Dear Nate & All
First, let me begin by saying that I more than understand your (and everyone’s)
frustration regarding the difficulty and often distressing path to obtain a
license in NYS. Second, let me clearly state that my intention in this email
is not to argue the pros or cons of licensure or to endorse or refute a
particular point of view. The truth is that licensure is a requirement in NYS
and we must adapt to this reality. The goal is to (briefly) explain, good or
bad, what has transpired in NYS over the last few years so that everyone can
understand and hopefully prevent similar situations from developing in their
respective states.
From a historical perspective, the “path” taken to get to this point has had
many twists, turns and some serious potholes. The process spans more than 15
years of negotiations and deliberations by political, academic, corporate,
union and hospital entities as well as educators, histologists, pathologists,
activists and lawyers. It is beyond the scope of this email to try and
summarize everything that has taken place in that time frame. More recently
(preceding the passage of the law), labor unions and national organizations
wrestled over the language and structure of the law with one side strongly
opposed and the other solidly in favor of licensing. These organizations
interests were just that, their interests based on furthering their agendas,
not those of the technician, technologist or profession. Under these
organizations influence, legislation was passed, the law was implemented and
the regulations created. It is important to note that the
law, as it was originally written, did not mention histologist or the
histology discipline. In fact, the educational requirements to practice in the
medical laboratory field (any sub-discipline) required a bachelors degree with
a curriculum derived almost completely from the clinical side of the
laboratory. The only anatomic pathology component was a semester of microscopic
histology. In essence, the initial law grouped all sub-disciplines together
(from blood-banking to histology) and created a set of educational requirements
that, in the eyes of the NYS education department, established an individual’s
qualifications to work in the medical laboratory profession in NYS. It should
also be noted that early in this process (to the best of my knowledge) it was
proposed/recommended that the law be structured similarly to the classification
system already established by the ASCP BOR for certifying medical laboratory
professionals. This idea was also
suggested recently but was rejected by the major players at the negotiating
table. Interestingly, this approach would have been far better for fattening
the state coffers. I would fully agree with René. The spirit of the law is
intended to ensure that individuals who have an education are not undermined by
those that are placed into laboratories as “stop-gap” (either for financial or
staffing reasons) measures by facility administrations potentially compromising
patient care. We believe that this has principally arisen out of the
increasing medical laboratory personnel shortage which can be in part,
attributed to the low salaries plus the poor decision making of administrations
determined to sacrifice “quality for quantity”. Unfortunately, as is more
often the case, the spirit of the law is lost in the wording. Much of this
transpired out of site of the average working tech and therein lays one of the
major problems. Be it
complacency, lack of involvement, or because of our busy schedules we allowed
others to make decisions that directly impacted us and our profession. By the
time we realized what was happening, much of the damage had already been done.
Nevertheless, the NYS Histotechnological Society immediately mobilized and
began lobbying to revise the law so that it better represented the interests of
current and future histology professionals in NYS. We have continued to
maintain a presence on the state legislative level as well as communicate with
the NYS education department (Board of clinical Laboratory Technology, Office
of Professions).
In regards to the examination, the only public comments that I am aware that
the state initially made was that it was in the “process of seeking an
organization to administer the exam”. Almost all parties recommended that the
state use the ASCP BOR (now called the ASCP Board of Certification) as the
model and for the actual examination. To the best of my knowledge, NSH was not
involved in the decision cycle. Again, it is important to keep in mind that
there is a significant difference between the state licensing examination and
the ASCP board certification. The NYS examination(s), which most likely will be
administered by the BOC, is only intended to demonstrate that minimum
competency (based on the NYS regulations) has been met. In contrast, the ASCP
board certification is intended to demonstrate proficiency and expertise. In
February of this year, the ASCP BOC was awarded a contract by the NYS Education
Department to be the sole provider of
licensure examinations for medical technicians and technologist (NYS clinical
laboratory technicians and technologist). It seems likely, although not
certain, that the HT examination will be appended to this contract.
As mentioned above, the initial curricular criteria for examination eligibility
was unrealistic for histologist, since it was based entirely on a curriculum
for a medical laboratory generalist, principally a bachelor’s degree in
clinical pathology. During negotiations for an amendment to the law (to
correct many separate flaws), we proposed that histology be considered
separately from the other sub-disciplines, analogous to the differentiation
that is already made by pathologist, i.e.:“CP and AP”. Once again, the goal was
to establish a minimum set of curriculum requirements for individuals to
practice histology in the field. Those educational criteria were based on the
educational curriculum at SUNY Cobleskill since this was the only
histotechnology program in NYS at the time. In fact, without this amendment,
the program would have been forced to close and would have eliminated any
dedicated histotechnology programs in NYS. Regardless, the
NYS Education Department acknowledged that there was a significant difference
between the education of a histologist and medical laboratory
technician/technologist and that those differences warranted a different set of
educational criteria to establish competency. Furthermore and to clarify, an
individual does not need to have the Associate’s Degree in order to practice
histology in NYS. Individuals with Bachelor’s degrees that meet all of the
states requirements (education, practical and examination) for licensing can
practice histotechnology in NYS. As a result of the amendment the program at
SUNY Cobleskill is open and began accepting students this year. The shortage
has also prompted several other colleges to explore and commit to creating
campus based and distance learning programs. We hope that these programs will
“bear fruit” but given the economic developments over the past few years and
the budgetary constraints on the
educational system, the outcome is uncertain.
Finally, we should not fault the bureaucrats for something that has been
happening in our “own backyard” for several years. We can all agree that the
shortage is only going to get worse. Perhaps the bureaucrats viewed licensure
as a preemptive measure to ensure that patient care was not compromised,
especially considering the complexity that is health care reform. Regardless,
it is up to all of us to work together to help correct issues/flaws by being
active and aware of what is happening at the hospital, local, state and
national levels. No one will do this for us, it is our responsibility. At any
rate, I hope that this helps clarify some aspects of the convoluted path to
licensure in NYS. If anyone has any questions please do not hesitate to
contact us.
Respectfully
Luis Chiriboga & Amy Farnan, NYSHS Legislative Committee
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Luis Chiriboga Ph.D.
Assistant Professor of Pathology
Vice President New York State Histotechnological Society
NYSHS Website
www.nyhisto.org
NYSHS Message Board
http://tech.groups.yahoo.com/group/NYSHS1972/
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