What Next? Board Certified Phlebotomists by Richard Bukata, MD
Wednesday, July 21, 2010 
W. Richard Bukata, MDI have worked in the same ER for 25 years. About three years ago, an EMT in our department who had been drawing blood for 20 years there (at least) was required to stop doing so and get a California phlebotomy license. He was required to take a 20 hour course and pass a test and pay $100 for the license. He was not a better phlebotomist after being certified than before.
As of 2007, to draw blood in California for lab testing, phlebotomists must now hold a state certification allowing them to perform this function. Here’s what’s required to get the certification if an individual has never been a certified phlebotomist in the past:
- A high school diploma (what this has to do with the skill required to draw blood is unclear but is typical of the growing trend to require certain minimal educational standards, even if those standards have absolutely nothing to do with the job).
- Successfully complete a 40-hour formal phlebotomy training class from an approved school (no “see one, do one, teach one”). 40 HOURS!!! What could they possibly be teaching that takes 40 hours to learn about drawing blood. Another example of “educators” who apparently know better, over doing something to help defend their existence. Nobody requires 40 hours of classroom training to learn to draw blood – nobody.
- Complete 40 hours of phlebotomy practice that includes at least 50 venipunctures and 10 skin punctures. What if you can get the required number performed in less than 40 hours – do you have to hang around until the time expires?
- Pass an approved phlebotomy certification exam (Are their essay questions by any chance??).
- Apply for certification and pay an application fee of $100 and expect to get your certification “within 90 days.”
- Obtain six hours of “approved” lab-related continuing education and reapply and pay a relicense fee every two years. What’s new in phlebotomy that requires six hours of CME? Have universal precautions changed? You expire in only two years? Then what? If you let your certification lapse then only 20 hours of class are required if you’ve expired and have worked at least half a year as a phlebotomist.
If these are the hoops needed to simply be able to draw blood, can you imagine the requirements for anything more sophisticated? I can only imagine the certificational process to start IVs (would think a masters degree would be a minimum with 4 months of post-graduate IV starter school). This is another great example of the inmates running the asylum. We need to make it easier to work in healthcare and not harder. We have to have reasonable expectations regarding what training is required. We can’t keep adding more and more requirements to be allowed to perform simple tasks and in the process make healthcare more and more expensive and harder and harder to find staff to provide care.
Reader Comments (3)
Amen! When I went to paramedic school in the early 90's training for IV insertion and blood draws consisted of a single afternoon of pairing up with 2 classmates and 1 instructor, and just sticking each other until everyone was anemic and proficient. With just this background we were all able to start lines in the back of a moving ambulance on a rural dirt road whilst driving at 70mph with a thrashing patient. The necessity of lights/sirens and IV access for trauma patients aside, we sure as hell knew how to draw blood quickly, safely and without the need for nanny-state regulations!
This is where we are heading in a risk-averse society that is governed more by process (being seen to be done) than by outcome. With all respect to our nursing colleagues, a lot of this culture comes from nursing management, where it is seen that standardisation and documented processes might somehow compensate for lack of competence and judgement. Some of our older nursing colleagues, who have proved their good judgement and competence over many years, are now caught up in the need to have pieces of paper to prove it, with the people certifying them having much less experience and talent than the people they are certifying.
My other personal hobbyhorse (one of many) is the trend towards "mandatory education" - on topics such as manual handling, child protection, suicide prevention etc etc.There is a one-size-fits all approach, from Board-certified emergency physician to front-desk clerk, with a rush to confirm that 100% of the workforce has been trained (ie all boxes ticked), then a sigh of relief is collectively breathed (until the next one comes along). My approach is to refuse to attend basic courses in which I already have specialised knowledge and experience (generally more experience than the "educator" delivering the course material).
Most importantly, what can we do to stop this inexporable trend?
Sue Ieraci
Dr. Bukata: This is a very sensible post! I wonder how you square this position (that competent people are competent regardless of their merit badges) with the overwhelming academic emergency medicine position that only residency trained and boarded ER docs are qualified to work in the ED?
It seems that the physician and phlebotomist perspective are quite similar in this regard. There is a labour shortage, there is quite obviously a group of quite diversely trained people working in many EDs with the exception of large academic facilities, and there is an increasing press for credentialling everywhere. The doctor in average-town USA hospital who has been practicing good emergency medicine for 20 years is sometimes finding themselves judged not competent or fit for work because they don't hold the right tickets.
It really seems to be a position held by the major emergency medicine organizations, and prominent ER docs (including some who blog here) and instead of community and skills building what seems to predominate is merit badging, puffed chests and poisonous rancor.
Are ER docs an exception to the sensibility argument?
Just a little devils advocate on a rainy day....
Dr. J..