Your health practitioner would like to run some tests and so you’ve had your blood drawn and your sample has been sent “off to the lab.” (Follow a Sample to find out what happens next.) You met the phlebotomist who drew your blood sample, but have you ever wondered who will actually receive your sample and conduct the tests?
There are a variety of skilled and educated laboratory professionals who, as a patient, you may never see face-to-face. However, these individuals play a very important role in your health care. People working in the clinical laboratory are responsible for conducting tests that provide crucial information for detecting, diagnosing, treating, and monitoring disease.
These professionals use specialized instrumentation and techniques to analyze patients’ samples, such as blood, urine, body fluids and tissue, and stool. They may be working in the lab located in the hospital, clinic, or physician’s office where you are being treated or they may be at a reference laboratory located hundreds or perhaps thousands of miles away. (See Where Lab Tests Are Performed for more information on the different laboratories and how they serve you and your health practitioner.)
Because they produce the results that impact the health care you receive, laboratory professionals are specially educated and trained for the functions they perform and, in most cases, have certification for their position. Those in supervisory roles, with extensive training and many years of experience, oversee the testing being performed in the laboratory. They also ensure that strict quality control and quality management systems are followed.
Clinical laboratories in the United States are regulated by the federal government under the Clinical Laboratory Improvement Amendments (CLIA). Passed by Congress in 1988, the regulations for the CLIA amendments established quality standards for laboratory testing to ensure that results are accurate, reliable, and timely. They include standards for the education and training of laboratory personnel so that you can be confident in their ability to process your specimen, perform the tests, and report accurate results.
The following information provides an overview of the field of laboratory medicine, from the current outlook for professionals in the field or looking to join it to a summary of many of the types of professionals who work in the lab. Links to various resources on educational programs and job databases can be found at the end of the article.
There are a variety of positions within a clinical laboratory, and roles are based on a career ladder of academic and technical milestones. Although terminology has changed slightly over time and may vary from location to location, the main elements to a clinical laboratory team include the laboratory director, technical and general supervisors, scientists/technologists, and technicians.
In addition, laboratories have people who manage the operations. While these professionals may not be performing tests on your samples, most have had training and experience in the technical aspects of the laboratory, and are an important element in ensuring that the laboratory runs efficiently.
The director of a clinical laboratory is usually a board-certified medical doctor, PhD scientist, or in some cases, a medical laboratory scientist. He or she must meet the requirements of CLIA, the federal law governing U.S. laboratories, and/or the College of American Pathologists (CAP), The Joint Commission (TJC), COLA, or the American Association for Laboratory Accreditation (A2LA) if the lab is to be accredited by one of these private organizations.
Many are pathologists, physicians who specialize in the science of identifying the nature and cause of disease and who are specially trained to interpret biopsy results, Pap tests, and other cytologic samples. If the laboratory director is not a pathologist, a consulting pathologist may be retained to provide services that require their expertise, including interpreting test results.
Regardless of the qualifications of the director, CLIA states that the director is responsible for managing overall operations within the laboratory, including maintaining the standards of agencies that inspect and accredit the lab and ensuring that all technical, clinical, and administrative functions of the lab are performed.
Pathologists are medical doctors who diagnose and characterize disease by examining a patient’s tissues, blood, and other body fluids. They are specially trained to interpret biopsy results, Pap tests, and other biological samples. Sometimes called a ‘doctor’s doctor’, pathologists work with primary care physicians as well as specialists, and use laboratory testing to identify or rule out diseases and conditions. A laboratory may employ one or more pathologists depending on the requirements of the lab.
Pathologists work in two broad areas:
- Anatomic pathology is the examination of the physical appearance and microscopic structure of tissues. Anatomic pathologists look at biopsies and organs removed at surgery (surgical pathology) as well as cells that are collected from brushings or body fluids (cytopathology). They also perform autopsies to investigate the cause of death (autopsy/forensic pathology).Some pathologists sub-specialize based on organ systems: neuropathologists (nerves/brain), renal pathologists (kidney), hematopathologists (blood and bone marrow), and dermatopathologists (skin).
- Clinical pathology deals with the measurement of chemical constituents of blood and other body fluids (clinical chemistry), analysis of blood cells (hematology), identification of microbes (microbiology/parasitology/mycology), and the collection, preparation and use of blood for transfusion (transfusion medicine). Clinical pathologists direct the laboratories that perform these tests and provide consultation to other doctors on the significance of test results.
Technical and General Supervisors
Clinical laboratories may also have technical or general supervisors, although the position title may be different in certain organizational structures. The lab director may serve as the technical supervisor as well. The technical supervisor may be a medical doctor (MD) or doctor of osteopathy (DO) with certification in anatomic and/or clinical pathology or other specialty, depending on the area s/he is responsible for, or has qualifications that meet the standards of board certification. The technical supervisor may also be a scientist with a PhD, a Master’s degree, or a bachelor’s degree in addition to acquiring the appropriate laboratory experience(s). S/he is responsible for the technical and scientific oversight of the lab.
A general supervisor, sometimes referred to as the laboratory manager, may have the same qualifications as the technical supervisor, but an individual with a bachelor’s or associate’s degree in the sciences and appropriate experience may qualify as well. A general supervisor is responsible for oversight of the day-to-day laboratory operations as well as the personnel conducting the tests and reporting results.
Medical Laboratory Scientist (MLS), Medical Technologist (MT), Clinical Laboratory Scientist (CLS)
These laboratory professionals are responsible for performing routine as well as highly specialized tests to diagnose and/or aid in the treatment of disease, troubleshooting (preventing and solving problems with results, specimens, or instruments), and communicating test results to the pathologist or treating health practitioner. They may examine blood or body fluid specimens under the microscope for bacteria, parasites, fungus, or cells that might indicate cancer or other diseases. They perform quality control checks, evaluate new instruments, and implement new test procedures. Scientists/Technologists also may assume managerial roles, including supervising laboratory personnel as the general and/or technical supervisor.
Many Scientists/Technologists specialize in one particular area, such as in hematology, clinical chemistry, immunology, molecular pathology, cytogenetics, microbiology, or transfusion medicine. Scientists/Technologists have a bachelor’s degree in clinical/medical laboratory science or the life sciences that included three or four years of academic course work and one year of clinical experience. Most labs require that they be certified to demonstrate their competence to conduct their job functions. Scientists/Technologists are certified by organizations such as the American Medical Technologists (AMT), the American Society for Clinical Pathology (ASCP) Board of Certification (BOC), or the National Registry of Microbiologists (NRM). Some states require Scientists/Technologists to obtain a license from the Department of Health or the Board of Education.
Clinical Laboratory Technician (CLT) or Medical Laboratory Technician (MLT)
A clinical laboratory technician (CLT) or Medical Laboratory Technician (MLT) performs routine tests in all areas of the clinical laboratory. Usually, CLTs/MLTs have an associate degree and have completed an accredited CLT or certificate program. CLTs?MLTs will use microscopes as well as other laboratory instrumentation and techniques to perform tests. Like Medical/Clinical Laboratory Scientists, they may specialize in certain areas of the lab, such as clinical chemistry, and may be certified by the Board of Certification or American Medical Technologists, and some states require a license.
Phlebotomists, sometimes called phlebotomy technicians, work directly with you, the patient, to draw your blood for laboratory tests using venipuncture or skin puncture. Usually, PBTs have completed high school and have received phlebotomy training, either through a program or on the job experience. Some may be certified.
Pathology Assistant (PA)
Pathologists’ assistants are usually responsible for the gross examination and dissection of tissue samples sent to the anatomic pathology lab and may perform or assist pathologists with autopsies (the postmortem examination of a body). They usually have a Master’s degree and are certified by the ASCP BOC. They prepare tissue that will be tested for specific abnormalities PAs may also supervise others in the anatomic pathology lab.
Cytogenetics is a subspecialty that examines blood and tissue specimens, specifically looking for any chromosomal abnormalities. Clinical cytogeneticists are usually MDs or PhDs who have been certified by the American Board of Medical Genetics and work closely with genetic counselors. They are assisted by cytogenetic clinical laboratory scientists/technologists who perform cytogenetic analyses. These cytogenetic technologists have a bachelor’s or master’s degree in the sciences or clinical/medical laboratory science and CG certification from an approved organization like the BOC. They prepare biological specimens for genetic studies and perform cell culture and microscopic analyses as part of cytogenetic studies.
Cytotechnologists are specialized laboratory technologists whose job it is to prepare and examine samples of cells from body tissue and fluids under a microscope to look for signs of cancer or other diseases by recognizing changes in the cells, such as their color, size, or shape. They may assist in performing fine needle aspirations (using a needle to remove cells from a cyst, an enlarged lymph node, or abnormal tissue masses or fluids) and examine the sample removed during the procedure for abnormal cells. They assist pathologists in making a diagnosis. Usually, CTs have a bachelor degree and have completed an accredited CT program.
Also known as histotechs, work in the pathology lab and are trained in the preparation of tissue samples used to diagnose disease. They help the pathologist to analyze small sections of body tissue that have been removed from a patient. The tissue sample undergoes special preparation before being examined under a microscope to look for evidence of disease, such as cancer. HTLs perform more complex procedures than histologic technicians (HTs; see below) and may supervise their work. They usually have a bachelor degree and have completed an accredited HTL program.
Histologic technician (HT)
Many laboratories are looking for professionals, ranging from individuals who have a two-year associate’s degree to those with advanced degrees and experience. Each laboratory must have on staff a sufficient number of personnel who meet the qualification requirements to perform the functions needed for the volume and complexity of testing performed at that lab. For this reason, the make-up of each lab differs in terms of the number and type of personnel that are on staff. Other people who might work in the laboratory include assistants, students in training, medical residents, pathology residents, and research fellows. However, the people holding the positions described above are the key people who will be handling your sample, performing the tests, and ensuring that the results they provide to your doctor are accurate, reliable, and timely. You may never meet them, but they are a crucial part of the health care team that cares for your health.
The following table summarizes the key positions in the lab, the education required for the position, and the standard responsibilities of the position.
|POSITION||EDUCATION & TRAINING||RESPONSIBILITIES|
|Laboratory Director||Doctoral degree (e.g., MD or PhD); sometimes a medical laboratory scientist
Board certification recommended
|Directs and manages all lab operations and ensures quality patient care; Interprets test results, with consulting pathologist|
|Technical Supervisor||Doctoral degree (e.g., MD or PhD); may be Master’s or bachelor’s degree with experience
Board certification recommended
May be the same person as the lab director
|Provides oversight of technical and scientific functions of the lab|
|General Supervisor||May be the same person as the lab director or technical supervisor
Depending on lab and experience, MLS/MT or MLT may qualify
|Provides oversight of day-to-day functions of the lab|
|Medical Laboratory Scientist (MLS) or Medical Technologist (MT)||Bachelor degree in clinical/medical laboratory science or life sciences and completion of accredited MLS/MT program
Licensure/certification may be required by employers
|Performs routine tests;develops new test methods under supervision; performs quality control tests; becomes group or team leader; supervises, teaches, delegates|
|Medical Laboratory Technician (MLT)||Associate degree and completion of accredited MLT or certificate program
Licensure/certification may be required by employers
|Performs routine tests and quality control tests under supervision on MLS/MT|
|Pathology Assistant||Master’s degree and board certification||Gross examination and dissection of tissue samples sent to anatomic pathology lab; assist with autopsies|
|Cytogeneticist||Doctoral degree (e.g., MD or PhD) and board certification||Performs cytogenetic analyses to diagnose chromosomal abnormalities in human genetic diseases|
|Cytogenetic Technologist||Bachelor degree (B.A. or B.S) in the sciences or clinical/medical laboratory science
CG certification recommended
|Prepares biological specimens for cell culture and microscopic analyses as part of cytogenetic studies; assists the cytogeneticist|
|Cytotechnologist (CT)||Bachelor degree and completion of accredited CT program||Examines human cells under microscope for signs of pathology (e.g., Pap smears for signs of cancer); with appropriate experience, may supervise a cytology laboratory|
|Histotechnologist (HTL) or Histologist||Bachelor degree and completion of accredited HTL program||Prepares tissue samples for microscopic examination by pathologist and performs complex procedures; can supervise histologic technicians and, with appropriate experience, may supervise histology laboratory|
|Histologic technician (HT)||High school degree and completion of accredited histology program||Prepares sections of body tissues for microscopic examination by pathologist, processes tissue biopsies, assists histotechnologists|
|Phlebotomist (PBT)||High school degree and training or work experience||Collects blood samples from patients for lab tests|
* Compiled in part from “Careers in Medical Laboratory Technology,” published by the American Society for Clinical Pathology; “Clinical Chemistry: Partnerships in Healthcare” by the American Association for Clinical Chemistry; the Association of Genetic Technologists; and Laboratory General: CAP Checklist 1 (April 1998). The specific name for many of these positions varies by location.