Q&A with Faye McNall, Director of Education for the American Society of Electroneurodiagnostic Technologists

By Laura Trude, HWIC Information Specialist

While neurodiagnostic technologists formed as an occupation over fifty years ago with the introduction of the Electroencephalogram (EEG) test, the small size of the field has proved a challenge for gaining recognition. Besides the EEG, which helps in the diagnosis of epilepsy, neurodiagnostic technologists conduct polysomnograms, which evaluate sleep disorders, intraoperative neuromonitoring, which is used to monitor the nervous system during surgery, and other electroneurodiagnostic tests. Their name was officially changed from electroneurodiagnostic technologists to neurodiagnostic technologists to better reflect the profession, although the Bureau of Labor Statistics has not yet updated their listing. Neurodiagnostic technologists were recently added to O*NET, a job analysis and career exploration resource created for the U.S. Department of Labor, Employment and Training Administration. With the 2010 Standard Occupational Classification (SOC) system updates, neurodiagnostic technologists will also be listed as an illustrative example under Health Technologists and Technicians, All Other. The federal listing of neurodiagnostic technologists marks a point of celebration for efforts to gain recognition for the field and will result in national supply and wage data collection by the Bureau of Labor Statistics for neurodiagnostic technologists. The data collected can be used to guide strategic planning and support advocacy efforts. The added recognition may also interest more students in pursuing neurodiagnostic technology as a career and aid other initiatives, such as efforts to develop state licensure and certification requirements. Faye McNall, Director of Education for the American Society of Electroneurodiagnostic Technologists (ASET), shares her insights on the challenges this allied health field has faced and comments on strategies for promoting the development and recognition of this profession.

Neurodiagnostic technologists will be listed as an example for Health Technologists and Technicians, All Other in the 2010 SOC update by the Bureau of Labor Statistics. Did the BLS decide they wanted to include neurodiagnostic technologists and then contact your organization, or did ASET petition he BLS for this inclusion?

We were actually listed with the BLS years ago when we were just the EEG techs and when we changed the name of our profession about 20 years ago to neurodiagnostic technologists, we lost our listing because the name didn’t match. It took until 2007 to get us listed again. Right now, we are listed under “health care technologists” because it’s such a small specialty that the BLS didn’t feel that we should go into our own category. We are definitely hoping that we can get as high up on that listing as we can. At least we get our own category under this listing so we can be found on the O*NET database as an entity. We did petition the BLS around 1998 or 2000, but they declined our petition. This time, they contacted me and said, “We want to list your profession.” They asked if I could work with them on creating an updated listing for neurodiagnostic technologists, so I’ve been working with the folks at O*NET since 2007.

When you petitioned them, was there a particular procedure you went through?

We just wrote a letter from the board of trustees stating our case. As far as I know, that’s what they did. It was before I was on ASET staff, so I don’t know anything about the body of letter.

When they contacted you for help, what did they ask for?

They wanted me to provide them with a list of experts that they could contact. These would be technologists working in various aspects of this field that they could then ask to fill out surveys regarding what they do every day and what the job description would be and so forth. Once I advised them on the subject matter experts, they went ahead and composed the actual job description. That was really the biggest part of ASET’s role in helping this process along.

Do you know when the Bureau of Labor Statistics is going to put data for neurodiagnostic technologists online?

No, I don’t. I just know that we would be listed officially with the upgrade/update of July 2010. As a profession, we’re very hard to find; it’s very hard to do any kind of survey or census on us.

I know we just have to wait and be patient and they will get around to all these specific specialties. I’m sure the BLS has their hands full because the need is very great and it’s urgent for every profession to get their recognition.

What are some of the strategies used by the American Society of Electroneurodiagnostic Technologists to help the profession gain recognition?

One of the things we do is try to strengthen our communication and our presence and our connection to our physician counterparts, the neurologists, through the American Clinical Neurophysiology Society [ACNS]. We feel it’s vital that physicians who are going to use our services and interpret the tests that we run be aware of the need for highly qualified technologists. If they are willing to accept low-quality tests, then we’re not raising the bar; we’re not getting the recognition we need.

We have a technologist representative on the Epilepsy Foundation of America to help promote awareness among patients regarding the need for qualified technologists to conduct their tests. Because the patients are educated, they know what questions to ask when they are being tested.

We participate with Health Professions Network and Health Occupations Students of America [HOSA] for added recognition. We attend HOSA’s annual conference and run a workshop to show student members what a career in neurodiagnostic technology is all about, as well as career fairs at college campuses and high schools.

We have our own marketing committee. We had an emergency summit with our physician counterparts and our credentialing organization to address the nation’s shortage of qualified techs. Out of the summit, we created committees to spearhead efforts we designated in our action plan. We wanted to create a career ladder. We wanted to compose specific job descriptions and we wanted to find ways to promote both primary and continuing education in that field.

We are also working on a “Career in END” video right now that we hope to put on YouTube. We started a campaign called, “Who’s Taking Care of Your Brain?” and this video is going to be the first product for this campaign. We eventually would like to have a public service announcement on TV.

Do you see it as helpful to be part of a common group (allied health) for recognition or not?

Absolutely. I think that groups working together and sharing resources get a lot further than someone struggling by themselves. Every time I attend a meeting of an allied health organization that’s bigger than the specialty I’m in, I always find it very, very helpful. I use my other organization connections a lot to compare where we are at, and what struggles we are having, with what other allied health specialties are going through and how they are resolving their problems. We’re finding a lot of us are in similar situations. For example, ultrasound techs don’t have licensure; they have voluntary credentials. When I go to a Commission on Accreditation of Allied Health Education Programs meeting, I learn a lot about what other groups are doing and how they overcome their obstacles.

What are some of the challenges that both neurodiagnostic technologists and other allied health professions face?

Allied health education is a big one. There’s a lack of clinical sites for students to go to. Distance programs require that each student connect with a clinical site even if they’re not showing up at a major campus for their college education. Sometimes there are students who literally can’t enroll because no hospital in their area will allow them to come in as a student. Other areas of allied health have similar problems with education, clinical sites, instructors that are willing to work as instructors instead of staff techs – sometimes the salaries are very different for the full-time educators versus full-time diagnostic staff. There’s just so much, so much that we’re all going through.

What advice do you have for other organizations seeking to gain recognition of an occupation?

I found out it takes a tremendous amount of persistence and work to gain recognition. You have to put people in trenches, really paying attention, listening to what’s going on and being willing to speak out and communicate. You can’t do this alone and you can’t sit and do nothing; it takes a very proactive approach.

Larger groups have better funding and more clout; respiratory therapy can get legislation passed much more easily than we can in neurodiagnostic technology. If we could afford a lobbyist, we’d have an easier path when it comes to getting government funding and working around government regulations, but we just can’t.

If you have someone in an organization that is able to do grant writing and find resources available for grants, it’s really, really helpful. Our organization and our profession suffer from fragmentation. Sleep medicine and intraoperative neuromonitoring are different, but they are all neurodiagnostic technologists. Each of these professions has their own credentialing organizations and their own membership organizations. If we could share our resources and work together more and make it more of a larger group effort, we would actually achieve more.

I also think it’s important to work with a grassroots campaign – have a vision for working with local and regional groups. Regional groups can go out and meet and greet and talk at regional meetings and go to local colleges and career fairs and tell us what’s going on with their state lobbies. They can write letters to their local government officials; they can do so much. There’s so much that can be done if you reach out.

What are some of the challenges neurodiagnostic technologists have faced in becoming a cohesive health care profession?

Our profession began in the 1950s when our first test, EEG, was developed and first used in hospitals. Back then, we only had on-the-job training; there was no such thing as trained technologists. But slowly, formal education became available: one or two schools opened and then more opened over the decades. But really, this is a small specialty field compared to other allied health professions. There are lots of radiology techs and respiratory therapists in hospitals and most colleges are willing to offer curriculums in these areas, but no one wants to offer a neurodiagnostic technology curriculum because it’s such a small specialty. So on-the-job training still takes place even today and sometimes it’s the only way a hospital can fill a position for a neurodiagnostic technologist, especially in rural areas.

We only have 26 neurodiagnostic programs and colleges throughout the whole United States and only 21 of these are accredited right now by the Commission on Accreditation of Allied Health Education Programs [CAAHEP], which is the organization that accredits allied health education. We have a total of about 115 to 120 graduates, total, annually nationwide: that’s all we get. We do have credentialing exams in this field for several different areas of practice, but none of these credentials are mandatory to practice by law in any state. It would only be a requirement of an employer. There’s also no licensure for neurodiagnostic technologists in any state and it’s kind of surprising when you think about our role. We are actually working with disorders of the brain. We are sometimes involved with open brain surgery and brain-death determination. It’s just amazing that there’s no regulation in this field.

A few states have tried to pass licensure laws; in particular, Alabama. It’s never passed through the legislature. At ASET, we have developed a model licensure bill to support these efforts. However, we also suffer from a chronic problem of identity, with no standardization for titles of our jobs in various hospitals and our departments are various names. If I call a hospital and try to find a tech to talk to, sometimes the operators just don’t know who to connect me to. We’ve been called EEG techs, END techs, neurodiagnostic techs, neurophysiology techs, and we have subspecialties such as sleep techs, nerve conduction techs, and intraoperative neuromonitoring (IONM) techs, so we’re all over the place. In many cases in a rural or small hospital, EEGs are done as part of another department, such as cardiology or respiratory therapy.

Do you have an idea of how many neurodiagnostic technologists would generally work at a hospital?

A rural hospital may not even have a neurodiagnostic tech or may hire someone to come in as needed or part-time or send the patient to a larger hospital. When you get into the big tertiary care medical centers with a lot of emergency services, there we would be very busy and very present. I worked at Children’s Hospital in Boston and there we had about 22 people with this job description to cover 24 hours a day on-call in all areas of the hospital. But it varies greatly and yes, there are some places that do not have one tech on staff.

Have there been any efforts by ASET to use a more consistent job title?

Yes, we recently officially changed our title to neurodiagnostic technologists, we dropped the electro, because we did a survey and found that’s what most hospitals preferred. We’re willing to come into alignment with what’s already a standard.

We request that members go to their managers and ask them to title their job description and departments to match that. We’re publishing a set of standard job descriptions to help hospital HR departments.

Have the training requirements for neurodiagnostic technologists changed much over time?

We’re getting better in terms of having more formal education available; also, since distance education is now available, our colleges are able to address needs in areas where there are no schools. In about 1998 or 99, ASET came up with a position statement that all neurodiagnostic technologists entering the field should have a minimum of an associate’s degree. That was supposed to be in place in 2005, and because we made this statement, our credentialing organization changed their eligibility criteria so that more people taking the credentialing exam would meet that requirement. We keep raising the bar a little bit.

We also have different levels of education available with our formal programs that are accredited. Some are one-year certificate programs and others offer the full associate’s degree. We try to meet the needs of everybody. When some people come into the field, it’s their second career and they might already have a degree. The certificate program helps them, too.

When hospitals hire someone without a degree, have you seen them encouraging neurodiagnostic technologists to pursue a degree or pay for part of that education?

In some cases. When the employers request that the technologist have the credentialing exam, it especially helps if they offer them the chance to get some of the education they need. ASET offers online courses. We created an EEG curriculum that helps them pass their exams.

Have you seen employers increasing their requirements?

Yes, I think they see there is less liability if their staff are truly qualified and have passed credentialing exams. I think it also benefits neurodiagnostic technologists because when you add this educational requirement, salaries eventually go up.

Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.