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With budgets frozen, careful management is key.

Money woes have led to delays in hiring and capital investment. While maintaining a low financial profile has not helped morale, lab management is trying to meet the challenge bravely.

BENEFITS, BUDGETS, and a fuzzy future glimpsed through a recession are on the minds of laboratorians responding to MLO's national survey of lab salaries.

Since fringe benefits are an important factor in the pay package, respondents were asked which ones are offered to them (Figure 1). Nearly all panelists (99%) can take vacations with pay. Most (97%) get both sick leave and medical insurance. A pension plan goes to 91%, and 89% receive employer-subsidized life insurance.

Although fat hospital profits do not necessarily lead to better benefits, plummeting profits can leave fringes trailing. The manager of a hard-hit public health laboratory in North Carolina, reports that last July his two medical technologists, employed by the county for 15 and 22 years, stopped receiving even their half-time holiday, vacation, and sick days. They now share one full-time position, often working 40-hour weeks each when full-time staff members are ill or on vacation. Yet even part-time health care workers at for-profit hospitals in the area receive benefits, according to the manager.
Figure 1
What benefits does your institution offer?
Are they adequate?
 1992 Offered
 Offered Adequate 1988 1990
Paid vacation 99% 93% 99% 100%
Paid sick leave 97 93 97 98
Medical insurance 97 76 97 98
Pension plan 91 70 88 87
Life insurance 89 82 86 91
Paid seminar/ 84 55 82 84
workshop expenses
Maternity leave 79 89 76 81
Paid CE tuition 76 67 72 74
Dental plan 73 70 72 69
Paid uniforms 43 91 29 19
Eye care plan 35 60 31 23
Paid parking 33 94 35 36
Laundry allowance 19 98 11 5
Paid professional 19 82 19 22
membership dues
Day care center 16 74 14 10
Meal allowance 7 79 8 9
Day care reimbursement 5 67 5 NA
Other 4 93 7 11
NA--not asked.
Totals exceed 100% due to multiple responses.
Respondents were asked to check off the fringe benefits
currently offered in their labs and, if offered, to rate the
adequacy of each. The same question was asked in MLO's 1988 and
1990 surveys.


Of the 17 benefits listed on MLO's questionnaire, seven are offered less frequently than in 1988, when a previous salary survey took place.|1~ Seven benefits are offered more often and three are offered with the same frequency. Thanks to new OSHA regulations and increasing awareness of the importance of preventing bloodborne infection, the provision of lab coats and other gear rose significantly (43% in 1992 versus 29% in 1990).|2~ Most of the other percentage changes in benefits were very small.

Hospital labs are more likely than independent and group practice labs to offer paid sick leave (98% in 1992 versus 93% in 1990), pension plans (95% versus 77%), life insurance (92% versus 85%), paid continuing education opportunities (83% versus 60%), a dental plan (80% versus 66%), day care (20% versus 2%), and meal allowances (9% versus 2%).

Independent labs are more likely than hospital facilities to pay for laboratory clothing (54% versus 41%), laundry (32% versus 14%), and professional membership dues (27% versus 17%).

* Benefits. Labs in the East, South, and Midwest are more likely than Western labs to pay for CE (81%, 75%, and 79% versus 64%, respectively). Labs on both coasts are more likely than Southern and Midwestern labs to offer a dental plan (84% and 86% versus 66% and 68%) and an eye care plan (47% and 59% versus 25% and 30%).

Western labs are more likely than all other regions to offer paid uniforms (62% versus 49%). Urban and suburban labs are more likely than rural labs to offer a dental plan (75% and 79% versus 64%), an eye care plan (39% and 36% versus 26%), and day care (24% and 16% versus 6%).

Respondents were asked to specify one benefit they wish they had and which benefit they value least among those now provided (Figure 2). Maternity leave is of least interest to 20% of those permitted to take it--but that number includes everyone in the lab, including people with no children and those whose children are grown. On the other hand, nearly one out of four respondents (23%) who now lack employer-supported child care benefits opt for them. Eye care is eyed by 17%, and 14% of respondents would like to have a dental plan.

In 31% of laboratories, employees can select the benefits that they want, cafeteria style, within defined dollar limits--about the same proportion as in the 1990 survey. Laboratories in the West are more likely than labs in all other regions to offer flexible benefits (51% versus 27%, respectively).

"I don't think retirement benefits |in most labs~ come close to being adequate or to matching those in big business or any level of Government work," says the manager of a group practice lab in a Utah suburb. "Doctors have to be forced to share the wealth more."

The manager of the lab at a large not-for-profit hospital in Virginia is considerably more satisfied: "In general, benefits, salaries, shift differential, and moving reimbursement are 100% better than they were 10 years ago."

Recent history has been less kind to the chief technologist at a small not-for-profit rural hospital in Wyoming, who says, "As in most work sectors, a decrease in income for the hospital means no updating of equipment and then salary freezes or only token yearly increases. Since salaries are their biggest expense, it's the first thing cut, along with benefits, with no regard for the long term."

* Freezes and cutbacks. "When the new management group took over two years ago, 200 FTEs were chopped hospitalwide," reports the lab supervisor at a large not-for-profit hospital in Georgia. "The hospital was in terrible financial shape. Morale was in the pits." The staff pulled itself out, apparently, for a happy ending: "We met the challenge to work smarter with less, and we are now happy and in the black."

Most survey respondents agree that, financially speaking, the clinical laboratory is in crisis. Two out of three respondents (66%) said that their labs had experienced budget cuts or freezes during the last three years, and described what actions resulted (Figure 3). Freezes or limitations on filling vacancies (66%) and capital spending (64%), experienced by some two-thirds of panelists, top the list. Budget cuts and freezes occurred with roughly the same regularity in 1990, according to MLO's previous survey.

Hospital labs are more likely to freeze capital spending than independent and group practice labs (69% versus 52%), which tend to limit salaries more than hospital facilities (73% versus 41%). Hospital labs are more likely than independent facilities to experience budget cuts or freezes (69% versus 51%). Western labs are more deeply affected than labs in the South and Midwest (79% versus 62% and 64%, respectively), and urban and suburban labs more than rural ones (70% and 69% versus 58%, respectively).

A section head in the lab of a large not-for-profit hospital in North Carolina reports that no drastic measures were being taken to address a budget problem, but "in the economic game we're barely staying even, particularly for long-term employees whose salaries are frozen." Similarly, for the manager of the lab in a large Nevada hospital, a budget crisis means "we are unable to hire new staff, start new services, update instrumentation, or install a new computer system."
Figure 2
Benefits: What do people want?
Which one benefit that is not currently provided at your lab
would you most like to see added to your benefits package?
Day care for children 23%
Eye care plan 17
Dental care plan 14
Paid CE tuition 9
Pension plan 6
Professional dues 6
Paid healthcare 5
Seminars/workshops 5
Which one benefit that is currently provided at your lab is
least important to you?
Maternity leave 20%
Life insurance 13
Day care for children 10
Paid uniforms 10
Eye care plan 5
Laundry allowance 5
Paid CE tuition 5
Totals are under 100% because only benefits cited by at least
5% of respondents are listed.
Nearly one-fourth of respondents who are not currently offered
day care for children wish this were available through the
workplace.
Figure 3
Coping with widespread budget restrictions
Has your laboratory undergone a budget cut or freeze in the
last three years?
Yes 66%
No 33
Unsure 1
Total exceeds 100% due to multiple responses.
If so, what actions resulted?
Freezes or limitations 66%
on filing vacancies
Freezes on 64
capital spending
Budget cuts 59
Freezes or limitations 49
on salary increases
Freezes or limitations 48
on continuing education
Layoffs 23
Other measures 8
More labs reported salary freezes or limitations in 1992 than
in 1990 (49% versus 38%).
Have budget restrictions affected your staff in the following
areas?
 Yes No Unsure
Morale 84% 10% 6%
Efficiency 57 34 10
Turnover 36 56 8


Staff attrition has had certain advantages at a rural hospital in Colorado, according to a lab supervisor there: "In some aspects we have become more efficient due to a freeze on replacements as staff members leave. The result has been more cross-training and hard looks at the process of various operations."

Over the years, DRGs have become less likely to be seen as the cause of budget cuts. They were blamed by 64% of panelists in 1988, 51% in 1990, and 40% last year. Of current panelists, 25% disagree, while 24% are unsure and 10% say DRGs don't apply to their labs.

* What impact? Overwhelmingly (84%), panelists believe the most grievous effect of budget restrictions has been to lower morale. Only 10% say that morale has not been affected and 6% are unsure. That doesn't mean workers walk out during a recession; employee turnover perceived as being driven by budget restrictions was significantly lower in 1992 than in 1990 (36% versus 52%, respectively).

"Because of low salaries and high pressure, some techs are seeking work elsewhere," says the supervisor of the lab in a midsize hospital in Massachusetts. "Due to the insecure economy, however, many are not job jumping and some are returning to work after periods of unemployment."

Still, says the lab manager in a midsize Illinois hospital, "It can be a vicious cycle. Technologists resign due to high workload, better pay, or chances to advance elsewhere. They are not replaced; this makes it worse for the rest. Then others resign, making the situation even worse."

According to the lab supervisor in a midsize not-for-profit city hospital in Oregon, "In the last four months we have cut 3.5 FTEs, mostly by laying off one full-timer and cutting part-time hours. Morale is the pits and, if workload does not pick up, more layoffs are coming. That could compromise service or the quality of work." Figure 4 provides a sampling of comments on the subject.

Many panelists say that added pressure has led techs to make more errors. The manager of a rural group practice lab in Ohio sees what others consider the worst result coming true: "Patient care has suffered."

* Viewing the future. More than half the respondents (51%) doubt that lab salaries will rise appreciably in the next five years, although 38% think they will and 10% are unsure. The proportion of respondents anticipating little change is significantly higher than in the 1990 survey, when 36% of panelists expected salaries to remain low indefinitely. It may be significant that the survey was completed before the Presidential election, which seems to have spurred a gentle optimism about the economy rebounding.

Panelists who expect pay to remain low were asked to check off likely reasons. Most (81%) cited budgetary problems, while one-third (33%) pointed to unprofitable operations and one-fourth (26%) to increased automation. (Multiple responses were accepted.)

Among the 38% of respondents who expect lab salaries to rise in the next five years, nearly all (91%) say pay hikes will be forced by the personnel shortage. Other reasons include increased productivity (34%), profitable operations (27%), and unionization (7%).

* Enough money? Most respondents (85%) believe lab workers are unhappy with their salaries. Only 7% think workers are satisfied; 9% are unsure. There were no significant differences between these findings and those of the 1990 survey.

Those who note widespread dissatisfaction with lab salaries were asked if that attitude had increased over the last 5 to 10 years. Yes, said 80% (39% said it had "greatly increased" and 41% "somewhat increased"). The unhappiness quotient has remained the same, according to 15%; 4%, seeing an upswing, said discontent had lessened.

Hospital laboratorians are more likely than those who work in independent labs to believe salary dissatisfaction had greatly increased (40% versus 29%), as were those working in the East and South compared with those in the West (44% and 43% versus 29%, respectively). The extent of those "greatly dissatisfied" has risen, say almost half (46%) of laboratorians working in rural areas, while one-third (34%) of panelists working in cities agreed.

When asked how this widely perceived unhappiness will affect the lab profession, 83% of those who found dissatisfaction rising believe more people will leave the field; 81% foresee increased difficulty in recruiting new lab personnel; and 12% are unsure. (Multiple responses were accepted.) Concerns about the years to come echo those expressed by respondents to the 1990 survey.

"The general consciousness, generated by changes in Medicare regulations and payments, OSHA, CLlA, and increased competition by large referral labs, is one of worry," says the supervisor of an independent laboratory in Missouri. "I do not feel optimistic about the future."

References

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

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

How have budgetary restrictions influenced morale in your laboratory?

Morale is the lowest I could ever want to see in an institution. --POL director, Massachusetts

Efficiency has improved out of necessity. So far I haven't noticed any marked drop in morale. Maybe they are too busy to get depressed. --Manager, group practice lab, Michigan.

Everyone has a gloomy outlook on their future at the hospital. Morale is very low. People are bitter because the job situation is grim in our area. Most hospitals have a freeze on hiring and techs are not used to being stuck in a job. We've always had the luxury of knowing we could get a job anywhere, anytime. This is no longer true. --Hospital laboratory supervisor, Connecticut

At the outset morale was low, but we now have new labs and computer facilities. Morale is good. Supervisors and managers have been given more responsibility over their areas, especially in terms of budgeting. --Hospital laboratory education coordinator, Ohio

We have a very low turnover rate overall with a significant number of employees who have 5 or 10 years of service or more. People complain but seldom leave. That says, "It's not so bad here after all." --Supervisor, independent laboratory, Florida

Morale has definitely suffered as limitations have been placed on continuing education. Tuition is paid, but if the hospital requires a training session on your scheduled day off, you are not paid. --Hospital laboratory supervisor, California

The morale in our lab is lower than it ever has been in the last 17 years. The number of people who are happy and satisfied to work here is growing smaller and smaller. --Chief technologist, hospital, Nevada

Morale has been greatly affected, especially when nursing always manages to have double or triple the salary increases of laboratorians. --Hospital administrative technologist, Pennsylvania

Efficiency is made up with equipment instead of FTEs and salary increases. Morale is down because of the increased pressure on the current staff when workload increases. --Laboratory section head, public hospital, Texas

Because many of our patients are on Medicare, reimbursement greatly affects our budget. Occasionally morale drops but since the economy is slow, turnover is down. People are working harder and smarter than ever before and not having anything to show for it. --Hospital laboratory supervisor, Arizona
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Article Details
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Title Annotation:Lab Salaries, part 2; medical laboratories
Author:Jahn, Mike
Publication:Medical Laboratory Observer
Article Type:Cover Story
Date:Jan 1, 1993
Words:2693
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