The lab shortage crisis: a practical approach. (Lab Management).

Laboratory professionals are well aware that the lab is not exempt from the current problems facing most other healthcare fields. Most laboratories are faced with filling vacant positions for technicians and technologists. According to the American Society for Clinical Pathology's Board of Registry 2000 Wage and Vacancy Survey, vacancies in five of the 10 laboratory staff positions are at a 12-year high, with rates ranging from 7% to 20%. As laboratory managers scramble to fill positions with temporary staff, those of us in the profession must look at two questions. First, what are the root causes of the current shortage? And second, how do we as a profession work toward a solution to the problem?

Potential causes of staffing shortages

Attrition of laboratory professionals can be ascribed to a number of causes, among them the coming retirement of those from the baby boom generation; dissatisfaction with salaries; absence of job satisfaction; inadequate training programs; and lack of awareness about the laboratory professions among young people.

In most institutions, the aging laboratory workforce is a great concern. The baby boom generation is nearing retirement age, which will affect the shortage in three ways: by expanding the demand for healthcare, by causing a huge loss of experience and by increasing the shortage of laboratory professionals.

Wages -- another cause of attrition for laboratory personnel -- have not kept pace with other allied health professions. At Argosy University, there are eight programs in allied health careers, all granting associate degrees. The minimum starting salaries for the histotechnician and medical laboratory technician graduates from Argosy University are generally around $15 per hour. As Figure 1 demonstrates, starting salaries for our laboratory professionals are significantly less when compared to our graduates in the other allied health fields. Because the present workforce is driven more by money than those in years past, salary is often the determining factor in career selection.

Job satisfaction is tied to workload, recognition and, again, to salary. In many institutions, shortages cause the remaining workforce to have to carry out the same volume of tests as a fully-staffed lab. Technicians are asked to work overtime and double shifts -- often, with skeleton crews -- and are still expected to maintain the same turnaround times. This can lead to exhaustion, burnout and increased potential for error. Temporary workers can sometimes help bridge the vacancy gap, but they are difficult to locate and come at a significant cost to the facility.

Clinical laboratory work also remains the "hidden profession." Laboratory workers are not commonly viewed by the public, thus recognition of their role and responsibility in patient specimen collection and processing is limited. This lack of recognition for the vital contribution the laboratorian brings to patient care is another problem faced by the profession.

The lack of public knowledge about professional lab opportunities -- another problem involved in the current shortage situation -- is very evident when people are asked about what careers are available in the medical field. Very few people know about the variety of careers available in the medical field other than doctors, nurses and, occasionally, paramedics. Even fewer people actually know what all the available careers in medicine entail. What little exposure the public has to the laboratory field via the media is often erroneous and negative.

Another issue confronting the laboratory profession's future is that training programs nationwide are dropping, due to the lack of enrollments and the high costs of maintaining them because of the significant expenses associated with consumables and equipment. According to the National Accrediting Agency for Clinical Laboratory Science 2002 Annual Report on accredited programs in laboratory sciences, the available accredited programs for laboratory sciences have decreased during 2002, as Figure 2 demonstrates. At a glance, these numbers may not be too alarming, but in one calendar year, 15 laboratory programs ceased to exist.

According to the U.S. Bureau of Labor Statistics for the period of 2002 through 2010, 12,400 graduates will be needed annually to staff the nation's clinical laboratories. Nationwide, less than half the necessary laboratory personnel are graduating. Currently, with 4,200 graduates per year, there is a deficit of about 8,000 laboratory professionals per year. (3)

Another reason for the shortage is the increased demand for laboratorians in alternate and complex lab testing facilities. Laboratory personnel are being hired in physicians' office laboratories, clinics, veterinarians' offices, industrial laboratories and research laboratories. For new graduates, as well as for current laboratory professionals, these represent exciting new options. For employers, it means more competition for the limited, available pool of candidates.

What can be done?

What can laboratory professionals, employers and educators do to help alleviate the problems? One way would be to increase public awareness of who laboratorians are and what they do. Community outreach programs or open houses that are cosponsored by employers and educational institutions could also be excellent ways to promote the profession to potential employees and trainees. Argosy's Lab Sciences programs were involved in just such a program where, in a period of about four hours, more than 60 people were exposed to laboratory careers.

Employers should become more involved with attracting employees by improving their work environments, offering sign-on bonuses, relocation assistance -- and scholarships for students. Supervisors and managers need to work more closely with current staff to restructure their jobs to make them more appealing to applicants.

High school counselors need to provide their students with information about the laboratory professions. This year, the Coordinating Council on the Clinical Laboratory Workforce is working with the American Society for Clinical Laboratory Sciences in developing a "Recruitment Tool Kit" for distribution that can be given to high school counselors, science teachers and clinical laboratory educators - kits designed to suggest ways to attract students and adults to laboratory science careers; to provide incentives and programs needed to be successful; and to distribute program application and entry information. Other potential candidate pools for laboratory professions are college biology and chemistry majors and local agencies that retrain and reemploy displaced workers. Every laboratorian has a responsibility to mentor and promote our profession to high school and college students.

Wages for laboratory professions need to be more competitive and in line with allied health careers. As the shortage intensifies, salaries have begun to rise slightly, even though there is still a long way to go. Does the shortage have to become more drastic before the issue of salary is addressed? It is a sensitive subject for most managers because of tight budgets and decreased reimbursement for lab tests. With the advent of diagnostic-related groups in the early 1980s, the laboratory changed from a profit-generating department to a cost center. Trying to justify spending more for salaries (when the department is not generating the income to support it) is a problem that needs to be brought to the forefront when trying to find solutions to the staffing crisis.

Students would be more inclined to apply for medical laboratory programs if salaries were more competitive and financial assistance was easier to attain. As members of state and national professional organizations, laboratorians can lobby their legislators to increase wages for the medical laboratory fields, making them comparable to other medical professions. Lab professionals can also work with state and federal governments to promote grant and loan opportunities for students who are interested in the lab sciences.

Clinical training for laboratory students can be a win-win situation for both the student and the site. Students learn valuable and necessary skills while being trained, and employers are able to evaluate the student for potential employment in their labs. Unfortunately, many laboratories feel they do not have the resources and time to invest in being a clinical training site. Most educational programs that have clinical training requirements will assist the site in setting up the program, as well as offer suggestions on how to deliver the training, with minimal investment of time and resources on the part of the lab. At Argosy, more sponsorship opportunities are being offered to students. The clinical training site offers a scholarship, and once accepted, the student will go to that site, agreeing to work for a specified period after completion of clinical training. The students have the assurance of jobs, and the employers have the assurance of employees.

Looking to the future

With the steady decrease in the number of medical laboratory programs and graduates, along with the increase in the number of available jobs, changes need to be made to bring more candidates into the employee pool. Employers and the general public need to be alerted to the possible ramifications regarding the lack of qualified lab personnel. Delays in the diagnosis of illnesses, inaccurate or incomplete test results and potential delays in treatment could result. Because of low enrollments and financial viability issues, the future for educators could mean the closing of already established programs. The healthcare consumer should also be concerned. Most patients would not react well if they knew their sample was being tested by a technician who was burned out and had a high chance of producing invalid results. Without quality laboratory personnel to perform the tests, all of us will suffer.

Figure 1

Current starting salaries of Argosy graduates in comparision to HT/MLT

                        higher

Histotech/Med lab tech    --
Radiology technologist    6%
Radiation therapist      20%
Ultrasound (DMS)         20%
Dental hygienist         66%

Figure 2

Decline of number of accreditation programs in 2002 (2)

Program type  Jan. 1, 2000  Dec. 31, 2002  Change

   CLS/MT         254            243         -9
  CLT/MLT         236            231         -5
     HT            22             23         +1
     HTL            2              2          0

References

(1.) American Society for Clinical Pathology, (March 2001), 2000 wage and vacancy survey of medical laboratories, Retrieved on February 11, 2003 from http://www.ascp.org/bor/medlab.

(2.) National Accrediting Agency for Clinical Laboratory Sciences, (2002), Annual report, Chicago.

(3.) Coordinating Council on the Clinical Laboratory Workforce, (2003, February 7), Medical laboratory organizations take action; offer solutions to address serious laboratory staffing shortage.

Roger Becker is acting MLT department head, laboratory manager and safety director, and MLT instructor, and Robert Brunner is department head, Histotechnology Program, Argosy University-Twin Cities, Bloomington, MN.