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ASCP Northern California Challenges a Shocking Increase in Licensing Fees: Part II Jordan Rosenfeld - July 7, 2026

Part I of this two-part article examines California’s January 1, 2026 licensing fee increases for laboratory professionals, which raised MLS and MLT fees from $179 every two years to $300 annually and shifted to annual renewals. The change was implemented without advance notice, prompting confusion and concern among professionals who discovered the increase during license renewal. In response, multiple laboratory organizations formed a coalition and launched a statewide advocacy campaign to push for reconsideration and address broader workforce implications. Stakeholders warn the higher costs could worsen staffing shortages, discourage new entrants, and negatively affect recruitment, retention, and access to laboratory services, particularly in underserved areas.

You can read Part I here.

Taking the fight to Sacramento

One of the first actions taken by the ASCP Northern California Chapter and the ASCP was the development of a coalition sign-on letter opposing the fee increase. The letter, signed by 21 organizations representing local and national laboratory stakeholders, was submitted to the California State Legislature on April 16, 2026.

Building on this effort, a delegation of laboratory professionals traveled to the state’s capital in Sacramento to advocate directly with state legislators during hearings of the California Senate Budget and Fiscal Review Committee on May 20 and 21, 2026. The delegation, led by Ann Ho Cichocki, included Laura Laakso, CLS, MLS (ASCP), Valerie Trenev, CLS, MLS(ASCP), Josilyn Schrage, CLS, MLS(ASCP)^CM, Marilyn Claire Virgo, BA, CLS, MLS(ASCP)^CM, and Luke Valencia, DCLS, MLS(ASCP)^CM who recommended for reconsideration of the licensing fee increases and highlighted their catastrophic effects on the laboratory workforce.

Although each speaker was allotted only about one minute to address the Senate committee, participants viewed the opportunity as an important step in raising awareness of the issue. According to Mrs. Cichocki, Senate Subcommittee 3 on Health and Human Services Chair Carolyn Menjivar appeared receptive to the coalition’s concerns.

Speaking on behalf of a coalition of 21 laboratory organizations, Ann Ho Cichocki urged the Legislature to address the massive fee increases and restore public oversight of future licensing decisions. During her May 20 testimony, she warned that "a 335 percent license fee increase places a major financial burden on laboratory professionals already facing workforce shortages and rising cost of living." She also emphasized the potential consequences for patient care, noting that the increases create "a serious risk for California's healthcare system, especially in rural and underserved communities on the state borders that already struggle to recruit and retain laboratory scientists."

At the May 21 hearing, Cichocki returned a second day and shifted her focus to concerns about transparency and accountability in the fee-setting process. Referring to AB 144, she told legislators that granting unilateral authority to the CDPH to adjust fees annually based on their operational needs "would reduce transparency and accountability." She argued that the financial burden of supporting broader laboratory oversight activities was falling disproportionately on laboratory professionals, stating that "the people in the lab" should not be expected "to subsidize the costs of broader laboratory oversight."

Mrs. Cichocki noted that she believes the Governor's current budget proposal makes clear that the revenue increase sought for Laboratory Field Services (LFS) is primarily intended to support general laboratory oversight activities rather than oversight of laboratory personnel. However, she argued that the financial burden of generating that revenue is being placed disproportionately on laboratory professionals themselves.

Addressing Issue 20 on the hearing’s agenda, Laboratory Licensing Resources, Mrs. Cichocki stated that laboratory professionals should not be expected to fund the state's regulatory infrastructure through their individual licensure fees. "The people in the laboratory should not have to pay for the department to hire inspectors and support other CDPH programs through their licensure fees," she said. "It is not appropriate for laboratory personnel to subsidize the costs of broader laboratory oversight."

Watch the conversation with Senator Carolyn Menjivar vs. CDPH Laboratory Field Services @ timestamp 4:35:01 & 5:02:00 by visiting the website here.

According to Mrs. Cichocki, the California Department of Public Health (CDPH) more than tripled licensing fees for Clinical Laboratory Scientists and other laboratory personnel, increasing them by approximately 161 percent to 335 percent, while fees for laboratory facilities increased by only about 24 percent to 64 percent. She cited this disparity as evidence that individual laboratory professionals are bearing a disproportionate share of the cost increases.

To illustrate the magnitude of the change, Ann compared California's licensing fees with those of other states. "For context, New York's license renewal fee is $170 every three years," she said. "The California equivalent is now $900 every three years, or $300 annually."

Ann warned that, amid ongoing staffing shortages, "these exorbitant, excessive fee increases risk driving highly skilled laboratory professionals out of the field and out of California altogether. International lab professionals are less willing to enter the state to work."

Throughout both hearings, coalition representatives emphasized that the issue extends beyond licensing costs. Ann reminded the Senate committee, laboratory professionals are "the very professionals responsible for providing lifesaving blood units and critical testing services in hospital labs across California." The delegation urged legislators to ensure that future fee adjustments include transparency, public input, and legislative oversight instead of granting the department unilateral authority.

Valerie Trenev described the experience as encouraging, noting the coalition’s diverse representation across laboratory practice settings and professional backgrounds. Despite limited speaking time, she said the group delivered a unified message about the potential consequences of the fee increase on California’s laboratory workforce.

Ms. Trenev felt optimistic, describing the coalition as “magical,” particularly that they all come from different backgrounds and sectors. “On the spot we were able to go in, as a cohesive, amazing, determined group that I think really made an impact,” she says.

The effort continued beyond the Senate hearings. Members of the local chapter’s Shared Leadership Council sent letters to California Assembly members seeking legislative support for the coalition’s position. One of the first responses came from an Assemblymember who represents a district in San Diego County. Laboratory advocates, including Marilyn Claire Virgo, Elma Kamari Bidkorpeh, Valerie Trenev, Josilyn Schrage, Dr. Luke Valencia, and Dr. Justin Hanenberg, later participated in a virtual meeting to discuss the issue and present their concerns. Participants viewed the meeting as a positive step toward securing legislative sponsorship for future action.

“One of the biggest concerns for our students is that the MLT trainee license now costs the same as a full professional license. Our students are now required to obtain a license, which costs $300 before they have even graduated and again once they finish for their full license. They must pay this fee while completing their didactic coursework and unpaid hospital clinical rotations. Many students attend community college because it is an affordable pathway into healthcare. They often rely on financial aid to cover tuition and are already balancing significant financial challenges while completing a demanding program that leaves little opportunity to earn income. Adding and raising these trainee licensing fees creates another barrier for students entering a profession that is already facing critical workforce shortages. We should be making it easier—not more expensive—for qualified students to become the laboratory professionals our healthcare system desperately needs."

— Dr. Luke Valencia, Professor, Medical Laboratory Technician Program, Folsom Lake College

Letters from ASCP members in California

In addition to direct legislative outreach, ASCP mobilized laboratory professionals through its internal network. Through the ASCP Action Alert campaign, thousands of California members were encouraged to contact elected officials regarding the licensing fee increases. The alert was distributed three times to ASCP members across the state, generating a total of 2,730 messages. Each participant sent messages to Governor Gavin Newsom, their state senator, and state assemblymember, demonstrating widespread concern about the impact of the fee increases —from the northernmost communities in Eureka to the southernmost communities in the San Fernando Valley.

The campaign data also provided insight into legislative engagement on the issue. Governor Newsom received a significant number of messages through the action alert. Among state legislators, Senator Steven Choi, a member of the Senate Budget Committee, received the highest number of constituent messages, while Assemblywoman Catherine Petrie-Norris, a member of the Assembly Budget Committee, received the most messages among Assembly members. Coalition advocates noted that these figures illustrate the significant level of grassroots participation from the local community and can help demonstrate to policymakers that the issue resonates with constituents throughout California.

Senator Dr. Akilah Weber Pierson is a board-certified physician, and Californians have reached out to her with the hope that her medical background and expertise will make her receptive to our concerns.

To participate with a California address, visit the ASCP Action Alert website here.

Hurdles and challenges

While coalition members sought dialogue with the California Department of Public Health Laboratory Field Services (CDPH-LFS), their outreach efforts did not result in meaningful engagement.

The coalition's advocacy efforts also revealed the complexities of building consensus among healthcare stakeholders during a difficult fiscal climate. While many organizations supported the campaign, some California hospital systems were hesitant to sign the coalition's advocacy letter because of broader concerns about the state's budget outlook. According to Ann, representatives from some hospital systems expressed concern that California is entering a challenging budget cycle and that public opposition to state funding decisions could be viewed unfavorably. One academic medical center indicated that it was concerned about the message that might be conveyed if the organization publicly opposed the fee increases while it is widely perceived as being in a strong financial position. For Mrs. Cichocki, these discussions highlighted the unique challenge of advocating for laboratory professionals during a period of fiscal uncertainty.

The advocacy campaign also faced challenges within the state's professional community. Initially, the board of directors of the California Association of Medical Laboratory Technology (CAMLT) voted not to sign the coalition's opposition letter. However, CAMLT later reaffirmed its support for the coalition and its efforts to address the licensing fee increase. Coalition members viewed this development as an encouraging sign of unity, underscoring the importance of presenting a coordinated voice on issues affecting the laboratory profession and workforce.

The cause also encountered organizational challenges in securing institutional support. Several laboratory directors expressed a desire to have their hospitals included as signatories on the advocacy letter because they shared concerns about the impact of the fee increases on the laboratory workforce. However, in some cases, the issue was not elevated far enough within the organization's leadership structure to reach executive decision-makers in the C-suite. As a result, some hospitals were unable to formally endorse the letter despite support from laboratory leadership.

Coalition members noted that this experience underscored the challenge of raising awareness about laboratory workforce issues within large healthcare systems, where competing operational and financial priorities often influence advocacy decisions. While not all institutions ultimately signed the letter, many laboratory leaders continued to support the coalition's goals and efforts to address the licensing fee increases.

When asked about the challenges she has faced as a lab advocate, Mrs. Cichocki points to the longstanding lack of visibility for laboratory professionals despite their critical role in healthcare. She noted that clinical laboratory scientists generate the data that guide most medical decisions, yet their contributions are often overlooked in leadership, policy, and regulatory discussions. "As a clinical lab scientist, that challenge can be amplified by perceptions about who is expected to have a seat at the table, advocate, or influence decisions," she says.

Ann says she overcame these barriers by trusting her expertise, seeking opportunities to collaborate with leaders across the laboratory profession, and remaining committed to speaking up on issues that affect both patient care and the workforce. Through advocacy and professional service, she finds ways to transform challenges into opportunities for meaningful change.

To better advocate for your laboratory, utilize the ASCP Negotiation & Advocacy Toolbox here.

Looking for a better path forward

While there has been no reversal of the fees yet, CLTAC will reconvene on Thursday August 13, 2026, and, Dr. Hanenberg says, “Our organizations aim to secure representation and bring ideas for reform to the table.”

To help shape the discussion at the upcoming Clinical Laboratory Technology Advisory Committee (CLTAC) meeting, please submit your questions and concerns via the intake form here.

In addition to a positive meeting with the Governor’s office on June 9, that left Ms. Trenev feeling “very encouraged by their willingness,” they will also be having a virtual meeting soon with the chair of both the Senate Budget Committee on Health and the Assembly Budget Committee on Health. “I'm hoping that they will listen to us and realize the gravity of the situation because we don't want to make it hard for doctors to get timely and accurate lab results,” she says.

Ms. Laakso is similarly committed, saying, "If it doesn't work out this time, we're going to keep going. We're not giving up."

Meanwhile, Ms. Trenev urges laboratory professionals to familiarize themselves with this and other issues pertaining to their careers, to develop relationships with their representatives, and speak up about this and other relevant issues. “Don't wait until there's a crisis to reach out,” she says.

Looking ahead, Mrs. Cichocki hopes to inspire the next generation of laboratory professionals to recognize the value of their voices. She encourages young women entering the field to have confidence in their abilities, stay intellectually curious, and understand that advocacy is an important part of professional responsibility. "When you advocate for yourself, your colleagues, or your profession, you help carry forward the work of generations of lab professionals who have advanced science and healthcare," she said.

She also hopes advocacy becomes more deeply embedded within the culture of laboratory medicine. "I want future laboratory professionals to see advocacy not as something extra, but as a natural extension of being a laboratory scientist," she said. Her vision is for a profession that values expertise, safeguards licensure, and empowers individuals to influence policy and practice. "When medical lab scientists are supported, respected, and heard, the benefits extend far beyond the laboratory—to the entire healthcare system and the patients we serve."

Social media has also played an important role in expanding awareness of the issue. Marilyn Claire Virgo, BA, CLS, MLS(ASCP)^CM, known to many as "Marilyn the Scientist," has used her online platforms to educate audiences about the impact of the licensing fee increases on California's laboratory workforce. Through her @marilynthescientist accounts, Ms. Virgo reaches millions of viewers each month, with her Instagram content alone averaging between 3 million and 20 million monthly views. By sharing advocacy updates and encouraging engagement, she has helped bring greater public attention to a profession that is essential to healthcare but often remains out of the spotlight.

The coalition's digital outreach efforts have also been supported by Xiana Fontno, CLSI Marketing Specialist, who, despite being based on the East Coast, has helped amplify advocacy messages across global social media channels. Xiana’s support reflects the fact that concern over California's licensing fee increases has extended beyond the state, with individuals across the country lending their expertise to the effort. Together, these efforts have helped increase visibility of the licensing fee issue, engage laboratory professionals throughout California, and expand public awareness of the vital role laboratory scientists play in patient care and public health.

The fight against the significant CDPH Laboratory Field Services (LFS) licensing fee increases continues. Members of the ASCP Northern California Chapter’s Shared Leadership Council are actively working to revise the laboratory licensure language within AB 144 and develop proposed amendments that would provide a better path forward. The coalition's goal is to submit these recommendations to the Governor's Office for consideration before the June 25 budget amendment deadline.

As the advocacy campaign continues, the ASCP Northern California Chapter hopes to build on the momentum generated over the past seven months. Coalition leaders encourage more hospitals, clinical laboratories, biotechnology companies, and professional pathology organizations to join the effort and lend their support in the next legislative cycle in 2027. By expanding participation across the laboratory and healthcare community, advocates hope to present a unified voice on behalf of the professionals who provide essential diagnostic testing to patients throughout the West Coast region.

Partnering Organizations:

American Association of Pathologists' Assistants
American Society for Clinical Laboratory Science (ASCLS)
ASCLS California
American Society for Clinical Pathology (ASCP)
ASCP Board of Certification (ASCP BOC)
ASCP Northern California Chapter
Association for Diagnostics & Laboratory Medicine (ADLM)
Association of Genetic Technologists (AGT)
Blood Centers of California
California Association for Medical Laboratory Technology (CAMLT)
California Blood Bank Society (CBBS)
California Society for Histotechnology
Clinical and Laboratory Standards Institute (CLSI)
Engineers and Scientists of California Local 20, IFPTE
National Accrediting Agency for Clinical Laboratory Sciences (NAACLS)
Northern California Branch, American Society for Microbiology (ASM)
Northern California Community Blood Bank
National Society for Histotechnology (NSH)
Philippine Association of Medical Technologists USA, Inc. (PAMET-USA, Inc.)
PAMET-USA, Inc. Cal 5
Tahoe Forest Health System
The Proficient Lab Inc.

3 Questions with Lindsey Westbrook, MD Team Critical Values - July 1, 2026

Dr. Lindsey Westbrook’s path to a career in pathology and academia was filled with impactful experiences and supportive mentors that drew her into the field. Those experiences and mentors also helped shape her present day “pay it forward” mindset and approach to working with medical students and trainees.

Here, Dr. Westbrook reflects on an early experience in the lab on her pathway to her career in pathology, the importance of having—and being — a mentor, and how her mindset brings connection and meaning to her work.

Was there a specific experience or moment that solidified your decision to choose a career in the laboratory?

I do vividly remember the first time I was introduced to the field. The summer before my senior year of college, I was accepted into a shadowing program at North Mississippi Medical Center in Tupelo, Mississippi. I was scheduled to spend half a day with a pathologist. At the time, I honestly had no idea what that meant.

That morning, I watched him gross several cases, including what he described as the largest thyroid he had ever seen. Then we spent time looking at slides under the microscope. I can’t fully explain why, but something about that experience just clicked for me. I found it fascinating from start to finish.

When I started medical school, that experience stayed with me, and I made a point to seek out more exposure to pathology. I don’t think there was a single defining moment that led me to pathology. It was more of a series of experiences that gradually drew me in.

Now that I interview medical students for pathology residency, I’ve noticed that most of them also discovered pathology before they even entered medical school. I think that really speaks to how important early exposure is.

Programs like the one I participated in can make a huge difference, especially for specialties like pathology and laboratory medicine that are not always part of required clinical rotations.

Have you had any mentors or role models who influenced your career choice? If so, how have they impacted your journey?

I’ve been incredibly fortunate to have so many amazing mentors throughout my journey in medicine and pathology, and one of the things that has really stood out to me is how kind and generous the pathology community is.

What’s especially meaningful to me is that some of the people who have had the biggest impact on my career were individuals I only interacted with briefly, like the first pathologist I shadowed in North Mississippi, who probably doesn't even remember me. Even if we've only had short interactions, all of my mentors made the effort to offer guidance, encouragement, and support, sometimes even years later.

Mentorship has been so impactful in my own path, and it’s also become one of my favorite parts of being in academic medicine. I find a lot of fulfillment working with students and trainees, helping them explore the field and find their own direction. I feel very grateful for everything my mentors have given me, and their influence has shaped how I try to show up for others. I really make an effort to pay that forward whenever I can.

What steps do you take to maintain a strong sense of purpose and connection to the human side of healthcare?

Maintaining a strong sense of purpose and connection to the human side of healthcare can be challenging in pathology, especially since we don’t often interact directly with patients. I feel that most on long or busy days when it’s easy to get caught up in the volume of work and think in terms of cases rather than people. I try to be intentional about stepping back and reminding myself that every specimen represents a real person who is waiting for answers, often during a difficult or uncertain time. I do my best to approach each case as if it belonged to someone I care about, like a family member or close friend.

That mindset helps keep me grounded and brings meaning back to the work. It also pushes me to give each case the same level of care and thoughtfulness

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.