Last week, California Governor Jerry Brown signed Assembly Bill 2281 into law, which expands MLT scope of practice. The new law’s provisions were informed by Healthforce Center at UCSF research and recommendations. For two decades Healthforce faculty member Susan Chapman has been leading and conducting research on the medical lab workforce, which is in short supply. We spoke with Dr. Chapman about this advancement in California health care policy.
Q: What are MLTs?
A: MLTs perform and monitor clinical lab tests that help diagnose, treat and prevent disease. In collaboration with other clinical lab workers such as lab assistants and clinical lab scientists, MLTs ensure that tests run smoothly, check lab results before sending to providers and conduct more complex tests. The MLT role exists in a number of states, although their recognition, licensure and certification vary from state to state. California developed a licensure for MLTs many years ago, but implementation and growth of the role has been slow. The shortage of clinical laboratory workers in California poses a challenge for the health care delivery system.
Q: How did Healthforce’s research inform this bill?
A: This is evidence-based policy informed by years of Healthforce research. In 2014, Healthforce released a report that explored how MLTs were being integrated into California hospitals. That report pointed out that there were some areas where clinical labs couldn’t fully utilize MLTs because they weren’t allowed to do specific tasks. Those tasks included performing blood smear reviews, microscopic urinalysis, blood typing and antibody screening. These are the tasks that California MLTs are now allowed to perform because of this new law. Our further research in 2017 found that other states allowed MLTs to perform these tasks.
Q: Why are medical lab technicians so critical to the health care workforce?
A: Although MLTs may be less visible to the public than physicians or nurses, they are essential members of the health care workforce. Clinical lab tests in health care are increasing in number and complexity. In the intensive-care unit and emergency departments, quick and reliable lab testing is needed on an ongoing basis. Lab tests are used to diagnose and monitor health conditions.
Q: What impact will this bill have on the workforce?
A:We’re hoping that allowing MLTs to perform additional tests will open more positions to MLTs and increase the educational pipeline for MLTs. Because the educational programs are linked to availability of jobs, it may increase demand and address current and expected workforce shortages.
Q: What can leaders of health care organizations do to ensure they are fully utilizing MLTs?
A: Health care organization leaders can look at their clinical laboratory workforce to ensure that people are working at the top of their experience and education. There should be a mixture of skills and credentials in the lab. Allowing MLTs to perform the additional tests identified in this legislation will improve laboratory efficiency.
Q: What is the Healthcare Laboratory Workforce (HLWI) and what role did it play in this process?
A: The HLWI was created in 2005 to develop innovative solutions to clinical laboratory workforce shortages. Staffed by the California Hospital Association, HLWI has worked with a group ofhospital and health system laboratorians, training program directors, the California Department of Public Health, and others committed to addressing this critical shortage of laboratory professionals. This group identified a set of specific tasks that MLTs are trained to perform, but unable to conduct under California law. If MLTs could perform the tasks that they are trained to perform, the group posited that efficiencies could be improved and shortages could be mitigated in clinical labs throughout the state. This group’s work led to Healthforce’s instrumental research on the issue.
Q: How does it feel to see legislative change after so many years of working on this issue?
A: It’s nice to see recommendations developed into legislation and get signed into law. We’re happy the state used research and data to inform policy making. Many other stakeholder groups have worked hard on this over the years. It’s good to see the evidence of our research address a workforce challenge and health care need.
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About Dr. Chapman
Dr. Susan A. Chapman is a professor in the Department of Social and Behavioral Sciences, UCSF School of Nursing, and faculty at UCSF’s Healthforce Center and the Institute for Health Policy Studies. In addition, she is co-director of the Masters and Doctoral programs in Health Policy at the School of Nursing. Her scholarly work focuses on health workforce research, health policy analysis, and program evaluation. Dr. Chapman’s workforce research focuses on transforming models of primary care to address new and expanded roles for the health care workforce and the long-term care workforce. She received her BSN from the University of Iowa, MSN from Boston College, MPH from Boston University, and PhD in Health Services and Policy Analysis from UC Berkeley.