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Fight or flight? Laboratorians' response to the shortage.

Fight or flight? Laboratorians' response to the shortage

In a perverse sort of way, the staff shortage may end up being a boon for beleaguered laboratorians by forcing administrators, physicians, nurses, and--dare one say it?--the general public to take notice. As panelists in MLO's recent survey point out, there is nothing wrong with the laboratory profession. The real problem is how its members are treated by others.

Fewer college graduates are emerging just when health care is intensifying demand for, and demands on, workers. While the usual complaints--low salaries, lack of respect, fear of AIDS--still apply, the major difficulty is supply and demand.

Simply put, far more technologists will be retiring than hiring in the next few years. "As an oldtimer myself, I hope I'm retired by the time everyone burns out," confides MLO Editorial Advisory Board member Ted Street, M.B.A., administrative director of pathology at HCA Wesley Medical Center in Wichita, Kan. "We're in for a bad five years."

Yes, the pool of technical talent is drying up. Sixty-one per cent of panel members report that their labs already feel the personnel pinch, and nearly three-fourths fear the worst is yet to come.

The current shortage is critical, according to many panelists. A small lab in Missisippi recently lost two of its four technologies when already understaffed. "One left the state in June, and the other retired," laments the department head. The two technologists left behind must now handle the work of six. "There has been some effort to help, but it is too little, too late."

Hospitals have been especially hard hit by the shortage of laboratorians. Sixty-eight per cent of the hospital labs have fewer FTEs than they need, compared with 43 per cent of the independents. The larger the hospitals, the greater the likelihood of a "help wanted" sign. Nearly 80 per cent of the large hospital labs polled in the survey have vacancies. This figure drops to 68 per cent in mid-size hospitals and 58 per cent in the smallest facilities. (Definitions of small, medium, and large hospitals are given in a box at the beginning of Part I of this report.)

* Nationwide problem. The shortage is truly nationwide, with little variation from the West (where 55 per cent of respondents cite a staff shortage) to the East (59 per cent) to the South (60 per cent) and the Midwest (61 per cent). Panelists from all over the country make the observation that it's getting harder and harder to find--and keep--laboratorians, and that it will grow harder still in years to come. Table I offers a comprehensive look at the types of workers in short supply and the sections and shifts stretching their staffers. Table II outlines the reasons that prompt laboratorians to move on, and where they go.

The labs polled in the MLO survey are hardly alone in their staffing woes. In fact, 75 per cent of panelists report that all or most of the labs in their communities have the same problem. Only 7 per cent say other nearby labs are fully staffed; 18 per cent are unsure about this. Table II details the current staffing shortage and offers panelists' predictions about future staffing levels.

Hospital size per se seems to have little effect on the shortage, although it appears to be slightly more widespread in cities--or at least in communities in which large hospitals are located. Nearly 80 per cent of panelists based at large hospitals share the shortage with other local labs, as do 78 per cent of those in mid-size hospitals and 75 per cent of workers in smaller labs. Geographically, the East leads the pack, with 80 per cent of respondents citing a universal staffing shortage. The South follows closely behind at 76 per cent; the Midwest, at 71 per cent; and the West, at 70 per cent.

While some labs have thus far escaped the strain of a staffing shortage, many others are feeling the pangs--some acutely. An Illinois lab manager searched for a year to fill a single part-time position. Other panelists, mostly from rural communities, comment that prospective employees simply aren't interested in going to the trouble of hiring a babysitter and driving many miles to bring home a part-time paycheck.

Several panelists acknowledge that applicants, who can now pick and choose, are doing just that. "Night and evening jobs are the most difficult to fill," notes an Illinois lab director. "Day jobs are easy." A Texas lab director agrees: "We have no shortage except during the undesirable shifts."

* Current vacancy rate. It seems clear there is a staff shortage, but just how bad is it? The average vacancy is 7 per cent of all laboratory employees. More telling, perhaps, is that about one-fourth of panelists say their current vacancy rate is less than the lab's annual vacancy rate. On the other hand, 60 per cent note little difference. The remainder (14 per cent) report a current staff vacancy rate somewhat higher than usual.

These figures may be a bit misleading, warns Barbara Castleberry, Ph.D., MT(ASCPe, vice president of the ASCP Board of Registry. "A 7 part cent overall vacancy rate may actually be much worse if you look at where the vacancies occur," she points out.

For example, let's say a laboratory has 10 FTEs--a lab manager, two supervisors, a secretary, and six technologists. Two employees leave within a month of each other, creating a 20 per cent vacancy rate. That's bad enough, but both are technologists. Thus the vacancy rate at the bench is 33 per cent. "The problem is at the staff level. Some of the labs in this survey may actually have much higher vacancy rates if they look at the numbers by position." Castleberry observes.

Many panelists would no doubt concur, considering that the majority (70 per cent) of those experiencing a shortage cite vacancies in the technologist ranks--a group nearly as large as the 37 per cent who mention a phlebotomist shortage. In addition, 25 per cent need cytotechnologists and 13 per cent are looking for histotechnologists. Supervisory and managerial vacancies also occur, although less frequently. Only 7 per cent of panelists say their labs are short on supervisors. Even fewer (2 per cent) are missing lab managers. Higher-echelon vacancies are generally much easier to fill. "There is always someone in the lab who is interested in moving up the career ladder," Castleberry notes. "But then you have to replace that person at the bench, and this isn't to easy."

Several panelists find the vacancy rate for cytotechnologists particularly disturbing; one calls it "critical." Castleberry agrees. "I believe the percentage of lab citing a shortage of cytotechnologists is artifically low," she cautions, explaining that the majority of the labs in the MLO survey probably do not have cytotechnologists in-house and thus, of course, would not report a shortage." "An ASCP survey found that only 29 per cent of laboratories have a cytologist on staff," she says. "If you eliminate the labs that do not employ cytotechnologists, the vacancy rate would probably be much higher."

* On the home front. The panelists themselves seem to be fairly well settled, at least for now. The majority (78 per cent) have worked in their current laboratories for at least five years. More than one-third are into their second decade; 16 per cent have been there for 20 years or more.

Nearly 60 per cent of panel members have no immediate plans to move on and expect to remain in their current labs for at least three more years. Just under 20 per cent say they probably will leave, and one-fourth haven't decided. As Table IV shows, those who do stay put will most likely continue in the same position--not surprising, since most of the MLO panelists are in the managerial ranks.

* Why techs leave, where they go. Guesss what? Money is the big reason technologists leave the laboratory. Forty-two per cent of panel members say low salaries are a major factor in the staffing shortage, followed by burnout and stress, cited by 38 per cent. Insufficient growth potential, lack of professional recognition, and poor morale follow, in that order.

The majority of panelists (nearly two-thirds) report that when staff members do leave, they're likely to go to another clinical laboratory. Nevertheless, 40 per cent of panel members have had technologists bail out of the field altogether. Table II provides a more complete breakdown of the whys and wheres of the staffing exodus.

* Impact on quality. A severe staffing shortage inevitably affects the quality and scope of lab services. Forty-two per cent of panelists say the shortage has adversely affected their labs (Table V). A disconcerting 60 per cent of panelists based at large hospitals have seen service slide, compared with roughly 40 per cent of those in smaller labs. In contrast, just 28 per cent of respondents representing independent labs cite a comparable decline.

On the plus side, 30 per cent of participating labs--and 44 per cent of those located in mid-size hospitals--are maintaining the quality of their work. Just over 7 per cent aren't sure whether quality has been affected. Another 20 per cent say they have no vacancies, making the issue irrelevant.

Many panelists are sure quality is taking a back seat, and they aren't happy about it. A Vermont laboratory no longer offers in-house microbiology; a lab in Tennessee has trimmed its test menu. Nor will the caliber of the current crop of job seekers improve quality, according to several panelists. A California lab manager frankly comments: "The lack of candidates necessitates that I hire virtually anyone who applies. In the past year, I have had to hire technologists I probably would not have considered if there had been more applicants."

* MT Schools. The ranks of schools as well as those of workers are shrinking. Panelists doubt this trend will reverse any time soon. From across the country--particularly Colorado, Illinois, Kentucky, Michigan, North Dakota, Oregon, Pennsylvania, Texas, Virginia, and Wisconsin--panelists report declining enrollments and school closings.

"Three years ago, the local university had 35 students in its med tech internship program," one panelist reports. "This year there were seven." A Kentucky panel member notes that the entire state university system yielded only 16 MT graduates this year. "Students are wise to our poor pay and our poor hours," offers an Illinois department head. "The better ones are choosing other professions."

Some of the students who do enroll are, shall we say, less gifted than earlier graduates. "We see much lower GPAs today than 10 years ago," a panelist confides. A Wisconsin QA manager cites a "significant" drop in students' body of knowledge. "Our institution continues to accept 10 to 16 students each year," says an Illinois supervisor. "We have had to compromise our acceptance standards, however, and thus the caliber of students has dropped."

If this is the status quo in many of the remaining MT schools, what will happen when these new graduates reach the bench? A California lab manager already knows: "The quality of the employees we do locate is much lower than our needs. This causes service problems in the quality of our results and turnaround. Training takes longer, and there are more terminations due to performance, language deficiencies, and computer illiteracy." Even so, this panelist's lab cannot find workers for the third shift.

If the warnings of a looming staff shortage and sliding quality sound dire, perhaps they should. More than 70 per cent of panelists expect the situation in their communities to worsen over the next two years. Eighty-six per cent predict that labs nationwide will see fewer and fewer technologists at the bench in the months to come. Yet laboratorians often seems to be the only ones who care.

* Administrative complacency. Suffering through a staffing crunch is bad enough, but when administrators remain oblivious to what many panelists consider a crisis, the situation becomes unbearable. Nearly 40 per cent of the panel members say their administrators (along with other health care professionals) haven't a clue about lab personnel or the lack thereof (Table VI). One-third of the panel, however, say their administrators and colleagues do appreciate the severity of the situation. (Eight per cent of panel members have no clue themselves, and the remaining 20 per cent say they have no shortage.)

Panelists feel it is high time hospital administrators and the rest of the health care team woke up and smelled the acetone. A Michigan chief technologist observes that you can't have high-quality health care without high-quality personnel.

Health care colleagues are not contributing enough to the cause, panelists aver. "Lab and hospital administrators here are making unreasonable demands on an already demoralized staff," objects a Pennsylvania supervisor. "Hospital administrators see only the nursing shortage and are willing to do anything to attract and retain nurses," comments a department head at a Pennsylvania lab, adding that the laboratory is viewed as a necessary evil.

A section head at a large hospital lab no doubt speaks for many in saying, "If hospital administration felt that the lab shortage of today was as serious as the nursing shortage of two years ago--and took the same steps," the technologist shortage "could be a thing of the past."

Several panelists take higher-ups to task. More than one angrily asks why pathologists and professional societies still fail to work together to improve the laboratorian's lot. Others consider it time they took charge of their own professional destiny. On a smaller scale, that happens every day; as a Connecticut lab manager points out, "Medical technology is what you make of it."

Betty Martin, M.S., M.B.A., for one, tends to agree and calls laboratory managers to task. "In general, I find administrators are open and willing to be supportive if lab managers provide solid factual information instead of just complaining. Our administrator has been very supportive," says Martin, who is pathology management associate and professor of medical technology at the State University of New York Health Science Center at Syracuse. "He allowed us to increase the entry-level salary and approved a significant shift differential package, which included standby and call-back pay."

Indeed, a little bit of homework can bring big benefits. Martin's lab, for example, now has an annual scholarship program for junior and senior medical technology and cytotechnology students. The laboratory presented the data; the administrator funded the program; and the lab gained access to a perpetual pool of graduting technologists. "This has allowed us to recruit competitively with other hospitals and has also helped morale," she explains. "The technologists now realize that administration does understand our problems, and they know that help is on the way, come June."

* What's being done. Necessity gives birth to many an invention. Labs are doing what they can. Castleberry of the ASCP calls such efforts the three "R"s--recruitment, retention, and retraining. "Increasing pay scales makes an immediate contribution to both retention and recruitment," she notes. It is "gratifying" to see from the MLO survey, she says, that a substantial percentage of labs in the survey are launching recruitment drives and retraining programs. "Participation in health fairs and high school career days is a good investment for the future," Castleberry observes. Going a step further, one chief technologist from New Jersey would like to see a public relations campaign targeted for junior high school students.

As staff size shrinks, such strategies must become increasingly creative. A Virginia laboratory now hires chemistry and biology graduates and then does "a lot of training," one panelist writes. A Florida supervisor believes that lab assistants and MLTs should be recruited heavily and utilized more effectively.

Several panelists report that their labs have affiliated with a university or independent medical technology school, thus getting first pick of the annual crop of graduates. Other labs operate their own MT schools. A Washington State lab has started an inhouse training program for phlebotomists and technicians. Many others, with an eye toward OJT, actively recruit majors in biology, chemistry, and natural science.

A county hospital lab in California plans to offer an education stipend in return for a mandatory "tour of duty" following graduation. A Texas laboratory trains pre-med students to help out. The supervisor at a small Minnesota lab hired a college senior to see the lab through a severe weeked shortage. She signed on full time immediately after completing her medical technology studies.

An Arkansas laboratory offers a sign-on bonus. A lab in Texas has high hopes for its new promotional video. Phlebotomists in a Rhode Island laboratory receive tuition reimbursement. (The lab manager wryly notes that three-fourths of the employees who take advantage of it head straight for nursing school.) Table VII lists the most and least effective recruitment and retention strategies cited by MLO panelists. Table VIII lists the ways panelists' labs find new staff members.

The bottom line, as usual, is money. The salary situation continues to be unenticing in many laboratories. A North Dakota department head reports that medical technologist start at $8.40 per hour. Technologists at one New Mexico laboratory have had one 3 per cent raise in the last eight years. Many, many panelists stress that until the financial outrages are rectified, recruitment and retention efforts will remain just so much talk.

* Words of wisdom. In previous surveys, panelists asked whether they would recommend medical technology to a young person making a career choice have been fairly evenly divided. For example, 46 per cent of those polled in 1985 said they would, as did 51 per cent of the 1987 panel.

This time, just under half (48 per cent) of the panel members would unhesitatingly say, "Welcome aboard." Since the 1990 survey offered a new twist, allowing panelists to say they weren't sure, ambivalence emerged in one-fifth of respondents when 19 per cent said they didn't know.

Perhaps the most encouraging observation is that in earlier MLO surveys, fence-sitters might have been more likely to say "nay" than "yea." One-third (33 per cent) of cufrrent panelists would advise against life in the lab. A sampling of panel members' advice and the reasons behind their comments appear in Table IX.

The biggest lab boosters by far work in the West, where 61 per cent of panel members give medical technology the nod. Runners-up include panelists based at independent labs, in mid-size hospital labs, or in the Midwest. At least half of all these panelists say yes, they would advise others to follow their professional lead. East Coast panelists are most leery; 40 per cent would tell advice-seekers to stay away from the lab.

Such professional pessimism worries Castleberry, who points out that disillusionment is not limited to medical technology. "Studies have shown that 33 per cent of teachers and 38 per cent of physicians would not recommend their professions, either," she said. "I would urge people to respond to such a question only after carefully recalling the reasons and values that led them to choose medical technology for themselves. You never know what talented future laboratorian you might be discouraging inappropriately."

Panelists promoting a career in the laboratory stress the challenges, altruism, job security, and geographic mobility they find in the field. More than a few point out that the educational background and clinical experience one needs and obtains in the lab make it an excellent stepping stone . . . to something else.

Many say they love the work even when they hate the job. "I always tell high school students to get their degree,pass the certification exam, be the best they can be, and be proud to sign MT after their name," comments a North Carolina supervisor. Another panel member mentions with pleasure a daughter who is following in her footsteps.

Several respondents say they would offer would-be laboratorians a realistic view of life in the lab. Citing mixed feelings, an Iliinois lab manager comments, "I would recommend medical technology, but deep down I would probably be doing the person a disservice. The money and opportunities are in nursing."

The familiar impediments arise. Respondents cite such shorftcomings as "ridiculously" low pay, high stress, and lack of respect and prestige. Several call medical technology a "dead" profession. An apparently disgruntled lab manager from Alabama comments: "Technologists can't take pride in their work because they don't take pride in themselves. If they did, they would leave the lab and find a more satisfying and fulfilling job."

Panelists tend to agree that the profession will change over the next few years--whether for better or for worse. A substantial number of respondents believe that the shortage itself will finally turn things around. A West Virginia department head speaks for many in stating, "The medical technologist is on the verge of recognition by the rest of the medical profession as a vital part of providing the best medical care available. The shortage has caused others to take note of our importance and will lead to the upgrading of pay scales to entice people into the profession."

It's too soon to tell when the shortage will bottom out. Once it does--as a panelist envisioning that day observes--"it can go no place but up."
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Title Annotation:Special Report, part 2
Author:Hallam, Kris
Publication:Medical Laboratory Observer
Date:Aug 1, 1990
Previous Article:Lab staffing in the shortage era.
Next Article:Lab administrators' role in retaining professionals.

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