Recoiling from CLIA, living with less.
The most common reaction to CLIA '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 laboratorians vented their spleen about the Federal regulations that some even say presage the twilight 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 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 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 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 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 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). 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. 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 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 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. 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 feels that CLIA won't affect staffing in her facility "because we must comply with strict New York City Department of Health guidelines. in other areas, the quality of techs will decrease."
* Job security. "I have an associate's degree, 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, 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 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 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, and low pay. Why would anyone want to go to the trouble to get a BSMT when a GED 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 and salaries will probably get better, but there are not many,opportunities for professional growth and Government regulations are becoming very frustrating," 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 in business or education," says a department head in a Florida blood bank.
According to 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 with common cold types of visits and only come in when they're more 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, bottom line shrinkage, 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, database) classes at a local community college and other outside continuing education 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," 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 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.
Tips for solving the personnel crisis
Make positions more desirable with career ladders. 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 degreed MTs to supervisory positions, allowing MLTs to perform bench work.
Adopt a career ladder on a national basis. Begin with phlebotomy 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" and practice as independents.
[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|
|Publication:||Medical Laboratory Observer|
|Article Type:||Cover Story|
|Date:||Sep 1, 1992|
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|Next Article:||Creative strategies to survive the shortage.|