) is YES.

    Furthermore, numerous lab personnel have noted the lack of advancement opportunities within the lab and the need to start school over from the beginning to become a PathA or pathologist – and this, too, may be partly due to efforts to put a wall between pathology and the button-pushers.

    As the poster said, “CAP Board of Governors will discuss this at their meeting this weekend as this is a scope of practice issue with CP, but there is little they can do if the Board of Regents in these respective states is approving these degrees.” I believe these problems will never be solved as long as labs and laboratorians are under the thumb of CAP and ASCP. In short, the DCLS is a shot across the bow of the pathology establishment, and I would expect them to react in the fearful and hostile manner you have seen here.

    On that note, perhaps it would be better to say that the objections are coming from pathology, not from lab. After all, “the lab” is a black box full of button pushers which is run by pathology but separated from it, and while laboratorians may be bitter or skeptical about physicians wanting lab advice due to their own experiences, I believe most would welcome greater educational and promotional opportunities in their field.


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