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Laboratorians speak out on benefits, managed care, and the bottom line.

Since 1990, the percentage of laboratorians predicting a grim future for lab salaries has more than doubled. Have we reached rock bottom?



I have been at my maximum salary level since my fifth year of employment," says the microbiology supervisor at a midsize, not-for-profit hospital in suburban Pennsylvania. "Other than cost-of-living increases, there has not been one across-the-board raise since 1991. Also, we have lost benefits in medical insurance and are unable to attend long-distance seminars and national conventions."

But the lab manager at a small, not-for-profit hospital in rural Oregon paints a different picture. "We offer a high wage and salary with a broad spectrum of benefits. A rural hospital with complex laboratory services may [otherwise] have difficulties recruiting, and it may be hard for spouses or significant others to find employment."

Focus on fringes. When raises are low or nonexistent, there is a natural tendency to focus on other job benefits. As part of its 1995 survey of salaries, MLO asked lab staff what fringe benefits their facilities offer and if they are adequate. As has been the case since the first survey was conducted in 1987, paid vacation, sick leave, and medical insurance top the list of benefits available in American labs.[1-4]

Of the top 10 benefits, virtually all laboratorians (99.8%) polled by MLO report that their labs offer paid vacations (Figure 1). Ninety-eight percent of respondents get paid sick leave and medical insurance. But while 93% are happy with the number of their vacation days and 92% judged their sick leave as adequate, only 80% of respondents feel that their paid medical insurance is sufficient. Ninety-three percent of labs offer pension plans, but only 71% of employees are happy with them. Other top benefits are paid life insurance (89%), maternity leave (87%), paid seminar/workshop expenses (85%), dental plans (80%), and paid CE (78%).

"Over the last 2 years, we have had many of our benefits reduced," the lab manager at a small, not-for-profit hospital in rural Colorado reports. "We have seen holidays dropped, employees required to pay more on health insurance, and cafeteria prices increased."

Rising benefits. Three benefits increased significantly in prevalence over the last 2 years: maternity leave (from 79% to 87%), dental plans (from 73% to 80%), and eye care plans (from 35% to 43%).[1] Of the 17 benefits listed in the survey, only one paid uniforms - dropped in prevalence (from 43% to 39%). That benefit is still more widespread than it was in previous surveys.[2-4]

Top benefits such as paid vacation, sick leave, and medical insurance vary very little across institution type or region of the country. Other less common benefits, however, vary considerably according to where respondents live or work. For example, the West seems to be the place to work for clinical laboratorians who need eyeglasses but not, apparently, for laboratorians who want to attend seminars or obtain CE at the expense of their employer.

* Eye care plans are vastly more popular in the West (61%) than in all other areas of the country, especially the South (35%), and are more common in suburban and urban labs than in rural ones (47% and 48% versus 32%, respectively).

* Paid seminar/work expenses are enjoyed by more rural laboratorians than suburban and urban ones (89% versus 83% and 83%, respectively) and are far more common in the Midwest (90%) than in the West (77%).

* Paid CE tuition is most prevalent in the Midwest and least common in the West (84% versus 73%, respectively).

* Dental plans are reported more often by laboratorians in large and midsize hospitals than those in small ones (89% and 92% versus 80%, respectively). They're also more popular in suburban and urban labs than in rural ones (83% and 85% versus 73%, respectively).
Figure 1

What benefits does your institution offer? Are they adequate?

 Offered Offered
 1995 Adequate 1993 1991 1989

Paid vacation 100%(*) 93% 99% 100% 99%
Paid sick leave 98 92 97 98 97
Medical insurance 98 80 97 98 97
Pension plan 93 71 91 87 88
Life insurance 89 84 89 91 86
Maternity leave 87 93 79 81 76
Paid seminar/ 85 61 84 84 82
workshop expenses
Dental plan 80 70 73 69 72
Paid CE 78 66 76 74 72
Eye care plan 43 67 35 23 31
Paid uniforms 39 86 43 19 29
Paid parking 36 90 33 36 35
Laundry allowance 19 93 19 5 11
Paid professional 20 87 19 22 19
membership dues
Child day care center 17 71 16 10 14
Meal allowance 7 82 7 9 8
Day care reimbursement 6 65 5 NA 5
Other 32 N/A 4 11 7

* Rounded from 99.8%.

NA = Not asked; N/A = Not applicable.

What would you like? MLO asked, "Which benefit not currently provided would you most like to see added?" Nineteen percent of respondents identified child care as their choice, 14% said eye care, and 10% wanted professional membership dues paid by their employer (Figure 2). When asked what they wanted least out of what was currently received, 21% identified maternity leave, 11% life insurance, and 11% paid uniforms.

Answering a different question, 37% of respondents said that their institutions provide flexible, cafeteria-style benefits that allow employees to choose the fringes they want within a maximum amount of benefit dollars. Sixty-three percent have no such option. (In the 1993 survey, 31% of respondents received flexible benefits.[1]) This year the option was more likely to be found in large hospitals than in midsize or small ones (51% versus 41% and 37%, respectively), and in the South rather than the West, Midwest, or East (45% versus 41%, 32%, and 31%, respectively).

Budget restrictions. More than three out of four labs (76%) have suffered budget cuts or freezes during the last 3 years; 21% have not; 3% were unsure. The 76% figure is up from the 1993 survey, in which 66% reported cuts or freezes.[1] More likely to have experienced cutbacks or freezes are:

* Hospital rather than independent/ group practice labs (81% versus 64%, respectively)

* Large rather than midsize or small hospitals (89% versus 87% and 71%, respectively)

* Suburban and urban rather than rural labs (82% and 82% versus 66%, respectively)
Figure 2

Top 5 benefits not currently received but desired

Child care 19%
Eye care 14
Paid professional 10
membership dues 10
Dental 9
Continuing education 8

Top 4 benefits provided but least desired

Maternity leave 21%
Life insurance 11
Paid uniforms 11
Child care 10

"Our lab makes money for the hospital, but that doesn't seem to matter much anymore," says a section supervisor at a large, not-for-profit hospital in Indiana. "Some of our budget reductions have cut things that were really wasteful, and that was fine. But after 3 years of cuts, we have cut to where any more budget reductions will reduce the quality of our work. This really bothers me.

"As a front line supervisor, I feel I have been left holding the bag," this laboratorian continues. "We have been told to expect 3 to 4 more years of cuts. So far I have been able to protect my staff and the quality of our work. But I wonder if I will be awake worrying every night next year."

The manager of a public health lab in suburban New Jersey agrees: "Our lab budget has been cut by 42% in the last year, but we are expected to carry on as usual."

According to a section supervisor at an independent lab in suburban Missouri, "Budget cuts can make the operation more efficient, but physicians still order tests Stat without consideration for batching."

"Our budget freezes have been primarily due to administrative policies and turnover at higher management levels," says a technologist at a small, not-for-profit hospital in rural Arizona. "This has somewhat decreased employee morale, especially among those at the lower end of the ladder. They see jobs being eliminated in some direct patient care departments, while jobs have been added in administration, the front office, and billing."

Tight money. Figure 3 shows the measures taken by those labs that experienced cuts or freezes. Overall, three out of four facilities (75%) placed a freeze or limitation on filling vacancies, 64% enacted further budget cuts, 57% placed a freeze on capital spending, and 52% restricted salary increases.

There were regional and other differences in how laboratories approached tightened purse strings. While the first step taken by all labs was placing a freeze or limitation on filling vacancies.

* Small hospital and rural labs froze capital spending as a second step, then cut budgets.

* Independent and group practice labs and Western labs froze salary increases before freezing capital spending.

"In order to reduce lab costs, our management was converted to a team approach," says a team leader in the lab of a midsize, not-for-profit hospital in urban Connecticut. "Department supervisors and their assistants were deleted. Each department now has a team leader instead."

Is CLIA a culprit? When those who experienced budget cuts or freezes were asked, "Is CLIA in any way responsible for these budget restrictions?" an overwhelming 64% said no, 16% said yes, and 21% were unsure.

In the opinion of the lab manager at a small, proprietary hospital in suburban Florida, "CLIA has created a better-documented lab but, at the same time, an unskilled labor force. Poor decision making is occurring and, with increased demands, errors are on the increase. I do not see new MT recruits at my door."

"Some managers feel justified in paying MTs lower wages because of a surplus of personnel and CLIA," says the LIS manager of a large, not-for-profit hospital in Utah. "Some have been paid as low as our student rate for several months. This has significantly decreased employee morale."

"Before CLIA and health care reform, I, as a manager, felt obligated to staff my laboratory with more educated and experienced technologists," says the lab manager at a small, not-for-profit hospital in rural North Dakota. "There is a direct relationship between education/experience and quality. Today, top-level administration is well aware of who CLIA defines as being qualified to perform lab testing. That, along with budgetary restraints, means my staff will eventually be replaced with less-educated workers."
Figure 3

How labs respond to budgetary distress

Freeze/limitation 75%
on filling vacancies

Further budget cuts 64

Freeze on capital spending 57

Freeze/limitation 52
on salary increases

Freeze/limitation on CE 43

Layoffs 32

Other 6

Multiple responses were accepted.

The manager of a group practice lab in rural Michigan is one of those who has learned to live with CLIA while harboring great reservations about the advent of managed care. "We were already complying with the CLIA regs, so the actual institution of those rules really had no significant impact on our operational expenses," she says. "The increasing trend to managed care systems, however, has significantly increased the amount of work being sent to referral labs. This has caused a notable loss of revenue in our POL." This manager projects that 25% of her work will be sent to referral labs this year, up from 10% in 1994. "Thirty new managed care contracts have been added in our area."

Managed care. MLO also asked those who experienced budget cuts or freezes during the last 2 years, "Is managed care in any way responsible for these budget restrictions?" An overwhelming 70% said yes, 18% said no, and 12% were unsure.

According to the evening shift supervisor working at a midsize, not-for-profit hospital located in urban Ohio, "With the sword of Damocles over our heads every time a managed care contract comes up, morale is down and tension is up." In Figure 4, survey respondents sound off about managed care and its impact on the future of the clinical laboratory.

Effect of cutbacks. MLO asked laboratorians if budget restrictions have affected their labs' operations in terms of employee turnover, morale, and efficiency.

Turnover. Sixty-two percent feel that turnover has been unaffected; 32% believe that it has been affected; 7% are unsure.

Morale. Eighty-nine percent of respondents say that morale was affected; 8% feel that it was unaffected; 4% are unsure.

Efficiency. Fifty-one percent say that efficiency was affected by budget cuts; 41% believe the opposite; 9% are unsure.

Rampant pessimism. Four out of five laboratorians (80%) believe that salaries will not rise appreciably over the next 5 years, 10% disagree, and 10% are unsure. Figure 5 shows the dramatic increase in this gloomy attitude over the last several surveys. Since our 1991 study, the percentage of laboratorians predicting a grim future for lab salaries has more than doubled.[4]

Of the vast majority who believe salaries won't rise, more than three out of four (78%) blame budgetary problems. Nearly half (49%) cite unprofitable operations, 43% blame increased automation, and 36% attribute it to a surplus of personnel. Multiple responses were accepted.

Three out of four laboratorians (75%) also feel that their colleagues nationwide are dissatisfied with their salaries, 13% disagree, and 12% are unsure. Of those who cited widespread unhappiness, 72% feel that the dissatisfaction has somewhat or greatly increased over the last 5 to 10 years; 23% feel the unhappiness level is about the same; only 4% think laboratorians are happier about their salaries. Eighty percent of those citing dissatisfaction believe that this condition will make more laboratory personnel leave the field; a nearly equal percentage (75%) think it will make it hard to recruit new personnel.

"Laboratory salaries have been a great disappointment to me," says the lab manager of a small state hospital in rural Wyoming. "Initially the laboratory field looked like a progressive and profitable field of endeavor. Now nurses, pharmacists, and physical therapists have exceeded our salary with basically the same education and often less responsibility."

According to the chief medical technologist at a group practice laboratory in urban Florida, "My son, who is a recent college graduate in environmental engineering, makes on his first job almost what I make after 14 years in the clinical laboratory field. How did it get this bad?"

Care is key. "The key issue of health care should be health care, not profit," says the lab manager at a midsize, not-for-profit hospital in Ohio. "We need to look at what has happened in other industries when mega deals have occurred: closed plants, lost jobs, increased taxes, and poorer education."

A lab section head in a large, not-for-profit hospital in urban Texas maintains, "Laboratorians are the hidden specialists; that which is not visible is forgotten. Limited or no patient contact places laboratory scientists in a subordinate position to nursing staff."
Figure 5

In the next 5 years, do you foresee lab salaries in general rising

 1995 1993 1991

No 80% 51% 36%
Yes 10 38 64
Unsure 10 10 NA

NA = Not asked.

"In a rare moment when we can catch our breath, we dream aloud about our next career - undemanding careers like retail clerk or mail-order operator," laments a section supervisor employed with a Missouri independent laboratory. "The paperwork and the constant fight to obtain reimbursement by insurance companies or Medicare tends over time to demoralize even the most self-motivated employee. Still, we keep on 'keeping on' because of the reward of serving our patients their gratitude and our knowledge that we are doing a hard job well."


1. Jahn M. Lab salaries, Part 1: A precarious balance on the shaky dollar. Part 2: With budgets frozen, careful management is key. MLO. January 1993; 25(1): 24-33.

2. Benezra N. Special report, Part 1: Lab salaries: Still too low, but rising. Part 2: Lab salaries: Many think compensation has to get better. MLO. January 1989; 21(1): 20-31.

3. Benezra N. Special report, Part 1: Lab salaries and benefits: Are they keeping pace? Part 2: Lab salaries and benefits: Dissatisfaction in the ranks. MLO. January 1987; 19(1): 30-39.

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


Laboratorians speak out on managed care

"At this particular time in the health care field, we cannot become greedy if we want our institutions to survive. Small hospitals must meet their budgets and become a part of the managed care system."

- Lab manager, small, not-for-profit, North Carolina

"Managed care has decreased volume so there are fewer dollars for other projects."

- Lab manager, small, not-for-profit, New Mexico

"With reduced pay to labs and increased testing, managed care has seriously damaged overall lab operations."

- Section head, small, not-for-profit, Iowa

"Because of the continual threats of layoffs, profit losses due to managed care, and the consolidation of lab testing, the hospital's attitude is: 'Be thankful you have a job-despite the fact there may not be money for merit increases.'"

- Section specialist, midsize, not-for-profit, Arizona

"Cutbacks by hospitals due to managed care concessions will cause more budget decreases. Everyone will be glad to have a job - whatever the salary - or will leave the profession completely and go to an industry related to medical technology or teaching medical technology."

- Lab manager, midsize, not-for-profit, Missouri

"For 25 years the benchmark was the MT with a 4-year degree. Thanks to CLIA, this has been undermined to that of an A.A. degree. Thanks also to automation and managed care, the MT has become doomed like the dinosaur. Why pay from $35,000 to $50,000 for a person with an MT degree to troubleshoot and think when you can pay an MLT under $30,000 and pocket the difference?"

- Lab manager, public hospital, New Jersey

"Managed care contracts are going to put a major crimp in salaries for all personnel. I have yet to understand how the public expects high quality care but not to have to pay for the skills and knowledge necessary to deliver it. Managed care organizations want to control the benefits people receive to save money for their stockholders. Someone somewhere has lost the focus of what health care is supposed to do. This is what happens when politicians, lawyers, and profiteers get involved."

- Lab manager, midsize, not-for-profit, Ohio

"Laboratories are particularly susceptible to the low reimbursement that results from their share of managed care contracts. It will be a challenge for laboratories located in small to midsize hospitals to remain cost-competitive and to avoid losing a part or all their business to non-hospital-based competitors,"

- Lab manager, midsize, not-for-profit, Colorado

"Managed care will hold salaries constant, force layoffs, and increase the utilization of technicians and unskilled personnel, in place of technologists, to decrease lab costs."

- Section supervisor, large, not-for-profit, Iowa

"Managed care will kill the commercial lab field, making fewer jobs available. But these jobs will require a greater variety of skills and, therefore, salaries will continue to be stronger than expected."

- Lab director, not-for-profit hospital, Michigan

"With increased managed care, funds are no longer available for benefits and salary increases. Salaries are based on community standards, and over the last 2 years the trend has been a decrease in the average salary."

- Lab manager, small, not-for-profit, Florida
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Title Annotation:Salary Survey, part 2
Author:Jahn, Mike
Publication:Medical Laboratory Observer
Date:May 1, 1995
Previous Article:Jobs plentiful, but incentives and salary increases scarce.
Next Article:Reengineering the laboratory.

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