Lab salaries make altruism still a vital component.
"The biggest frustration for lab employees is that we have to fight for every little salary adjustment," explains the laboratory manager at a midsize proprietary hospital in lllinois. His own lab has granted no cost-of-living increases for six years.
The average lab raise in 1990, 5.6%, was slightly lower than the 5.7% reported in MLO's 1988 survey. ' (The latter figure was rounded off to 6% in the January 1989 issue of MLO.) Respondents' latest raises are delineated in Figure 1.
Barbara Castleberry, Ph.D., MT(ASCP), vice president of the Board of Registry of the American Society of Clinical Pathologists, Chicago, reviewed MLO's 1990 survey results. The 5.6% average raise for laboratorians, she says, is consistent with average pay raises in most occupations nationwide.
That equity, however, may not console the 57% of respondents who report that their latest raises failed to keep pace with inflation. Salaries did meet that challenge for 31% of MLO panelists, while the raises of a fortunate 12% exceeded inflation.
* Not enough. Low raises intensify laboratorians' impression that their salaries do not reflect their education and skill. As a lab supervisor at a Wisconsin POL wryly puts it, "After four years of college, one internship, and 25 years of experience, I somehow have the feeling my salary should be higher than [that of] the engineer who drives the train at the local zoo. "
The chief technologist from a small nonprofit hospital reiterates the point: "In my 20 years of experience, [laboratory] salaries have never been commensurate with our level of education and responsibility as [they are in] other health care professions, such as nurisng or even outside the field such as grocery store checkers.
A quality assurance manager at an independent lab in Indiana takes the view that laboratorians today merely want an easier job that pays more. "Gone are the days of true dedication to a great job and the patient on the other end," she says. "Technologists just want to put in 40 hours or less and leave. They do not want to be inconvenienced with problems. We pay comparable or higher salaries, but we ask our techs to use their education on the job. " 9 Loyalists. Those who have stuck with the profession longest, respondents' comments indicate, often consider themselves inadequately paid. "Our lab does not recognize longevity of employment for bench techs," observes the chief technologist at an American Red Cross blood center in Wisconsin. "Those who have been here for 20 years earn the same as those who have been here for five. Right or wrong, this irritates longtime employees, who don't feel appreciated for their loyalty. "
The chief technologist of a group practice lab in California tells a similar story. "When our one bench technologist left last July, he was making $12.50 an hour. We had to raise the salary to $15 an hour to fill the position. This is 50 cents an hour more than I make as chief technologist, and I have been here 17 years. "
* Good standing. Laboratorians in the higher echelons do comparatively well financially. The average salary of lab managers ranks high among those of other top health care managers in hospitals, according to a recent study from the American Hospital Association.2 In hospitals employing 1,200 to 2,199 FTES, the average salary of lab managers was $49,500-just below top-ranked pharmacy managers, with an average salary of $57, 1 00.
Laboratory managers also rated second in hospitals employing 2,200 or more FTES, with an average salary of $54,500. First once more was pharmacy with an average salary of $63,500. Even with diminishing hospital size, salaries for lab management remained among the four highest.
In MLO surveys performed in 1990, 1988,(1) and 1986,(3) manager and nonmanager panelists alike were asked to compare their salaries with those of employees in other departments. Few found the result favorable to themselves Figure 11).
Looking around, laboratorians see hospital colleagues doing better financially than they are. "Nursing is probably their [laboratorians'] first point of reference," explains Castleberry, who was instrumental in developing ASCP's own 1990 salary survey. "I think we can sense in MLO respondents' comments a feeling that although there may have been increases, they certainly weren't comparable to those reported for nurses and other departments." The constant comparison between lab and nursing salaries is explored in "Are nurses worth more than laboratorians?," which starts below left.
Money doesn't say it all. Living proof of the axiom that there's more to job satisfaction than a paycheck are the faithful laboratorians who have not let poor salaries disenchant them. "I have seen some dissatisfaction, especially from people in larger institutions, where the salaries were probably larger than mine in a small hospital," remarks a laboratory supervisor in a small nonprofit hospital in Minnesota. i am not sure that all of it relates only to money. Many of these people seem to simply dislike their jobs. I enjoy mine and feel that my salary is adequate. "
"I work for a lower salary than many MTs, but my job satisfaction is very high," writes the supervisor of a physicians' office laboratory in Ohio. "I have a good working environment, fair to very good equipment, decisionmaking authority, and respect from col leagues. I like my work.
* Fringe benefits. An important part of anyone's compensation package is fringe benefits. Almost all respondents' institutions offer paid vacation 99%), paid sick leave 97%), and medical insurance (97%). For the most part, MLO panelists consider their benefits adequate (Figure 111).
Asked what benefits they would like added to their existing packages, respondents most often cited children's day care centers or subsidies, dental plans, and eye care plans Figure 111). That child care, cited by 19% of respondents, was desired more than any other single item suggests the large female contingent in the laboratory work force. Dental plans, next in line, were desired by 18%.
* In demand. Two-thirds of laboratorians (66%) say their geographic areas are experiencing a significant shortage. Only 2% report a significant surplus, while 28% report neither a surplus nor a shortage and 4% are unsure. Respondents employed by hospital labs are more likely to have a significant shortage of personnel (67%) than those employed by independent or group practice labs (58%). More laboratorians working in the South (72%) report a shortage in their area than do those in all other regions combined (63%).
True to the law of supply and demand, the shortage has helped boost salaries at many MLO panelists' labs (Figure IV). Sixty percent say their institutions paid higher salaries to attract new personnel. Nevertheless, such a step isn't always feasible. As the chief technologist from a small nonprofit hospital in Michigan observes, poor economic conditions have prevented many hospitals from offering higher pay to lure laboratorians.
* MT/MLT rift. With the shortage of personnel in full swing, many labs are hiring more medical laboratory technicians to do the same work as medical technologists-often less money (Figure V). A laboratory information system coordinator from a midsize nonprofit hospital in Calfornia describes the situation at her laboratory: MLTs are being asked to do more and more work that once was done only by MTs and with little recompense. In some cases, I have noticed MTs pushing unwanted duties on already overworked and understaffed MLTS." A department head from a small nonprofit hospital in Indiana asserts, "Technicians doing the same work as technologists should be paid the same. If not, give merit raises. "
On the other side of the fence is a laboratory supervisor from a large nonprofit hospital in Florida, who writes, Technologists are dissatisfied with MLTs who are taking the state exam for technologists and being hired and paid as MTs without the same amount of time and education. "
Barbara Castleberry of the ASCP believes the real question is, "What things- do your technologists do that your technicians don't?" Another important issue, she feels, is whether administrators provide opportunities for technologists to use their skills.
"As the personnel shortage increases," Dr. Castleberry observes, "it is going to be a real management challenge to find the people we need and to use their talents appropriately. It is a very difficult situation to have staff members perform exactly the same tasks with no differentiation, yet pay them differently. " o Recruitment. Many MLO panelists worry that low salaries not only drive away lab workers but also discourage others from entering the profession. "It is embarrassing to discuss laboratory salary ranges when speaking at high school or middle school career fairs," writes the education coordinator from a large nonprofit hospital in Michigan. "Lab professions do not offer appropriate rewards to attract bright young people or career changers to our field. "
Starting salaries are rising impressively, MLO survey findings reveal. Average starting salaries for medical laboratory technicians rose from $15,800 in 1988 to $18,000 in 1990, representing a 13.9% increase. Medical technologists' starting salaries rose from $20,200 to $24,000 in the same period, an even heftier increase of 18.8% (Figure VI). Figure VII lists average starting salaries in 1990 for five lab positions.
Raising salaries to strengthen recruitment and retention efforts can work well, according to the administrative supervisor in the lab of a large nonprofit hospital in California: "Recent negotiations resulted in a 17.75% increase in salaries over a two-year period. Prior to this increase, employees were leaving to go to labs paying better salaries. Now, technologists from other labs are applying to work at our institution. " Offering financial incentives beyond a higher straight salary is another popular recruitment technique (Figure VIII). 9 Retention. Once lab workers have been employed, what salary enhancements might entice them to stay? Merit raises, the most common route, appear on the paychecks of lab workers in more large hospitals than small ones (68% and 57%, respectively). Across-the-board percentage increases in pay are offered in 39% of respondents' institutions, while 19% offer bonuses. Bonuses are offered by 21% of large hospitals and 12% of small hospitals. Multiple responses were accepted.)
Asked for unusual salary enhancements offered by their institutions, respondents listed monthly gift certificate drawings for employees who have not used all their sick leave time, free housing for three months, and up to 75% tuition reimbursement for dependent children attending college. One small nonprofit hospital in Maryland reportedly provides free parking, sign-on bonuses, weekend differentials, tax-deferred annuities, and extra pay for unused holiday, sick, or vacation time.
Dr. Castleberry doubts that such incentives will resolve the shortage crisis. "The answer to our problem is not to recruit people from other labs. We need to recruit people into the field," she states. "Bonuses do not create new people in the work force. They merely pull individuals from place to place. We have to do something about salaries. Bonuses are a one-time shot that don't reflect a long-term commitment to improving the salary structure.
Only the lucky ones. Attractive recruitment packages are by no means universal. Respondents indicate that although many facilities lack necessary personnel, they simply do without. "Our supervisor is making no offers to entice people," says a hematology supervisor from Arkansas. "We just have to pick up the slack." Similarly, from a department head in the laboratory of a small hospital in Louisiana: "Our lab works several people short with no salary adjustment. Employees are killing themselves trying to cover 24 hours. "
Institutions that do not offer financial incentives may find themselves selecting employees from a dwindling pool of applicants. "We have only been able to hire new grads or people who have relocated because they moved to the area with their spouses or to be close to family," says the administrative director from a small nonprofit hospital in Minnesota.
Spending freeze. Budget restrictions or freezes have been implemented or maintained in 61% of respondents' facilities during the last three years-fewer than the 69% of respondents who reported that situation in 1988.4 Among labs instituting budget restrictions or freezes in 1990, 67% put a limit on filling vacancies and 65% on capital spending. In addition, 64% instituted budget cuts, 47% restricted continuing education, 39% froze salary increases, 20% laid off staff, and 4% used other measures. Multiple responses were accepted.) Most respondents (88%) say budget restrictions lower morale. The education coordinator from a large nonprofit hospital in Michigan states, "There are many frustrated and angry technologists and managers who are looking for a way out of the health care environment or have developed an attitude of just putting in my time, just collecting a paycheck' in order to survive the stress of increased work with decreased resources. "
A case in point: Having had no pay raises in four years and then being notified of a cut in pay for standby call, reports the chief technologist from a small Federal hospital in Mississippi, led to the departure of all the facility's medical technologists.
Not only do budget restrictions affect personnel, but they can impair patient care. A chemistry supervisor in Wyoming reports that reduced spending has caused a dramatic decrease in the number of patients admitted and treated in his small VA hospital.
A supervisor from a small nonprofit hospital in Michigan points out: "Budget cuts are improving efficiency at the expense of patient care. Very poor upper management and too much middle management are mostly responsible for irresponsible spending. " Administrators at one institution, finding that drastic reductions in spending were having a negative affect, changed their minds. "Cuts had been made across the board even though th lab was experiencing g explains one panelist. "Cuts and freezes for the tab were lifted after only two months and for the rest of the institution after eight months. We are now experiencing phenomenal growth. "
The problem with budget restrictions, Dr. Castleberry says, is that they prevent management from hiring the number of people needed to do the ob. Management then "demands more of the staff they have. This in turn increases stress, which is a major source of morale problems," she says. "Unfortunately, the items that are cut, such as CE, are the things that are important to improving retention. It is a continuing downward cycle without the positive reinforcement needed to keep staff members. " o Whose fault is it? The places to lay blame for the state of affairs in the clinical laboratory profession are numerous-and everyone points to someone else. Recurring comments focus on the following factors:
Management. Many respondents fault management for having failed to deal effectively with problems confronting laboratorians-even though the MLO panel represents supervisors and above rather than a cross-section of all lab employees. "Burnout will increase with the feeling of worthlessness that low salaries bring to employees," states a lab supervisor from a small proprietary hospital in New Mexico. "Management needs to wise up and act proactively in regard to the shortage of trained clinical lab personnel before it becomes as critical as the nursing shortage. If we were as blind to our changing market as they [management] are to our needs, we'd be out of business. "
"I have not seen morale this low in the I I years I have been in this institution," says a department head from a small nonprofit hospital in Pennsylvania. "I find it increasingly difficult to continue to support the policies of the administration. "
A pathologist from a midsize nonprofit hospital in New Jersey expresses a similarly high level of frustration: "The administration had better wake up and listen to the pleas of the pathologists and lab managers. We cannot continue to produce high-quality work while being underpaid, overworked, understaffed, and undercapitalized. "
DRGs. About half of MLO panelists (51%)-considerably fewer than in 1988 64%)-blame DRGs, at least in part, for budget restrictions in the laboratory. "The DRG system demands speed and efficiency, but also creates irrational stress resulting in turnover, low morale, and poor quality," asserts a technical supervisor from a midsize proprietary hospital in Florida. "Under these conditions, it is impossible to provide adequate health care. "
Before DRGS, notes the lab manager in a small proprietary hospital in Georgia, annual raises at that institution were 7% to 10%. Now they are 2% to 5%.
CLIA 1988. Panelists' comments were divided concerning likely effects on lab salaries of the Clinical Laboratory Improvement Amendments of 1988. Some feel that CLIA 88 will decrease the value of laboratorians' salaries, while others believe it will increase them.
The education coordinator at a midsize nonprofit hospital in Ohio writes, "Salary scales will not reflect the true worth of MLTs and MTs until we are recognized as professionals who provide a significant contribution to the health care system. Congress and CLIA have gone a long way to prevent this by portraying MLTs and MTs as overeducated button pushers. "
The lab manager from a midsize nonprofit hospital in Arizona anticipates mixed results from the pending regulations: "I expect CLIA 88 will have a positive effect in raising salaries and a negative effect on lab morale overall. The chief technologist from a small nonprofit hospital in Kansas believes CLIA will cause technologists' salaries to increase but technicians' to drop.
* The U" word. According to the results of MLO's survey, 15% of respondents said employees at their facilities are unionized-virtually the same proportion as in the 1988 MLO survey. Among this 15%, clerks constitute the largest group of lab employees belonging to a union 59%), followed by bench workers 55%), glassware staff 34%), supervisors 18%), and others (23%). In 44% of the small group of respondents' labs where unions are a presence, all nonmanagerial employees are union members.
Castleberry believes the next few years will tell whether union membership will expand in U.S. clinical laboratories. "Unions are something management definitely has to think about," she warns. "If you don't address a basic fundamental need, such as salary, and you compound that failure with stress and poor working conditions, then you are setting up the perfect environment for staff to be attracted to the things which unions promise. " Almost half (47%) of respondents whose colleagues belong to unions say unionized employees have not increased compensation due to membership. Among the 53% who disagree, unionized employees in nearly three-fourths (74%) of panelists' labs that recognize unions can attribute pay raises to union membership. Other prizes include better fringe benefits (64%) and working conditions (48%). (Multiple responses were accepted.) Panelists report relatively few unionized employees at their facilities. Nevertheless, rumblings continue. "Laboratory personnel will have to follow the model of RNs requiring representation by a professional bargaining unit to command better wages, " declares a supervisor from a small nonprofit hospital in Michigan. A section head supervisor from a midsize nonprofit hospital in Illinois states, "Pathologists deserve unions.
Even the gains of unions can create dissension among the staff. A supervisor from a small nonprofit hospital in California cites one: "If the laboratory staff belongs to a union, there should be an increase of salaries based on the individual's performance. Right now, our techs' salary increases are based on union and management's negotiations. A productive tech gets paid the same as an unproductive tech. "
A look to the future. More than half (64%) of panelists expect salaries to improve in the next five years. Figure IX compares panelists' views from the last three MLO surveys on whether salaries are about to improve, and why.
In spite of the fact that many express hope for the coming years, a number of respondents speak only of leaving the field to find a more rewarding career. The laboratory director from a small nonprofit hospital in Utah feels that many less stressful jobs pay as well or better.
A department head from a blood bank in Florida sees this trend developing in her staff. "Many of the employees in our lab are currently going back to school. Several are going into nursing for the higher pay scale that nurses have in our area. Others are looking into the teaching profession. "
A lab supervisor in a large nonprofit hospital in Ohio states that five out of I I employees there are attending graduate school to change careers. Another supervisor from a group practice lab in Wisconsin has the same problem: "Three of my key staff members are looking for better-paying opportunities. One is considering leaving the field. "
It's hard to gauge the number of individuals leaving the profession, Castleberry says, since no substantial data on the subject are available. "If you ask people whether they are going to be working in this field in the next five years, they say no," she says. "But if you come back five years from now, the majority will still be here. "
1. Benezra, N. Lab salaries (Special Report, Part 1): Still too low, but rising. MLO 21(l): 20-23, January 1989.
2. Fitzgibbon, R J. What lab managers earned in 1990 (Editor's memo). MLO 22(11): 9, November 1990.
3 Benezra, N. Lab salaries and benefits (Special Report, Part 1): Are they keeping pace? MLO 19(l): 30-34, January 1987.
4. Benezra, N. Lab salaries (Special Report, Part 11): Many think compensation has to get bet ter. MLO 21(l): 29 31, January 1989.
5. Benezra, N. Lab salaries and benefits (Special Report, Part 11): Dissatisfaction in the ranks. MLO 19(l): 37 39, January 1987. Are nurses worth more than laboratorians? Nearly one-third (32%) of respondents to MLO's 1990 salary survey say their employers are more generous to nurses than to laboratory workers. They aren't happy about it. "Nurses' salaries continue to improve to meet market demands," observes Margaret A. Wachowski, MT(HHS), chemistry supervisor at Roxborough Memorial Hospital, Philadelphia, "but 'ancillary services' are considered less crucial."
"Lab salaries have never been comparable with those of the nursing profession," says Robert E. Shelton 11, administrative director of laboratory services, Maryvale Samaritan Medical Center, Phoenix, "even though at the minimum an A.A. [Associate of Arts) degree with an internship is required for entry-level technician work."
Barbara Bloom Kremi, M.S.I.R., director of the department of human resources at the American Hospital Association (AHA) in Chicago, asserts that hospital salaries generally are based on the requirements of each job, not on the specific education acquired to obtain it. "An educational degree should only be used if it is an integral part of the bona fide occupational qualifications," she says.
According to the Bureau of Labor Statistics, the average starting annual salary for registered nurses in the United States in March 1989 was $24,605.1 Data collected by researchers at the University of Texas Medical Branch at Galveston showed hospital RNs' starting salaries to average $23,488 in 1989. The following year, medical technologists were starting out at an average salary of $24,000 (see Figure VI). Even accounting for inflation, the figure is closer than many frustrated laboratorians might have predicted. El Greener grass. Connie R. Curran, R. N., Ed. D., FAAN, a health care consultant in Chicago, cites another factor: working conditions. "The average MT makes more money than the average nurse and has a much more desirable work schedule," says Curran, a past vice president of the AHA. "On holidays, 95% of all employees working in hospitals are nurses. In addition, unlike nurses, laboratorians aren't alone at night with people who are dying, and having to make decisions about it."
Kreml makes a similar point. "Nurses are called upon to make critical decisions and use a great deal of judgment on a day-to-day basis. They have to react to life-or-death issues very quickly," she says. Technologists have to use critical judgment to Assess slides, but in many instances they have more lag time. If they don't make a decision at that moment, it is not going to affect a patient as radically as a delayed decision by a nurse will."
Distinctions should be made for nurses who do less critical decision making, an MLO survey respondent believes. "With the increased health risks in the lab today, laboratorians should be paid as much as or more than the nurses who only check charts and oversee work, " says Mary Alyce Watkins, MT(ASCP), manager of the laboratory at the Guilford County Health Department in High Point, N.C. "Some nurses at our institution do nothing but write down [patients') temperature and blood pressure, yet they make three to five thousand dollars a year more than we do."
"Nursing is generally seen as a more attractive profession than medical technology," says Janet L, Pailet, J.D., director of government and professional affairs for the American Society for Medical Technology in Washington, D.C. "Nurses are perceived as being directly involved with patient care and having much higher visibility as professionals. "
*Organization. Many laboratorians seem to think the nursing profession is solidly unified under one association. Not true, says Curran. "The nursing profession certainly isn't organized," she says. "That is one of our big problems."
Laboratorians also crave organization, but it has remained elusive. "Technologists do not band together to promote the profession," notes Kathleen Smith, M.A., MT(ASCP), laboratory manager at Bakersfield Calif.) Memorial Hospital. "A group will have more power than an individual, especially when it comes to lobbying."
MLO panelist John Bryant, chemistry supervisor at Castleview Hospital in Price, Utah, has a similar opinion. "Hospitals are bending over backwards to recruit nurses with bonuses and point systems for earning gifts," he says. "Lab personnel feel cheated and not well recognized for their profession, but we lack the good organization to do anything about it." But until laboratorians are recognized by hospital administrators for what they do, notes Pailet, the disparity in salaries between nurses and technologists will continue.
*Strength in numbers. Constituting the largest single group of employees in hospitals has helped nurses gain financial ground, notes Lucille A. Joel, R.N., Ed.D., FAAN, president of the American Nurses Association. She admits this advantage has helped nurses attain their current status. "Nurses represent the largest single group of employees in hospitals. As such, their value is very visible," says Joel, professor and chair of the department of adults and the aged at Rutgers College of Nursing in Newark, N.J. "Because of the strategic position they hold, nurses have been successful in speaking out both on their own behalf and on behalf of their patients."
Being the largest group rivets administrators' attention at any sign of trouble. "When you have a shortage of your largest group of workers, you've got a problem," Curran says. "The quick fix has been to offer things like bonuses."
The common practice of rewarding nurses with bonuses has aroused considerable dissension in the workplace, believes Diana J. Wiebusch, MT(ASCP), afternoon supervisor at Wyandotte (Mich.) Hospital and Medical Center. "The nursing shortage has resulted in multiple perks for nurses, including those who have less formal education and experience than technologists," she says.
Curran acknowledges that nurses often receive the redcarpet treatment. "To keep beds and units open, hospitals have gone to a variety of incentive programs," she says. "Typically, the only group to receive bonuses has been nurses. The reason is that if hospitals have to close units or beds, they not only won't need nurses-they also won't need medical technologists or any other health care group."
The way in which hospitals explain to employees why some groups will receive bonuses and others won't can be a problem in itself. "Some hospitals have actually said to lab people, We'd like to give you more money, but we have to give it all to the nurses,' " Curran reports. "This kind of communication does nothing but engender hostility. It would be better if the administration would simply say, We have to do this [pay nurses more] to keep the beds open. if we can't keep the beds open, then everyone's job will be jeopardized."'
* Shortage. Many panelists responding to the MLO survey expect salaries to rise as the personnel shortage reaches critical levels. "The demand for MTs will begin to rival that of the nursing staff soon, and salaries should reflect that demand," says MLO panelist Dana Shelley, CLS(NCA), laboratory manager at Vaughan Regional Medical Center in Selma, Ala. But although the shortage will help boost salaries to some extent, cautions management consultant Annamarie Barros, M.A., CLS(NCA)CLDir, it will do less for lab salaries than the nursing shortage did for nurses'.
"There are alternatives if you are short of laboratorians," Barros points out. "You can send tests out, you can bring in more automated equipment to reduce the need for manpower, or you can hire individuals with fewer qualifications and train them on the job for specific tasks. I am not necessarily in favor of these substitutes," she adds, "but it is reality." Barros expands on this controversy in next month's Viewpoint column.
MLO survey respondent Peter Read, assistant manager of the laboratory at Falmouth (Mass.) Hospital, notes, Although a shortage looms large now and in the foreseeable future, I don't think we will ever attain the wages nurses have. Unfortunately, lab people don't have the high visibility that nurses do."
As the shortage of technologists worsens, Kremi forecasts, market forces will drive salaries up. "We are seeing a lag time because the laboratorian shortage has not hit as hard or as fast" as the nursing shoratage did, she says.
By the time the market comes into play, however, it may be too late. MTs are already leaving hospitals for small group practices and physicians' office labs, Pailet observes. Consulting, she says, is another growing field for medical technologists.
MLO survey respondent Betty J. Reed, MT(ASCP), laboratory director at Orchard Creek Hospital, Rosenburg, Tex., has decided not to wait much longer for salaries to rise. "I for one have started RN training for a career switch in case wages don't improve quickly," she reveals.
Reed says it made sense for her to go back to school as a hedge against probable developments. "I love nursing, too," she says. Like lab work, "it is related to medicine and the money is so much better" than lab salaries. "Because of rising costs, some rural areas may need to combine the two [nursing and medical technology]. I will probably look for that type of position.
"Everyone says that the reason nurses are paid more is supply and demand," she concludes. If everyone gets out of the lab field, there goes the supply. if that's the way hospital administrators, comptrollers, personnel departments, and laboratory management want to do it, that is how we will play it."
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|Title Annotation:||includes article comparing nurses' & lab technologists' salaries|
|Publication:||Medical Laboratory Observer|
|Date:||Jan 1, 1991|
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