medical laboratory technicians earned an average salary of $51,219, while medical laboratory scientists earned a salary of $67,888. an added disadvantage for mlts is that some institutions will only employ mlss, although that practice is starting to change due to recent efforts in cost reduction, and due to staffing shortages. in practice, the term medical laboratory technician may apply to persons who are trained to operate equipment and perform tests, usually under the supervision of the certified medical technologist or laboratory scientist. depending on the state where employment is granted, the job duties between mlss and mlts may or may not be similar. for example, in florida, a mlt may only perform highly complex testing while under the direct supervision of a clinical laboratory technologist, a clinical laboratory supervisor, or a clinical laboratory director. this may make it impractical for a mlt to lawfully work in a florida blood bank. california has similar restrictions on mlts. to accommodate california's restrictions, the american association of bioanalysts (aab) developed a separate certification examination for california licensure. however, this exam does not include material covering the areas of immunohematology or microscopy. although the typical entry-level academic requirement for most mlts is an associate degree, a 60 credit certificate program exists through military training programs; such as the u.s. army's 68k military occupational specialty. as in other countries, staffing shortages have become a major issue in many clinical laboratories in the united states. due to several factors, including boomer retirement, and inadequate recruitment and retention efforts, the medical laboratory workforce is shrinking. for the decade 2010–2020, workforce needs are expected to grow by 13%. this translates into about 11,300 positions per year that will need to be filled, with only about 5000 new graduates per year coming out of various programs. by 2025, it is estimated that the shortage of medical laboratory professionals will reach 98,700 in the u.s. united kingdom in the united kingdom (uk) there are two varieties of registered healthcare scientist in hospitals - clinical scientists and biomedical scientists (bms). there is a strict and formal post graduate training programme for both careers followed by statutory registration for each with the health & care professions council uk (hcpc):, for the safety and assurance of the customers - the patients. they are two similar but distinct careers with parallel but different training paths and different entry requirements. the role of clinical scientists is to improve the health and well-being of patients and the public by practising alongside doctors, nurses, and other health and social care professionals in the delivery of healthcare. their aim is to provide expert scientific and clinical advice to clinician colleagues, to aid in the diagnosis, treatment and management of patient care. examples of the type of work they undertake include: advising, diagnosing, interpreting, and treating patients. advising health and social care professionals in the diagnosis and treatment of patients. researching the science, technology, and practise used in healthcare to innovate and improve services. designing, building, and operating technology for diagnosing and treating patients. ensuring the safety and reliability of tests and equipment used in healthcare. trainee clinical scientist posts are advertised nationally, usually between november and february on the clinical scientists recruitment webpages where application forms may be obtained and electronic submission of applications can be made. these posts are for the approved pre-registration training programme, designed to prepare entrants for higher professional qualifications, further clinical training and eventual consultant responsibility. clinical scientist training involves enrolment of graduates (first or second class honours degree or better is essential due to the high competition for limited training places) into an intensive three-year training scheme leading to certification and eventual registration before starting the higher career structure. the basic qualification for becoming a clinical biochemist, clinical immunologist or clinical microbiologist is a good honours degree in an appropriate subject: for clinical biochemistry, that subject might be biochemistry or chemistry (or another life science subject which contains a substantial biochemistry component); for clinical immunology, that subject might be any life science degree with an immunology component; for clinical microbiology that subject might be any life science degree with a microbiology component. although not essential, some candidates will apply with higher degrees in an attempt to improve their chances of selection for training and several universities currently offer msc courses in clinical biochemistry, immunology and microbiology which have been approved by the acb or the ahcs. full-time and 'sandwich' courses are available, and further information may be obtained from individual programmes, although the level of financial support provided varies, and should be clarified at interview. some entrants to the profession will already have obtained a phd, and the training and research experience that this provides is invaluable to the work of the clinical scientist. in larger departments, there may be opportunities to study for a research degree after entering the profession and acquiring registration, but since this has to be fitted in with other responsibilities, it may take some years to complete. it should be clearly understood that the major role of the profession is patient care and that research, management and all the other aspects will come as side issues and not be the predominating factor in the career path. the work of biomedical scientists and clinical scientists have impact on the diagnosis and treatment of almost every patient admitted to hospitals in the united kingdom. the united kingdom is facing a shortage of qualified clinical and biomedical scientists. the royal college of pathologists and the royal college of physicians have pointed out the need for increased government funding for medical training programs to prevent diagnostic facilities and medical infrastructure from being overwhelmed. msf claims that these workers have lost out financially since the decision of the then health minister kenneth clarke to exclude them from the pay review body in 1984. nigeria in nigeria, medical laboratory science is a high skilled profession charged by act 11 of 2003 laws of the federation of nigeria. the initial qualification awarded graduates of the programme, like some other medical programmes, was associate of the institute of medical laboratory technology/science (aimlt/aimls) the medical laboratory science council of nigeria, which was established by act. 2004 cap 114 laws of the federation of nigeria, regulates the practice of medical laboratory science in nigeria. in nigeria, the medical laboratory science programme is bachelor of medical laboratory science (bmls), regulated by national universities commission (nuc) and by the medical laboratory science council of nigeria (mlscn). students at their first year (100 level) are trained under the faculty of science in basic sciences and faculty of arts, management and social science in general studies and entrepreneurship. at the 200 level, students are taught basic medical sciences and are introduced to medical laboratory science. the third year of the programme marks the beginning of the professional training as students are engaged in the classroom for lectures as well as in the hospital laboratory for the professional or practical training. at the fourth year students are taught the basics in all the special areas of medical laboratory science. at the end of 400 level programme, successful students are presented for the first professional examination, to be moderated by the medical laboratory science council of nigeria at the fifth year, students break into 4 core or specialized areas of medical laboratory science, namely: medical microbiology/parasitology, chemical pathology/immunology, haematology/blood transfusion science and histopathology/cytopathology. at the end of the fifth year, suitable students are presented for final professional examination by the medical laboratory science council of nigeria. certification and licensing a lab tech uses a microscope for a cell count. united states there are currently three major certification agencies in the united states of america for clinical laboratory scientists. they are the american association of bioanalysts (aab), the american medical technologists (amt), and the american society for clinical pathology (ascp). clinical laboratory science programs have the option to be accredited by the national accrediting agency for clinical laboratory science (naacls). all three national accrediting agencies will certify scientists in the clinical laboratory as generalist (chemistry, hematology, immunology, immunohematology/blood bank, and microbiology). the american association of bioanalysts and the american medical technologists certifications continue to use the traditional designation medical technologist (mt), while the american society for clinical pathology has adopted the designation of medical laboratory scientist (mls). regardless of terminology, these highly qualified individuals serve as scientists in the clinical laboratory. there are two other organizations that have previously provided proficiency examinations to clinical laboratory scientist. the first, is the us department of health and human services. the second, is the national credentialing agency for laboratory personnel (nca). the nca was absorbed by the american society for clinical pathology in 2009 and promptly dissolved. in the united states, the clinical laboratory improvement amendments (clia '88) define the level of qualification required to perform tests of various complexity. clinical laboratory scientists, medical technologists and medical laboratory scientists are near the highest level of qualification among general testing personnel and are usually qualified to perform the most complex clinical testing including hla testing (also known as tissue typing) and blood type reference testing. provider performed microscopy, or ppm (doctorate or master's level health provider) and cytology have additional requirements. in addition to the national certification, 11 states (california, florida, georgia, hawaii, louisiana, montana, nevada, north dakota, rhode island, west virginia and new york) and puerto rico also require a state license. puerto rico, in order to provide the state license, requires either a local board certification with a state examination, or any of both the ascp and the nca. minnesota, texas, illinois, massachusetts, michigan, vermont, washington, new jersey, iowa, utah, ohio, south carolina, wyoming, pennsylvania, virginia, south dakota, delaware, missouri, and alaska are currently attempting to obtain licensure. all states require documentation from a professional certification agency before issuing a state certification. a person applying for state certification may also be expected to submit fingerprints, education and training records, and competency certification. some states also require completion of a specified number of continuing education contact hours prior to issuing or renewing a license. licensing is somewhat controversial as it adds a bureaucratic layer in a field that is severely understaffed. simply requiring testing personnel to obtain and maintain their national certification would help ensure competent testing personnel without increasing costs to testing personnel. some states recognize another state's license if it is equal or more stringent, but currently california does not recognize any other state license. united kingdom in the united kingdom all clinical scientists and biomedical scientists have had to be registered with the health & care professions council (hcpc) in order to work unsupervised, to develop through the careers grades of their profession and to use the protected titles of "clinical scientist" or "biomedical scientist". the hcpc registers nearly 200,000 healthcare professionals and while success in an approved degree course from an accredited university is sufficient for all other professions, both clinical scientists and biomedical scientists have post graduate training and no approved degree courses. autonomous assessment of applicants in these two professions with subsequent certification for successful ones, is the only approved uk route to registration for them. "clinical scientist", just as "biomedical scientist", is a protected title under the law (there is a £5000 fine for transgressors who fraudulently use the title without being registered by the state). the hcpc can strike people off the register for malpractice in just the same way as for doctors with the general medical council (gmc). those who are working in "trainee" positions in the profession are permitted to use the title with an appropriate caveat, for example – "pre-registration clinical scientist", trainee clinical scientist, etc. alternatively some may use titles specific to the discipline they train in, such as trainee clinical biochemist", "clinical immunologist in training" or “ pre-registrant clinical microbiologist” which is also perfectly acceptable since it is not implying the protected "clinical scientist" title of fully qualified and registered practitioners. it is against the law to formally work with the title of “clinical scientist” without professional registration. nigeria in nigeria successful student at the end of the training in both academic and professional assessments with respect to the graduation requirements is certified by the respective university, inducted and licensed by the medical laboratory science council of nigeria after a successful internship