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A precarious balance on the shaky dollar.

Compare your own situation with that of the local and national norm reported by respondents to MLO's latest reader survey on pay, raises, and other matters related to wallet and career.

I SUPPOSE I'm lucky to have a job these days but I feel overworked and underpaid," says the lab supervisor at a small hospital in Connecticut. Frustration typifies sentiments expressed by clinical laboratorians who responded to MLO's biennial salary survey.

The lab supervisor at a rural physicians' office laboratory in Ohio is on the way to being fed up. "I have had to beg for increases to match the responsibility of my position. I'm finished--no more," this laboratorian declares. "I'm looking for another position, and if the pay doesn't match my level of decision and responsibility, I'm leaving the field for less hassle. I may even do volunteer work at the local library."

The lab supervisor at a midsize not-for-profit Arizona hospital finds that pay raises may be driven by the personnel shortage: "Our institution raises salaries when we can't compete with our nearest competitor. We used to pay the highest salary and could pick and choose our staff. Now we play catch-up and hope we can hire the best tech available."

"When I started working in a clinical laboratory in 1982," says the lab supervisor at an independent lab in Missouri, "the general climate was excitement, prosperity, enthusiasm, excellence, pride, and advancement. Beginning with DRGs the climate has been depression, fear, resentment, and frustration. I've seen the program that trained me close down, cutbacks made across the board, and continuing education virtually disappear. It's a vicious, sad cycle, with a mournful quality. I'm still proud of what I do, but have nowhere near the satisfaction I used to take for granted."

* Raises. Salary increases, which peaked in the late 1980s, have fallen to their lowest point in the eight years MLO has conducted biennial salary surveys. (An earlier one was published in January 1982.) According to current respondents, the average raise for all laboratorians in 1992 was 5.1% of annual salary. Respondents' increases averaged 5.2% in 1986,|1,2~ 5.7% in 1988,|3,4~ and 5.6% in 1990.|5~

Lab workers employed in independent and group practice labs fared best this time, reporting an average salary increase of 6.8%. Those working in the East and in suburban labs also did better than the average, with increases of 5.8% and 5.6%, respectively.

Pay hikes for laboratorians far from the city averaged only 4.4%. "Salaries in our rural area are competitive, but not with the nearest metropolitan areas," says the evening supervisor at a large not-for-profit rural hospital in Tennessee. "With our salary ranges, we can't recruit the few MTs available. We have initiated career ladders for both MLTs and MTs to retain employees but would like to be able to offer better salaries to potential employees who have specialty certifications."

"Rural labs must compete for staff with urban facilities," says the director of the lab at a small not-for-profit hospital in Iowa. "You can't keep technologists in a small country hospital if the pay is $2 to $4 per hour higher in the city and the person can drive there and make more money."

* Inflation. More than half of respondents (52%) say their salary increases have not kept pace with inflation. Not quite one-third (31%) believe that their raises have kept pace; 16% say their raises have exceeded the inflation rate. The 1992 findings approximate those of the 1988 and 1990 studies.

Rural laboratories again are most affected; there, 63% of respondents believe that their raises have failed to match the rate of inflation. Half of laboratorians in cities and 44% of those working in suburbs feel the same way. Yet officially the annual inflation rate was 3.2% as measured at the end of October 1992.|6~ Perhaps respondents' perceptions simply signify an inability to keep up financially.

* Starting salaries. Figure 1 lists starting salaries for seven job titles and comparable numbers for the five listed on the 1990 and 1988 MLO surveys. At the upper end of the pay scale are administrative technologists and lab managers, whose 1992 average starting salary of $40,800 had increased from $39,700 in 1990 (2.8%). Chief technologists started at $34,000 in 1992, an increase of 3.7% over 1990.

Technicians earned least of the group in 1992, with an average starting salary of $19,000--5.5% higher than the $18,000 of two years before. Technologists start work at an average salary of $24,700, as compared with $24,000 in 1990.

A shortage of cytotechnologists and histotechnologists having been detected in another MLO survey,|7~ MLO added those two job titles to this one. Cytotechnologists start at a national average of $30,200 and histotechnologists at $22,700, respondents say.
Hospital size
Hospitals and medical centers in this article have been
categorized in the following groups:
Small 1-199 beds
Midsize 200-399 beds
Large 400 or more beds

One respondent reports a quick climb up the career and pay ladders. "As a cytotech, my salary has risen 125% in the last five years," says the cytology laboratory manager at a large not-for-profit hospital in New York City. "I began as a staff technician, then switched labs and became assistant supervisor, supervisor, and then manager of the lab."
Figure 1
Starting salaries for seven job titles, 1988-1992
 MLO salary survey
Job title 1992 1990 1990-92 1988
Technician $19,000 $18,000 5.5% $15,800
Technologist 24,700 24,000 2.9 20,200
Section supervisor 30,600 29,400 4.1 24,900
Chief technologist 34,000 32,800 3.7 28,000
Administrative 40,800 39,700 2.8 34,400
lab manager
Cytotechnologist 30,200 NA Unknown NA
Histotechnologist 22,700 NA Unknown NA
NA--not asked.

The director of the laboratory at a large not-for-profit hospital in Maryland offers hiring bonuses of up to $5,000 for cytotechnologists. The quality assurance officer of an independent lab in a Pennsylvania suburb reports a higher pay scale for cytotechnologists than medical technologists.

Starting salaries are clearly affected by whether one works in an urban, suburban, or rural setting (Figure 2). Similarly, starting salaries vary by geographic region, sometimes dramatically (Figure 3).

* MTs and MLTs. Nearly 8 out of 10 laboratorians (79%) say that MLTs currently perform the same level of work as MTs at least some of the time (Figure 4). An equal level of work is more likely to be performed by MTs and MLTs in rural labs than by those in urban or suburban settings (42%, 25%, and 30%, respectively).
Figure 2
Salary differences, city to country
 Work setting
Job Title Urban Suburban Rural
Technician $19,000 $19,400 $18,700
Technologist 25,400 25,000 23,500
Section supervisor 31,700 31,400 26,600
Chief technologist 35,400 35,800 30,800
Administrative 44,100 42,500 34,300
lab manager
Cytotechnologist 30,700 31,000 26,800
Histotechnologist 22,700 23,800 21,000

The compensation gap is narrowing. Although MTs and MLTs enjoy the same pay levels in less than one-fourth (23%) of labs where they do the same work, that's nearly double the proportion (12%) found in MLO's 1990 survey. MLTs are most likely to receive equal pay for equal work in small hospitals and in Midwestern and rural labs (24%, 25%, and 28%, respectively).

"I believe an MLT should be paid the same as an MT if performing the same duties," says a section head in the lab of a midsize Government hospital in an Iowa city. "Some of our MLTs are better than some of the MTs they work with." The manager of a rural group practice lab in Ohio notes, "Our most recently hired MLT was paid $3 per hour more than the other employees."

"I foresee more |bench-level~ jobs for the two-year MLT in the future and fewer for the four-year medical technologist," predicts a section head at a large not-for-profit hospital in Minnesota. "Med techs will probably |be more likely to~ become supervisors, managers, and administrators."

How do laboratorians feel about their salaries? Apparently, despite their occasional harsh words, they accept them. Earnings are "adequate" according to 35% of respondents, "somewhat adequate" according to 39%, and "very adequate" according to 6%. Surprisingly, only 20% call their salaries "not adequate." Shrunken raises notwithstanding, a smaller proportion of respondents call their salaries inadequate now than in 1988 (20% versus 30%, respectively).

* How salaries compare. One sign of dissatisfaction is the suspicion--accurate or not--that one's employer pays less than others nearby. Asked how their salaries compare with those of laboratorians holding similar positions in their own geographic areas, only 43% of respondents find them to be about the same. One in three (32%) believe their salaries are lower than their peers'; 7% say that their salaries are higher; 19% are unsure. These findings are approximately the same as those for the 1990 MLO survey.

Comparing lab salaries with those of other health professionals in the same institution, a favorite sport in the break room, had its place in the questionnaire. A plurality (44%) feel they earn less than other health care professionals with comparable responsibility and training, while 31% say their salaries are about the same, 8% say their salaries are higher, and 16% are unsure. Figure 5 compares respondents' salaries with those of their local and institutional peers.
Figure 3
Starting salaries around the U.S.
Job title East South Midwest West
Technician $20,800 $18,600 $18,600 $18,800
Technologist 25,400 23,500 23,300 28,600
Section 31,900 28,900 28,700 35,600
Chief 31,800 33,800 33,100 38,900
Administrative 41,500 39,100 32,900 47,900
lab manager
Cyto- 30,700 28,800 28,800 33,700(*)
Histo- 23,900 21,600 22,600 23,600(*)
* Response to this part of the question was low; figures may be
These statistics show several fairly stark examples of regional
disparity. Technicians do best in the East but virtually
everyone else looking for higher pay might consider heading

Unless salaries for medical technologists come into line with nurses', comments the manager of a North Carolina POL, CLIA '88 will cause potential lab workers to gravitate toward nursing instead, with its greater salaries, prestige, and number of job opportunities.

"The separation in salaries between nurses and laboratorians has been a longstanding sore spot," says a section head at a small rural proprietary hospital in Utah. "The real slap in the face, however, is between salaries paid to medical technologists and those paid to x-ray technicians, respiratory therapists, and those in many other expanding fields, such as sleep therapy, angiography, and echocardiography." This laboratorian proudly reports having a lab administrator who believes that laboratorians and nurses should be equally paid--"a rare and probably unique situation indeed."

* Local shortages. A substantial proportion of respondents (42%) note a "significant shortage" of lab personnel in their own regions of the country. Nearly half (47%), however, find employees available in sufficient numbers (Figure 6).

Demonstrating that perception can be deceiving are responses to a similar question posed in MLO's recent survey on staffing.|7~ In that survey, more than half of respondents (54%) reported a personnel shortage in their own geographic areas, whereas 16% observed no such shortage and 30% were unsure. Nevertheless, the overall survey indicated a deepened personnel shortage across the nation. "It's happening," panelists seemed to be saying, "but it isn't happening here."

* Reasons for raises. Pay raises have been higher during the last few years due to the personnel shortage, according to 44% of respondents. Somewhat more (53%) report no change in raises, however, and 3% are unsure. More than half of MLO panelists (55%) say their labs have reacted to the personnel shortage by offering higher salaries to new staff. Two out of five (41%) report no such change; and 4% are unsure.

Some lab managers hope that boosting salaries of current staff will aid retention efforts. An example comes from the manager of the lab at a large not-for-profit hospital in Texas: "In April we gave a 5% increase to |our current~ MTs because there were several openings in neighboring hospitals. We did not want our staff to begin looking around."
Figure 4
Technicians and technologists: Equitable duties and pay?
Do MLTs in your lab perform the same level of work as MTs?
 MLO salary survey
 1992 1990 1988
Yes 79% 63% 74%
No 20 36 26
Unsure 1 |is greater than~1 NA
NA--not asked.
If so, do they receive the same pay?
 1992(*) 1990 1988
Yes, same pay 23% 12% 12%
No, paid less 76 87 88
No, paid more 2 |is less than~1 0
* Total exceeds 100% due to rounding.


When asked whether lab salaries are routinely increased at specific intervals, most laboratorians (84%) said yes; 16% said no. Among the former group, 89% say that raises are given at their facilities once a year, while the balance report receiving increases at two-year (5%), six-month (1%), and other intervals.

* Enhancements. The labs of almost all respondents (99%) offer at least one form of pay enhancement. Nearly 8 out of 10 respondents (79%) say their labs offer overtime pay. Differentials for evening and night shifts are paid in 74% of panelists' labs. Merit raises are granted in 61%. Salaries of all staff members are increased by a uniform percentage across the board in 38% of reporting labs. Nearly one-third of labs (31%) offer incentive-based compensation of various kinds (Figure 7). Bonuses are accorded by 22%, while 5% say their labs offer other forms of salary enhancement. (Multiple responses were accepted.)

Hospital labs are more likely than independent labs to offer overtime (86% versus 70%), differential pay (87% versus 51%) and uniform percentage increases (39% versus 29%). Independent labs are more likely than hospital facilities to offer variable compensation (45% versus 30%) and bonuses (34% versus 19%).

* Recruitment strategies. The most common recruitment incentive, offered by 30% of respondents' labs, is the sign-on bonus. Relocation expenses are paid by 16% of labs, and 8% offer recruitment bonuses (to employees referring a person who is hired).

"Our facility currently offers moving expenses and a $3,000 sign-on bonus, paid in the first paycheck," says the blood bank supervisor at a midsize not-for-profit hospital in rural Colorado. The money must be repaid (pro rated) if the employee leaves before two months have elapsed. This laboratorian notes, however, that "the offering is based on a shortage of lab personnel in our geographic area and is subject to constant evaluation."

A supervisor at a group practice laboratory in a Florida suburb reports a $5,000 sign-on bonus as well as paid time off that accrues faster than usual (12 hours per month as opposed to 8 hours). New employees who have paid out of pocket in order to continue insurance coverage under the previous employer's policy are reimbursed for three months' fees.

* Eternal carrot. A supervisor who left a small rural not-for-profit hospital in Nebraska left a gap the lab couldn't fill. A whopping raise was lure enough to return: "When I quit in 1989 after working for eight years as supervisor of the entire lab, l was making $7 per hour. That left only an MLT and an on-the-job-trained part-time employee--a definite shortage of qualified techs. A year and a half later the lab offered me my job back--starting at $11.50 per hour and going to $12 six months later."
Figure 6
Personnel shortage
How well is your geographic area supplied with laboratory
 MLO salary survey
 1992 1990 1988
Experiencing a 42% 66% 67%
significant shortage
Neither too few 47 28 31
nor too many workers
Significant surplus 5 2 2
in potential work force
Unsure 6 4 NA
NA--not asked.
Considerably more respondents to MLO's 1990 survey (66%)
reported a significant local shortage than was the case two
years later (42%).

The lesson here may be in keeping employees happy enough not to leave in the first place. "Our unusually good benefits have saved us through the years," notes the chief technologist at a small rural not-for-profit hospital in Michigan. "However, they are currently being reevaluated." How budgets and benefits stack up across the country, what salary-related developments laboratorians anticipate in the future, and other issues are discussed in Part 2 of this report, which follows below.
Figure 7
Variable compensation
Does your laboratory offer any kind of incentive-based
Yes 31%
Mode of compensation Offered Not offered Unsure
Exempt (salaried, 74% 26% 0%
not hourly) pay
Skill-based pay 35 64 2
(career ladders(*)
Gain (profit) sharing 29 71 0
Total quality management 3 93 5
incentive pay(*)
* Totals exceed 100% due to rounding.


1. Benezra N. Lab salaries and benefits (Special Report, Part 1): Are they keeping pace? MLO. January 1987; 19(1): 30-34.

2. Benezra N. Lab salaries and benefits (Special Report, Part 2): Dissatisfaction in the ranks. MLO. January 1987; 19(1): 37-39.

3. Benezra N. Lab salaries (Special Report, Part 1): Still too low, but rising. MLO. January 1989; 21(1): 20-24.

4. Benezra N. Lab salaries (Special Report, Part 2): Many think compensation has to get better. MLO. January 1989; 21(1): 29-31.

5. Knopp D. Lab salaries make altruism still a vital component (Special Report). MLO. January 1991; 23(1): 28-37.

6. Harper L. Latest figures show economy is on upswing. Wall Street J. November 16, 1992; A2.

7. Jahn M. Lab staffing today, Part 1: The shortage gets worse, but laboratorians get better. MLO. September 1992; 24(9): 24-29.

How the survey was conducted

On Aug. 26, 1992, MLO mailed a five-page questionnaire with postpaid return envelopes to its 1,450-member Professional Advisory Panel, consisting of readers who have agreed to participate in such surveys. The questionnaire was prepared by the editors in collaboration with the Medical Economics research department, which later compiled data based on the results.

By the cutoff date, Sept. 18, 1992, respondents had returned 524 usable questionnaires, yielding a 36% response rate. Note: Because the sample represents a selected panel of laboratorians at the supervisory level and above, results may not necessarily represent the views and experiences of all laboratorians.

Of those returning usable questionnaires, 35% listed their titles as laboratory manager or administrative technologist, 17% as lab supervisor, 12% as lab director, 11% as section head, and 10% as chief or assistant chief technologist. The remainder include administrative technologist (5%), pathologist (3%), education coordinator (2%), and other titles (7%). Multiple responses were accepted.

Among respondents, 56% are employed by acute-care hospitals, 9% by independent labs, 7% by Government or Armed Forces hospitals, 7% by proprietary hospitals, 7% by group practice labs, 5% by physicians' office labs, and 8% by other labs. (The total is less than 100% due to rounding.)

The setting in which 41% of respondents work is in urban areas, while 30% work in rural locations and 29% work in the suburbs.

Respondents live in all segments of the United States (see map for distribution): the South (32%), Midwest (31%), East (19%), and West (19%).
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Article Details
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Title Annotation:Lab Salaries, part 1; survey on salaries of medical laboratory technicians
Author:Jahn, Mike
Publication:Medical Laboratory Observer
Article Type:Cover Story
Date:Jan 1, 1993
Previous Article:Health care reform tops Clinton agenda.
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