(The fact sheet referred to in Dr. Coon's statement follows:)

A FACT SHEET-CAREERS IN THE MEDICAL LABORATORY

The practice of modern medicine would be impossible without the tests performed in the medical laboratory every day. Here, a medical team of pathologists, medical technologists, cytotechnologists, technicians, and laboratory assistants work together to track down causes of disease and determine the presence, extent, or absence of cancer, diabetes, polio, tuberculosis, or other diseases.

This work requires an array of precision instruments: microscopes, centrifuges, electronic counters, automatic analyzers, incubators, autoclaves, spectrophotometers, colorimeters, microtomes, balances capable of weighing to one tenthousandth of a gram.

Some diseases, such as diabetes and leukemia, can be positively identified solely by laboratory methods. Cytologic examinations, such as the "Pap" smear tests, can discover cancer in its early stage, making cure quicker add surer. And it is in the laboratory that blood-matching tests requiring life-or-death precision are made when a patient must receive an emergency blood transfusion.

As a result of the growing number and complexity of laboratory tests due to recent advances in medicine, demands for laboratory service have increased tremen dously. But the supply of trained personnel has been unable to keep pace. The laboratory offers limitless career opportunities at every level, according to the individual's ability, aptitude, and interest. Positions are available in all parts of the country, in hospitals, clinics, physicians' offices, public health agencies, the armed services, industrial and pharmaceutical medical laboratories, and public and private medical research programs. Many women return to work when their children are grown, others work beyond the usual retirement age. The laboratory also provides a rewarding career for many handicapped persons, since not much physical activity is required.

YOUNG PEOPLE INTERESTED IN LIFE SAVING CAREERS IN THE PATHOLOGY LABORA TORY MAY DIRECT THEIR FUTURE GOALS TOWARD ONE OF THESE OPPORTUNITIES ON THE MEDICAL TEAM

The pathologist

The director of the laboratory is a pathologist-a physician trained to employ laboratory methods to aid in the diagnosis and treatment of disease by scientifically testing the patient's blood, tissues, body fluids, and excretions. The pathologist reports and interprets these findings to the family physician or other attending specialists.

Laboratory directors are often specialists in clinical pathology, which finds clues to disease by analyzing body fluids and tissues. Anatomic pathology emphasizes the structural changes brought about by disease in tissues removed during surgery or at autopsy. Forensic pathologists are concerned with procedures associated with legal proceedings, such as toxicology, gunshot wounds, etc. Pathologists also teach in medical schools and engage in research.

To be a pathologist and become eligible for certification by the American Board of Pathology requires 3, often 4 years of premedical training in college, 4 years at medical school, 1 year of internship, and 4 years of pathology residency. Incomes of pathologists are comparable to those of other certified medical specialists. More than 5,000 pathologists have been certified, but twice this number will be needed by 1970 to keep pace with the demands of laboratory medicine in health care.

Details on pathology as a career may be found in "Should You Be a Pathologist?" a pamphlet available without charge from New York Life Insurance Company, Box 51, Madison Square Station, New York, N. Y., 10010. For other information, write to Intersociety Committee on Pathology Information, 1785 Massachusetts Avenue, NW., Washington, D.C., 20036.

(Careers outlined below are described more fully in the succeeding pages.) Medical technologist

It is the medical technologist who usually performs the chemical, microscopic, bacteriologic, and other medical tests used in the laboratory.

Three years of college and a year's training in an AMA-approved school directed by a pathologist are the minimum educational requirements.

Widespread opportunities exist for medical technologists to advance as teachers, supervisors, specialists, and scientific research assistants.

Cytotechnologist

Cytotechnologists screen slides in the search for abnormalities that are the warning signs of cancer. Cytotechnology is a restricted specialty in the broader field of medical technology, requiring 2 years of college, 6 months of training at an AMA-approved school of cytotechnology, and 6 months' supervised experience in an acceptable laboratory.

Laboratory assistant

High school graduates may become laboratory assistants by attending a 1-year course in a hospital or laboratory school approved for such training under medical auspices. National examinations given at the end of such training will certify the ability of graduates to perform many of the simpler diagnostic tests and laboratory procedures in urinalysis, chemistry, hematology, serology, bacteriology, and histology.

REGISTERED MEDICAL TECHNOLOGIST-MT(ASCP)

THREE YEARS OF COLLEGE PLUS 12 MONTHS OF PROFESSIONAL EDUCATION

Medical technology is one of the newest and fastest growing professions associated with modern advances in medical science. Medical technologists perform the scientific fact-finding tests in the clinical pathology laboratory that help track down the cause and care of disease. They are the indispensable, top-level laboratory workers—the supervisors, the specialists, the teachers-for a wide range of complex diagnostic and treatment procedures.

For example, they examine the blood chemically for cholesterol, and microscopically for leukemia. They culture bacteria to identify disease-causing organisms, analyze the chemical composition of urine for diabetes and of spinal fluid for polio. And now that nuclear medicine has opened new areas of study, some technologists are using radioactive isotopes to help detect cancer and other diseases.

Because of their thorough scientific training and education, medical technologists know not only how to perform a test but the theory behind it, and they understand the scientific fundamentals of its performance. With this background they are able to apply their skill and knowledge accurately and reliably to the supervision and performance of an ever broadening scope of laboratory procedures.

Scholastic requirements

To become a medical technologist requires at least 3 years of college, including 16 semester hours each of approved chemistry and biology courses, and one course of mathematics, followed by 12 consecutive months in a school of medical technology approved by the American Medical Association. There are 784 AMA-approved schools (see box), located throughout the country.

Almost all these professional schools are affiliated with a college or university in a degree program that prepares the student to acquire a B.S. academic degree from the college, as well as the professional MT(ASCP) certification given to graduates who pass the examination of the Board of Registry of Medical Technologists of the American Society of Clinical Pathologists most AMA-approved schools charge no tuition, and many offer room, board, laundry, and a small monthly stipend as a type of scholarship to the student. Other scholarships also are available in many areas for college and professional study.

In these professional schools, a minimum ratio of one instructor to every two students is maintained for laboratory practice, and the students learn to perform laboratory procedures on actual specimens from hospital patients. Because their learning is thus related directly to real persons and their illnesses, the students develop an important professional ingredient of medical technology—a sense of responsibility toward the patient.

There are no shortcuts to becoming a medical technologist. It takes 4 years after high school to become a professionally recognized medical technologist. Only graduates of AMA-approved schools are eligible for MT (ASCP) certification, which means that they have met the professional standards recognized by the medical profession. What can happen when students are inadequately trained is described in articles in the October 1963 Harper's Magazine and May 1965 McCall's.

Shortage of medical technologists

How

Today, there are 40,000 registered MT (ASCP)'s in the United States. ever, more than 7,000 are currently not working, and many health facilities are seriously understaffed. Looking ahead to 1975 with increased population and medical facilities, a need for 75,000 medical technologists is foreseen. This includes technologists in hospitals, clinics, public health and doctors' offices, but many more also are needed for research laboratories and pharmaceutical and industrial companies.

Salaries and future opportunities

Salaries are increasing steadily. In the past 10 years, they have risen nearly 50 percent, to a median annual salary for a full-time MT (ASCP) of $5,190 in 1963. Almost 25 percent of working medical technologists received $6,000 or more and 7 percent earned more than $7,200. (Median income of all woman college graduates was about $3,190 in 1961, latest year figures are available.) Promotion to administrative and supervisory positions is gained through experience and self-improvement. Unlimited opportunities exist for teachers in training hospitals, and research in medicine and industry offers more and more opportunity for original or collaborative investigation.

Medical technology training also provides an excellent background for graduate work leading to advanced degrees in bacteriology, biochemistry, hematology, and other laboratory sciences. In addition, a few universities offer master's degrees in medical technology for those wishing to specialize in teaching and administration.

Continuing opportunities for professional growth are provided by seminars and workshops sponsored by pathology groups and by the American Society of Medical Technologists, professional organization for MT (ASCP)'s, which now has 10,000 members.

CERTIFIED LABORATORY ASSISTANT-CLA

HIGH SCHOOL DIPLOMA PLUS 12 MONTHS OF TRAINING IN AN APPROVED SCHOOL

Properly trained personnel at the post-high school level are urgently needed to perform the simpler, more routine tests in the laboratory. With such assistants, the professional medical technologists can spend more time on the complex, highly technical laboratory procedures, many of them involving college-level science.

A new training program, initiated in 1963 by the American Society of Clinical Pathologists and the American Society of Medical Technologists, provides standardized training and national certification under medical auspices for certified laboratory assistants.

Currently, the Board of Certified Laboratory Assistants is accrediting hospital and laboratory schools to provide qualified high school graduates with 1 year of practical and technical training in routine laboratory work, at a level less advanced than that necessary for the professional medical technologist. Graduates of these schools who pass an examination given under the board's direction may place the letters CLA after their names, indicating their certification as qualified laboratory assistants.

Duties of laboratory assistant

The laboratory assistant works under the direct supervision of the medical technologist and a pathologist or other qualified physician, performing routine laboratory procedures in bacteriology, blood banking, chemistry, hematology, parasitology, serology, and urinalysis. Specific tasks might include collecting blood specimens, grouping and typing blood, preparing and staining slides for microorganisms, concentrating specimens for parasitologic study, analyzing blood and body fluids for chemical components, microscopic examination of urine, blood, and body fluids, and taking electrocardiograms and basal metabolism tests.

Graduation from an accredited high school, preferably with ability and interest in science and mathematics, is required for admission to an approved school for certified laboratory assistants. The course of training is 12 months long, and includes a minimum of 100 hours of formal instruction, plus 40-44 hours per week of laboratory training, with one instructor for every two students.

In almost every city, town, and rural area, hospitals urgently need these trained laboratory assistants. A 1962 statewide survey, projected nationally, suggests total estimated need for 100,000 laboratory assistants by 1975. Pay scales vary,

but compare favorably with other paramedical jobs at the same level.

Whereas the national salary median for a registered medical technologist (3 years college, 1 year professional training) is $5,190, the trained laboratory assistant usually earns $1,200-$1,800 less.

Approved schools for laboratory assistants are being set up in nearly every part of the country. For further information write: Secretary, Board of Certified Laboratory Assistants, 9500 South California Avenue, Evergreen Park, Ill., 60642.

CYTOTECHNOLOGIST-CT(ASCP)

TWO YEARS OF COLLEGE PLUS 12 MONTHS OF TRAINING

Hundreds of skilled scientific assistants are needed in pathology laboratories to work as cytotechnologists, screening slides on which there are human cells to look for the abnormalities that are the warning signs of cancer.

Peering at slides of cell samplings under the microscope, the expert eyes of the cytotechnologist trace clues to disease in the delicate patterns of cytoplasm and nucleus, stained with special dyes to make them stand out brightly, and magnified a thousand times.

Training required

There are about 80 AMA-approved schools of cytotechnology in the United States at present, currently training some 400 cytotechnologists but with room for about 100 more. Minimum prerequisites include at least 2 years of college with 12 semester hours in biology. The prescribed cytotechnology course provides for a minimum of 12 months' education and training, with 6 months in an approved school and the balance working under supervision in a cytology laboratory acceptable to the director of the school.

A number of schools receive grants from the cancer control program of the U.S. Public Health Service, which provide student scholarships up to $225 a month for 6 months. American Cancer Society and other scholarships also are

available.

Upon the successful completion of the 12 months' formal curriculum and apprenticeship, the student is eligible to take the certifying examination given by the Registry of Medical Technologists. Those who pass may place the letters C.T.(ASCP) after their names. As of August 1965, 1,252 persons had been certified as C.T.(ASCP)'s, plus 5 specialists.

Opportunities for cytotechnologists

Those completing a basic course usually can find employment as screeners at an apprenticeship level. They screen the slides and mark any unusual or atypical cellular findings, so that the attention of the pathologist reporting the case to the patient's physician will be brought to these areas. The more adept they become, the more responsibility they are given. Some become supervisors and teachers. Others go into research.

Cytotechnologists are needed in almost every part of the country, to screen the growing number of cervical smears taken from women over 21, who recognize the value of regular examination in preventing deaths from this type of cancer. Tests on approximately 10 million women were made last year, and this number is increasing each year. With more personnel, laboratories could perform twice as many tests, but would still fall short of checking the 57 million American women in this high-risk age group. A recent survey indicated that there is a national shortage of about 900 cytotechnologists right now, and that a shortage will continue to exist for some years to come.

A list of AMA-approved schools of cytotechnology and additional information on this field are available from the Registry of Medical Technologists, Box 2544, Muncie, Ind.

More details on cytology may be found in "Cell Examination-New Hope in Cancer," 25 cents, Public Affairs Committee, 381 Park Avenue South, New York 10.

OTHER CERTIFICATION BY BOARD OF REGISTRY OF MEDICAL TECHNOLOGISTS,

ASCP

1. Specialist certification.-Specialist in a specific science-those in chemistry, for example, would be listed: Spec.C. (ASCP).

Must have master's or doctorate degree in specialty, plus 3 years' experience in acceptable medical laboratory; pass registry examination.

2. Blood banking technologist-MT (ASCP) BB.-MT (ASCP) with 1-year training in blood banking school approved by the American Association of Blood Banks; pass registry examination.

3. Chemistry technologist-C(ASCP).-Must have B.S. in chemistry, plus 1 year's experience in chemistry in acceptable medical laboratory; pass registry

examination.

4. Certificate in microbiology-M(ASCP).-Must have B.S. in bacteriology, plus 1 year's experience in microbiology in acceptable medical lab; pass registry examination.

5. Nuclear medical technologist-NMT (ASCP).-MT (ASCP) with 1 year in acceptable clinical radioisotope laboratory; or B.S. in biologic sciences or chemistry plus 2 years' experience as above; or 2 years of college with specified science courses plus 4 years' experience; or B.S. in physical sciences with specified science courses, plus 2 years' experience; or high school diploma plus 6 years' experience (these qualifications remain through 1966); and pass registry examination.

6. Histologic technician-HT(ASCP). A job opportunity in the laboratory that requires a less formal type of post-high-school education is that of histologic technician.

The Board of Registry of Medical Technologists gives limited certification, following examination, for histologic technique. This requires a high school diploma plus a year of supervised training in a clinical pathology laboratory. As of August 1965, the registry had certified 2,517 persons as H.T. (ASCP)'s.

The histologic technician cuts and stains tissues which have been removed from the body, so that they can be examined microscopically by the pathologist for any signs of malignant or questionable cells.

Individuals interested in becoming histologic technicians may contact the pathologist in their local hospital about the possibility of learning this specialty Mr. FRIEDEL (presiding). Doctor, I want to compliment you on a very fine statement. You have cleared up a number of points I was

in doubt about.

Congressman Moss.

Mr. Moss. Doctor, I am very much interested in your comment on page 3 of your statement, wherein you state, "I for one am all for the junior colleges and I am right now developing a 2-year certified laboratory assistant program."

Dr. CooN. Yes, sir.

Mr. Moss. It appears to me that your reference here to junior colleges is also as a terminal education. The truth is to the contrary, is it not?

Dr. CooN. I have not made an exhaustive study of this. My understanding is that there is variation. I think there are some where one can go straight on and acquire another 2 years and acquire a bachelor's degree. I think the concept of many is that they offer terminal programs and therefore one can't automatically transfer. Very frankly this is one of the difficult problems that I am wrestling with right now since our 2-year program will actually be under the university and the university will grant the associate degree. The problem is that of transfer of a student from the 2-year program to the 4-year program, admission requirements, admission standardsthere are many problems.

Mr. Moss. I am very much concerned over the direction of programs that have come before members of this committee in recent years where I think we are ignoring the role, the appropriate role, of a well financed, properly conceived junior college system.

I believe my State has such a system in the State of California. Dr. CooN. Yes, sir. Yours is the outstanding example.

Mr. Moss. We have about 90 junior colleges. We have approximately 18 State colleges operating at the moment. Others are in the planning stage. And there are nine campuses of our State university in addition to some other very fine schools. Yet as these programs