This is a companion article to the CLP feature, “Histotechnology Faces New and Ongoing Challenges.” 

Histotechs are solid professionals, and they work hard, but what about the future?

Eric Ambrozic and Renee Mason operate one of 13 automated immunostainers at UPMC.

Eric Ambrozic and Renee Mason operate one of 13 automated immunostainers at UPMC.

“Changes will keep coming from outside the lab, and histotechnologists must adapt,” says Michael Nalesnik, MD, professor of pathology in the division of transplantation pathology at the University of Pittsburgh Medical Center. “It’s certainly desirable for histotechnologists to obtain as much additional training as possible, so that they can cope with changes arising from such related disciplines as molecular diagnostics. But doing so isn’t always easy for people who are already working full-time at high-volume, demanding lab jobs.”

Nalesnik observes, for example, that some cancer types are now being defined by the presence (or absence) of specific genes or gene products detectable by immunohistochemistry or in situ hybridization, and that the reliability of such tests is critically dependent on proper tissue handling, processing, and quality control. Much of this genetic testing is currently performed in molecular and other labs, but as less-expensive reagents for tissue localization become available, many such assays can filter directly into histology laboratories—if the labs are up to the challenge.

There’s still an overall shortage of techs in all labs, and with an 8% to 14% increase in histotechnology job growth forecast for the future, Nalesnik notes, adjustments will need to be made in the methods used to attract people to the profession and in the training provided by histotechnology schools.

At UPMC, Houston Christopherson prepares samples for subsequent manual and automated histochemistry stains.

At UPMC, Houston Christopherson prepares samples for subsequent manual and automated histochemistry stains.

Histotechnology is still largely a manual job for which a large proportion of the work is devoted to cutting and preparing samples, and related functions. Training in how to execute such tasks correctly, with an eye toward preparing students for the reality of the clinical laboratory environment, remains a vital need, especially with constantly changing equipment. Nevertheless, the job is not all “hands-on” the way it used to be. Increasing adoption of automation and more-sophisticated testing methods has changed that.

“The amount of work that our lab turns out daily could not possibly be done completely manually,” Nalesnik says. But automation also creates opportunities. “In practice, machines are nowhere near perfect; they allow greater productivity but also need constant oversight and guidance by lab techs,” he says. In addition to the basic skills, an understanding of the underlying histologic process and how it is performed by automated equipment—plus an ability to troubleshoot or employ alternative solutions when things go wrong—are invaluable assets for the 21st-century histotechnologist.

For histology labs, a danger in not responding effectively to such gradual but inexorable changes is that there may be increasing pressure to introduce non-histology technicians to handle advanced processes, or to outsource important testing developments to other clinical labs.

Because of the hard, complex, and intense work that histotechs perform, it’s difficult for them to keep current through continuing education. But it is imperative that they try, says Nalesnik. Doing so will enable them to increase job security, maximize their career options, and enable the labs they work in to remain viable and relevant in an ever-changing medical and regulatory environment.

John D. Allen, MBA, MT(ASCP), director of laboratory services at Tucson Medical Center, says his organization has been very fortunate to be able to attract well-qualified and experienced histotechnologists to fill vacant positions over the past few years. But most of those technologists have been persons working elsewhere in his community.

At UPMC, Paul Harris and Margarette Turner perform case assembly and prepare slides for sendout.

At UPMC, Paul Harris and Margarette Turner perform case assembly and prepare slides for sendout.

There are still very few new histotechnologists being trained in the United States, and very few or none in accredited schools in southern Arizona, says Allen. His facility currently has an opening that has been posted for about a month and has received only a few qualified applicants, he says.

“Our strategy is to lead our histology department with true transparency, abundant input from those doing the work, investment in good equipment, and consistent respect and recognition of work well done,” says Allen. “In so doing we endeavor to become a great place, and the place, to work in southern Arizona.”

The histotechnology staffing shortage remains an issue in rural areas of the nation, in part because of the dearth of schools that offer this course of study. But Beth Sheppard, MBA, MT(ASCP), current president of the National Society for Histotechnology (NSH), says she has observed a slight increase in new schools offering advanced degrees in histotechnology.

“The need to promote the field to new students continues, and will expand greatly as many technologists retire,” says Sheppard. “In addition to shortages, there are increasing demands to produce better-quality results, faster. Professional societies such as NSH are providing educational opportunities for current technicians to extend their experience into advanced technologies. They are also promoting the profession to young students interested in science and math.”