The first "Doctorate of Clinical Laboratory Science" is set to graduate

[pathperson]

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 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)

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

And she also has a blog!

www.roadtodcls.com

Enjoyed this article:
What Do They Ask?

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?

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.

https://www.kansasregents.org/resou...gram_Approval/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.

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

---

Members don't see this ad.

 

[cmz]

Doctors are giving up their autonomy at every corner. Mid levels are coming in from all over. I think a person in this position could be a useful part of the team but they would in no way replace an MD.

 

[Alteran]

There is one memorable quote that I remember from a faculty member at my medical school in reference to mid-levels: Mid-levels are great until they hit "the precipice of ignorance".

There are certain experiences that are unique to the medical training of a resident/fellow, in any specialty, that a mid-level simply can't get. Period. There are reasons we have to be physicians to be pathologists- our diagnoses and consultative advice have a very real and direct effect on patient care and we bear the responsibility for it.

So here's the larger point. If this doctor of CLS isn't going to bear full responsibility for bad medical decision making or be allowed to hold a CLIA license and all that comes with it, they'll never replace us. Their role sounds more like what mine was like on a CP rotation, just answer a bunch of clinician phone calls we would rather not have taken.

 

[Autopsy101]

If they take a certifying exam, they will be able to hold the CLIA certificate of a high complexity lab.

High Complexity – Laboratory Director Requirements

MD, DO with current medical license in state of lab’s location AND certified in anatomic and/or clinical pathology by ABP, AOBP, or equivalent qualifications

MD, DO, DPM with current medical license in state of lab’s location AND 1 year laboratory training during medical residency

MD, DO, DPM with current medical license in state of lab’s location AND 2 years experience in directing/supervising high complexity testing

PhD in chemical, physical, biological or clinical laboratory science AND certification by the HHS-approved boards (effective 02/24/2003) which are:

1. ABB – American Board of Bioanalysis
2. ABB public health microbiology certification
3. ABCC – American Board of Clinical Chemistry
4. ABFT – American Board of Forensic Toxicology (limited to individuals with a doctoral degree)*
5. ABHI – American Board of Histocompatibility and Immunogenetics
6. ABMGG – American Board of Medical Genetics and Genomics (formerly known as American Board of Medical Genetics (ABMG))
7. ABMLI – American Board of Medical Laboratory Immunology
8. ABMM – American Board of Medical Microbiology
9. NRCC – National Registry of Certified Chemists (limited to individuals with a doctoral degree) *

 

[jupiterianvibe]

clin lab isnt medical practice so theyll have that.

nobody but mds/ dos are touching ap. its too niche.

 

[WEBB PINKERTON]

I'd rather see a MT become a pathology midlevel than a nurse. A nursing degree is the equivalent of a biology degree for complex testing according to CMS now. I could easily see more nurses becoming Doctorates in clinical lab science. There will come a day when we will have to plug a pathologist into the matrix to combat these nurses when they have taken over.

I have noticed at many cytopath meetings they keep beating the drum about some cytopath midlevel. We are already producing too many cytopathologists. What is the point of adding a midlevel to a contracting field? Is cytopath such a dying field that we now want to let some midlevel deal with it?

 

[dukeresident]

I sense a certain aura of denial in these comments.

 

[wholeheartedly]

Non-pathologist PhDs can already become full fledged lab directors after things like clinical microbiology or clinical chemsistry fellowships. As a clinical lab scientist I was really opposed to people with science PhDs being lab directors instead of pathologists. But after seeing the fellows side by side with the residents, they did pretty good and the pathology residents just weren't into some of these CP areas. I'd rather see someone in those fellowships with a clinical lab background and doctorate than someone with minimal clinical lab exposure. The few we've had come through our clin chem fellowship with the clinical lab background did exceptionally well. They have a much better understanding of testing methodology and development than the path residents do. Most wind up in academic fields working on improving diagnostics or developing new ones.

Most pathology residents I've met seem pretty bored and uninterested in areas like clin chem or clin micro etc.

 

[ScubaV]

Yeah I really have no interest in the clinical lab. I'll do it if a job needs it, but I'll never be interested like I am with AP. I suspect many (most?) pathologists feel the same way. As a resident, CP rotations were treated as a red-headed stepchild by pretty much everyone involved. Even the CP faculty (such as they were) didn't really know what to do with us and spent at most an hour a day teaching or showing us the day-to-day before shuffling us off to techs or self-study.

I'm not sure how the compensation fits in though. I see a lot of complaints about how reimbursement for medical directorships and clinical lab work for pathologists is going down. My residency hospital dumped a lot of the clinical lab PhDs and relied on supervisor and manager types to pick up the slack. Why pay some midlevel $180k when the hospital could pay a pathologist a few thousand to be the CLIA name while the already existing managers handle the day-to-day they already do?

 

[wholeheartedly]

Yeah I really have no interest in the clinical lab. I'll do it if a job needs it, but I'll never be interested like I am with AP. I suspect many (most?) pathologists feel the same way. As a resident, CP rotations were treated as a red-headed stepchild by pretty much everyone involved. Even the CP faculty (such as they were) didn't really know what to do with us and spent at most an hour a day teaching or showing us the day-to-day before shuffling us off to techs or self-study.

I'm not sure how the compensation fits in though. I see a lot of complaints about how reimbursement for medical directorships and clinical lab work for pathologists is going down. My residency hospital dumped a lot of the clinical lab PhDs and relied on supervisor and manager types to pick up the slack. Why pay some midlevel $180k when the hospital could pay a pathologist a few thousand to be the CLIA name while the already existing managers handle the day-to-day they already do?

I would be terrified of some of the supervisors and managers I know making some of those decisions...

 

[pathperson]

Here is the DCLS degree candidate response to my post here on SDN. WOW! I had no idea I was worthy of such fame in the blogosphere! And for the record, I have never written to this individual on her blog, or communicated with her, or done anything like that. So I do not know where that is coming from to say that she "knows who I am," and where I practice and what comments I have left on her blog and other silliness. Perhaps there is more than one pathologist who thinks the DCLS is an unnecessary degree?

This, Too, Shall Pass

 

[LADoc00]

Hold it, hold it. This is fake news or something...

THERE IS NO WAY WHATSOEVER THIS STATEMENT CAN BE TRUE: "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/yea"

UNLESS THERE IS A HOSPITAL PAYING A PATHOLOGY GROUP $600,000+$180,000+ANOTHER $90,000 FOR BENEFITS=$870,000 PER YEAR (?!).

If there are hospitals paying this to path groups PLEASE dear Lord tell me where...

Okay I see where the 600K figure comes from: "In addition to performing rounds at the hospital with the medical team, Gunsolus reviews all laboratory test orders and is part of the hospital’s diagnostic management team as well as a nationally sponsored consumer information response team that answers patient questions about lab tests. During her residency, she documented nearly $700,000 in savings that came from consulting with clinicians and health care providers about lab tests. But what most excites her is being part of the attending health care team."

This is bogus. Any of us can document 2 million dollars we saved yesterday by doing something something too haha. Yes I stopped myself from ordering 1,100 immunos yesterday and I saved the hospital my entire fee, look at me I can justify my six figure salary with ease!!

This is an old game.

Also tons of Clin Path M.D.s round with the teams at big hospitals. I use to do it all the time in training AND medical school...

You can really wave a hand and with enough charisma convince a hospital CEO that routine Happy Endings Thai Massages for anatomic path staff save money because they order less stains on DRG reimbursed/capitated patients afterward. So what?

 

[pathperson]

Yes, I know that Clinical Pathologists round on patients. There are entire hospitals where CP does a diagnostic care team and it is a huge success. I think she would respond (and maybe you will get a shout-out on her blog, too, LaDoc!) that this is not available everywhere hence the need for a non-physician to do it? I do not know. As for the salary, I have heard that the salary "should be" something "in line" with other doctoral degrees in the "range of $120-180k starting." I do not know if this was the actual starting salary the DCLS degrees are/will be offered, I guess I misspoke on that point. It is what the degree candidates believe they should get or what the hospitals think they are worth for these "savings," I am not sure where the number comes from on their end, I thought it was an actual offer. I have also heard a starting salary 2-3x a current top MLS salary is what is expected. This is what the MLS colleagues are telling me they are hearing from their other colleagues.