Addressing management issues

March 1, 2009

Edited by C. Anne Pontius, MBA, CMPE,

Tooting my own horn

Q For 20 years, I have
worked at a physician office with two nurses, two doctors, an office
manager, two receptionists, a referral person, and one MLT (me) with a
limited license for X-ray. My employer has had a terrible time relating
to my pay level. I was first classified as an LT. After two years, I
finally got someone to listen to me and was raised to MLT status and pay
— but was not given back pay. (I currently make $12.88/hour.) And I was
told the office would not hire an MLT again.

Why is there not the respect for the lab techs
that we deserve? Without us, doctors would have trouble diagnosing
patients, at least those with acute problems. No one seems to understand
our qualifications. I do proficiency testing because we are a
moderate-complexity lab. I do CBCs, protimes, urines, lipid panels,
HbA1c, and send out to a reference lab. When I am out, a nurse fills in
for me because the temp agency does not have any MLTs. I feel like I
have to toot my own horn much of the time, especially when the patient
says, “I had a nurse stick me to get blood once, but you didn’t have any
trouble,” and I repeatedly tell them, “I am not a nurse; I am an MLT;
and I am trained to do this. Nurses are not trained to take blood.”

Thank you for listening to me complain.
Sometimes, it helps to talk to someone who does the same job as me.

According to Larry Crolla, “In most — but not
all — physician offices there are three levels of employment:
physicians, nurses, and all others. It sounds as if you are in the
grouped into the latter category. In this situation I do not expect to
see much change. So, I ask, why do you continue to work there if you
believe the pay is bad? There is a shortage of lab personnel — you
should be able to get employment with pay commensurate with your skill
set and training.

We can all either learn to live in this under-recognized state
or allow ourselves to be victimized by it.

A “Most physicians in
private practice, along with the general public, are just not ‘tuned in’
to what happens or what is required as far as work to maintain an
accredited laboratory. At this point, I do not think you will be able to
reverse this situation. I am sorry I do not have a ‘magic bullet’
(answer) for this situation. My advice is to find some other employment
if you do not want to work at your current job for the pay you are

Alton B. Sturtevant says, “Many in the medical
field and the laboratory do not get the respect in terms of pay that
they deserve. State and federal laws stipulate what education, training,
and experience are required by laboratory personnel to perform the
various functions in the laboratory. Typically, an MLT has an associate
degree from an accredited college or university, and is a
well-recognized and respected member of the laboratory team. The MLT is
qualified to perform both moderate- and high-complexity testing with
appropriate supervision and direction. In many states, nurses can
perform testing, based on their education and training, under
appropriate supervision and direction.

“How physicians and medical managers recognize
and pay their personnel is usually based on the market as well as on the
individual person. Usually, organizations have published pay scales
stipulating pay relating to grade and experience of the individual. It
is well within your rights to speak to the manager relating to the scale
and how you are classified for pay within your organization. Whether you
can get the manager to increase your pay based on these criteria will
depend on the manager and the organization. It certainly would not hurt
to visit this issue with your manager.

“In order to help the manager understand the
requirements of the laboratory, including personnel requirements and
duties, you should prepare a one-page list summarizing these items. You
can get the necessary information from sites on the Internet such as
Centers for Medicare and Medicaid Services (,
College of American Pathologists (,
The American Academy of Family Physicians (,
and many other professional organizations’ websites. I suggest doing a
Web search by simply searching on CLIA (

“Select data that will have the most impact on
the practice manager and your medical director. It should prove
educational, since most managers and physicians are not well versed in
the requirements placed on the lab and its personnel. This comment
applies to most physicians who act as directors (and supervisors) or the
medical-practices laboratory.

“You can also help engender respect and higher
pay through demonstrating continuing educational accomplishments on your
part, performing well on routine CLIA inspections, having written
procedures, doing well on proficiency testing, producing timely and
accurate testing results to the medical staff, and providing good
customer service to the patients and staff of the clinic. In other
words, continue to work to earn the respect for you and the laboratory
that you deserve.

“In the final analysis, if you do all that is
required from you and more, and still are not paid according to the
going market rate, you may have to find a job at a facility that will
recognize and reward you for your training and experience.”

In Marti Bailey’s opinion, “Your unhappiness has
been shared by scores of other MTs and MLTs over the years. Lab
professionals have still not achieved the level of gratitude and
recognition that they believe is their due, in spite of really
impressive attempts to turn this around. This is, in large part, because
of their small numbers and their lack of exposure.

“The number of nurses is overwhelmingly greater
than the number of lab techs that we remain the forgotten few. This is
all the easier to do because many lab techs get little patient exposure,
and all the thanks from patients and their families is directed toward
those caregivers who have the most patient exposure. We can all either
learn to live in this under-recognized state or allow ourselves
to be victimized by it.

“One of the issues you seem to have is whether
your lab meets licensure regulations. I cannot speak for your state
regulations; but insofar as CLIA is concerned, since you have a
moderately complex license, your lab must have met the requirements for
supervision. Thus, I doubt that you have a problem there.

“When your employer recognized that your salary
had been set incorrectly but was not willing to adjust your back pay,
that should have been a real ‘red flag’ to you. Do you really want to
stay with this employer?
You obviously chose to stay on; but after
this kind of insult, who would ever feel good about her job?

“It appears to me that the lack-of-recognition
issue seems even worse to you because of all your other unhappiness with
your job. It is truly surprising that you have stayed on for 20 years,
but that is your choice. There is no shortage of lab tech jobs in my
area or in numerous other areas, so your best options are to either quit
and get another job — or make your peace and accept the shortcomings of
the one you already have.”

Bottom line. It is great to hear from a
professional in a physician office laboratory (POL). Unlike our three
experts, I spent the majority of my career in your environment and would
not have traded the close patient and physician relationships for any
amount of money. As you and I (and our POL colleagues) know, CLIA does
not have supervision requirements for moderate-complexity testing.
Working by yourself in a POL, you shoulder a great amount of
responsibility and should be fairly compensated for it. As the experts
suggest, search the Internet for supporting documents (including salary
surveys) to justify your requests. If your name tag does not include
your MLT credentials, consider having one that does, and when folks ask
what that means, proudly tell them.

Anne Pontius is a senior medical
practice consultant with State Volunteer Mutual Insurance Company in
Brentwood, TN, and president-elect of CLMA 2007-2009. Send questions to
Ms. Pontius at
[email protected]