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Recoiling from CLIA, living with less.



Laboratorians assess the impact of regulations, the depth of the recession, and the dearth of recruitment. Prescriptions are offered for surviving all three.

The most common reaction to CLIA CLIA Clinical Laboratory Improvement Amendments of 1988 Congressional legislation that promulgated quality assurance practices in clinical labs, and required them to measure performance at each step of the testing process from the beginning to the end-point of a  '88 expressed by laboratorians responding to MLO's 1992 survey on Lab Staffing Today is summed up by the laborato manager at a large proprietary hospital in Texas: CLIA is a "slap in the face for MTs," she says. "Why go to school if a high school grad or robot can do the work?"

* Passionate. That response to CLIA was fairly mild. In no uncertain terms, normally taciturn tac·i·turn  
adj.
Habitually untalkative. See Synonyms at silent.



[French taciturne, from Old French, from Latin taciturnus, from tacitus, silent; see tacit.
 laboratorians vented vent 1  
n.
1. A means of escape or release from confinement; an outlet: give vent to one's anger.

2. An opening permitting the escape of fumes, a liquid, a gas, or steam.

3.
 their spleen spleen, soft, purplish-red organ that lies under the diaphragm on the left side of the abdominal cavity. The spleen acts as a filter against foreign organisms that infect the bloodstream, and also filters out old red blood cells from the bloodstream and decomposes  about the Federal regulations that some even say presage the twilight twilight, period between sunset and total darkness or between total darkness and sunrise. Total darkness does not occur immediately when the sun sinks below the horizon because light from the sun that strikes the atmosphere is scattered (both by the air itself and by  of the profession.

CLIA provoked the most passionate responses but was far from being the only matter of concern to laboratorians. In the survey, MLO MLO Mycoplasma-like organism(s)  also asked for general comments about lab staffing, personal prescriptions for solving the personnel crisis, assessments of the impact of the recession, and advice to young people who might be considering a career in health care.

Those concerns were heartfelt heart·felt  
adj.
Deeply or sincerely felt; earnest.


heartfelt
Adjective

sincerely and strongly felt: heartfelt thanks

Adj. 1.
 and honestly expressed, as befits a profession that has patient care at its core. But it was CLIA that aroused far and away the most ire.

* CLIA's cloud. "The medical technologist This article or section may deal primarily with the U.S. and may not present a worldwide view.  profession has been destroyed by CLIA '88," says the department head in the lab of a large not-for-profit hospital in Oklahoma. (For definitions of hospital size as used in this report, see "Hospital size," page 25.)

"I will probably leave the field when I can get something else going," says the laboratory supervisor of an independent laboratory in Missouri. "I don't think I'm paid enough for my level of responsibility and personal risk. I'd rather work this hard for myself."

While the most commonly heard complaint is that CLIA will result in an influx of low-paid, poorly trained employees who will displace dis·place  
tr.v. dis·placed, dis·plac·ing, dis·plac·es
1. To move or shift from the usual place or position, especially to force to leave a homeland:
 medical technologists with college degrees, the problem faced in rural areas is quite different. "Small rural hospitals have a very difficult time competing now with urban hospitals for staff, so we have to take what we can find," says the lab manager of a small not-for-profit hospital in Iowa. "MTs do not want to work in small hospitals with calls and one-shift staffing. So the requirement for supervisory positions will be difficult if not impossible to fill."

CLIA mandates that supervisors have a minimum of an associate degree plus two years' experience in high-complexity testing (see "How to Meet the New Personnel Requirements While Continuing to Operate Your Laboratory," page 47). "How are small rural hospitals and clinics supposed to pay the salaries that will be demanded when their reimbursement Reimbursement

Payment made to someone for out-of-pocket expenses has incurred.
 level is so low?" asks the lab manager of a small not-for-profit hospital in Minnesota.

"This is a very small hospital. We find it hard to attract qualified med techs - everyone here must be able to handle the lab alone," says a department head at an independent laboratory in Tennessee. "How can MLTs or lesser-trained employees (the most likely recruits at small rural institutions) handle the responsibility and meet CLIA supervisory rules?"

"At present, our institution has no 11-7 shift and all technologists are required to be on call. Therefore they must qualify as general supervisors under CLIA," says a bench technologist at a small not-for-profit hospital in Kansas. "So if our lab doesn't expand, we're all safe and can keep pay scales up. Right now we're all MT(ASCP ASCP American Society of Clinical Pathologists. ). But if we expand and start an 11-7 shift as planned, only the 11-7 and 3-11 techs must be MTs and administration will be free to hire less-qualified personnel to staff the day shift."

The Kansan sees a pay freeze or even an across-the-board cut if less-qualified workers are hired. "Here in small-town U.S.A., we interact with physicians and nurses on a personal and professional level. I see respect and prestige going downhill if the techs who answer the phone can't handle technical questions."

A department head in the lab of a midsize not-for-profit hospital in Pennsylvania sees the human side of the controversy. "More than 50% of our staff are MLTs. They are working mothers of young children with no time to go back to college to obtain their degrees." Their ability to function as supervisors is certainly in question.

* Silver lining silver lining
n.
A hopeful or comforting prospect in the midst of difficulty.



[From the proverb "Every cloud has a silver lining".
. CLIA "may make it easier to recruit but tougher to recruit experienced personnel," says the lab manager at a small not-for-profit hospital in Pennsylvania.

"The technologist shortage will be overcome by the lab industry's ability to function with lesser-skilled employees," says the lab manager at a large Government hospital in Georgia.

"The new CLIA personnel standards are a two-edged sword," says the administrator of a health department laboratory in Indiana. "As a state inspector years ago, I saw lab staffs without formal lab training doing a great job in small county hospitals, but at the same time it saddens me to think that the training received by myself and others now means very little in the professional clinical laboratory world. Facilities will redefine Verb 1. redefine - give a new or different definition to; "She redefined his duties"
define, delimit, delimitate, delineate, specify - determine the essential quality of

2.
 through CLIA who is now qualified, and I believe that CLIA has terminated the future of the medical technologist."

Reports of the death of the technologist are, no doubt, premature. Nonetheless, MLT (MultiLink Trunking) See port aggregation.  education is seen by some respondents as benefiting from the hard times predicted for MTs. "Two-year MLT programs should blossom if CLIA personnel standards are sustained," says the lab manager at a small not-for-profit hospital in Indiana.

"CLIA has shifted focus to the MLT-level employee," agrees the department head in the laboratory of a large not-for-profit Oklahoma hospital. "As these schools expand class size and improve the quality of students, hospitals may be willing to hire them."

* States' rights states' rights, in U.S. history, doctrine based on the Tenth Amendment to the Constitution, which states, "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people. . As Lifshitz and De Cresce pointed out in last month's MLO, CLIA's personnel requirements are a floor, not a ceiling., Many institutions won't want to lower their personnel standards; many more will be prevented from so doing by state and local law.

"Our hospital administrators met with lab personnel in the wake of CLIA to assure us that they are interested wholly in quality lab reports and to support our opposition to CLIA's changes in lab personnel standards," says a lab department head at a midsize not-for-profit hospital in Kentucky. This laboratorian adds, though: "I hope their position remains as firm in two years."

The administrator of laboratory services at a large not-for-profit hospital in New York City New York City: see New York, city.
New York City

City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S.
 feels that CLIA won't affect staffing in her facility "because we must comply with strict New York City Department of Health guidelines guidelines,
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks.
. in other areas, the quality of techs will decrease."

* Job security. "I have an associate's degree as·so·ci·ate's degree
n.
An academic degree conferred by a two-year college after the prescribed course of study has been successfully completed.
, 20 years' lab experience in all areas, of hospital work, and passed the HEW exam," notes the director of a group practice laboratory in Kansas. "But I only qualify under CLIA as |testing personnel.' For that reason, I am returning to school with the intention of leaving the field altogether."

In four surveys since 1985, MLO has asked laboratorians questions designed to reveal how they feel about their jobs, their laboratories, and their profession. Despite all the upheaval and uncertainty that have racked the profession in the last seven years, respondent markably unvarying in their dedication. Figure 1 shows how laboratorians have answered the question, "In three years, do you expect to hold your current job?"
Figure 1
Optimism about the job
In three years, do you expect to hold your current job?
        1985     1987     1990   1992[dagger]
Yes      59%      62%      60%    64%
No       41       38       18     16
Unsure   NA(*)    NA(*)    22     21
(*) Not asked
[dagger] Total exceeds 100% due to rounding.


Approximately two-thirds of laboratory professionals have, through the years See also Through The Years (Gary Glitter song) or Through The Years (Tim Finn song). For the Jethro Tull album, see Through the Years (Jethro Tull). For the Artillery box set, see Through the Years (Artillery album). , displayed optimism about their jobs. Moreover, the percentage of pessimists has dropped from 41% in 1985 to 16% in 1992.

Figure 2 shows responses over the years to the question, "In three years, do you expect to be working in your current lab?" As with the query about jobs, two-thirds of respondents consistently feel positive about their future in their particular laboratory. And again, the percentage of negative respondents has dropped over the years, from 34% in 1985 to 16% in 1992.
Figure 2
Optimism about the lab
In three years, do you expect to be working in your current lab?
         1985     1987     1990   1992
Yes       66%      65%      58%    64%
No        34       35       18     16
Unsure    NA(*)    NA(*)    24     20
(*) Not asked


Figure 3 offers insight into laboratorians' advice to those contemplating lab careers. Over the years, about half would have recommended the medical technology field. Nay-sayers declined from 54% in 1985 to 34% in 1992. Clearly, the burst of profession-bashing that followed the institution of DRGs in 1983 has waned. What do today's laboratorians think?
Figure 3
Optimism about the lab profession as a career
Would you recommend medical technology as a career?
         1985     1987   1990   1992
Yes       46%      51%    48%    47%
No        54       49     33     36
Unsure    NA(*)    NA*    19     17
(*)Not asked


The clinical lab, yes. Medical technology is "a good profession that now has room for growth and a good salary," says the administrator of the New York City facility.

"It's a great way to participate in the care of your fellow man, and it will always be needed," says the manager of an independent laboratory in Arizona.

"It is still a good profession for moving around geographically," says the LIS LIS - Langage Implementation Systeme.

A predecessor of Ada developed by Ichbiah in 1973. It was influenced by Pascal's data structures and Sue's control structures. A type declaration can have a low-level implementation specification.
 manager of a midsize not-for-profit hospital located in Missouri. "There is good flexibility in schedules, and it's a fine background for another profession."

"I think that in the next five years the personnel shortage will increase, salaries will increase, and the field will be more attractive as a result," says the chief technologist in the laboratory at a small not-for-profit hospital in New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
 State.

The clinical lab, no. "There is no reason to enter a field where the education requirement is extensive and the pay will never be on a par with nurses' or physical therapists'," comments a laboratory department head at a small not-for-profit hospital in Oklahoma. "The risk of disease is very high, and stress is high. There is no respect from other professionals or administrators."

The bench technologist in the small not-for-profit hospital in Kansas cites "insufficient professional growth opportunities, status, respect, recognition, plus low morale, burnout Burnout

Depletion of a tax shelter's benefits. In the context of mortgage backed securities it refers to the percentage of the pool that has prepaid their mortgage.
, and low pay. Why would anyone want to go to the trouble to get a BSMT BSMT Basement
BSMT British Society for Music Therapy (UK)
BSMT Bachelor of Science in Medical Technology
BSMT Bachelor of Science in Marine Transportation
BSMT Bernstein School of Musical Theater (Bologna, Italy) 
 when a GED GED
abbr.
1. general equivalency diploma

2. general educational development

GED (US) n abbr (Scol) (= general educational development) →
 will do under CLIA? You get all the duty jobs no one else wants - on-call supervisory tasks - by virtue of your degree."

"Working as a bench technologist is a good job for a young person," says the lab director of a small Government hospital in Mississippi. "But burnout claims most technologists before they reach the age of 50."

Unsure. "Jobs are plentiful plen·ti·ful  
adj.
1. Existing in great quantity or ample supply.

2. Providing or producing an abundance: a plentiful harvest.
 and salaries will probably get better, but there are not many,opportunities for professional growth and Government regulations are becoming very frustrating frus·trate  
tr.v. frus·trat·ed, frus·trat·ing, frus·trates
1.
a. To prevent from accomplishing a purpose or fulfilling a desire; thwart:
," says the lab manager at a midsize not-for-profit hospital in Indiana.

"This field has certainly been good for me, but considering the effect current legislation might have on salaries and the status of MTs, a young person might be wasting an education on a dead-end job," says the laboratory manager at a small not-for-profit hospital in Missouri.

"In order to get to the top of the field, you need a master's degree master's degree
n.
An academic degree conferred by a college or university upon those who complete at least one year of prescribed study beyond the bachelor's degree.

Noun 1.
 in business or education," says a department head in a Florida blood bank.

According to according to
prep.
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3.
 the QA director of an independent lab in Indiana, "Security seems to be the profession's greatest draw; esteem and monetary rewards certainly are not."

* The recession. The poor state of the American economy "probably has kept people in their current positions longer, helping delay further short-staffing problems," says the laboratory supervisor at a large not-for-profit hospital in Illinois.

The recession "has decreased the drain of MTs from the hospital," says the lab director at a small not-for-profit hospital in New York. "Some people are moving from industry back to the lab."

According to the assistant chief technologist at a small not-for-profit hospital, "In Massachusetts the current economic situation has all but stopped turnover in our lab. People are less likely to take a chance on a new job, knowing if they blow it there aren't many more opportunities out there."

Job security has its price, however. The laboratory manager at a small not-for-profit Georgia hospital reports a temporary 10% reduction in pay affecting all hospital employees. A department head in the lab of a small not-for-profit Oklahoma hospital says, "The pay scale has been frozen at this institution for several years."

Some respondents note a change in the type of work being done. "As people lose their jobs and consequently their insurance, they do not seek health care except in emergencies," says the laboratory manager at a midsize proprietary hospital in Illinois. The change in habits affects hospital census and staffing, he says.

"As a POL, we have noticed a shift in the type of patients seen and tests ordered from general preventive type work to more acute care," says the manager of a group practice lab in Michigan. "Patients are dispensing dispensing

provision of drugs or medicines as set out properly on a lawful prescription. A prescription can only be filled, the drugs supplied, by a registered pharmacist, veterinarian, dentist or member of the medical profession.
 with common cold types of visits and only come in when they're more seriously ill A patient is seriously ill when his or her illness is of such severity that there is cause for immediate concern but there is no imminent danger to life. See also very seriously ill. . Maybe they are unemployed and have no medical benefits, or perhaps their employers have scaled back existing policies."

The laboratory supervisor at a midsize not-for-profit hospital in Ohio reports less payback Payback

The length of time it takes to recover the initial cost of a project, without regard to the time value of money.
, bottom line shrinkage Shrinkage

The amount by which inventory on hand is shorter than the amount of inventory recorded.

Notes:
The missing inventory could be due to theft, damage, or book keeping errors.
, closer observation of lab by top management, and freeze or reduction in staff while workload increases."

* Solutions. MLO asked laboratorians for their "personal prescriptions" for resolving the staffing shortage. A lab supervisor in a midsize proprietary hospital in Virginia summed it up this way: "Salaries, respect, and recognition must increase greatly, and high workload and short staffing must be eliminated."

All well and good, but how to accomplish these objective? Figure 4 offers a sampling of respondents' suggestions.

"I have implemented changes in pay, scheduling, instrumentation, and in-house menu to relieve the staff of some of the bothersome aspects of their jobs," reports the laboratory manager at a small not-for-profit hospital in Virginia. "I have also provided computer (spreadsheet, word processing word processing, use of a computer program or a dedicated hardware and software package to write, edit, format, and print a document. Text is most commonly entered using a keyboard similar to a typewriter's, although handwritten input (see pen-based computer) and , database) classes at a local community college and other outside continuing education continuing education: see adult education.
continuing education
 or adult education

Any form of learning provided for adults. In the U.S. the University of Wisconsin was the first academic institution to offer such programs (1904).
 at no charge to the employee." Instituting pay incentives for certification helped this manager keep staff as well.

Some laboratorians - to the envy of others - are not suffering the effects of a shortage. According to the manager of an independent lab in Mississippi, "I have very few staffing problems because of the work environment. My people work for less money because of the following: no night call, no weekend work; good insurance, good vacation and retirement plans, good company."

* Future techs. The laboratorians across the country who report no shortage are the lucky ones. More typical is the sort of managerial desperation that results in a call for a sweeping overhaul of the way medical technologists are used.

"There will be a need for good technologists but not sitting in front of an automated analyzer analyzer /ana·ly·zer/ (an´ah-li?zer)
1. a Nicol prism attached to a polarizing apparatus which extinguishes the ray of light polarized by the polarizer.

2.
," says the director of an independent lab in Tennessee. "The use of MTs throughout a lab is a luxury we can't afford. Managers need to find ways to use MTs to supervise work areas rather than doing repetitive, mindless tests."

"I believe there will be fewer techs with bachelor's degrees and more with associate's degrees," says the lab supervisor at an independent laboratory in Michigan. "Those with four-year degrees will be the supervisors and specialists, especially in large laboratories."

A lab section manager at a midsize not-for-profit hospital in Illinois agrees. "I envision clinical labs of the future staffed with significantly fewer MTs. The MTs will supervise small groups of minimally trained technicians. The atmosphere will be less professional and more businesslike busi·ness·like  
adj.
1. Showing or having characteristics advantageous to or of use in business; methodical and systematic.

2. Purposeful; earnest.

3.
 and production-oriented."

The laboratory manager at a midsize not-for-profit hospital in Massachusetts recommends a somewhat old-fashioned approach. "Have a good operatiqn', treat people fairly, reward them appropriately, and practice good, ethical medical technology, math state-of-the-art equipment, good procedures, and good follow-through. In short, create a good working atmosphere." Your lab will then have little trouble attracting qualified med techs, this laboratorian predicts.

Figure 4

Tips for solving the personnel crisis

Make positions more desirable with career ladders The Career ladder is a metaphor or buzzword used to denote vertical job promotion. In business and human resources management, the ladder typically describes the progression from entry level positions to higher levels of pay, skill, responsibility, or authority. . initiate continuing education. Promote more technologist interaction with hospital staff.

Work around schedules so people can attend school. We have 10-hour shifts and schedule them to allow a four-day weekend every two weeks.

Move to creative shifts. We use 7:30-4:30, 8-5, 9-6, 10-7, and 11-8.

Provide financial incentives for MLTs to get their BSMTs.

Offer incentives such as tuition reimbursement. Increase the number of MLT schools. Elevate el·e·vate  
tr.v. ele·vat·ed, ele·vat·ing, ele·vates
1. To move (something) to a higher place or position from a lower one; lift.

2. To increase the amplitude, intensity, or volume of.

3.
 degreed de·greed  
adj.
Having or requiring an academic degree: a degreed biologist; a degreed profession. 
 MTs to supervisory positions, allowing MLTs to perform bench work.

Adopt a career ladder on a national basis. Begin with phlebotomy Phlebotomy Definition

Phlebotomy is the act of drawing or removing blood from the circulatory system through a cut (incision) or puncture in order to obtain a sample for analysis and diagnosis.
 and, as education increases, allow a progressive certification exam.

Follow up recruitment in high schools by having med techs serve as mentors for students. Stick with them through college.

License laboratory professionals and allow us to "hang out our shingle shingle

Thin piece of building material made of wood, asphaltic material, slate, metal, or concrete, laid in overlapping rows to shed water. Shingles are widely used as roof covering on residential buildings and sometimes also for siding (see Shingle style).
" and practice as independents.

Reference

[1.] Lifshitz M, De Cresce R. How CLIA will change instrument selection. MLO. August 1992; 24(8): 33-36.
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Title Annotation:Lab Staffing Today: Part 2; Clinical Laboratory Improvement Amendments of 1988
Author:Jahn, Mike
Publication:Medical Laboratory Observer
Article Type:Cover Story
Date:Sep 1, 1992
Words:2853
Previous Article:The shortage gets worse, but laboratorians get better.
Next Article:Creative strategies to survive the shortage.
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