Bench press: The technologist/technician shortfall is putting the squeeze on laboratories nationwide September 2000

Vida Foubister At a time when technology talk is nonstop, the clinical laboratory profession isn’t joining in the fanfare. "People just really don’t know what medical technology is all about," says Kay Doyle, PhD, MT(ASCP). "It’s like we’re the hidden health profession." Dr. Doyle is professor and program director of the medical technology program, University of Massachusetts Lowell. Tests performed in clinical laboratories are an essential part of modern medicine. It’s estimated that up to 85 percent of physicians’ decisions regarding a patient’s diagnosis and treatment are based on laboratory test results. As medical knowledge continues to advance, the battery of tests laboratories have to offer, and their complexity, is expected to increase. But those entering today’s workforce aren’t choosing medical technology. And a majority of those in the profession are baby boomers who will begin retiring en masse within the next decade. According to the U.S. Bureau of Labor Statistics, 5,300 new medical technologist and medical laboratory technician positions will be created annually through 2008. Retirements will push that number up to an estimated 9,300 available positions a year. Yet the National Accrediting Agency for Clinical Laboratory Sciences reported that only 2,491 medical technologists and 2,381 medical laboratory technicians graduated last year. Medical technologist programs are closing, and enrollment in the remaining programs is far below maximum class size. From 1983 to 1999, the number of medical technologist programs dropped from 638 to 273, and enrollment declined from 8,296 to 5,117. "We will have an estimated shortfall of about 5,000 positions a year on the supply side in the next five to 10 years," says Kory Ward-Cook, PhD, MT(ASCP), vice president of the American Society of Clinical Pathologists Board of Registry, Chicago. Not surprisingly, that’s expected to leave laboratories already struggling to fill open positions even shorter staffed. Dr. Ward-Cook, who oversees the ASCP Board of Registry’s biennial wage and vacancy survey of medical laboratories, says she believes the 10.3 percent vacancy rate for medical technologists in 1998 is escalating. She thinks this holds true for medical laboratory technician positions as well, which had a 10.7 percent vacancy rate in 1998. This isn’t necessarily a new problem. Previous market cycles, most recently in the early 1990s, have resulted in a shortage of clinical laboratory personnel. However, the depth and complexity of the problem appears to be unprecedented. "As a clinical laboratory director, some days I have hour-by-hour concerns about staffing difficulties," says Stephen E. Kahn, PhD, DABCC, associate director of the clinical laboratories and professor of pathology and cell biology, Loyola University Medical Center, Maywood, Ill. Laboratory managers and educators interviewed by CAP TODAY blame numerous factors for the shortage. The biggest one appears to be salaries. Though laboratories reportedly are offering signing bonuses of up to $10,000 to recruit new personnel, salaries-especially those of long-time employees-essentially have remained flat. "As an educator, it’s a real moral dilemma for me to go out to high schools and say, ’Oh, come into this profession. It’s honorable; it’s worthy. You’re going to be in a high-risk and high-stress environment. You’re going to make a measly $30,000,’" says Diana Mass, MA, CLS(NCA), MT(ASCP). Mass is clinical professor and director of the clinical laboratory sciences program, Arizona State University, Tempe. A close second to low salaries is lack of public knowledge about the profession. At the University of Massachusetts Lowell, most of the medical technology students are entering the program as transfer students. "When they came to the university, they heard about our program and that’s what they were interested in," Dr. Doyle says. "But they had never heard of it before they came here. . . . There needs to be a better structure. [Right now] it’s almost like an accidental thing." Educators, guidance counselors, and school recruiters, in many cases, lack basic information about the field. Dr. Doyle tells the story of a high school student who wanted to do a field project on medical technology but whose biology teacher told him, "There’s no such thing anymore." The student replied, "Yes there is, my mother’s a supervisor." Many believe government officials, as a whole, also are uninformed about medical technology. Those making this claim point to the squeeze on Medicare reimbursement rates for laboratory testing under President Clinton’s administration. "From 1992 to 1998, Part B expenditures for laboratory testing dropped from about 2.8percent to 1.6 percent of the overall Medicare budget," Dr. Kahn says. "The system is woefully out of date," he continues. "It doesn’t take into account the impact and the value of laboratory test results and their effects on patient care and outcomes. It doesn’t take into account technology changes over the years." Just as diverse as the factors contributing to the shortage are the efforts to solve the problem. "We didn’t get into this situation overnight, and we’re not going to be able to get out of the situation in six months or a year either," Dr. Kahn says. "It is going to require a coordinated, long-term strategy of a lot of groups, societies, and individuals working together." But the need for the profession to pool its resources comes at a difficult time. The pressures on laboratories to control costs have led many to eliminate training programs or affiliations, cut continuing education funds, and limit research projects. In this transition, many laboratories have gone from being "a really dynamic place to work" to one where "they’re really looking at the bottom line and getting these cases out," says Theresa Somrak, JD, CT(ASCP), director of the ASCP’s cytopathology education consortium. Not surprisingly, morale is low, and many laboratory professionals are looking for new career options. Some of them are being lured away from one laboratory to another by the promise of a signing bonus. Others are looking outside the profession and taking jobs with industry, which has quickly learned to value their expertise. "We used to get ads that would say microbiologist or chemist, but biotechnology companies have hired enough med techs that now they are advertising for medical technologists," Dr. Doyle says. Laboratories lacking a sufficient applicant pool increasingly are turning to individuals who have less experience, less education, or both. Some say this switch in personnel qualifications became possible under the Clinical Laboratory Improvement Amendments of 1988. "I’ve been in the field for over 25 years now, and I can remember labs years ago that would only hire MTs, and now they’re hiring MLTs," says Dave Glenn, MT(ASCP), clinical coordina-tor of MidPlains Community College’s medical laboratory technician program and lab manager of Pathology Services P.C., North Platte, Neb. "Labs that could not hire MTs, but hired MLTs, now can’t find enough MLTs," he continues. "They’re using on-the-job trained personnel to perform a lot of the preanalytical and postanalytical tasks and, in some cases, even to do the actual testing because that’s allowed." There is little hard evidence that the switch to less experienced personnel, coupled with the general shortage of staff, has affected the quality of laboratory testing. However, anecdotes persist. One recent example involved a laboratory running patient samples with outdated reagents. The staff seemed to focus solely on the validity of the electronic control for the blood gases measurement. They didn’t understand that the readings might be different with an actual sample. Furthermore, "We do know from the CLIA inspections that the laboratories that have the highest qualified, experienced, educated personnel had the fewest deficiencies and fewest problems on proficiency Surveys,"asserts Glenn. Others say the recent changes have not affected quality. "When you are running at a higher vacancy rate, it’s harder to get the work done, and people are stretched thinner. It’s a work situation that you would certainly prefer not to deal with," Dr. Kahn says. "But there are still many, many standards and requirements that have to be followed to protect patient care and ensure quality in delivering laboratory services." The release of the Institute of Medicine’s report on medical errors last year has renewed the attention to quality issues in health care. This should give clinical laboratory managers and educators a strong foundation on which to rebuild the profession. As a first step toward that goal, the American Society for Clinical Laboratory Science recently brought together, in Chicago, representatives of major laboratory associations to address the personnel shortage. Among those attending the summer conference were members of the American Association for Clinical Chemistry, American Medical Technologists, ASCP, Clinical Laboratory Management Association, American Society of Microbiology, and National Society for Histotechnology. "We’re going to have to be a little more proactive, get away from the instrument, and get in front of people and volunteer to take some of these programs that are being developed by the summit conference and by the organizations that already have them and show the youth what is available to them in the future," Glenn says. The participants in the Chicago summit have not committed to a course of action, but the group intends to hold a second meeting to define further the initiatives it will undertake collectively. The participants are focused on raising awareness of the profession and improving efforts to recruit students into medical technologist and medical laboratory technician training programs. Dr. Doyle, for one, can’t say enough about the profession’s need for publicity. She would like to see articles in widely read magazines, such as Parade Magazine, which "just about every Sunday paper in America has," and specials on such television news programs as "ABC News 20/20". "In basic science, because of research and publication, people are very good about tooting their own horn about how hard it is, how analytical it is, and the kinds of skills and training and the intelligence that it takes," Dr. Doyle says. "Well, laboratory medicine is no different, but nobody talks about it , so people don’t know what it is." For a model, she points to another allied health profession—nursing—and its "Everybody Needs a Nurse" campaign. Nurses in the New England area are striking to oppose mandatory overtime, which they feel isn’t in the best interest of patient care, and "the public supports them because they understand what nurses do," Dr. Doyle explains. Several other groups have begun their own media initiatives. In August 1999, the American Association for Clinical Chemistry launched the Health Indicators Five, or HI 5, campaign to improve awareness of the value of clinical laboratory testing. It encouraged patients to learn about the results of five common blood tests—for glucose, cholesterol, prostate-specific antigen, thyroid-stimulating hormone, and hemoglobin. "AACCis taking the message to the public that understanding the value of laboratory testing is integral to your health," Dr. Kahn says. This summer, ASCP was featured as a "Champion of Industry" in a two-minute segment produced by Pat Summerall Productions. The segment was broadcast on Fox News Network and MSNBC in late July, and an expanded five-minute version is now available on the ASCP Web site, www.ascp.org. "What we focused on was who are the professionals that work in a laboratory, who are pathologists, and who are the technicians and technologists that perform your laboratory tests," Dr. Ward-Cook explains. Dr. Doyle also would like to see segments about the profession aired on educational television. About two years ago, she was one of 30 people selected for an "Ask the Professor" program transmitted to local high schools via distance learning television. The question was, "How are heart attacks diagnosed by laboratory tests?" Her 30-minute presentation, which was broadcast to two high schools, helped students find the answers. Glenn says he would like the participants in the recent Chicago summit to "work together to produce some materials that can be used at the grassroots levels by MLT and MT programs." The ASCP Board of Registry, for example, is producing a new career video to attract people to the profession. It also has developed brochures and PowerPoint presentations about the profession that can be downloaded from its Web site, www.ascp.org/bor/pub/. Partnering with science museums is another way to raise local awareness of medical technology. These museums typically have a medical section, and their staffs often are interested in hosting speakers who can talk about health issues in the news. The audience for these presentations tends to vary from teenagers to adults to, in some cases, more focused groups, such as high school science teachers. Dr. Doyle has worked with the staff at Boston’s Museum of Science to sponsor a number of speakers. About 10 years ago, the focus was on cholesterol testing as access to these tests moved from the doctor’s office to the shopping mall. More recently, a speaker discussed food poisoning following problems with bacterial contamination of South American raspberries. Another challenge facing the profession is "figuring out how to get onto kids’ radar screens," Dr. Doyle says. Because information technology is the top choice of many students, highlighting the fact that computers are used throughout the laboratory might attract kids’ attention. Students might not know that, in addition to laboratory information systems, most of the instruments are computerized. "We need to get in these grade schools and let kids know, ’Hey, this is a fun occupation. There are some neat instruments. You can play with computers. You get to do good for humanity by helping physicians diagnose and treat,’" Glenn says. Instead of relying on course catalogs or other similar books, organizations need to send their message through a medium that reaches today’s kids. An obvious channel is the World Wide Web. Guidance counselors and program recruitment officers also can help to spread the word about medical technology. Talk to them, send them letters, and write articles about the field for their publications, Dr. Doyle recommends. However, she adds, given the restrictions on college recruitment, it might be best for the professional organizations to step into this role. Recruitment is the area Washington state’s Clinical Laboratory Advisory Council work group on clinical laboratory personnel shortages has chosen to address. Even though a recent survey found that Washington’s vacancy rates are lower than the national average, the work group concluded that the lack of people entering the field is a major concern. "The bottom line is there aren’t enough [MTs or MLTs] in the country. We’re going to have to encourage people to go into the field," says Gail Neuenschwander, MT(ASCP), program manager of the Washington State Department of Health Office of Laboratory Quality Assurance. The need to ensure training programs remain viable is another item on the summit participants’ agenda. Despite the closing of 57 percent of the medical technology training programs nationwide since 1983, some good news can be found. University programs whose clinical affiliations were being terminated as a result of consolidation in the hospital industry are once again finding hospital laboratories eager to become partners. "We’re trying to step up our efforts to affiliate with programs," Dr. Kahn says. "It provides a program with an opportunity to place their trainees for a period of time in a real-world lab environment, and, in turn, the people in the labs are hoping to be able to employ the good students as they finish their training." Programs in need of financial aid might also want to consider looking for support from reference laboratories and other companies that lack personnel. Dr. Ward-Cook points to a novel associate degree MLT program that was initiated by Burlington, NC-based Labotory Corporation of America Holdings. LabCorp approached Alamance Community College, Graham, NC, which is 11 miles away from the company’s Burlington headquarters, about starting the program to meet LabCorp’s staffing needs. The cosponsored program enrolled its first students in 1988. Faculty members are on staff at the college, but all training takes place in a student classroom and laboratory that is located within the Burlington facility. However, the MLT program’s enrollment is down, and Peggy Simpson, MS, MT (ASCP), its director, now finds herself having to justify LabCorp’s funding. "We need to be proactive in providing continuing education for their employees," explains Simpson. "They also appreciate the availability of entry-level graduates. We need to give them some kind of payback." Simpson is chair of the ASCPBoard of Registry’s board of governors. College and university programs, in general, can benefit from offering courses to students who are not enrolled in those programs. In one case, a program threatened with closure was maintained after it demonstrated that the tuition income it generated from students campuswide was greater than the program’s expenses. "Then it’s not just your students who need the courses, it’s other people who need them and so you have support from other departments," Dr. Doyle explains. Program directors desiring to ward off closures might also want to obtain a free program revitalization booklet released last year by the Chicago-based National Accrediting Agency for Clinical Laboratory Sciences. (Call 773-714-8880 and ask for the booklet, "Program Revitalization: Strategies for Survival," or send an e-mail to info@NAACLS.org.) "There have been cases where people have fought to have the program kept open and succeeded," says Olive M. Kimball, EdD, executive director of NAACLS. A further focus of the summitwas on educating industry representatives and government officials about medical technology. One such effort that is already underway is the Laboratory Healthcare Partnership. The partnership is composed of a group of professional organizations and industry members that joined together several years ago to educate medical directors of managed care organizations about the value of laboratory testing. Along those same lines, Mass recommends educating hospital administrators about the potential impact of the clinical laboratory on the overall hospital budget. If the laboratory is understaffed or some of its employees are underqualified, it might increase test turnaround times or lead to errors that increase lengths of stay, she says. Whether government will take an active role in addressing this shortage is unclear. On March 7, Mass testified before the U.S. House of Representatives Appropriations Subcommittee on Labor, Health and Human Services and Education about the need to increase funding for allied health project grants. As a member of the Clinical Laboratory Improvement Advisory Committee, she had brought the potential quality implications of the laboratory personnel shortage to the subcommittee’s attention in May 1999. The issue was put on the subcommittee’s agenda last September, and the subcommittee concluded this spring that a problem exists. But the only step CLIAC has taken so far is to send a letter to Donna E. Shalala, PhD, secretary of the Department of Health and Human Services. "Essentially, from my perspective, the government is doing zilch," Mass says. Dr. Kahn is more optimistic. He points not only to the CLIAC hearings, but also to the participation of representatives from the U.S. Food and Drug Administration and Centers for Disease Control and Prevention in the recent summit. "We’re struggling through a difficult period right now, and it doesn’t seem that there will be any immediate relief, but hopefully some of the things that are being done will have a positive impact down the road," he says. Buoying that perspective is that medical technology services are going to be in high demand as a result of the baby boomer generation retiring. "They’re much more interested in their health care," Dr. Ward-Cook says. "They’re going to be demanding more tests to monitor their health." Though laboratories have become more automated, most samples from baby boomers are still going to be processed manually. And despite the profession’s low salaries, the 1999 Jobs Rated Almanac listed medical technologist as 16th and medical laboratory technician as 18th in a national jobs survey. "I can’t predict the future," says Glenn, "but I would put my money on the fact that it’s going to be good for MTs and MLTs." Vida Foubister is a reporter for American Medical News.