Has a High School Found the Solution to the Laboratorian Shortage?

Welcome to Clinical Lab Chat, part of the MEDQOR Podcast Network. I’m Chris Wolski, Director of Business Intelligence for CLP, and today I’ll be speaking with Jim Payne about how he is helping to solve the laboratorian shortage. Jim is the medical lab assisting and phlebotomy instructor at WEMOCO, where over the last 10 years he has developed a top level medical laboratory program for his juniors and seniors in high school.

Now as regular listeners of Clinical Lab Chat and readers of CLP know, I’ve spent a lot of time over the past year or so talking and writing about the laboratorian shortage and how we can solve it. Certainly there’s no easy answers, but I think as my introduction indicated, today’s guest is tackling the problem in a very direct way that could be a key part of solving this dilemma or puzzle.

Jim, welcome to Clinical Lab Chat. I’m really excited to talk to you about the training program you run at WEMOCO. Let’s dive right in. First, tell me a bit about the program. How does it work? My understanding is it’s a real hands on thing. It’s not just kids sitting in there taking notes, right?

No, absolutely. Thank you very much. I’m really excited to be on Clinical Lab Chat tonight. I have a high school medical laboratory assisting and phlebotomy program in Spencer Port, New York. Our juniors and seniors in high school will learn about 60 employable laboratory skills, and they will learn those not only in medical lab skills, but they’re transferable to biotechnology, to chemical labs, food labs, environmental labs, research forensics, all those sorts of things.

Our students in their first year will gain experience in a variety of techniques that I learned a lot in college, whether it’s using micropipettors, using binocular compound microscopes, using spectrophotometers, doing titration. Our students even learn a little basic organic chemistry as part of making soap.

They learn extensively the theory and the technique behind phlebotomy, not only in the antecubital region drawing blood in the elbow, but also learning how to do hand veins, learning how to do finger sticks. They will get into college level hematology and learn the techniques around blood smears and how to do hematocrits. They get into college level immunology. We actually play a fun board game that helps them to imagine that they’re a microorganism trying to destroy the body and they get to see how the different parts of the immune system attack them so that they can better imagine what they’re seeing.

Then we get into some A&P. They will spend 40 hours drawing blood on real patients for real samples in our local laboratories as part of a certification that they can get at the end of their first year in phlebotomy. In the second year, they’ll do college level microbiology. They’re doing all sorts of stains, whether it’s gram stains, endospore stains, capsule stains, all sorts of things like that. We get into some advanced plating, so not only are they doing streaks but they’re getting into MacConkey, EMB, MSA, they’re doing Kirby-Bauer antibiotic testing.

They’ll even get into catalyst testing and some other basic biochemical tests using like carbohydrate fermentation tests. They’ll even get into some clinical chemistry and urinalysis. They will get certified in CPR, AD, and first aid. They’ll also get into molecular diagnostics, genetics at the college levels. They’re learning things like restriction digestion and cloning, PCR, bacterial transformation. They’ll spend 80 hours in the medical labs training to be medical lab assistants so that they can then sit for national certification and medical lab assisting. In both cases they can get jobs straight out of the program. But we like to think of this program as the minor league of the medical laboratory because if you have the minors filled in baseball, you have a large set of minor league players, some of them can move up to the majors, some of them stay down in the minors, that’s a great phlebotomist that anyone can draw their blood.

But our guys, a lot of them do go on to college for medical lab careers and they even get into some research with other universities. It’s a really strong program. Granted because it’s college level stuff, there’s certainly some book work but they get a lot of skills along with it. And unlike your normal IB or AP course, that’s a biology course, my students, the goal is that they become skilled in that. So if they make a mistake when they’re doing a titration or when they’re doing a microbiology test. They can’t just skip over it and go copy off their friend like what tends to happen. The goal is each individual student comes out skilled in all 60 skills ideally.

Yeah, great. And you’re really giving them a leg up. We talked about a bit about that in the pre-interview and one thing that we also talked about was kind of the stigma of vocational education. So I mean this all really kind of falls into the vocational high school experience and we talked a little bit about how this is really taking a little bit of the stigma off it because you are recruiting a much more diverse academic student population and there’s some issues involved with that, when we were talking about that. So talk about A, how you’re taking that stigma off, maybe that vocational education, which it shouldn’t have a stigma no matter what you’re doing for sure. But also talk about how maybe you have a little bit more of an academically diverse student population that’s taking this and how’s that helping the program?

So the old term was vocational education. Now it’s called career and technical education. And really the vocational education was very much of like a monkey see monkey do you know? The teacher teaches you how to turn the wrench and you do that. There wasn’t as much academics as there is now across the board. All programs are a lot more academically focused than they ever used to be. I mean my students can get science credit, they can get English credit, they can get health credit. We have currently five and we’re gaining another one. So it’ll be eight dual credits through local colleges. So the rigor is there and as I’ve gotten tons of local leaders to come in, whether that’s politicians like town or county legislators, state representation like assembly people or state senators to come in and really see what these kids can do, that they are so much farther advanced.

And they may have been a student that struggled in high school before their junior year and before they came to me because they didn’t really have direction, “Why do I have to learn how to do algebra or geometry or biology class if it doesn’t mean anything to me. And if I already didn’t have the base skills I should have gotten in elementary school, now I’m even farther behind.” Where with my students, when we’re teaching them how to do the math around making laboratory solutions for example, that requires algebra and they have to actually make something with the algebra and suddenly it starts to make a lot more sense than the way that they were taught in a traditional high school where it’s, “I explain how to do this problem and then you do 50 more at home. If you didn’t really get it well then you’re falling behind.”

And so with these guys, they’re seeing I made something, I had to make a 10% bleach solution. I had to do a little algebra to figure that out or I needed to make this molar solution, I had to do a little algebra to figure that out. And so I find our students, even a lot that did struggle in high school, when they find their passion, they find what they want to do, they’re a lot more driven. And these are kids that may not have always been college students bound, although I do have plenty of those, that find their niche and if they don’t go straight to college, a lot of them after a few years of working, know for certain this is what they want to do and then they’re off to college and are way ahead of their classmates.

Yeah, for sure. And we talked about, one thing I think was interesting is that you’ve had it both sides of the coin too. You talked about the one student you had who was really interested and the idea of going to pathology and you think, I don’t know about that. And she got into it and said, “This is for me. And you had another one who was determined that he was going to go on to, I think it was Howard, and said, “This isn’t really for me.”

No, I can give you the brief version of those. So the one that was interested in microbiology and going to Emory, he wanted to work with the most infectious things on the planet and after going through my course, found out he didn’t like icky things and microbiology is icky things. So if you’re not interested in that, there’s not much you can do in micro that’s not icky. And so he ended up being auto tech. He decided, “I like working on my car, that’s what I want to do.” And had he gone to college, he would’ve been third year of college before he was a hundred percent certain, it’s the micro, it’s not that one course.

Exactly.

With the other student that was interested in pathology, because she was very interested in wanting to figure it out, I set her up with a shadow in our local lab where she got to spend three hours in the gross room with the pathologist assistant, half hour with the top pathologist in our area on one of those multi-head teaching scopes while she was diagnosing disease. And then even got to sit in on a gross conference after an autopsy at the hospital for two and a half hours, got to see a human brain, all these other tissues that were coming down. And one of the things with pathology is, especially if you’re on the pathologist assistant side of it, you’re seeing whole organs. They have smells, definitely the formal and preservative has a smell and you got to know if you, that’s something you want to do.

And had she not done that in high school, she may have gone all the way to her pathologist assistant school and then realized, “Oh yeah, I don’t like that.”

For sure.

It’s a huge advantage, the connections that we can make for our students and allow them to really explore all the different careers in laboratory medicine.

And it keeps them interested and excited too.

Oh absolutely.

As well. Yeah. The other thing I think was interesting, what you’re talking about is how the way you’ve been recruiting students, is kind of now your little, I think your secret weapon. And so talk a little bit about how you are now recruiting students. How difficult it was and then how you’re recruiting them now?

Yeah, so for a number of years we had issues with recruitment. The medical laboratory, as everyone knows listening to this, we’re the hidden profession. To a certain extent a career technical education is the hidden type of education that it’s supposedly only for students that can’t be successful in college or are problem students. And it’s not what it is at all. It can be, but it can also be for your regular student to be able to explore a career. But we struggled trying to get the message out properly, that sort of thing. And the way that my program works is students select to come to it from their high school. So they’re missing two and a half hours a day to come to me. And so when they did our tour day where they got to come in for 45 minutes and view our program, I traditionally would do a, I’ll lecture for 20 minutes about what the program is and then we’ll try to get you in the lab, hopefully have some fun.

And when you’ve got 15 or 20 students in a room trying to get them to cycle through all these different stations, it was like four minutes a station and you really can’t have any discussion. And so I flipped it on its head and said, “No, no, no, I’m not going to do any talking. If I can get away with not talking at all, that’s what we’re going to do. I want the kids running the show.” And so the students who are interested in the program come in, they get lab coats on, they get gloves on. And then my one student starts off telling the story of what’s going on, that we got a medical mystery, got two patients that are sick, we’re going to draw their blood, we’re going to have some urine we got collected and then you guys are going to go back in the lab and you are going to do the tests and record down the data and then come up front and we’ll discuss what the results could be.

And while they’re teaching these students how to load an agarose gel, how to put bacteria on a slide or how to do a blood smear or how to do urinalysis, all those sorts of things, the students are also talking about the program. They’re doing all the stuff that they used to do, talking about you have this many dual credits and this many hours of co-ops and yada, yada, yada. They do all that talking and it’s student to student and if a student suddenly has a question, they’ll answer it in a student friendly way, that it completely changed. We went from typically getting somewhere in the range of eight new students a year to 16 in one year. And I think it’s only going to continue to grow. Right now, I have maxed out on my lab benches.

All right.

So now I’m going to have to start finding other places to put students.

That’s not a bad thing.

No, absolutely not. But yeah, that was the change, is trying to have the students do the teaching. And that’s actually the same model that we use with those legislators and district superintendents and that sort of thing. Have them become the techs in training, have them learn from my students, have my students do all the talking. And I just sit back and if they have a specific question for me, I answer it. But otherwise I don’t want to talk.

Yeah, that’s great. I think it’s terrific. And you’re seeing that, I imagine that excitement too, you’re kind of building on… You can get up there and make lots of promises, but if you have students talking about, you brought up things that were important to the students, their credits and how it’s going to help them directly, how it’s helped them, I think that really makes it a lot more, it lends a lot more credibility as well to the process.

Absolutely.

So one of the things that I think also we talked about and you’ve already alluded to and I talked a little bit about this, is these students are basically employable in a lab the day they graduate or they have to take certification tests or whatever, but they’re ready to be employed. So how does that motivate a lot of the students through the two year program? Certainly you have students who plan on going to college and you talked a little bit about some of those, but you also have students, as you said, those kind of minor leaguers who they just want to have a good job and a good career and go up the ladder in a more natural way. So how is that motivating the students? And I’m assuming that the parents also really love the fact that they have kids who are walking out of high school with employable skills.

Oh absolutely. Yeah. I mean it’s hugely motivating. It’s something that to a certain extent I can kind of hold over their head. You got to have a certain academic standing in terms of your grades. You have to be not having any referrals or any of that sort of stuff that I’m not going to let you go out on co-op. Therefore, you couldn’t get the certification, you couldn’t get the experience necessary to get employed if you are not working hard in my class. And my way that I describe it to the students on day one is this is a two year long interview.

And so I can do great recommendations. I can guarantee that you’re going to get a job. Not only here, but I’ve even had some of my students that have gone to Texas and I have connections through LinkedIn where I called them up, I said, “I have a student that’s going to be moving to San Antonio. Do you have anyone that you can connect me with that I can talk to them about my student?” And so that breadth of connections, that ability to help students get jobs is hugely motivating. And it makes it so that every day you’re coming in and you know you got to work. And when there’s downtime, they’re working on other stuff. I mean at minimum if they’ve got all their work done, they’re completely caught up, it may lead to them in the short term working on their med terms. Cause we do a thousand pre fixtures in suffixes of medical terminology.

But it also can be where I can, I had one student that was three weeks ahead, I sent him out on a shadow where he went to local labs and watched people draw blood before he went out on co-op. And that’s a huge motivator too. “If I get stuff done early, you’re telling me that I can go out on a shadow?” Yeah. So absolutely that’s hugely motivating. And the parents love to see their kids grow. Just even the first open house, usually three to four weeks into school, their students know how to do stuff that I learned in college.

So for example, they’re able to use a micropipettor to collect a sample of pond water or set up a slide for doing a bacterial stain. Then they’re going and actually grabbing real bacteria and showing their parents how to stain it. And then they have the binocular compound microscopes that go up to a thousand x and are research grade optics and they could show their parents, this is bacteria that was on that plate that we collected from over there and it’s just a powerful experience. And they’re only three or four weeks in, let alone when they’re done with two years of work and have 60 or so skills in their back pocket.

That’s really great. As you’ve indicated, you not only get that work experience, but it’s also very academically rigorous too. I mean we talked about it in the pre-interview about very regular tests, I mean it sounded like college level type tests that you’re giving them.

Pretty much, yeah.

You’re really challenging these kids.

Yeah, no, like I said, stuff that I was doing in college or even some things that I learned later on in my career when I was working in research, those are things that they’re learning in high school.

Yeah. So what about the labs? We’ve talked a lot about the kids, how they’re motivated by this. The parents are excited. You certainly have legislators that are interested. You’re getting the equipment you have. It sounds like you’re being highly supported by the school district or school districts I guess. What about the labs? How are they reacting? I mean you’re talking about placing kids in after school, they’re Texas, they’re locally in Rochester, in the western New York area. What’s their reaction, do they get excited the fact that you are helping to fill that pipeline, at least at entry level point?

Absolutely. They’re super supportive. I have the University of Rochester, Rochester Regional Health and the America Red Cross are all wanting to work with us, with our students. They realize that same thing that I talked about earlier with the minor league of the medical lab. They have huge needs. I did a talk in last March, so this is the reason I have the number in my head. At that time there were 52 phlebotomy openings at the Christmas time before that March talk. So December of 2021, there are 52 openings for phlebotomy, 25 for MLT and 105 of MLS.

Wow.

So the need is there. They realize it and similar stuff for the lab assistant role in terms of comparison to phlebotomy. And it’s something that you got to kind of think out of the box. And it took a while to convince them.But I had several students that basically acted as my ambassadors who completed my program. We didn’t have the co-ops at that time. So they went and worked in the labs. I was able to help them get into the labs to work there. And those managers saw how good my students were. And so they started to go, “Okay, yeah, this is legit.” And so working with my way up in terms of the administrative levels to the point where when I got high enough in those levels, they said, “Let’s make it happen. We’re going to get our lawyers involved with your lawyers, we’ll figure out.” And the first one took about three months. The second one took about six weeks.

Wow.

Cause we already kind of knew what was needed for those organizations to allow it. But I have students that are under 18 drawing blood on real patients for real samples with those companies trainers. And so it’s really like they’ve been hired, so they’re going through the same initial HIPAA trainings for that company and they’re being onboarded essentially. So they go through the onboarding process and then they have their trainer and the trainer’s going to do it at that student’s pace. The goal is that they have to have at least 50 successful sticks, but sometimes we get as high as 120. And I think all of them so far have had at least an 85% success rate. So it’s not like they got 50 but they tried on a hundred patients.

Right. Exactly. Exactly.

And there’s been times when students, they were initially refused, because I’m a tough stick and I’m a cancer patient. And then the trainer’s supposed to do it and the trainer couldn’t get it after two tries. And so the patient said, “Well you’re here, why don’t you give it a shot?” And she got it and there was a huge confidence boot. So they go into these trainings, a little bit nervous, scared, that sort of thing. And because they haven’t done a ton of in-person draws, they have a fake arm that they do it on. But then after the end of the week they come out kind of cocky, “Give me a vein, I’ll hit the vein, I don’t care.”

Exactly.

And so it’s just a amazing transformation in that week or two weeks. Because the phlebotomy, we do 40 hours, eight hours a day, five days a week. The medical lab assistant, we break up so that it’s two hours a day over the course of several months, simply because we just don’t want to burden the labs that much with doing two weeks straight to knock it out.

All right. Well one thing I’m interested in, and I asked this particularly because I was someone who was turned off from science and math in high school due fortunately to frankly some duds of science and math teachers. And I think that’s a very common sort of thing that happens to a lot of young people. I mean from your experience, when do you think we should be introducing science to kids and more and more importantly, how do we keep them engaged? Now you’re certainly doing that at your program, but more in general, how do we keep more kids? How do we get to a point where you’re basically either having to build a new classroom, a bigger classroom, or you’re having to turn kids away to your program? So what are some of your ideas on thoughts on that?

I would say that you definitely, in middle school and high school, you could develop lessons that teach the content that they were supposed to be teaching in terms of biology or chemistry or any of those sort of things that they’re doing in their science classes in those years that are obviously at the level that they can understand but have medical laboratory concepts in them. And that makes it a lot more interesting than taking an onion and putting a little bit of stain on it and watching it on a slide. Trying to bring in some of those real things that could help students imagine this in a real life situation versus this is just something I’m doing for science class and I’m actually trying to work with a couple of friends of mine to develop those sort of lessons that could be turnkey for science teachers and have it so that they could immediately hop in and be teaching about the medical laboratory.

Especially if you took in patient stories. So like the ASCP has their patient champions website that has all these great stories about patients and how laboratory medicine helped them. But then bringing in what’s going on in the background, part two is part of that lesson. So you’re getting that blood sample from the phlebotomist and that person draws blood. Maybe even have the person happen to mention while they’re talking, “I got a certification to do this. I didn’t have to go to college.” Or having, talking about the medical lab technician took the sample and did this with it, or the scientist did this or whatever so that would be something more in their head. Because right now with medicine, everyone knows what a doctor does. Everyone knows what a nurse does. They know what a dentist does.

They think they know that the phlebotomist is a nurse. Oh I’m not a phlebotomist. So there, there’s a lot of misconceptions and then any of the other stuff that’s actually in the laboratory portion don’t exist in their minds. And so that’s why we’re the hidden profession. We need to be getting out there so that it’s on their tongue at least in middle school, if not definitely by high school. But also you can definitely bring in guest speakers and things of that nature to elementary school students. You obviously got to bring it down to their level, but you can do some really fun things that are just magic to them, that they wouldn’t even imagine. And that can just have that little bit of spark, especially if you can help those teachers to keep that spark going. Here’s some things you can talk about or if you saw this thing in the news, here’s a little bit that can help you.

And so it could be a very powerful thing. Another thing that I was suggesting that we do, is at the high school level, maybe even the middle school, having local labs bring laboratorians out from the workforce to come into high schools. So contact the counselors or the science teachers or even the administrators of those schools say, “We’d like to come in and we’re going to do a activity day thing where we’re going to talk about the medical laboratory careers and have some activities for the students to participate in.” And then in their back pocket saying, “We also would like to do a field trip.” And so having students come into the medical labs and see the real thing. So one of the things that I think because it is behind the curtain, no one can imagine themselves behind that curtain because they’ve never seen it. Where the first field trip that my students go on to see the medical lab, suddenly everything that we’ve been doing makes sense.

It has that context. And even if you weren’t in a program like mine, but you suddenly see, okay, so they were talking about molecular diagnostics and looking at karyotypes like you do karyotype labs in high school, see an actual karyotype being done, all those sort of things. And then I would even have it that a certain number that are interested, maybe set up out between a one and eight hour shadow and have the students get a chance to see a tech work at their job. Because the only downside to a field trip is generally you have a limited amount of time in a given area and the really cool thing may have come in two minutes after you left. And so if you’re there for an hour to eight hours, you’re probably going to run into something interesting having come down the pipeline at some point. And that can be a really powerful thing. And then they have a really good understanding and start to imagine themselves that these are my people, is the way I like to phrase it, that I belong here.

I think that’s an important thing. I think that imagination part of it is an important part of it. There was something we posted on the website, it was about science education and I think it was a first grade class. And they had all the kids imagine themselves as various scientists and particularly the girls, they had imagined themselves as Marie Curie and it was kind of like your little mystery thing or your activity around something like real and historical or something. And kids just ate it up. They just absolutely loved it. And it was a really powerful way in particular to the part of the program is to engage more girls in science and they really found that it really helped to do that. But both for the boys and the girls, to have them imagine themselves as these historical figures and pretend and that also makes it real.

And I think that’s a really important thing. And as you get older, you can make it more and more real. And then you imagine yourself, as you said in the profession. So now there’s no doubt, obviously you are helping to solve this problem, at least in your local area. And certainly you have students going all over the country it sounds like. But not all of our listeners can or want to switch careers to education. So what can they do? You touched on this a little bit, but what can they do directly? What are some ideas that are listeners saying, Hey, this is great, what Jim’s doing? What can I do to help maybe alleviate the shortage a little bit?

Yeah, no, I think that the biggest thing is actively advocating for the profession. So ASCLS has that hashtag labvocate and I absolutely, any chance I get, I’m labvocating. I’m going out and trying to talk to anyone about the laboratory. And so trying to have some statistics in your backpack or other things that can be good talking points that can really make a powerful statement to people is really useful with that. So for example, I know that we do 13 billion laboratory tests every year. To put that in perspective, if we counted that in seconds, what is 13 billion seconds? That’s 412 years. So we do a lot of tests.

We have 26,000 new graduates we need every single year, we only graduate 5000. 45% of the field has 20 or more years experience. So we have a retirement wave coming. Like I said, locally, we had 52 phlebotomy openings, 25 MLTs and 105 MLS, which is even harder to make up because you require that four year degree. But having some of those stats in your back pocket, knowing the potential career pathways, whether you’re talking about at the entry level, the phlebotomist, lab assistant, your sterile processing tech, your two year degrees, your histotech and your MLT, your four year degrees like cytotech and MLS and histotechnologist, your master’s degrees like pathologist assistant, and then you got your doctorates. So that’s your pathologist or your doctor of clinical laboratory science, the DCLS. So knowing about those career paths and a little bit about them, putting a little research into that can be helpful in those conversations.

So when I may ask you a question, you don’t have to go, “I don’t know.” But you can also be actively talking to your bosses. So let’s say you’re working in a lab and you really think that this would be a great idea to do what I was just talking about with going into those labs and doing the guest speaker presentations, the field trips. Talk to your bosses, see if they might be interested. We are in a crisis in terms of the medical laboratory and every person helping, we’ll get through this, but we need to be actively all of us doing our part. And it requires a little bit of outside work out of your day, but it’s so worth it. And I know ASCP also has the career ambassadors program, so they can even help you with that presentation part if that’s not your skill set.

And certainly those are skills that if you don’t have them now, they can really help your career down the road. So it’s a good way to get going on that. But actively trying to do that. If you’re a part of a church or a community group, say, “Can I do a talk about the medical laboratory, laboratory medicine?” Most likely they’re going to say, “Yes.” Talking to, if you got a kid in preschool or elementary school, can you come in and talk to your kids’ students, their class about what you do and bring stuff with you. If you can bring anything that they can touch and do, do it. Cause it becomes so much more real than, “So I do medical laboratory tests and I do this.” You got to have something for them to want to get engaged with.

Well, with that, I think we’re going to have to cut our discussion short and I think it’s just a preliminary of many more we can have. Jim, thanks so much for taking the time to speak with me today and thank you for what you do. I really think you’ve created a model for other school districts to follow and other educators like yourself to follow. And I hope you can come back and visit me again very soon. Maybe even bring a student with you next time. I’d love to speak, maybe one of them.

Okay.

Yeah. I also want to thank you the laboratory audience for listening. Look for more episodes of Clinical Lab Chat in the future and visit us online at clpmag.com and on all of the major social media platforms. Until next time.