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Hospitals and other testing facilities can expect more difficulty in finding and keeping qualified testing personnel as demand continues to outstrip supply in the clinical laboratory workforce. The imbalance will only get worse over the next decade, most research studies show, as the aging lab workforce begins to retire and there aren’t enough new graduates to fill vacated and new positions.

Faced with today’s shortage, hospitals and other labs have resorted to offering special financial incentives to recruit and retain qualified testing personnel, including higher salaries, sign-on bonuses, even help with relocation expenses. Labs also have increased their use of per diem and contract workers and overtime. But more is needed to address the shortage, say clinical laboratory and pathology societies—the professions also must offer more avenues for career advancement to attract workers and reduce attrition in the ranks.

These issues got a full airing at the recent meeting of the Clinical Laboratory Improvement Advisory Committee (CLIAC). The mid-September meeting in Atlanta featured a special session devoted to briefings on the future of the lab workforce. CLIAC’s look at the issues comes at a time of dwindling federal funding for lab workforce programs and no congressional authorization of new funding (see box "Push For New Lab Training Money Falters").

Backdrop to the Future

The annual need exceeds the lab workforce supply by approximately 2 to 1, Kathy Doig, PhD, CLS(NCA), CLSp(H), told the CLIAC panel. Doig is director of the biomedical lab diagnostics program at Michigan State University in East Lansing. Roughly 10,000 to 12,000 workers are needed yearly, while only 4,000 to 5,000 are produced. (The Labor Department has estimated that each year until 2014, 15,000 jobs for lab personnel will open up due to industry growth or replacements of the aging workforce.)

The attrition rate for professionals in the first five years of practice is about 5%, Doig noted. Most recent statistics indicate a vacancy rate of approximately 6% overall for generalist professionals, lower than six years ago when the rate was 10% to 15%. But this is cyclical, she added: "When the economy turns down, healthcare careers look good."

The supply crisis is taking on a different dimension too, Doig observed. The average age of lab professionals is in the upper 40s, and a substantial number of retirements can be expected in the next 10 to 15 years, she said. And there aren’t enough young people to meet demand in all areas of the economy. "We are competing with other sectors and with other healthcare professions."

The shortage exacerbates chronic problems in the lab workforce, including career dissatisfaction, diminished morale, and attrition, Doig said, pointing to:

• Lack of clear distinctions between levels of practice for clinical laboratory scientists/medical technologists (CLS/MTs) and clinical/medical laboratory technicians (CLT/MLTs), leading staff to believe that they are doing the same job for less pay or that their skills are underused.
• Salaries that lag behind comparable health professions (see "Salaries in Clinical Laboratory Science Comparied to Other Health Professions"). CLS/CLT salaries have just kept pace with inflation since the 1970s.
• Market changes that undermine the value of professional education. Employers in states that do not require lab personnel licensure can hire anyone, including high school graduates, and often do so out of desperation. They must ensure, however, that their employees meet the CLIA personnel requirements.
• Perceived lack of appreciation by medical caregivers and hospital administrators.
• Lack of opportunities for advancement in clinical practice.

There is some good news, Doig said. "Anecdotally, many programs report higher occupancy rates and higher application numbers than in recent years." The bad news is that the capacity for educating professionals is reduced because of the steady decline in hospital and university-based CLS and CLT training programs. But having more programs will not solve the problem if young people are not motivated to enroll and graduate, she cautioned.

Forecast for the Future

The lab workforce of the future will still reflect diverse skill levels, Doig said—pathologists, doctoral scientists, bachelor’s level scientists, associate level practitioners, aides and phlebotomists. The non-physician professional mix may change (increased use of lesser skilled staff as technology advances, for example) or the scope of practice may shift as clearer distinctions are made between CLS/MTs and CLT/MTs.

A big spot for the future, Doig said, is development of an advanced degree path for career advancement. (Work on this is already being done by the Professional Doctorate Task Force spearheaded by the American Society for Clinical Laboratory Science and including members from ASCLS, the American Society for Clinical Pathology, and the National Accrediting Agency for Clinical Laboratory Science. The latter also has a Graduate Programs Task Force looking into this degree.)

The doctorate degree would be an optional route for the CLS, with additional education to equip the individual to consult with pathologists and doctoral scientists on test ordering and interpretation, including participating in interdisciplinary rounds. The advanced practice lab professional could also consult with treating physicians and patients on test results and help develop research on improved patient care and reduced costs.

There definitely is interest in the advanced practice degree, Doig noted. She and colleague S. Beck surveyed 972 early-career CLSs in 2005 and got 299 responses to the question: What is your impression of this proposed career option, assuming the salary is commensurate with the required doctoral degree?

• I’d be interested in pursuing this option – 65.2%.
• This would be a good option for people who currently choose to become MDs, physician assistants, etc. – 28%.
• Not of interest to me; I prefer remaining in the lab – 10.2%.
• Not of interest to me; I wouldn’t want to make the time or financial investment in a doctoral degree – 9.2%.
• Not of interest to me for other reasons – 5.8%.

Interdisciplinary Roles

Kathleen Hansen, CLS(NCA), briefed CLIAC on efforts at her institution to make the CLS the "face of the laboratory" in patient care units. She is interim president of Fairview Laboratory Services and director of lab operations at the University of Minnesota Medical Center (UMMC)—Fairview in Minneapolis.

When interdisciplinary process improvement (PI) teams were established for patient care units, the lab stepped forward to be sure that a CLS was appointed to each team, Hansen said. The PI teams address cost per case issues and support implementation of the Computerized Physician Order Entry (CPOE) program, Verisafe (positive patient ID, using bar-coded armbands), and a new process for ordering blood products.

There have been some short pilots where lab personnel joined clinical rounds on a daily basis. CLS staff from the core lab felt they made a contribution, Hansen said, but sometimes had to go back for answers about "special diagnostic" lab services. They would be more confident about commenting on test ordering patterns if they had more clinical training in test utilization and best practices.

This experience showed there is a need for and an interest in scientific and other skills training to support CLS involvement with clinical teams, Hansen said, and underscores the importance of the effort to establish a lab doctorate option for advanced practice.

November 6, 2006 - Table of Contents

NIR November 6, 2006 (full PDF issue)

Final Medicare Rule Cuts Physician Fees, Punts on Pod Labs

Hopes Dim for Lab Workforce Legislation

Industry Anxious Over Proposed New ‘Home Brew’ Controls

The Changing Landscape of Supply/Demand, Clinical Practice

Medicare to Expand Physician Quality Measures in 2007

Medicare Payment Errors Continue to Drop, Says CMS

Medicare Managed Care Watch