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ASCP Northern California Challenges a Shocking Increase in Licensing Fees: Part I Jordan Rosenfeld - June 30, 2026

Effective January 1, 2026, licensing fees for Medical Laboratory Scientists (MLSs) and Medical Laboratory Technicians (MLTs) in California increased from $179 every two years to $300 annually. Similar increases were implemented for other laboratory personnel licenses and certifications.

Many California Clinical Laboratory Scientists (CLSs) first became aware of the change when renewing their licenses online and discovering that the renewal fee had risen to $300 per year. A review of the California Department of Public Health (CDPH) website confirmed that, effective January 1, 2026, licensing and certification fees had increased for clinical laboratory personnel, clinical laboratories, tissue banks, and biologics programs. In addition, all personnel licenses transitioned from a biennial to an annual renewal cycle.

The fee increase was implemented without advance notice or public discussion, leaving many laboratory professionals concerned about its potential impact on the workforce. In response, leaders from the Northern California Chapter of the American Society for Clinical Pathology (ASCP), ASCP, the ASCP Board of Certification (BOC), and several professional organizations launched efforts to advocate for reconsideration of the new fee structure. What began as a response to the fee increase has grown into a statewide grassroots campaign focused on the broader implications for recruitment, retention, and workforce sustainability.

An ad hoc coalition was formed through collaboration among the ASCP Northern California Chapter, the Medical and Public Health Laboratory Workforce Coalition (MPHLWC), the American Society for Clinical Laboratory Science (ASCLS), PAMET-USA, Inc., and PAMET Cal 5. The MPHLWC, led by Matthew Schulze, Senior Director of the ASCP Center for Public Policy, is a national advocacy coalition convened by ASCP to address critical workforce shortages among laboratory professionals and pathologists across the United States.

The email that changed everything

When Laura Laakso, CLS, MLS (ASCP), President-Elect of the ASCP Northern California Chapter, received a notification email in 2025 about the enormous fee hike, her first reaction was, “You've got to be kidding me, this is a mistake.” She was shocked at the lack of forewarning and even more, “that there was no opportunity to question it, to speak to it.” She fully expected a retraction email to come shortly thereafter.

The fee hike happened during a hiatus of the state’s Clinical Laboratory Technology Advisory Committee (CLTAC), and no one was quite sure why the fee increased so dramatically. The CLTAC committee will reconvene on August 13, and the organizations aim to bring ideas for reform to that meeting.

Ms. Laakso says that once she realized there would be no “oops” follow-up email, the ASCP local chapter, which has more than 1,000 members, got together and said, “We need to fight for our people here and we need to get everyone together."

Members of ASCP Northern California quickly realized their feelings were shared by others within laboratory groups such as ASCP, the American Society for Clinical Laboratory Science (ASCLS), and the Philippines Association of Medical Technologists –USA, Inc. (PAMET-USA, Inc.). Ms. Laakso credits Ann Ho Cichocki, CLS, MLS (ASCP)^CM, Treasurer for the ASCP Northern California Chapter and a Senior Clinical Laboratory Scientist at Stanford Health Care, for “bringing everyone together, spearheading this and just getting us all on a call together” to figure out next steps.

It was a galvanizing moment, Ms. Laakso says. "As scientists, sometimes we tend to not really speak up for ourselves. We tend to be more in the background, more comfortable behind a microscope than in front of a podium. But this was too much. We were going to need to do something here."

Concerns about the long-term impact

While the fee hike itself is a burden, its impact may stretch beyond laboratory professionals’ wallets. According to Justin Hanenberg, DCLS, President of the ASCLS California chapter, it could have a negative impact on morale, retention, and recruitment.

"There are definitely barriers to entry for our workforce already and difficulties about moving up within it. And so, this licensure fee just creates more of that,” he says.

Additionally, Dr. Hanenberg is concerned this could worsen California’s significant laboratory shortage. “I worry that this is going to put more of a chokehold on the existing workforce and professionals who would love to be here in this state,” he said.

Reflecting on his own experience, he admits that if he were a young person looking at licensure costs, “I would see that fee and say, 'I'll choose something else.'" He recently learned that laboratory directors now have the highest renewal fees ($570/year) of all health professions, higher than even physicians or surgeons.

Dr. Hanenberg adds, "We want a healthy and operative Laboratory Field Services licensing program that works for both the workforce and to sustain the department."

Mrs. Cichocki is also concerned about students entering laboratory careers. “The students most affected by this bill are already struggling with student debt,” she said. “In a state with one of the highest costs of living in the country, this additional burden may deter qualified students from pursuing careers in laboratory science, exacerbating existing workforce shortages and shrinking the pipeline of professionals entering the field.”

Elma Kamari Bidkorpeh, CLS, MLS (ASCP)^CM, legislative chair of PAMET-USA, Inc. and past president and adviser of the Southern California chapter, discussed the potential impact of the proposed licensing fee increase on both PAMET-USA members and the medical laboratory profession. Dollie Marie Jacosalem, MLS (ASCP), national legislative chair of PAMET-USA, Inc. and president of the Michigan chapter, noted that similar fee increases could potentially influence licensing costs in other states with laboratory licensure requirements. Today it is California, tomorrow it could set a precedence for other states to increase their fees as well.

PAMET-USA, Inc. highlighted concerns that higher licensing fees may exacerbate workforce shortages, particularly in rural and underserved communities. The organization emphasized that increased costs could create additional barriers to recruitment and retention of qualified laboratory professionals in these critical healthcare settings, potentially affecting access to essential laboratory services.

Valerie Trenev, CLS, Immediate Past President of CAMLT, echoed that “we’re having a very big struggle staffing laboratories right now and so this just adds another barrier to trying to fill positions, which is really hard on the manager. It's hard on the HR department. It's hard on the rest of the crew.” She’s one of many people having to take on extra shifts at her job, often less than ideal ones, like graveyard shifts, to fill the gap. “It's really a hardship and we don't want it to get worse,” she said.

The ripple effects are already in motion

Laboratory leaders fear the fee increase will affect staffing in rural areas and facilities that depend on travelers or cross-state staffing arrangements. "Scientists are already very hard to find,” says Mrs. Laakso who is also the Director of Laboratory Services at Tahoe Forest Health System.

"Nevada scientists right now all carry California licenses, which is very convenient for me because we can trade staff back and forth. They're telling me they may not renew their California licenses. So, I may no longer have that option to bring scientists over to the town of Truckee to cover, which is just another hard hit,” she says.

For people weighing the choice of healthcare or health science careers, she fears that the high fees could nudge people away from laboratory careers. “If you're looking at what it costs to be a nurse versus what it costs to be a scientist, some may question justifying the choice to become a scientist. The pay is about the same."

The negative impacts of this can’t be understated, she says. “You can't have a hospital, you can't have an emergency room, without a lab."

The advocacy campaign also gained momentum through a public petition created by Tatyana Rijkova on Change.org. Calling for reconsideration of the dramatic increase in California laboratory licensure fees, the petition has attracted more than 1,542 signatures and has helped elevate awareness of the issue among laboratory professionals and the broader public.

Individuals outside California who wish to support the effort can sign the petition online here.

Part 2 of this two-part article will take an inside look at the ASCP Northern California Chapter's fight against the expansive increase in licensure fees at the state level.

Telepathology in Tanzania: Expanding Access to Expert Cancer Diagnosis Jordan Rosenfeld - June 16, 2026

For years, the pathology department at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania has been understaffed, making it difficult to get specialists to weigh in on certain kinds of cancer diagnoses. 

That began to change in 2018, when a collaboration between the American Society for Clinical Pathology (ASCP), Duke University, and KCMC launched a telepathology consultation platform using whole slide imaging (WSI). This allowed pathologists in Tanzania to digitize slides and securely share them with subspecialty experts in the United States and the Netherlands for remote review.

A recently published study in the American Journal of Clinical Pathology (AJCP) led by ASCP Global Health Fellow, Aisha Mohamed, MD, a third-year pathology resident at the University of Minnesota Department of Lab Medicine and Pathology, found that telepathology improved access to expert consultation, supported education and mentorship, and in many cases changed diagnoses in ways that directly affected patient care. 

Dr. Mohamed says, “This paper also provides a template for other similarly resourced pathology departments to follow. It provides a cost breakdown of the implementation of telepathology at KCMC.”

Building a pathology service with limited resources

Before telepathology, between 2006 and 2015, KCMC’s pathology department did not have a full-time local pathologist. The time between visiting pathologist consultations could range from weeks to months, according to Alex Mremi, MD, PhD, Head of Pathology at KCMC. The staff pathologists also had limited access to immunohistochemistry and subspecialty expertise. “It was challenging and therefore telepathology is very important,” Dr. Mremi says.

While telepathology has been essential in giving “generalists access to subspecialty expertise that otherwise would not have been available,” Dr. Mremi stresses that “telepathology did not replace local pathologists at KCMC.” It enhanced their work.

How whole-slide imaging makes remote consultation possible

Whole slide imaging expands access by scanning traditional glass slides into high-resolution digital images that can be reviewed remotely. At KCMC, laboratory staff use a Motic whole slide imaging system and upload files to a secure cloud-based platform, which can then be shared with consultants abroad. The AJCP study found that 92 percent of the digital images were considered “diagnostically adequate.” 

The WSI and telepathology enables KCMC pathologists to consult pathologists in subspecialties, which Dr. Mremi calls a form of “external quality control but also teaching and networking.” 

Dr. Mohamed adds that “Telepathology offers an avenue for pathologists in high-resourced settings to give back by providing mentorship to junior pathologists abroad and their expertise on challenging cases, without having to cross an ocean.”

Measuring diagnostic agreement across subspecialties

The AJCP study analyzed 1,266 challenging pathology cases submitted for teleconsultation between 2018 and 2025. Researchers compared the local pathologist’s initial diagnosis with the consulting expert’s interpretation to measure concordance, partial concordance, and clinically significant discordance. They found a 44.8 percent full concordance rate, a 19.75 percent partial concordance rate, and a 32.78 percent discordance rate — meaning the expert's diagnosis differed from the local pathologist's enough to have an impact. 

The discordance rate is a likely result of “comparing difficult cases,” Dr. Mremi said. He explains that many of the cases submitted for teleconsultation were especially rare or diagnostically difficult. These were often evaluated using only routine H&E staining without the broader immunohistochemistry or molecular testing panels commonly available in higher-resource settings. “I believe if we also had access to immuno, perhaps the concordance rates would be much improved,” Dr. Mremi says. 

Even so, the study demonstrated that remote consultation could still meaningfully improve diagnostic confidence and help clinicians make more informed treatment decisions.

When a second opinion changes treatment

One of the study’s key findings was that telepathology did improve workflow; turnaround time substantially improved over the study timeline, dropping from pandemic-era highs in 2020 to less than five days in 2025. Additionally, in many cases, an expert consultation of the preliminary report altered or refined the diagnosis, allowing treatment decisions to be adjusted accordingly. 

Dr. Mremi says, “If now we get the feedback which is contrary to the primary diagnosis, then we will update the report accordingly. So that's how the data in the platform can influence the treatment.” 

For patients with cancer or rare tumors, those revised diagnoses could influence everything from surgical decisions to chemotherapy planning.

Mentorship, training, and long-term capacity building

The telepathology platform’s value extended well beyond second opinions. Regular interaction between Tanzanian pathologists and subspecialists abroad created ongoing mentorship, educational exchange, and collaborative research opportunities.

Dr. Mremi says, “we gained a lot of insights from the pathologists who are reviewing our cases.” In particular, he explains, “Having junior pathologists interacting with the very senior, to me, is very much critical for career development, but also [to] improve the services.”

The future of the fellowship

Kenneth Landgraf, MS, Director of the Center for Global Health at ASCP, sees the study as one example of a broader pattern of successful partnerships the Global Health Fellowship produces. “This research demonstrates the long-term collaborative partnerships that are formed through the fellowship program,” he says.

For Mr. Landgraf, the fellowship’s value lies in the mutual exchange it fosters. ASCP fellows and their host pathologists learn from each other, building the kind of practical knowledge and cross-institutional relationships that directly translate to better patient care.

Mr. Landgraf points out that the pathologist workforce shortage in LMIC settings extends beyond raw numbers. Due to limited fellowship training pathways and resources, most pathologists in these settings practice as generalists, with some engaging in subspecialty interest groups as a means of continued learning.

”This study demonstrates that telepathology is a viable model to expand access to advanced subspecialty diagnoses in resource-constrained settings,” he says, “improving patient care and supporting the development of local pathologists along the way.”

Dr. Mremi looks forward to a forthcoming multi-site study with ASCP involving deep learning-aided breast cancer pathology analysis, drawing from low- and middle-income countries (LMIC) cohorts across Africa and beyond.

Additionally, thanks to a recent commitment from the ASCP Foundation, the Global Health Fellowship has secured ongoing annual funding into the foreseeable future, with applications for 2027 opening later this summer. 

What sets the fellowship apart, Mr. Landgraf emphasizes, is that it doesn’t end when the fellow returns home. “It’s not just a month in-country and then forgotten,” he explains. “The relationships continue virtually for months and years ahead.” This study is itself evidence of that: Dr. Mohamed, Dr. Mremi, and Mr. Landgraf have continued collaborating on research for more than a year since the fellowship concluded.

Dr. Mohamed expresses gratitude for her opportunity, not only “to learn from and work with Dr. Mremi and his colleagues at KCMC during my global health fellowship” but also to Mr. Landgraf, “who was another great research mentor.” 

She highly recommends that residents apply for the global health fellowship, which she calls, “A mutually beneficial opportunity where you learn to become a better pathologist by relying on your morphology skills while your host institution will benefit from hearing your perspective on things based on the training you had.”

So long as LMIC settings like Sub-Saharan Africa face understaffing in pathology, Mr. Landgraf sees tools like telepathology as “a way to make sure that patients get the right diagnosis.”

With additional research collaborations and AI-assisted pathology studies already underway, KCMC’s telepathology program may represent the beginning of a broader transformation in cancer diagnostics across low- and middle-income countries.

In Their Own Words: Residency Team Critical Values - June 9, 2026

Third year residents and ASCP Resident Council members, Lauren Miller and Tayler Gant—Chair-Elect—know what the first year of pathology residency is like and have advice for residents at the beginning of their programs.

In this video, they reflect on those first few months of their residencies, share the advice they’d give their first-year selves, the impact a mentor has on your residency experience, and more.

This video was originally published on thepathologist.com in May 2026.

Advancing Cervical Cancer Screening Through Data and AI Jordan Rosenfeld - June 2, 2026

Cervical cancer screening in the U.S. still faces major challenges, including inconsistent reporting and data that does not fully reflect all populations. To address these challenges, the American Society for Clinical Pathology (ASCP), with an inaugural grant from the Alliance for Women’s Health and Prevention (AWHP), spearheaded the Cervical Cancer Screening Collaborative.

Using large-scale, multi-site datasets, and a novel natural language processing (NLP)-based algorithm, the project aims to improve cervical cancer screening accuracy and equity across diverse populations in the U.S.

A preventable cancer still showing troubling gaps

Even with effective screening and HPV testing tools widely available, cervical cancer continues to disproportionately affect women who face barriers to care, particularly women of color and women in rural communities, according to Millicent Gorham, PhD (Hon), MBA, FAAN, Chief Executive Officer of the Alliance for Women's Health and Prevention.

Those disparities reveal a need for a broader and more inclusive understanding of how screening performs across different populations and geographic regions.

“Cervical cancer is one of the most preventable cancers we have,” Dr. Gorham says. Yet advanced cases rising disproportionately among Black and Hispanic women, women in rural communities, and women with limited access to care are “a signal that the system meant to catch this disease early is not reaching everyone it needs to,” she adds.

What also drew AWHP to ASCP’s Cervical Cancer Screening is that much of the U.S.-based evidence informing national screening guidelines comes from a single integrated health system: Kaiser Permanente Northern California. “What we are questioning is whether one health system in one region can tell us what we need to know about cervical cancer screening for every woman in this country. It cannot,” Dr. Gorham says.

Hence their support of research like ASCP’s project, which “broadens the evidence base, so that guidelines, coverage, and access are built on data that reflects the full diversity of women in this country,” Dr. Gorham adds.

A more representative national dataset

The initiative is built upon a large retrospective study drawing data from 10 participating sites across the United States. It combines Pap test results, HPV testing data, and cervical biopsy findings collected over roughly a decade, allowing researchers to analyze screening outcomes longitudinally and across diverse patient populations by age, ZIP code, race, and ethnicity.

Sachin Gupta, PhD, MBA, MLS(ASCPⁱ)MBⁱ, LSSBB, CPHQ, ASCP’s Scientific Director in the Center for Quality and Patient Care, explains that one of the aims of the project is to study how Pap testing diagnostics rates and HPV positivity rates vary across demographics and geographic regions. The project could eventually help validate “whether current screening guidelines are appropriate and up to date or not,” Dr. Gupta says.

By aggregating data from multiple institutions, ASCP hopes to create a broader evidence base that more accurately reflects the populations’ current screening guidelines are intended to serve.

Why cervical biopsy reports are difficult to analyze at scale

Although Pap and HPV test results are often captured in structured fields in a pathology report, cervical biopsy reports frequently exist as narrative “unstructured text,” Dr. Gupta explains, making large-scale analysis and standardized data extraction more difficult.

“The cervical biopsy result can hide within a lengthy description,” Dr. Gupta says. It’s not sustainable to pull these findings out through manual review, “given the rapid growth in documentation and expanding demand for data-driven clinical insights.”

Traditionally, extracting information from these reports would require a person to manually examine patient charts one by one. That process is labor-intensive, and prone to human error, especially when analyzing tens of thousands of pathology reports across multiple institutions.

To address that challenge, ASCP is using their Performance & Diagnostics Insights (PDI) platform and developed an NLP-based approach capable of converting narrative pathology reports into structured, analyzable data. In other words, ASCP developed a tool that can read the pathology reports and automatically sort the information into organized data, making it easier to study and spot patterns across thousands of cases.

Training an NLP model to understand pathology language

Many existing pathology NLP libraries are tissue-specific and do not generalize well to cervical biopsy data, making a custom solution necessary.

“ASCP developed a hybrid framework that integrates deep learning techniques along with BERT (Bidirectional Encoder Representations from Transformers),” Dr. Gupta says. Instead of generating text, the system interprets clinical language and extracts diagnostic information from pathology narratives.

Understanding context is critical because pathologists may phrase findings differently across institutions or reporting styles.

“Every pathologist writes their report a little differently. It’s not a kind of standardized template, so to speak. And a diagnosis can be hidden in a long text string somewhere,” Dr. Gupta says.

The system uses multiple processing steps, including text preprocessing, information extraction, feature engineering, and sentiment analysis, to help interpret the meaning behind narrative pathology language. Rather than simply searching for keywords, the model is trained to understand how pathologists communicate diagnostic findings within clinical context.

Validating the model across multiple health systems

After training and validating the algorithm on more than 10,000 pathology reports from one participating site, ASCP is now applying the model to data from additional institutions. “Our algorithm's performance turned out to be great with superb accuracy and precision and now we are in the process of using it for datasets of additional sites,” Dr. Gupta says.

Each new site introduces differences in reporting structure, formatting, and terminology, giving researchers an opportunity to evaluate how well the model adapts across real-world practice settings.

Shaping quality improvement and future guidelines

Dr. Gupta says the work may help standardize reporting practices and improve researchers’ ability to study incidence rates and screening outcomes in specific populations. The project could also create new opportunities for benchmarking and population health analysis across participating institutions.

From Dr. Gorham’s perspective, “Cervical cancer screening guidelines in this country should rest on evidence that reflects every woman the guidelines are meant to serve.”

Ultimately, the goal is fewer women diagnosed with advanced cervical cancer, Dr. Gorham adds. “We know how to prevent this disease. The work is making sure access to preventive care reaches everyone.”

The laboratory’s role in shaping the future of screening

Although the initiative relies on advanced AI and NLP tools, Dr. Gorham stresses the importance of pathologists and laboratory professionals, who are “central to this project — without them, it does not happen.”

While AI may dominate healthcare headlines in abstract terms, this project represents a highly practical application grounded in pathology workflows and laboratory data.

3 Questions with Aadil Ahmed, MD, FASCP Team Critical Values - May 28, 2026

Medicine is not practiced on assumptions, and the realization that pathology provides the most objective and definitive evidence of disease in medicine is what drew Aadil Ahmed, MD, FASCP, to the field. To see how diseases evolve in real time under the microscope and through molecular testing, whether watching blast counts decrease after induction therapy, or seeing chimerism patterns shift in a transplant patient, is powerful to witness. It underlines the fact that pathology doesn’t just diagnose disease; it tracks the response to therapy, shapes prognosis, and guides critical decisions for both clinicians and patients.

Dr. Ahmed was also drawn in by the realization of how essential pathology is for documenting disease in a way that is recognized not only medically but also administratively. The requirements for insurance coverage, treatment authorization, and clinical eligibility decisions underscore the responsibility to how central pathology is to ensure patients receive the care they need.

Here, Dr. Ahmed shares his thoughts on his career in the laboratory.

What is something that has surprised you about working in the lab?

Every single step of processing a patient’s specimen is absolutely critical. From accessioning to grossing, embedding, sectioning, staining, and interpretation, each step forms a chain, and if even one link is weak or overlooked, it affects everything downstream. You might think a small deviation is inconsequential, but in pathology, even minor errors can compromise a diagnosis or delay the information clinicians rely on.

That’s why succeeding in this field requires more than technical skill; it requires genuine passion, attention to detail, and vigilance. People who truly care about the work are the ones who notice when something looks off, when a block feels unusual to cut, when a stain doesn’t appear quite right. This sense of ownership and pride in the process is what keeps the entire diagnostic pathway safe and reliable for patients. All of these steps also require that there is camaraderie among the staff. Everyone from the lab assistants to the histotechnologists to the pathologists plays a vital role.

The lab may seem quiet from the outside, but there is always a lot happening to ensure results are accurate and timely.

What is your favorite test to perform and why?

My favorite test to perform, if I can call it a test, is reviewing a good H&E stain. To me, H&E is the most powerful stain in all of pathology. It’s basic, it’s universal, and yet it delivers the greatest amount of information a tissue can offer. Call me old‑fashioned, but pathology is, at its core, a visual discipline.

Even in an era where we have impressive ancillary tools, immunohistochemistry panels, molecular assays, flow cytometry, sequencing, there are times when those studies yield non-diagnostic or inconclusive results. Everything starts with morphology, and while the fundamental patterns of diseases are consistent, the finer details are often subtly different. Those small deviations challenge you to slow down, and to appreciate nuances that no molecular test will point out for you. It’s in those details where the art and science of pathology truly meet.

How do you approach difficult cases, and collaborate and communicate with clinicians to maintain a strong sense of purpose and connection to the human side of healthcare?

I see challenging cases as important opportunities to reinforce that pathology does not function in isolation, even though, as a behind-the-scenes specialty, our role can sometimes be overlooked. In these situations, I’m not hesitant to pick up the phone and speak directly with the clinician to gather additional clinical context or discuss management considerations. Having a working understanding of treatment strategies is especially valuable here; it not only improves diagnostic precision but also demonstrates the broader clinical perspective we bring, which helps build trust with our clinicians over time.

At the same time, I’m intentional in how I communicate through my reports. I try to use clear, active language that reflects thoughtful interpretation, so it’s evident that there is a physician actively engaged in the diagnostic process. That approach helps me feel more connected to patient care, while also fostering a sense of collaboration and confidence among the clinicians who rely on our work.