CLS Issues Today

Bay Area Lab Administrators MeetingMay 8, 2006

Robert J. Thomas, Section ChiefLaboratory Field Services

CA Dept of Health Services

Lab Personnel in CAPublic health microbiologists since 1920sMedical technologists since 1939Category name was changed to “Clinical Laboratory Scientists” (CLS) in 1996Basic requirement: BS degree in science 12 months training/experience, and state-administered exam

CLS shortage

Chronic shortage since the mid- 1990sCLS work force retiringAdvances in laboratory technologyExpanded use of unlicensed personnelQuality of laboratory tests>70% of MD’s diagnosis based on lab results

Efforts to reduce shortage…What can be done?

Raise money through grants to fund trainingExpand license categories Require less educationAccept on-the-job experienceRecruit personnel from out-of-stateAccept other certifying organization exams

And, in 2005

Medical laboratory technician (MLT)

MLT “scope of practice”…W and M testing in chemistry, hematology, microbiology, immunologyNo microscopy or immunohematologyPhlebotomyWork under supervision,

BS-level licenses in CA……

Clinical lab scientists (state administered exam)Chemist, microbiologist, toxicologist, immunohematologist, hematologist scientistsCytogenetic, genetic molecular biologist scientists (NCA cert exam)Histocompatibility scientists (ABHI exam)Cytotechnologists (ASCP exam)Public health microbiologists (state administeredexam)

The push for national certification exams…

Certification exams or license exams?

Lab Field Services has been administering licensing exams for over 50 years.Number of applicants decreasing.Need for contractor help with exams increases costs to the state.Part of MLT regulation package, Section 1031.8, would allow LFS to switch to certifying exams.Some license categories already use certifying exams, as CT, histocompatibility scientist, genetic scientists.Pressure to switch to certification exams.

Switch to certification exams in CA

Will be done over next 3 yearsTry to approve CLS and MLT exams firstConcern about whether certification exams will adequately evaluate the candidateConcern about whether certifying organizations will accept CA candidatesFour year “look-back” for persons applying for licensure

The benefits of certification exams for licensure

Exam would be more accessibleExam could be given throughout the yearNew license categories difficult to testWould save the state moneyWould encourage persons from outside CA

Downside of certification exam

How to control quality of the exams?How will the exam be made available to all applicants including foreign?How much additional cost to applicants?How to test for state law concerns?

Standards to approve certifying exams…

The certifying organization must be nationwide in scope;Be independent of any vested interests;Be not-for-profit;Certify professional categories of persons

How the exam is developed…

Job assessment to establish blueprint of the exam, knowledge and skills neededProcedures for keeping job assessment current and relevantQualification of persons developing questionsExplanation of how exam questions fit job assessment

How the exam has performed

Psychometric evaluation of each question’s performance, reliability and validityExplanation of how each question is weightedExplanation of how cutoff score is determinedExamination performance statistics for previous 5 years, pass/fail rate, number of applicants, number persons passing examConfidential review of exams for previous 4 years

The certifying organization must agree to…

Provide the exam to any person that LFS approves. Not necessarily require the applicant to meet certification standardsProvide documentation of candidates passing exam to LFSProvide documentation to candidates that they have passed the exam

Labs Approved to Train CA CLS

1571978

322005

212000341995541990

791985

2011974Year No. of Approved Training Schools

Reference: Laboratory Field Services Records

Summary of License Exam Stats

628 (237)96 (87)724 (324)2005

939 (365)58 (50)997 (415)2003

423 (186)51 (47)474 (233)2000

544 (213)153 (138)697 (369)1995

1353 (471)193 (154)1546 (625)1990

1780 (359)392 (363)2172 (722)1985

1655 (243)860 (723)2515 (966)1980Non-CACATotal (pass)Year

Reference: "California Clinical Laboratory Scientist Licensing Examination Statistics" from the research project report, "Clinical Laboratory Scientist Review Seminars Directed Toward California Licensure" dated September 2005 written by Dora Wong Goto, MS, CLS, MT(ASCP), CLS(NCA), SanFrancisco, CA. and Laboratory Field Services examination data.

Licensed CLS in California

About 17,000 CLS on active status in 2005Down from about 27,000 active at time of CE requirements in 1992/1994About 20,000 – 22,000 active CLS in 1980sAbout 18,000 – 20,000 active CLS in 1970sLosing about 850 licensees per yearAbout 450 new licensees per year

CA Licenses, 2005CLS 16,452BS Scientists 791Cytotechs 783Public Health Micro 1,592Genetic Scientists 465PhD Directors 214

Total Licensed 19,514

Certified Phlebotomists 4,865

Online Applications! What is it and how does it work?

Electronic processApplicants register through internetFees paid by credit cardStatus can be verified through websiteApplicants can update info and make limited changesAvailable to new license applicants onlyFuture plans include license renewalsCheck out the LFS website at www.dhs.ca.gov/ps/ls/lfsb/

A Word about CLS License Renewals

Good news… No fee increase for 2006!!!Please keep LFS advised in writing of address changesRenew promptlyThanks for updating us about your birthdateFurther staggering of renewals to begin in 2007Biennial renewals vs. annual renewals

How are things at LFS now?

Severe staff shortage of professional positions continues.Workload backlogs in phlebotomy certification, lab director oral exams, state initial onsite inspections.Delay in processing CLS applications.Limited hiring of permanent staff.Many retired annuitants fill clerical positions.No new positions until about July 2006?

Thank you. LFS new Richmond Facility! Questions