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. Below is a description of these and other positions as well as a table summarizing the training and roles associated with each.
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 smears, 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.
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, or a bachelor's degree and experience. 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) or Medical Technologist (MT)
Medical laboratory scientists (MLSs) or Medical technologists (MTs) play an important role in the clinical laboratory. They 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 may train other laboratory personnel, perform quality control checks, evaluate new instruments, and implement new test procedures. MLSs/MTs also may assume managerial roles, including supervising laboratory personnel as the general and/or technical supervisor.
Many MLSs/MTs specialize in one particular area, such as in clinical chemistry, immunology, molecular pathology, microbiology, or blood bank/transfusion service. MLSs/MTs 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 MLSs/MTs be certified to demonstrate their competence to conduct their job functions. MLSs/MTs 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).
Medical Laboratory Technician (MLT)
A medical laboratory technician (MLT) performs routine tests in all areas of the clinical laboratory. Usually, MLTs have an associate degree and have completed an accredited MLT or certificate program. MLTs will use microscopes as well as other laboratory equipment and techniques to perform tests. Like MLSs/MTs, they may specialize in certain areas of the lab, such as clinical chemistry, and may be certified by the BOC or AMT.
There may be other personnel within the laboratory as well, including several with very specific functions. These include:
- 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 for complex tests such as frozen section, flow cytometry, and immunohistochemical staining. PAs may also supervise others in the anatomic pathology lab.
- Cytogeneticist (CG). Cytogenetics is a subspecialty of medical genetics. Clinical cytogeneticists are usually MDs or PhDs who have been certified by the American Board of Medical Genetics. They perform and interpret cytogenetic analyses in order to diagnose chromosomal abnormalities and help manage genetic disorders. They are assisted by cytogenetic technologists, who usually have a bachelor's degree in the sciences or clinical/medical laboratory science and CG certification from an approved organization like the BOC. Technologists prepare biological specimens for genetic studies and perform cell culture and microscopic analyses as part of cytogenetic studies.
- Cytotechnologist (CT). CTs 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.
- Histotechnologist (HTL). Also known as histologists, these technologists 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). HTs perform routine specimen preparation, a task that usually involves slicing thin pieces of human tissue and mounting them on glass slides for examination under the microscope by the pathologist. Usually, HTs have completed high school and an accredited histology program.
- Phlebotomist (PBT): Phlebotomists, also 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.
In addition, laboratories have people who manage the operations. While these professionals may not be performing tests on your samples, they are an important element in ensuring that the laboratory runs efficiently. Many labs are looking for laboratory professionals with advanced degrees and experience.