For several years now there has been a push to revise and update training for cytotechnologists to ensure that they are prepared for the needs of the future. Both the American Society for Clinical Pathology and the College of American Pathologists have submitted letter to the Cytotechnology Program Review Committee (CPRC) detailing specific areas that they would like to see covered in all cytotechnology training programs, and the CPRC has taken these suggestions to heart and is actively engaged in the process of implementing these recommendations as part of the Standards and Guidelines for the Accreditation of Educational Programs in Cytotechnology
As a practicing pathologist and cytologist and as a member of the American Society of Cytopathology, I strongly support these efforts. I look forward to the day when the cytotechnologists in my hospital system can be aiding in the interpretation not only of tests that are traditionally in the area of clinical pathology (FISH, molecular diagnostics, laboratory management) but also in areas that are traditionally the purview of pathologists (special stains, immunohistochemistry, primary sign out of non-gynecologic cytology). I foresee a time when the name “cytotechnologist” may be too restrictive, and titles such as “Anatomic Pathology Practitioner” may be more appropriate.
Nevertheless, while I strongly support these efforts, I do see an area where my vision of the future is slightly different than the one that is described in these letters. In these letters, the rivalry between cytotechnologists and medical technologists/medical technicians (MTs) remains strong today. While MTs are willing to give up very specific and limited areas of their field, they most certainly are hanging on tight to their primary role in the clinical laboratory. This makes sense – like cytotechnologists, MTs are under pressure from management to justify their utility, and I would be hanging on tight if I were in their shoes as well. Since there are many more MTs than cytotechnologists, in any competition between these two specialties, cytotechnologists can not come out ahead. Does this matter for the future of the cytotechnology?
I would say yes. There is an opportunity out there that I have not seen clearly articulated in any of these letters to date. That opportunity is in the very small hospitals (where I spend most of my time), not the academic centers. There are many small hospitals in this country, and there is a real need for assistants to pathologists in this setting. In academic centers, there is enough work to keep an “anatomic pathology practitioner” busy just doing anatomic pathology. In small hospitals there is not. In my hospital there are 1-2 hours of anatomic pathology a day, and in no circumstance would I ever be able to hire an “anatomic pathology practitioner” for this setting. It’s simply not a financially viable arrangement. On the other hand, if I could hire some one who can cut the frozen, examine it at the microscope (with my help via telepathology), do the rest of the AP processing, and then work in the clinical laboratory for the remaining 6 hours of the shift, that would be highly attractive to many pathology groups and hospitals. What I am describing of course is a cytotechnologists/histotechnologist/medical technologist hybrid.
Other specialties have also used these small hospitals to gain acceptance as full -fledged members of their health care teams. While nurse anesthetists work in larger hospitals under the direct supervision of anesthesiologists it is their role in smaller hospitals, where they are often the only person on site, and where the extent of what they can actually do has been demonstrated. The same could happen for cytotechnologists.
But can we actually get to this point? I believe the key step to making this happen is for cytotechnologists to give up – they are never going to win a fight with MTs. Instead they should create a hybrid program that gives them just enough qualification to work in the clinical laboratory, but then focus on developing their anatomic pathology skills. While there are many models that can successfully enlarge the practice sphere of cytotechnologists, if they really want to gain acceptance as full-fledged anatomic pathology specialists, perhaps the easiest route is through smaller hospitals. A license that contains permission to practice in the clinical laboratory is the key to greater responsibility in the anatomic pathology world.
Andrew Renshaw, MD
ASC President, 2012-2013