Clinical and medical laboratory scientists all have one thing in common: the baccalaureate degree they need to obtain their certification. From there, however, the career options are varied and vast.
From lab director to care consultant to business administrator, those who are interested in furthering their education and skills have many possible bright futures ahead of them. The trick is figuring out which path to pursue—and how to reach your goal.
The details can be complicated, but this guide to post-baccalaureate education and certification will help you keep them all straight. In this review, we focus on several advanced degrees and positions that can enhance your career in healthcare. You’ll get clarity on each role, educational and professional requirements, any applicable certifications, and insights into salaries and career prospects.
In this article:
BOARD-CERTIFIED HEALTHCARE PROFESSIONALS
Medical Laboratory Director – Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
Description of Duties
Medical laboratory directors must be qualified to make judgments about the significance of laboratory data. They are usually licensed physicians who are legally responsible for the scope, standards, and quality of laboratory service. There are specific criteria concerning these responsibilities set forth by the CLIA of 1988 statute and the College of American Pathologists (CAP) laboratory director standards (1,2). In addition to their clinical responsibilities, medical laboratory directors oversee laboratory operations, although the day-to-day management of these tasks may be assigned to a laboratory manager.
People in the role of medical directors usually have completed a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. However, they may possess a Doctor of Philosophy (PhD) degree in chemistry, biology, a physical science, or clinical laboratory science, provided that they are board-certified; these credentials of education and board certification qualify them as laboratory directors of high-complexity testing. (See Medical Laboratory Director – Non-Physician.)
Certification/Licensure/Education
Most medical laboratory directors are physicians who specialize in pathology. Before physicians can practice medicine, they must be board-certified and state-licensed. Board certification for MDs and DOs is administered by various boards, depending on the physician’s specialty. A major certifying board for pathologists is the American Board of Pathology (ABPath)(3).
Salary
According to the U.S. Bureau of Labor Statistics (BLS), pathologists in 2022 can expect to earn an annual salary of $252,850 (4). The salary of non-physician medical directors can vary depending on the type, size, and location of the organization, as well as on the qualifications and experience of the individual.
Career Trajectory
Statistical information regarding pathologists’ career growth is included in information provided about physicians and surgeons by the BLS. The projected employment growth for physicians and surgeons for the years 2021–2031 is 3% (4).
Medical Laboratory Director – Non-Physician
Description of Duties
Individuals who are not physicians but who have trained with a concentration in immunology can serve as medical directors, managing high-complexity clinical immunology laboratories or clinical laboratories that perform immunology, flow cytometry, or molecular assays, as long as they are board-certified.
As medical directors, they determine assay selection, interpret test results, and offer consultations to healthcare providers. They may also participate in laboratory and medical education, research and development, and the regulatory aspects of clinical and diagnostic immunology.
Certification/Licensure/Education
Board certification for PhDs to qualify as laboratory directors of high-complexity testing is administered by a professional board approved by the Department of Health and Human Services (HHS). Numerous boards qualify; an up-to-date list can be obtained through the Centers for Medicare & Medicaid Services (5).
In 2018, ABLMI suspended its certification exam for medical laboratory immunology. However, individuals with appropriate training (see Diplomate in Medical Laboratory Immunology) may get certified through the American Board of Bioanalysis (ABB) or the American Society of Clinical Pathologists (ASCP).
The ABB offers five levels of director certifications. Two of these are appropriate for people with expertise in immunology. The first is the Bioanalyst Clinical Laboratory Director (BCLD), which requires that applicants have technical experience in three of the following five clinical laboratory disciplines: chemistry, diagnostic immunology, hematology (including flow cytometry), microbiology/public health microbiology, or molecular diagnostics.
The second level of interest to immunologists is the High-complexity Clinical Laboratory Director (HCLD) certification. This certification requires that candidates have expertise in high- complexity testing in at least one of the following clinical laboratory disciplines: andrology, chemistry, diagnostic immunology, embryology, hematology (including flow cytometry), microbiology/public health microbiology, or molecular diagnostics.
The certification designation offered by ASCP is the Diplomate of Medical Laboratory Immunology (DMLI). This designation is exclusive to the ASCP. Until recently, the Centers for Medicare & Medicaid Services (CMS) did not recognize DLMI certification by the ASCP—which meant individuals certified by this route needed an alternative certification (such as ABB) to serve as medical directors. As of July 2023, the CMS recognizes the ASCP DMLI certification (6).
There are three Eligibility Routes for the ASCP certification of DMLIs. The details are outlined on the ASCP website (7). All routes require a doctorate degree from a regionally or nationally accredited college or university. Acceptable degree concentrations are varied, depending on the route taken by the applicant. PhD degree concentrations may be in immunology, chemistry, biology, microbiology (or equivalent). Also acceptable are Doctor of Public Health (DPH), MD, or DO degrees.
In addition to the education requirement for certification eligibility, ASCP requires candidates to complete a program approved by the Committee on Postgraduate Educational Program (CPEP) if certifying by Route 1. If certifying by Route 2 or 3, candidates must have post-doctoral experience (Route 2) or pre- and post-doctoral experience in an approved lab (Route 3). Acceptable laboratories for required experience must be accredited by one of several accrediting agencies approved by the DMLI Examination Committee (8).
Laboratory experience is required to be eligible to sit for the DMLI exam. Laboratory experience is included in CPEP programs (Route 1). Laboratory experience for Routes 2 and 3 must include immunologic techniques, immunodiagnosis and clinical correlations, and clinical laboratory management and operations. Details of sub-areas within these main areas are available on the ASCP website (7).
CPEP Fellowship
The American Society for Microbiology (ASM) offers two- or three-year postgraduate training programs in medical/public health laboratory microbiology and in medical laboratory immunology, all accredited by CPEP. CPEP Fellowships train postdoctoral fellows to be directors of medical/public health microbiology and medical immunology laboratories. A complete list and the details of programs offering CPEP Fellowships in microbiology and immunology are available through the ASM website (9).
To be eligible for a CPEP Fellowship, the candidate must possess a PhD in an approved concentration, an MD, a Doctor of Science (ScD), DO, or a DPH degree. Individuals with a Doctorate of Clinical Laboratory Science (DCLS) or Doctor of Pharmacy (PharmD) degree are not eligible. Previous work experience in medical and/or public health diagnostic laboratories may be considered when evaluating candidates, but this is not a requirement to apply. Publications and scholarly activity are viewed very favorably in determining a candidate’s acceptance. Each program has unique acceptance criteria, so it is important to research the criteria of the program carefully.
Salary
The salary of a DLMI is nearly impossible to ascertain, as the job title they may hold is variable. The DLMI is qualified to serve as a medical director, but the DLMI may hold other positions such as a laboratory manager, post-doctoral fellow, researcher, or faculty. The salaries associated with these distinct positions vary widely.
Career Trajectory
Again, the employment outlook for individuals holding a DLMI degree is difficult to determine, since the job titles and responsibilities of the DLMI are so varied.
NON-BOARD-CERTIFIED HEALTHCARE PROFESSIONALS
Medical Laboratory Manager
Description of Duties
A medical laboratory manager reports to the medical laboratory director and manages or supervises the laboratory’s business tasks, such as budgeting, operations, personnel management, and compliance.
Certification/Licensure/Education
Although certification is not required to be a medical laboratory manager, ASCP offers certification as a Diplomate in Laboratory Management (DLM). Similar to DLMI, this certification is exclusive to the ASCP organization. There are six Eligibility Routes for the ASCP certification of DLMs. The details are outlined on the ASCP website (7). Eligibility to sit for the ASCP DLM certification exam includes postsecondary education, all routes require a baccalaureate, masters, or doctorate degree from a regionally or nationally accredited college or university (10, 11). Degree concentrations may be in management/business, or in medicine, chemistry, biology, immunology, microbiology, allied health, medical laboratory science, or an appropriately related field. Some routes require that that the candidate have ASCP MLS or specialist certification.
In addition to meeting the education criteria for certification eligibility, ASCP requires DLM candidates to have anywhere from 2–5 years of recent, full-time experience in clinical laboratory supervision/management in an acceptable clinical laboratory, which requires the participating laboratory to maintain a CMS CLIA certificate of registration/compliance/accreditation, JCI (Joint Commission International) accreditation, or accreditation under ISO 15189 (12). Recent experience is defined as experience within the last 5–10 years, depending on the eligibility route taken by the applicant.
Experience must include having worked in 25 of 39 areas defined by ASCP on their website (12). These defined areas include many sub-categories of finance, operations, human resources, and quality management.
Salary
The BLS website does not provide statistics for those with DLM certification specifically, but it does provide employment numbers for medical and health services managers. The data includes information about compensation as a whole. BLS also compartmentalizes the data into profiles of industries with the highest levels of employment, the highest levels of employment per 1,000 jobs, and the top-paying industries that employ medical and health services managers. The mean hourly wage for medical and health services managers is $57.61, and the mean annual wage is $119.840 (13).
Career Trajectory
There are two ways of projecting a career trajectory for medical laboratory managers. The statistical information provided by the BLS does not separate managerial positions from clinical laboratory scientists (CLSs). As such, the estimated job growth for CLS technologists between 2021–2031 is projected to be 12% (14). However, a medical laboratory manager is a supervisory position that can reasonably be included in the statistics provided by the BLS for medical and health services managers. The projected job growth for these individuals between the years 2021-2031 is estimated to be 28% (13).
Pathologists’ Assistant
Description of Duties
Pathologists’ assistants provide anatomic pathology services under the direction and supervision of a licensed, board-certified, or board-eligible anatomic pathologist. They perform gross examination, dissection, and tissue preparation of pathology specimens and conduct postmortem examinations. The role is to assist the pathologist in establishing a pathologic diagnosis. However, it is the sole responsibility of the pathologist to finalize any diagnoses. Additional roles of the pathologists’ assistant may include administrative and supervisory responsibilities (14).
Certification/Licensure/Education
Certification is not required to practice. However, for individuals wishing to obtain certification, there is one route available; it is offered by the ASCP. The details are outlined on the ASCP website (7). To be eligible to sit for the ASCP Pathologists’ Assistant certification exam, the candidate must possess a baccalaureate degree from a regionally or nationally accredited college or university.
ASCP does not specify the degree concentrations required, but the qualified candidate must also have successfully completed an NAACLS-accredited pathologists’ assistant program within the last 5 years. Depending on the program, specific prerequisites must be met, likely including coursework in biology, chemistry, and mathematics. Information about NAACLS-accredited schools for Pathologists’ Assistant programs is available through the NAACLS website (15).
Salary
The salary range for most pathologists’ assistants in the United States is $62,000–$109,000/year, with a median salary of $91,000. More detailed information can be obtained at Assistant Pathologist Salary | Salary.com and from the Mayo Clinic College of Medicine and Science (14).
Career Trajectory
Most pathologists’ assistants will begin their careers with technical duties (see Description of Duties). As they gain experience, they may move into managerial roles that include tasks such as accreditation-inspection preparation, personnel management, writing and reviewing standard operating procedures, coordinating medical student training, and budgeting.
The BLS does not provide data specific for pathologists’ assistants, but applicable data is included in the category for physician assistants. As such, the job growth is predicted to be 27.6% from 2021–2031 (13).
Physician Associate/Assistant
Description of Duties
A physician associate/assistant (PA) is a licensed clinician who practices medicine as an adjuvant to supervising physicians, rather than as a completely independent practitioner. PAs are permitted to practice in all medical specialties, both autonomously and collaboratively with physicians when required. The degree of autonomy of a PA is negotiated and agreed upon by the supervising physician(s) and the PA. The types of patient care a PA may provide include taking medical histories, conducting physical examinations, ordering and interpreting diagnostic tests, diagnosing health issues, formulating treatment plans, performing certain medical procedures, prescribing medications, and assisting in surgery (16, 17).
Certification/Licensure/Education
The steps necessary to become a physician associate/assistant include graduating from a PA program accredited by an Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), become nationally certified, and obtain a state license to practice (18, 19).
Most PA programs award master’s degrees, but doctoral programs are available to certified PAs that grant a Doctor of Medical Science (DMSc) degree upon successful completion of the program. Currently in the United States, PAs are not required to earn a doctoral degree.
Once individuals complete an accredited PA program, their next objective is to pass the Physician Assistant National Certifying Exam (PANCE), which is administered by the National Commission on Certification of Physician Assistants (NCCPA).
Additionally, PAs must maintain their certification. This is done by completing 100 hours of continuing medical education (CME) every two years and by taking the Physician Assistant National Recertifying Exam (PANRE) every 10 years (18,19). After becoming certified, PA practitioners must obtain a license in the state(s) in which they wish to practice. All states require that candidates graduate from an accredited PA program and pass the PANCE (18, 19).
Salary
According to BLS, the median annual salary for most physician associates/assistants in the United States is $121,530/$125,270 (13, 20).
Career Trajectory
The projected 10-year job growth (2021–2031) for PAs is a robust 28%. The reasons for this are manifold and include an aging population, a concern for medical care cost containment, a physician shortage, a less rigorous training program compared to physicians, and a high level of job satisfaction (20, 21, 22).
Doctorate in Clinical Laboratory Science (DCLS)
Description of Duties
Professionals with a DCLS degree are expected to be members of patients’ diagnostic management teams. They contribute to patient care by attending grand rounds, analyzing patient records, and collaborating with other members of healthcare teams. Ideally, the DCLS is a clinical laboratory testing expert who can provide clinicians with knowledgeable insight about appropriate laboratory tests to aid in disease diagnosis and patient monitoring.
The DCLS can act as a consultant in patient care and work to enhance the effective utilization of laboratory tests by suggesting overlooked tests, advising against unnecessary tests, and offering to help interpret high-complexity test results (22, 23, 24, 25).
With their intensive training, DCLSs are also equipped to participate in health policy decision- making, contribute to laboratory operations, and educate administration, healthcare providers, patients, and patients’ families about health policy. Moreover, with the research training they receive, they can conduct outcomes-based research to optimize laboratory-testing practices specific to the patient population served by their institution (23, 24, 25, 26).
Certification/Licensure/Education
Three universities in the United States offer a Doctorate in Clinical Laboratory Science degree: Rutgers University in the School of Health Related Professions in Newark, New Jersey; the University of Texas Medical Branch, in Galveston, Texas; and the University of Kansas Medical Center in Kansas City, Kansas.
Prospective students should access the universities’ websites for detailed information, but the programs generally share similar expectations and requirements for admission and completion. All three programs require prospective students to be either be an ASCP or equivalently certified medical laboratory scientist/medical technologist who has also participated in ASCP or equivalent certificate maintenance/continuing education.
In addition, the universities offering the DCLS degree require applicants to have either 2 or 3 years of clinical laboratory experience (27, 28, 29). The programs offered by these institutions have curricula that include 75–80 hours of didactic studies and up to 1 year of full-time clinical practice residency. Finally, completing a research project is a required component of these programs (27, 28, 29).
Certification and/or licensing for the DCLS degree is not offered at this time.
Salary
There is no designated job position for the DCLS, so it is difficult to determine a reliable salary range. The BLS classifies the DCLS in the same category as medical/clinical laboratory technologists for job-growth projections, and the annual salary estimate for those positions is $59,130 (7). However, the DCLS is not intended to operate primarily as a bench scientist performing day-to-day testing procedures; the scope of their practice is assumed to be at a consultant level. It is reasonable to assume that salary offers will reflect this sophisticated level of contribution to the healthcare team.
Career Trajectory
The DCLS is a relatively new role and is not yet widely accepted by clinical facilities as a value-added position. The challenge facing DCLS-educated individuals is to advance the position and prove to those in clinical administration that the position is beneficial to the patient and healthcare facility in terms of improving patient outcomes and reducing costs.
The BLS classifies the DCLS in the same category as medical/clinical laboratory technologists for job-growth projections, and the projection for that category is 12% over the next 10 years (2021–2031) (7).
Master of Business Administration
Description of Duties
A Master of Business Administration (MBA) degree gives people a big-picture perspective on business operations. It provides individuals with a flexible and widely diverse skillset that allows them to contribute to the activities of any number of businesses, including the business of healthcare delivery. In general, business administration includes all aspects of business operations, such as facilities oversight, financial/accounting government, data analysis, sales/marketing management, project management, and organization research and development (30).
Certification/Licensure/Education
The first step to obtaining an MBA may be taking the Graduate Management Admission Test (GMAT) or the Graduate Record Examination (GRE), which are required by many institutions offering MBA programs. However, other schools do not and will not review scores on these exams.
MBA programs generally require 40–60 semester credit hours to complete. The core courses prepare individuals to make informed decisions about business operations. They include various areas of business administration such as accounting, business law, economics, ethics, human resource management, finance, marketing, and statistics.
Some programs also offer elective courses to broaden the students’ expertise. Many programs require students to complete an internship before graduating to gain practical business experience. Often a dissertation or a major capstone project is part of the degree requirement, and many MBA programs include a comprehensive exit examination at the end of the program (31, 32, 33).
Institutions offering MBA degrees are accredited to help prospective students as well as prospective employers ascertain that the MBA program meets certain quality standards. Currently, there are three accrediting agencies in the United States: The Association to Advance Collegiate Schools of Business (AACSB) (34); the Accreditation Council for Business Schools and Programs (ACBSP) (35); and the International Assembly for Collegiate Business Education (IACBE)(36). Individuals looking to gain education in healthcare management should investigate graduate institutions that are accredited by the Commission of the Accreditation of Healthcare Management Education (CAHME)(37).
Although MBA programs are accredited, there is no certification or licensure offered for the MBA degree.
Salary
As with several other postgraduate education options, MBA salaries are difficult to predict with accuracy. The average annual salary of someone with an MBA is in the six-figure range, but there are several factors that govern this estimation, including industry type, geographical location, and experience (38, 39). Industries with the highest average salaries are finance, consulting, technology, and marketing (7, 38, 39). It should be noted that the MBA has the highest return on investment of all the master’s degrees (40, 41, 42).
Career Trajectory
There are multiple employment opportunities for people with MBA degrees. Individuals with MBAs are trained to assess business operations and develop judicious plans for organizational improvement. Many careers requiring an MBA are leadership positions. The major fields of career possibilities for MBA graduates include accounting, information systems, general management, contracts/procurement, human resource development, project management, and risk management.
Businesses that need people with MBAs include insurance companies, manufacturing companies, government agencies, educational institutions, consulting firms, and healthcare facilities. Both the employment fields and the businesses needing MBA expertise are diverse and extensive. In addition to offering a strong financial return on investment, an MBA degree promotes an individual’s versatility, so it will very likely provide degree holders with improved job mobility.
It is also worth noting that advanced MBA degrees are available, specifically the Executive Master of Business Administration (EMBA) and PhD degrees in business administration. The EMBA is a degree that is designed for corporate executives and senior managers already in the workforce. Typically, individuals pursuing this degree already possess considerable work experience before entering the EMBA program. The EMBA focuses on growing the leadership skills of people who have experience in business management (43). A PhD in business administration grounds students in business operations and then trains them to apply business theory to research. A PhD in business administration will prepare students for careers in academia or research institutes (44).
Master of Health Administration
Description of Duties
The duties for people with a Master of Health Administration (MHA) degree generally involve managing hospitals, health services organizations, public health, or health administration consulting (45). It is not dissimilar to the careers open to people with MBAs, the key difference being that an MHA prepares individuals to focus on healthcare administration, whereas the MBA promotes administration of all business types, including healthcare.
Certification/Licensure/Education
The MHA is a graduate professional degree that provides students with the competencies needed for careers in health administration. Admission into an MHA program may include taking an entrance examination such as the MCAT (Medical College Admissions Test), GMAT, or GRE. However, each program has its own specific policies regarding the necessity of taking these exams (45, 46, 47).
MHA programs can range from 45–140 semester credit hours to complete, but most programs can be completed with approximately 45 semester credit hours. The core courses focus on business-management skills needed for the healthcare industry. A significant portion of an MHA program will include the concepts covered in an MBA program.
Coursework covers various areas of business administration, such as accounting, business law, economics, ethics, human resource management, finance, marketing, and statistics. However, since the MHA is directed specifically towards healthcare, the degree programs may also offer courses in U.S. healthcare systems, insurance and payment issues, the economics of U.S. healthcare, and healthcare quality/delivery. Moreover, MHA programs investigate the biology of health, so the program may offer courses in epidemiology, health epidemics, population health informatics, social determinants of health, and other courses germane to public health (46, 47).
Interested students should seek out programs that are accredited. The Commission on Accreditation of Healthcare Management Education (CAHME) is the only accrediting organization that is recognized to grant accreditation to graduate programs offering a professional master’s degree in healthcare management education (37).
Arthur H. Sheppard III, CPA, MBA is an accountant specializing in valuation and credit risk analytics for financial institutions. email: [email protected]
Sara A. Taylor, PhD, MLScm (ASCP) MBcm is an assistant professor in the University of North Carolina Chapel Hill division of clinical laboratory science in Chapel Hill, North Carolina. Email: [email protected]
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