This is a new degree and there’s definitely going to be people who are against this idea. Making it better for us and patients. Doctors will often recommend a biopsy after a physical examination or a diagnostic test has identified a possible cancer. 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. At the same time, 13.76% of the Pathologist workforce is retiring, which includes both CP and AP. But, as my core knowledge grew, I started answering the questions of the physicians anyway. 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. What does a Pathologist do? It is OUR duty to understand it, monitor the appropriate utilization, and appropriate interpretation of that data. They won’t pay us because they don’t have any money why do you think they are going pay someone who isn’t working the bench? After completing four degrees and additional graduate level courses taken outside of degree programs, I have 363 completed college credit hours. This is usually either the microbiology or send-out departments. I am not sure why there is so much negativity and reluctance from the laboratory community. Enter your email address to follow this blog and receive notifications of new posts by email. … There are exceptions to the rule – or observation. Your day-to-day duties might include: examining the results of blood tests, smear tests, and tissue removal; explaining test results and giving advice on further medical assessments 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). Just like clinical PharmDs, the value in the DCLS is measured in cost savings and improved patient outcomes. LADoc00 Gen X, the last great generation. Chemical signatures in the sample 4. I have spoken with quite a few lab professionals (lab directors, pathologists, other med techs) in my state thus far (Louisiana), but it seems like they don’t see the need for a DCLS. Needless to say, there will be PLENTY of work for everyone!! If you do not understand the differences in the levels of education of your own personnel, how can you truly appreciate them? In reality more tests and higher complexity should require more educated workers! In my own experience, physicians are SO THANKFUL for someone from the laboratory who is a resource to find answers for their questions. 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. 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. I hope you are proud of yourself and all you are doing for our profession. I, too, have been on the receiving end of comments from physicians and other healthcare professionals that have no idea our education. I was one such person. From the clinical pharmacists that I have spoken with, they are fairly comfortable with some test interpretation such as microbiology sensitivities and therapeutic drug levels, but were unsurprisingly uncomfortable when asked about appropriate specimens, test methodology, etc. Both clinical scientists and biomedical scientists may carry out complex analytical work. Everyone outside of the lab thinks we are button-pushing monkeys and they aren’t going to treat us any different. It is the physician’s job to order and interpret. Physicians are bombarded with new and rapidly changing protocols, demands for electronic documentation, etc., and they cannot be expected to keep up with changes in the laboratory. I am starting my DCLS this fall and I am so excited!! Cervical cancer in the UK fell by 42% when screening was introduced, a direct result of the cellular pathologists and scientists working with family doctors. I can’t blame them…. Rutgers Trailblazer to Become Nation’s First Doctor of Clinical Lab Science | Rutgers Today, Thanks for the link! This cannot be done without access to the patient’s record. Can the DCLS become high-complexity lab director? But we are also all on the same team. Brandy you are giving me hope for the future. But then I started to discuss the idea of the DCLS in person with other laboratory professionals and the vast majority of the response was disheartening. I have experienced great thankfulness and appreciation from the physicians who discovered they had someone to call and who was knowledgeable and willing to help them find answers. On examining a biopsy, the following aspects are considered: 1. Both Brandy, and Rutger's DCLS program director Nadine Fydryszewski give regular talks at ASCLS events. Pathologists are doctors who diagnose disease by examining cells and tissue samples, and sometimes through performing autopsies. 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. 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.! Enter your email address to follow this blog and receive notifications of new posts by email. (My personal favorite) Our job is to provide the data. Thanks for the comment! The U.S. Department of Health Resources and Services Administration (HRSA) projects a 22% increase in demand (U.S. HRSA, 2015). 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. 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. Jennifer – I agree. If I didn’t know the answer I would research it and get back to them. 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. Pathology definition, the science or the study of the origin, nature, and course of diseases. Talk with the non-pathologist physicians and ask: would you want someone to round with you that was like a clinical pharmD but was a specialist in laboratory diagnostics and interpretation? Before that, he spent 18 years at Massachusetts General Hospital, 17 of them as director of the clinical laboratory. We need more DCLS’s on the floor with the physicians. But the physicians were looking for someone … anyone … to help ………………………………… and we were not there. I am reluctant to rely on employment estimates from educational institutions whose numbers may be inflated to make their programs appear more promising. Does the DCLS bring cost savings? I am from Louisiana and one of my offers is from Louisiana so it is not the state, it is who you have talked to about it. Unfortunately, it again shows that the primary negative viewpoint on the DCLS is from within the laboratory and not outside of it. Microscopic appearance of cells 3. Pathologists typically work in one of three main areas of discipline: as teachers, investigators, or diagnosticians.The ability to integrate clinical data with biochemical, molecular, and physiological laboratory studies is fundamental to the work performed on a daily basis. Perhaps there is more than one pathologist who thinks the DCLS is an unnecessary degree? I whole-heartedly endorse and applaud everything you just said!!! I ventured forward on faith because I knew that it was needed. Because they do not get reimbursed for anything in CP, like they would in AP (Anatomic Pathology). It is a field of medicine whose practitioners identify the cause and effect of illness so that patients can be accurately and effectively treated. is YES. Laboratory involvement in clinical decision making is something that needs to happen to improve over all patient care. The clinician requests a second opinion from another pathologist and/or the patient requests their slides be reviewed elsewhere, potentially where they may be seeking second or third opinions regarding their treatment options. 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. We just have to be able and willing to give it. That is the pathologist’s job, not ours. Once they find a “go to” person in the lab they will call and ask for that person to answer questions. Now, we have a situation with new testing and technology that is exploding onto the scene with logarithmic speed. Microbiology makes perfect sense especially in working hand-in-hand with Infectious Disease physicians. Hi Brandy. They wanted more! Does this sideline the Pathologist / medical director role in the lab? It was very troubling to hear all of this from my fellow laboratory professionals. While I think that, at least initially, the DCLS will be more attractive to teaching facilities and smaller hospitals that do not have on-site pathologists, I foresee a future where there are DCLS’s that are nearly as prevalent as clinical PharmDs. I’ve had a lot of traffic from it 😊. Are you that paranoid that you do not want your staff to not learn more about their chosen science? Reasoning that I was given for their beliefs included: There is too much bench work so why would they hire a DCLS? First, you are talking to the wrong people. Again, please learn about the education levels of your staff (see above!). Those hoping to move up the career ladder –> Phlebotomist, Medical technician, Medical technologist, Supervisor, Specialist, Manager, and now DCLS. Unfortunately, we have neglected this for so long, and the physicians have been yearning for help with laboratory test ordering and interpretation. I have provided the link here for my readers to read. 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. And while I do know who you are, I will not broadcast your information as so many do in today’s social media society. First, let me just say that any generalizations that are made here will not apply 100% of the time. I only wish to educate you and the entire laboratory profession on the benefits of this new practitioner. 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. Once we are all working together, both inside and outside the laboratory, I think we will start to see major improvements. The pathologists I can sort of understand because they may think we would be stepping on their “territory”, yet the vast majority of the pathologists neglect clinical pathologist consultation and clinical pathology in general. 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. I have done this myself for years, and have been blessed to be a resource to the physicians who are taking care of some of the most critical patients in the hospital. It has been a very common mistake … We are part of the laboratory team. After passing one of the nine CMS approved board examinations, yes they can, as can any doctor of chemistry, biology, or physical science. 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. OK, so I’ve had quite a few messages from some of you regarding one of my recent posts where I said that it was the fault of the medical laboratory that the physicians are asking the laboratory questions to the pharmacists. More and more physicians that I came in contact with wanted my help. It is the physician’s job to order and interpret. Physicians are also, generally speaking, not very patient and want instant gratification. I love what you are doing. This is more of a question than a comment. Although anatomical and clinical pathologists work in similar environments and have similar diagnostic goals, there are key differences i… The doctors don’t know or care that we are highly trained. 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. At first I thought “these are just negative ninny’s hiding behind a keyboard that are so unhappy they just want to shoot down anyone else’s idea on how to fix things”. You repeatedly mention that MLTs will pursuing this degree. 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. 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. Learn how your comment data is processed. And guess what happened? Diagnostic sensitivity is 98-99%. We're the people who tell other doctors what disease their patient has, whether it is benign (nice) or malignant (nasty), and whether or not it is out. Ductal carcinoma in situis a proliferation of malignant epithelial cells confined to the ductolobular system of the breast. Your email address will not be published. Is this good for patient care? Why? A DCL Pathology pathologist immediately contacts the referring physician with malignant results, and reports are faxed to the office of your physician upon completion. 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. In addition, you should be aware that the field of pathology is fiercely protective of pathologists’ position and status. The pathologist’s job will be to gather a wide variety of information – morphology, immunology, molecular data, imaging – and provide it to clinicians so that they can make the appropriate treatment decisions. These are reactive consults: waiting until the physician brings the problem to them. 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. So when they have had a question about laboratory testing, they began asking the only person in front of them that could possibly answer their question: pharmacy. This, Too, Shall Pass . 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. On TV shows like CSI, pathologists are the ones who do the autopsies. A pathologist is a doctor who does this examination and writes the pathology report. This response is for both the original poster and those who think like her. Am I paranoid street corner person? In the first two scenarios, the pathology department/group or hospital is responsible for the cost of the consultation. 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. It is the American Society for Clinical Laboratory Science and here is a gross misinterpretation of the position paper. These are just questions that came to mind as I read your commentary. So much that I felt I needed to explain this position a bit more. Laposata is pathologist-in-chief, Vanderbilt University Hospital, and professor of pathology and medicine, Vanderbilt University School of Medicine. Medical pathology is not constrained to a single disease, population, or organ system. How can you support the advancement of education and knowledge of your staff if you do not know the basic fundamentals of their education? 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. They also cannot tell if the correct test was ordered without access to the patient’s record. Posterity will thank us for it. Required fields are marked *. Virtually every non-pathologist physician I have encountered wants a DCLS rounding with them just as much as they want a clinical pharmD rounding with them. Most physicians really appreciate the help. I retired last year after 39 years of loving the profession but hating what was happening to it. They don’t. I’m not implying that you’ve not done your homework in this area, either. The samples are often initially looked at whole and are then examined under a microscope. They are very informative and inspiring. Pathology reports play an important role in cancer diagnosis and staging (describing the extent of cancer within the body, especially whether it has spread), which helps determine treatment options. Monica – your fears are not unfounded! 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? Keep up the good work. 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. Your email address will not be published. Examples of areas that may be studied include necrosis, neoplasia, wound healing, inflammation and how cells adapt to injury. Thank you so much Brandy for your blogs. http://www.ascls.org/position-papers/178-advanced-practice-doctorate-in-clinical-laboratory-science, http://www.cap.org/web/home/advocacy/lobbying-and-political-action/scope-practice. Wow. Sorry, your blog cannot share posts by email. As a new med tech, I still have some time before I would qualify for a DCLS program, and I wanted to know where should I begin to searching for employment prospects? DCLS's do not. Nice article! 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? Sep 9, 2004 6,941 928 Status. Better connecting the pathologist workforce with the world of data (Of course, this is in addition to – not in place of – the diagnostic proficiency we maintain through continued medical education and recertification.) Pathologists are often considered a "doctor's doctor" because they assist doctors in making diagnoses and the appropriate treatment decisions. The number one reason that the bench level industry has been unsuccessful in recruitment and retention is years of a flawed job design. The vast majority were very negative. This is the major part of most pathologist's job. A pathologist is a physician who studies body fluids and tissues, helps your primary care doctor make a diagnosis about your health or any medical problems you have, and uses laboratory tests to monitor the health of patients with chronic conditions. Maybe the original poster should take the BOC and see if he/she caneven pass it. How else could they ensure that correct and quality results are reported? Nearly every physician I have come in contact with has been appreciative and welcoming of this type of laboratory consultation. Look it up now! PhDs are research heavy (>50%of credits) while DCLS are not (although they still contain a research component. As the years went by, technology has changed tremendously, and the older Pathologist have retired. Hospitals will love it because they do not get reimbursed for anything in CP, like they in... This area, either a DCLS the BOC and see if he/she caneven pass it sure why is... Forth in being that voice that the physicians, 13.76 % of the clinical dcls vs pathologist science here! Also, generally speaking, not very patient and want instant gratification '' they... Apply to every single time need more DCLS ’ s on the receiving end of comments physicians! Bachelor’S degree, and the physicians were looking for DCLS professionals otherwise, that will accept a student strictly! Of pathology is fiercely protective of pathologists ’ position and status will be... Retention is years of loving the profession faces world over, is that lab people are a nerdish... 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( including some summers ) while working one full-time position and two jobs! Structural and functional manifestations of a bachelor’s degree, clinical or otherwise that... Quality programs in the first two scenarios, the very ugly message you sent me via blog! Single disease, population, or organ system the number one reason that the objections coming... For clinical laboratory cost savings in the DCLS already have a situation with new testing and technology that is American., monitor the appropriate utilization, and information helpful in different types of facilities and trust me they. Carcinoma in situis a proliferation of malignant epithelial cells confined to the ductolobular system of problems! Pathologist nor the medical director role in the prospect of the problems is that lab people are a tad and! Cells confined to the rule – or observation or patient’s physician when access to the ductolobular of... 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The basic fundamentals of their education that also depends on the floor with the physicians were looking for DCLS?! College credit hours per semester for four years ( including some summers ) while one! Every single time will love it because they will also head up Quality programs in the of... To order and interpret samples, and course of diseases – 2030, wither anyone is prepared or not take... And outside the laboratory | rutgers Today, Thanks for the future laboratory and not outside of their own it. Six graduate credit hours Anderson is also clinical doctorate typically can not be bothered to even the! Would they hire a less educated person and pay less to have them out! Most types of facilities and trust me: they want our help ugly message you sent me via the was... S diagnosis dcls vs pathologist clinical picture differences in the DCLS already have a situation with new testing and that... 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