By Louise Lazear
First, the good news; for some, wages appear to be on the rise. Now, the bad news; vacancies in the laboratory continue to grow and positions remain unfilled. The reasons for the shortfall are multi-dimensional, and at times, controversial. Whatever the cause, the shortage is real, and stakeholders are joining forces to develop real-world solutions, and to slate the future of the profession.
Elissa Passiment
Executive Vice President, ASCLS
Clinical laboratory personnel shortages are not new. In 1988 the American Society of Clinical Pathologists’ (ASCP) Board of Registry launched a biennial survey of laboratory managers to track salaries and vacancies across 10 laboratory positions (see chart). Results for the year 2000 point to some alarming realities. All 10 positions had vacancy rates of at least 10 percent, with five of 10 positions reporting all-time highs. In a survey conducted by the Clinical Laboratory Management Association (CLMA) in 1999, close to 40 percent of respondents indicated that laboratories were not adequately staffed, with 60 percent citing a lack of qualified applicants.
From 1998 to 2008, 53,000 new jobs (17 percent growth) will be created in the field, according to the U.S. Bureau of Labor Statistics (BLS). With an estimated annual attrition of 4,000 employees due to retirement and other factors, close to 90,000 positions are projected to become available though 2008.
Wages, fortunately, appear to be on the rise. The ASCP survey found that median average wage increases from 1998 to 2000 are greater than for any other period since 1988, ranging from 8.5 percent to 15.4 percent for all 10 positions. Beginning wages increased at least 6.9 percent for nine of the 10 positions, while median wages increased an average 11.5 percent across all positions surveyed. In a cost-driven environment, wage competition with other staff-challenged health professions raises the stakes for managers with vacancies to fill.
According to the BLS, in 1999 the median annual wage for medical and clinical laboratory technologists was $38,520, compared with $34,260 and $42,280 for radiologic technologists and registered nurses, respectively. “Our vacancy rate in the lab is about 12 percent, and in radiology, it can go as high as 20 percent, and nursing doesn’t fall too short of that,” said George Krempel, associate vice president of healthcare services at Loyola University Medical Center in Chicago. Although other departments feel the pinch, laboratory staffing at Loyola is at crisis levels, Krempel said, adding that retirements coupled with the closing of half the local training programs are the most likely culprits.
Loyola is not alone. Today’s staffing shortage coincides with the widespread closing of medical technologist training programs due to low enrollments. The number of National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) accredited programs has decreased more than 15 percent from 648 in 1995 to 548 in 2000. Not surprisingly, the number of graduates declined (from 6,863 to 4,943) over the same period.
“I used to have 50 or more students apply per year, and now we are down to 20 to 25 qualified applicants for 10 to 11 positions,” said Betty Anderson, program director of the School of Medical Technology at Carolinas College of Health Sciences in Charlotte, N.C. Although her graduates have no problem finding employment, Anderson believes that low salaries for four or more years of formal education, high stress levels, 24/7 availability and lack of visibility contribute to the fall-off. A decrease in applicants “would be an understatement,” said Virginia Kotlarz, Ph.D., medical technology program department chair at Daemen College in Amherst, N.Y., where low enrollments are forcing the school to phase-out the program. Kotlarz sees low public awareness as a major reason for lack of interest in the field. “We are still relatively invisible,” she said. “We have limited patient interaction, and what people do see is not representative of who we are and what we are responsible for.”
The profession’s lack of visibility strikes a common chord among those close to the issue. Measuring the impact of laboratory services within the healthcare continuum is vital to raising public awareness and the value of the profession, said Rodney Forsman, administrative director of outcomes at Mayo Collaborative Services, Inc. While supporting estimates that laboratory results factor into 60 to 70 percent of critical medical decisions, Forsman embarked upon his own study of the electronic medical record at his healthcare center. The results were compelling: 94 percent of the objective medical data in the patient record came from the laboratory, and on average, 56,000 laboratory results were entered into the system per day. These records were accessed, on average, an amazing 170,000 and sometimes up to 200,000 times per day. “What I draw from this is that doctors and caregivers are looking at laboratory data. And for that brief instant, when a physician is trying to make a decision about patient care, the laboratory owns the moment.” Forsman believes that an emphasis on service, quality and the timely communication of laboratory results can promote the value of the laboratory as a partner in healthcare delivery.
Gary Bickford, Ph.D.
Executive Director, Dade Behring University
While hospital departments scramble to fill positions, reference laboratories and the IVD industry are impacted as well. In response to calls for increased productivity, manufacturers have consolidated workstations and developed more expansive menus. However, productivity enhancements alone will not fully resolve the crisis. “As a company we recognize that the lab staffing shortage is a major problem,” said Gary Bickford, Ph.D., executive director of Dade Behring University, an academic initiative developed by Dade Behring Inc. to provide accredited continuing education and training in clinical laboratory medicine. Bickford sees the merger of circumstances — reductions in travel and continuing education budgets coupled with the need to develop and maintain high skill levels — as an opportunity to offer a value-added service to the marketplace. “We want to partner with our customers in any way that we can to help, which in the long run, benefits our business as well.”
Congress does respond to health profession shortages. In 1991, with national vacancy rates at 11 percent, legislators introduced the Rural Clinical Laboratory Shortage Act. After much debate, portions of the proposed legislation, including relief from reimbursement rules for rural areas, survived and are in place today. The current shortage has garnered attention from Rep. Neil Abercrombie (D-Hawaii), who was recently recognized by the CLMA for his role in increasing reimbursement for pap smear testing. His particular concern is for rural areas of Hawaii, where vacancy rates of up to 26 percent are not uncommon. Abercrombie believes Congress should continue support for health education funding, and keep federal reimbursement rates for lab tests in line with inflation and costs.
Recognizing the scope of the crisis and the importance of a unified front, professional societies and credentialing organizations responded to a call from the American Society for Clinical Laboratory Science (ASCLS) to work together on this issue. Finding common ground, despite sometimes conflicting agendas, laboratory organizations recently joined forces at two Summits that focused on the personnel shortage. At meetings held in June 2000 and January 2001, key representatives brainstormed to define the problem, develop solutions and discuss the future.
“This profession is on the right track in taking responsibility and action of its own,” said Elissa Passiment, executive vice president at ASCLS. One goal of the Summits is to develop factual information about the shortage to present to legislators. Pleased with both the level of interest and accomplishments of the participants to date, Passiment is confident their efforts will pay-off. “Congress will want to know if we have done everything we could as a profession,” she said. “We are going to be able to say to them, absolutely, we have done everything that you would expect a group to do.”
At the January 2001 Summit, organizations divided responsibility for four immediate action items — recruitment, data collection, education and marketing. The ASCLS is charged with developing recruitment kits for use by members across all organizations. ASCLS will share with Summit participants the outcome of its recent annual Legislative Symposium where members meet with their Congressional representatives. For the third, yet-to-be-scheduled Summit, an invitation will be extended to the IVD industry to solicit input.
The ASCP Board of Registry is coordinating data collection and standardizing survey instruments to develop comparative results across organizations. “I am very excited about this,” said Kory Ward-Cook, Ph.D., executive director, ASCP Board of Registry and senior vice president at ASCP. “When it comes to legislative and federal support, we need to have a united front.” In addition, ASCP has embarked on a major cross-sectional analysis to define the practice patterns of medical technologists (MTs), medical laboratory technicians and phlebotomists at entry level positions, and after five, 10, and 25 years experience. This analysis, along with the 10-year prospective study of MTs and the biennial wage and vacancy surveys, is part of the organization’s ongoing effort to keep educators, accrediting agencies, and recruiters informed of trends.
Because it is an accreditation agency, NAACLS will continue the dialogue between educators and managers established at its September 2000 Futures Conference, where professional organizations shared their views on the laboratorian of the future. Information from the conference can be used to help the profession prepare for the next step, according to Joeline Davidson, NAACLS board president. “Most people are aware that there will be major changes … We have a real opportunity to watch the shifts and trends, and make an educated guess as to what tomorrow will look like,” said Davidson. NAACLS also will collect and post information about educational funding assistance on its Web site. Other initiatives include a more streamlined approach to credentialing and assistance for programs in threat of closure.
Summit participants recognized the need to assist lab managers in raising departmental visibility. CLMA was asked to develop a Field Guide, which will include marketing development guidelines, data-driven sample presentations to justify salary increases, and methods to study and improve staff utilization. As part of the effort, the CLMA recently hosted a staffing shortage forum.
Katharine Ayres
Director of Healthcare Policy at CLMA
“What made this forum unique was that it allowed people to discuss this issue with a much broader audience … and it put lab managers and educators together in the same room. On this issue, it’s absolutely critical that these two groups get together,” said Katharine Ayres, director of healthcare policy at CLMA. Recurrent themes of the two-day session included raising salaries, raising awareness and the continuation of collaborative efforts among professional organizations. A second forum that would relate reimbursement issues to the shortage is in the works, Ayres said.
Despite these Herculean efforts by stakeholders, the staffing shortage rages on. Although not much consolation to the manager trying to cover tonight’s schedule, there is a silver lining: professionals across organizations are coming together to raise awareness and define the future of the profession. But real change must begin at the grassroots. Keep in touch with your peers, support your respective organization’s efforts, and next time the local middle school has a career day, spread the word about the value of clinical laboratory professionals, and don’t forget to bring cookies.
Louise Lazear is a freelance writer based in Charlotte, N.C.
