Justin Hanenberg, MLS(ASCP)CM

This is my summary and concluding thoughts on the series, “Tracing Our Roots,” by Virginia R Kotlarz.

The earliest histories of clinical laboratory sciences (CLS) begin around the mid-1920s, but the societal nuances that informed shaping of the profession began as early as the American Revolution. When women began attending college after the Civil War, there was an assumption that graduating with a degree was merely for self-fulfillment and to better themselves as wives and mothers. Career opportunities were limited, as mostly male-dominated spaces left little room for mobility. However, several epidemic outbreaks in the late 19th century (typhoid, tuberculosis, dipthera, etc.) created a new need for laboratory testing in patient care. In the early 1900s, having a laboratory in the hospital was considered a luxury. [1] Increased demands on pathologists to meet changing expectations of public health and “big science” started to carve out a niche for female scientists. With this, CLS was one of the first occupations women could find work that was not the conventional low-level clerical role (albeit because the special skills demanded were “feminine,” such as bacteriology and cleaning glass wear). [1]

Following World War I, there was a shortage of qualified staff, and demand for services increased, exacerbated by the American College of Surgeon’s accreditation standard of 1919 that required hospitals have a lab. ASCP established the Board of Registry in 1928, and the next 20 years would be spent sorting out titles, academic requirements, and whether or not the practice of laboratory technology was “purely mechanical,” requiring “little thought”. [2] There was a spectrum of opinion on impact and importance of laboratory technicians. Pathologist Dr. Harvey Black argued to keep salaries low because the job was just temporary to “bridge the gap between graduation and marriage.” [3] Dr. Kano Ikeda believed recognizing lab techs as professionals would elevate the service and status of clinical pathology. [2] Bailey (1936) described them as “silent partners to Aesculapis (god of medicine) …” [3] Salaries would eventually see an increase with World War II because the military couldn’t meet staffing demands.

It was around 1936 and with the formation of ASMT that the term “medical technologist” fell into favor. Texas Society of Medical Technologists was the first state chapter to affiliate with them in 1939. [4] ASMT had an Advisory Committee to the BOR over feeling resentful of ASCP’s “dictatorial practices,” such as “under no circumstances” could a med tech practice or teach without the supervision of a qualified physician/pathologist. The Code of Ethics was written in a way that gave pathologists power to impose sanctions and control supply of lab personnel. California was the first state to institute licensure based on statute in 1937 when ASCP opposed the idea.

In 1938, prerequisites increase to two years of liberal arts college to have MTs be “educated” and not “trained.” [5] In 1946, nurses were no longer accepted to training programs as having equivocal education. Specialization and certification was introduced in 1948 as high as doctoral degrees. Nearly 250 schools were approved in 1943 and expanded to 650 schools in 1958. The AMA proposal for three years college prerequisites went into effect in 1962. Objectives of MT programs would then become “To inoculate within the student … a curious mind … beyond those needs ordinarily required for simply learning theory and technical procedures …” [5]

As more options for employment became available to women in male-dominated spaces (with better pay and recognition), the National Committee for Careers in Medical Technology was formed by ASCP, ASMT, and CAP to increase recruitment. Between 1953 and 1959, enrollment increased by 56 percent, and schools grew by 28 percent. However, lack of visibility to high school students and limited advancement opportunities curtailed student increases. [5] The Allied Health Professionals Training Act of 1966 was the first national level legislation that allocated resources to increase career opportunities, and ASMT began formalizing a career ladder in 1973. [6]

The 1960s and 1970s were tumultuous as ASMT and our workforce sought to solidify its professional status with standardization among academic programs and gain autonomy from ASCP. Carnegie College in Ohio filed the first of a series of legal cases against the BOR in 1962 for “engaging in restraint of trade.” [7] In 1964, a New Jersey case claimed “monopolistic control over medical technology by the BOR in the state.” In 1966, the DOJ asserted that CAP violated civil antitrust laws where “CAP had illegally monopolized and restrained the medical laboratory trade for the benefit of its member pathologists.” A 1969 lawsuit by ASMT charged that ASCP “engaged in conspiracy to monopolize trade” using the BOR. As a result, NAACLS was organized in 1974 with equal representation between ASCP and ASMT and governed as an independent entity. [7] ASMT was soon renamed as the American Society for Clinical Laboratory Sciences (ASCLS), publishing position papers between 1973 and 1976 that defined the occupational mission and responsibilities of clinical laboratory science. [8]

Career opportunities expanded greatly in the 1980s as sophisticated technologies, administrative duties, and non-traditional laboratory settings became commonplace. The number of people over 65 started to increase dramatically, consumer education and interest in personal health became en vogue, and expansion of federal Medicare/Medicaid programs all contribute to the massive increase in demand for laboratory services. It was around 1989 when the clinical laboratory started to be considered “high tech.” [10] In context, the Clinical Laboratory Improvement Act of 1988 (CLIA ‘88) were passed in October 1988 defining three tiers of method complexity and required personnel standards for operation. [8]

Despite the allure of advanced technology, computers, and public interest, little attention was given to the “female factor,” particularly regarding salaries. Workforce studies in the late 1970s and 1980s showed that men made 5.7 percent more and were 2.4 times more likely to be in higher positions. [10] In 1992, Medical Laboratory Observer (MLO) reported that 49 percent of women surveyed experienced sex discrimination in various forms. Very few who left the field did so for family reasons (or, if they did, they planned to come back) despite Harvey Black’s predictions. Attrition was more greatly correlated with “unmet needs for self-actualization and esteem and to low salaries.”

Reflecting back, the occupational saga cataloged by Kotlarz clearly exemplifies the challenges, and celebrations, in shaping the field of CLS. We can see the evolution of our practice from “women’s work,” trained under strict supervision of pathologists, to an educated occupation with its own agency(ies), and then advancing into a “high-tech” profession distinct and recognizable from pathology. It has not been an easy path. Numerous examples through the articles show that clinical laboratorians faced much more opposition than support through the decades. In more recent years, the growing echelons of our profession to include the DCLS has been celebrated and welcomed by pathologists and other allied health fields. Hearing the perceptions and actions from individuals, and related organizations, to curbing the growth of CLS leaves me to believe that many of our own existing beliefs about our professional value were not defined by the people who make up our professional body. The challenges of staffing and recognition experienced by our predecessors are all too familiar for us today. Interestingly, we are in an unprecedented time during the COVID-19 pandemic that could very well mimic our 1900s early history as new chapter in our occupational development. Let this be a time for us to challenge old assumptions of what makes a laboratorian and redefine our value from within so we can attain the highest level of service to our colleagues and patients alike.

References
  1. Kotlarz, VR. “Tracing Our Roots: Origins of Clinical Laboratory Science.” Clin Lab Sci. 1998; 11(1):5-7.
  2. Kotlarz, VR. “Tracing our Roots: The Beginnings of a Profession.” Clin Lab Sci. 1998; 11(3):161-166.
  3. Kotlarz, VR. “Tracing Our Roots: Early Clinical Laboratory Scientists and Their Work – Myth and Reality.” Clin Lab Sci. 1998; 11(4): 209-213.
  4. Kotlarz, VR. “Tracing Our Roots: A Professional Identity Emerges: 1928 to 1945.” Clin Lab Sci. 1998; 11(5): 275-279.
  5. Kotlarz, VR. “Tracing Our Roots: The Broadening Horizons of Clinical Laboratory Practice (1945-62).” Clin Lab Sci. 1998; 11(6): 339-345.
  6. Kotlarz, VR. ‘Tracing Our Roots: A New Era in Clinical Laboratory Science Education. Clin Lab Sci. 1999; 12(4): 213-219.
  7. Kotlarz, VR. “Tracing Our Roots: Years of Turmoil (1962-1977).” Clin Lab Sci. 1999; 12(6): 336-341.
  8. Kotlarz, VR. “Quest for Professional Recognition.” Cllin Lab Sci. 19989; 11(1): 35-43.
  9. Kotlarz, VR. “Tracing Our Roots: The Rocky Road Toward Recognition of Clinical Laboratory Science’s Professional Status (1962-1977).” Clin Lab Sci. 2000; 13(3): 166-171.
  10. Kotlarz, VR. “Tracing Our Roots: New Opportunities and New Challenges in Clinical Laboratory Science (1977-1992). Clin Lab Sci. 14(1): 12-18.