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Lab staffing and career trends: time for cautious optimism?

Lab staffing and career trends: Time for cautious optimism?

After a few years of decline brought on by prospective payment, employment levels have stabilized at many laboratories and begun to rise at a number of others. Managers and supervisors are more optimistic about job prospects in the laboratory field than they were two years ago.

Increased outpatient testing is the main reason more jobs will be available in the future, according to MLO's latest survey on lab staffing and career trends. We received responses from 288 members of our Professional Advisory Panel, all of them holding laboratory management positions.

Part I of this special report will concentrate on staffing and scheduling. In Part II, which follows, members of the management team ponder their own professional prospects and what medical technology can offer a newcomer to the field.

The most encouraging news from the staffing front is that the tide of layoffs that followed the arrival of DRGs appears to have ebbed. As Figure I shows, only one-fourth of the laboratories surveyed in 1987 reduced their staff within the last year, versus 42 per cent of those polled in a similar 1985 study. Better yet, 32 per cent of the laboratories actually gained FTEs--almost double the percentage of the earlier survey.

These figures were fairly uniform across the East, South, Midwest, and West. Laboratories in the West and Midwest saw the biggest turnaround this year; in the 1985 survey, half of them had suffered staff reductions within the previous 12 months. Independent laboratories were particularly active in adding FTEs; 45 per cent expanded their staffs.

The outlook for the future has also brightened considerably. Fully 40 per cent of the panelists (24 per cent in the 1985 survey) believe staff size will grow in the next three years. Conversely, only 14 per cent foresee staff cuts, compared with 30 per cent in 1985. The remaining panel members, 46 per cent as in 1985, expect no change in staff size.

Three-quarters of those who plan to hire more staff point to increased outpatient testing as a key reason (Figure II). Fifty-seven per cent also mention a larger in-house test menu.

When laboratories must instead cut back on staff, attrition remains the method of choice. Two-thirds of the facilities that lost FTEs in the last year did not fill vacancies (Figure III). This approach was favored by nearly 90 per cent of the labs cutting staff size in hospitals with more than 300 beds and by half the labs cutting staff in smaller institutions.

Nearly a quarter of the labs pared labor costs through cutbacks in paid hours, and the same proportion instituted selective layoffs by jobs classification.

Twenty-seven per cent of the panelists with reduced staffs cite lower workload as a reason, a much smaller proportion for this factor than the 56 per cent recorded in the 1985 survey.

On the other hand, 51 per cent attribute staff reductions to budget cuts, nearly as many as in 1985. Two-thirds of those whose staffs shrank at larger hospitals blame budget cuts, compared with half of those at smaller facilities. Budget cuts played a part in lowering FTE totals at 71 per cent of the labs with reduced staff in the South; at the other extreme, only 28 per cent of Midwestern labs with reduced staff were affected by budget cuts.

Another significant cause of staff reductions was reorganization of laboratory services, cited by 30 per cent of the labs.

As for the size of the management staff, 74 per cent of the panelists report no change this year over last year, and 78 per cent anticipate no change in the next three years. These figures were similar to those in the '85 survey.

Fourteen per cent of the surveyed laboratories--about 20 per cent of the independents and larger hospital labs--added management staff during the last year, and an equal percentage plans to add more in the next three years. Twelve per cent eliminated some supervisory positions in the last year, and 8 per cent predicted future cuts.

No clear trend emerged on the mix of medical technologists and technicians in laboratories. Sixteen per cent of the labs raised their proportion of MLTs, 13 per cent raised their proportion of MTs, and 71 per cent made no change in the mix during the last year. Over the next three years, however, 25 per cent of the panelists look for an increase in MLTs over MTs, 12 per cent look for the opposite to occur, and 63 per cent anticipate no change (Figure IV).

Among those favoring more MLTs, an Arkansas panelist remarks that they "are cheaper than MTs, and saving money is now the name of the game.' Some laboratories view MLTs as a way to get added mileage from a limited budget. An Ohio laboratory director notes that his lab plans to hire less costly technicians and increase total budgeted payroll hours to accommodate heavy demand for early-morning testing.

Many other panelists, however, laud the technical versatility of medical technologists. "Under DRGs, the laboratory staff has to do more with less, and the "less' has to be broadly trained and well educated,' one laboratory manager explains. And a coagulation/ urinalysis/immunology supervisor feels that the number of technicians in the laboratory will decline because more of them are returning to school to prepare for an MT or an equivalent registry.

In the area of scheduling, 70 per cent of the laboratories are on standard seven- or eight-hour shifts, compared with 74 per cent in the 1985 survey. The geographic breakdown shows wide variation in dependence on standard shifts, from 85 per cent of the labs in the East and 72 per cent in the Midwest to 63 per cent in the West and 62 per cent in the South.

The most common alternative is the 10-hour shift (or four-day work week), used at least to some extent by two-thirds of the remaining laboratories. In the West, it's the main choice of 90 per cent of the labs that are not on standard shifts.

Other laboratories rely on a variety of scheduling strategies to maximize efficiency and accommodate a fluctuating workload. A 350-bed Connecticut hospital laboratory with 81 FTEs solved the problem of covering its evening and night shifts on weekends by devising a unique schedule for two of its technologists. After completing a standard tour from Monday through Friday, one technologist works a 16-hour shift starting at 4 p.m. on Saturday and again on Sunday. Then that technologist rests for a week while the other goes on the seven-day work schedule.

A Texas laboratory uses a combination of 10-hour shifts, 16-hour shifts for weekends, and a seven-on, seven-off rotation-- seven 10-hour days followed by seven days off.

In Albuquerque, employees at three Presbyterian Healthcare Services hospitals can work different schedules--such as 10- or 12-hour shifts--if their preferences and the institutions' needs coincide. According to administrative laboratory director David Huelsmann, PHS gives employees 40 hours of pay for every 36 hours worked on weekends, thereby solving one particular scheduling problem.

Staff members rotate through sections, or work in more than one section, at 73 per cent of all laboratories, which matches what MLO found in its 1985 survey. Rotation is more common in labs at hospitals with fewer than 300 beds (90 per cent) than in larger hospitals (55 per cent). Eighty-two per cent of the labs in the West and the Midwest practice rotation, compared with about two-thirds of those located in the South and the East.

Given this multidiscipline emphasis, it's no surprise that nearly half the panelists expect to see more generalists on staff in coming years. Just 9 per cent say their labs will have fewer generalists, while 42 per cent believe the number of generalists in their labs will remain the same. On the other side of the coin, only 15 per cent predict more specialists in their labs, while 44 per cent expect to have fewer specialists, and 41 per cent foresee no change.

One laboratory manager explains the decline in specialization by observing, "A medical technologist is paid for his or her ability to work in all sections of the lab. Those who do not keep up their cross-training are actually losing part of what makes them more valuable to the lab.'

Forty per cent of the surveyed labs have formal cross-training programs. By region, cross-training is conducted at 52 per cent of the labs in the South, 44 per cent of the labs in the East, 35 per cent of the labs in the West, and 32 per cent of the labs in the Midwest.

Survey findings about part-time staffing and overtime closely paralleled those of the 1985 study. Among the 86 per cent of panelists at labs with part-time employees (Figure V), nearly half expect an increase in use of part-timers during the next three years; only 5 per cent look for a decrease. As for panelists whose labs do not use part-time employees, 38 per cent predict they will hire part-timers within the next three years.

Eighty-nine per cent of the surveyed labs offer overtime pay (Figure VI). The South dips below this average, to 80 per cent. Technologists are paid overtime in 90 per cent of the labs, technicians in 74 per cent, and the clerical staff in 62 per cent.

Thirty-six per cent of the panelists predict the amount of overtime hours will drop during the next three years. Twenty per cent expect it to increase.

Then there's the opposite of overtime. At a number of laboratories, employees can volunteer to take a cut in paid hours when workload drops. It's a fairly popular way to lighten the payroll during slow periods and preserve jobs. Forty-six per cent of panelists report their organizations have tried it, more often at hospitals (60 per cent of those with fewer than 300 beds, 42 per cent of larger insitutions) than at independent laboratories (22 per cent). The practice is especially widespread in the Midwest (61 per cent of all labs) and not as common in the more heavily unionized East (31 per cent).

Several panelists believe this type of voluntary work cutback helps their institutions survive. Employees understand and are willing to do their part.

A small hospital laboratory in the state of Washington has a core of employees who routinely volunteer to go home early. When the amount of slack time theatens to decimate their paychecks, however, the rest of the lab staff shares the burden of taking unpaid time off.

A large Texas hospital gives staff members two hours of pay on "unpaid' days off. A New Mexico laboratory has designated several positions as 0.8 or 0.9 PFT (permanent full-time). In return for full benefits, these employees agree to work either a full- or part-time schedule as needed.

The plan must be fair, and benefits must be protected, panelists point out. A supervisor at a 200-bed hospital laboratory in Pennsylvania notes that many hourly employees there have refused to give up paid hours because management is not asked to make a similar sacrifice. Exemption of supervisors from paid-hour cuts has had a "devastating' effect on the staff of a 450-bed Oregon hospital laboratory, according to the lab director.

Commenting on retention of benefits for those working fewer hours, the president of a Midwest reference lab says: "You have to be careful that the hours do not fall below an insurance carrier's minimum, unless prior arrangements have been made.'

Some panelists complain that the workload invariably picks up as soon as volunteers head home, which leads to understaffing, and that employees are quick to leave as soon as their workstation clears even though there is plenty to be done elsewhere in the laboratory.

One laboratory dropped its reduced-hour program because it disrupted normal operations. "Employees abused the system and began planning ahead for their unpaid time off,' a manager commented.

"The entire staff was extremely dissatisfied with the cut in hours,' recalls the chief technologist of a small Louisiana hospital. "We went back to selective layoffs, and things finally returned to normal.'

That concludes the first part of our report on staffing and career trends. Turn to Part II for the panelists' evaluation of what the future holds for themselves and others in the lab field.

Table: Figure I How has staff size changed since 1986?

How will it change during the next three years?

Table: Figure II Why lab staffing will increase in the next three years . . .

. . . or decrease during the same period

Table: Figure III How have staff cuts been made?

Reasons for staff cuts

Table: Figure IV Will labs hire more or fewer MLTs in relation to MTs?

Table: Figure V Does the lab now have part-time employees?

If so, how will the use of part-timers change in the next three years?

If not, will the lab begin using them in the next three years?

Table: Figure VI Does the laboratory offer overtime?

Which staff members receive OT?

How will the amount of OT change in the next three years?
COPYRIGHT 1987 Nelson Publishing
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Copyright 1987 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Part 1; prospective payment upheaval, increased staffing, expansion of services
Author:Hallam, Kris
Publication:Medical Laboratory Observer
Date:Aug 1, 1987
Previous Article:Congress hears complaints about hospitals' outreach lab testing.
Next Article:Lab staffing and career trends: some encouraging words.

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