Factors contributing to shortage of med techs and other lab scientists include limited training programs in clinical laboratory science, pay disparity, and staff retention, notes infectious disease specialist Judy Stone, MD
Staff shortages are a growing challenge for medical laboratories, and now the problem has grabbed the attention of a major media outlet.
In a story she penned for Forbes, titled, “We’re Facing a Critical Shortage of Medical Laboratory Professionals,” senior contributor and infectious disease specialist Judy Stone, MD, wrote, “Behind the scenes at every hospital are indispensable medical laboratory professionals. They performed an estimated 13 billion laboratory tests in the United States each year before COVID. Since the pandemic began, they have also conducted almost 997 million diagnostic tests for COVID-19. The accuracy and timeliness of lab tests are critically important, as they shape approximately two-thirds of all medical decisions made by physicians.”
Though Stone states in her Forbes article that clinical laboratories in both the US and Canada are facing staff shortages, she notes that the problem is more acute in the US.
As Dark Daily reported in February, the so-called “Great Resignation” caused by the COVID-19 pandemic has had a severe impact on clinical laboratory staffs, creating shortages of pathologists as well as of medical technologists, medical laboratory technicians, and other lab scientists who are vital to the nation’s network of clinical laboratories.
In her analysis, however, Stone accurately observes that the problem pre-dates the pandemic. For examples she cites two surveys conducted in 2018 by the American Society for Clinical Pathology (ASCP):
Many pathologists and clinical laboratory managers would agree that Stone is right. Dark Daily has repeatedly reported on growing staff shortages at clinical laboratories worldwide.
And in “Lab Staffing Shortages Reaching Dire Levels,” Dark Daily’s sister publication, The Dark Report, noted that CAP Today had characterized the current lab staffing shortage as going “from simmer to rolling boil” and that demand for medical technologists and other certified laboratory scientists far exceeds the supply. Consequently, many labs now use overtime and temp workers to handle daily testing, a strategy that has led to staff burnout and more turnover.
“There is a critical shortage of medical laboratory professionals in the US, and in Canada to a lesser extent,” wrote infectious disease specialist Judy Stone, MD (above), in an article she penned for Forbes. “Here [in the US],” she added, “we are 20-25,000 short on staff, with only 337,800 practicing. That is roughly one medical laboratory scientist per 1,000 people.” Clinical laboratories are well aware of the problem. A solution to solve it and return labs to former staffing levels is proving elusive. (Photo copyright: Forbes.)
Why the Shortfall?
In her Forbes article, Stone notes the following as factors behind the shortages:
Decline in training programs. “There are only [approximately] 240 medical laboratory technician and scientist training programs in the US, a 7% drop from 2000,” Stone wrote, adding that some states have no training programs at all. She notes that lab technicians must have a two-year associate degree while it takes an average of five years of post-secondary education to obtain a lab science degree.
Pay disparities. Citing data from the ASCP, Stone wrote that “medical lab professionals are paid 40%-60% less than nurses, physical therapists, or pharmacists.” Moreover, given the high cost of training, “many don’t feel the salary is worth the high investment,” she added.
Staff retention. In the ASCP’s 2018 job satisfaction survey, 85.3% of respondents reported burnout from their jobs, 36.5% cited problems with inadequate staffing, and nearly that many complained that workloads were too high.
Inconsistent licensing requirements. These requirements “are different from state to state,” Stone wrote. For example, the American Society for Clinical Laboratory Science (ASCLS) notes that 11 states plus Puerto Rico mandate licensure of laboratory personnel whereas others do not. Each of those states has specific licensing requirements, and while most offer reciprocity for other state licenses, “California [for example] does not recognize any certification or any other state license.”
In a 2018 report, “Addressing the Clinical Laboratory Workforce Shortage,” the ASCLS cited other factors contributing to the shortages, including retirement of aging personnel and increased demand for lab services.
Possible Solutions
Stone suggested the following remedies:
Improve working conditions. “We need to reduce the stress and workload of the lab professionals before we reach a greater crisis,” Stone wrote.
Standardize state certification. This will facilitate “mobility of staff and flexibility in responding to needs,” Stone suggested.
Improve education and training opportunities. The ASCLS has called for clinical lab science to be included in the Title VII health professions program, which provides funding for healthcare training. Rodney Rohde, PhD, a clinical laboratory science professor at Texas State University, “also suggests outreach to middle and high school STEM programs, to familiarize students early with career opportunities in the medical laboratory profession,” Stone wrote.
Recruit foreign workers. Stone suggested this as an interim solution, with programs to help them acclimate to practice standards in the US.
It will likely take multiple solutions like these to address the Great Resignation and bring the nation’s clinical laboratory staffing levels back to full. In the meantime, across the nation, a majority of clinical laboratories and anatomic pathology groups operate short-staffed and use overtime and temporary workers as a partial answer to their staffing requirements.
Influenza Outbreak Calls Attention to Shortage of Medical Technologists, other lab staff
It took the threat of an influenza pandemic recently to get at least one news reporter to realize the shortage of medical laboratory technicians has reached epidemic proportions.
While the recent outbreak of A/H1N1 influenza turned out to be a dress rehearsal, it inspired Wall Street Journal (WSJ) reporter Laura Landro to focus on the critical role played by medical technologists, clinical laboratory scientists, medical laboratory technicians, and other lab professionals, along with the potential consequences of this clinical laboratory staffing shortage when a killer bug turns out to be “for real.”
Similar diagnostic delays due to clinical laboratory staff shortages are reported in other nations as well Critical pathology shortages are causing lengthy delays for clinical laboratory test results in New Zealand, according to a report that states some patients are waiting over a month for a melanoma diagnosis. This situation puts the lives of cancer patients at risk in the island nation. The Melanoma Network of New Zealand (MelNet) is working to reduce the number of people who develop the...
Proposed regulation to limit rate increases during health crises gets pushback from staffing agencies and travel nurses who disagree with salary restrictions
Hospitals across the nation are seeking relief from skyrocketing costs due to increased demand for temporary workers—especially travel nurses. This has led organizations like the American Hospital Association (AHA) to step in and call for legislators to cap spiking salary rates. Many clinical laboratories report similar increases in salaries following the outbreak of SARS-CoV-2 for medical technologists (MTs), clinical laboratory scientists (CLSs), histologists, and other skilled positions. This increase in salaries of lab scientists was mirrored by an even greater increase in the cost of travel MTs.
According to analysis conducted by Becker’s Hospital Review of hiring data from Vivian Health, an online job placement website for healthcare professionals, “Average weekly travel nurse pay climbed from $1,896 in January 2020 to $3,782 in December 2021, a 99.47% increase.”
A prior study by Kaufman Hall and Associates, LLC., found rates for temporary workers almost 500% higher than pre-pandemic times. While numbers are trending downward, it’s clear that rates are still high enough to cause alarm, KFF Health News reported.
“During the pandemic there were staffing companies who were making a lot of promises and not necessarily delivering,” Dave Dillon (above), VP of Public and Media Relations at Missouri Hospital Association, told KFF Health News. “It created an opportunity for both profiteering and for bad actors to be able to play in that space.” (Photo copyright: L.G. Patterson/Missouri Hospital Association.)
AHA Alleges Price Gouging
Demand for temporary healthcare workers surged during the COVID-19 pandemic, and, because supply was limited, salaries for temporary workers—such as travel nurses—soared as well. This dramatic increase in hospitals’ costs prompted the AHA in 2021 to send a letter to the Federal Trade Commission seeking relief for healthcare providers from what the organization called “anticompetitive pricing by nurse-staffing agencies.”
In January 2022, about 200 House members urged then White House COVID-19 Response Team Coordinator Jeffrey Zients “to investigate reports that nurse staffing agencies are taking advantage of the COVID-19 pandemic to increase their profits at the expense of patients and the hospitals that treat them,” an AHA new release noted.
In an AHA House Statement titled, “Pandemic Profiteers: Legislation to Stop Corporate Price Gouging,” the AHA wrote “Our concerns range from potential collusion to increased prices way beyond competitive levels and/or egregious price gouging and the impact these behaviors could have on efforts to care for patients and communities.”
Temporary nurses make up a large portion of staff nationwide with 1,760,111 employed nationally as of September, according to Zippia research. With some nurses commandeering $40,000 signing bonuses and pay rates up to $10,000 a week for ICU nurses during the height of the COVID-19 pandemic, the significant impact of these rate hikes cannot be ignored.
“We have received reports that the nurse staffing agencies are vastly inflating price by two, three, or more times pre-pandemic rates, and then taking 40% or more of the amount being charged to the hospitals for themselves as profits. This situation is urgent and reliance on temporary workers caused normal staffing costs to balloon in all areas of the country,” Representatives Peter Welch, D-VT, and Morgan Griffith, R-VA, wrote in the letter submitted by the AHA to House members.
States Take a Stand
But nothing was done at the federal level to cap rates for travel nurses, so hospital organizations in 14 states lobbied legislators to cap rates at the local level. However, this has proven to be problematic.
At this time, at least 14 states have proposed legislation that impose limits on what temp nursing services can charge and what stipulations they must follow during a crisis. Navigating this patchwork of state laws could be challenging for both hospitals and temporary nurses.
Some states are taking sterner measures, KFF Health News reported:
Missouri regulators proposed legislation that would allow felony charges to be brought against healthcare staffing agencies that raise prices during emergencies.
Texas lawmakers proposed legislation that would administer civil penalties against agency price-gouging—laws which the state does not have on the books at all—and also would allow fees up to $10,000 to be assessed per violation of the proposed law.
New York proposed amendments to legislation that would cap the amount temporary staffing agencies could charge.
Nurses, Staffing Agencies Tell Their Side
The implementation of new laws to protect hospitals from alleged temp agency price gouging presents new challenges. One issue is state-to-state competition.
“It might become difficult to hire travel nurses, and some states could face a lower-quality hiring pool during a national crises if the neighboring state doesn’t have strict measures,” Hannah Neprash, PhD, Assistant Professor, Division of Health Policy and Management at the University of Minnesota, told KFF Health News.
And financial handcuffs may not sit well with staffing agencies that feel misunderstood by hospital organizations pushing for regulation. According to KFF Health News, “Typically about 75% of the price charged by a staffing agency to a healthcare facility goes to costs such as salary, payroll taxes, workers’ compensation programs, unemployment insurance, recruiting, training, certification, and credential verification, said Toby Malara, a Vice President at the American Staffing Association trade group.”
Malara added, “hospital executives have, ‘without understanding how a staffing firm works,’ wrongly assumed price gouging has been occurring. In fact, he said many of his trade group’s members reported decreased profits during the pandemic because of the high compensation nurses were able to command,” KFF Health News reported.
Not surprisingly, many nurses have also come out against government regulation of their wages.
“Imagine the government attempting to dictate how much a lawyer, electrician, or plumber would make in Missouri. This would never be allowed, yet this is exactly what’s happening right now to nurses,” Theresa Newbanks, FNP, a nurse practitioner who is affiliated with several hospitals in multiple states.
Creative Responses Required
Increases in both rates and legislation continue to spur creativity among hospitals needing to fill shifts, support staff, and prevent worker burnout.
The American Hospital Association December 2022 Task Force noted this in their “Creative Staffing Models” paper. The AHA cited telehealth visits, technical support, and working with non-traditional partners as beneficial ideas. These were also noted as meaningful ways to recruit and retain staff.
Other hospital systems have even created their own staffing agencies. Allegheny Health Network (AHN) developed a variety of systems where nurses can work a single weeklong assignment, multiple-week assignments, or transfer to other facilities, Kaiser Health News reported. While these staffing scenarios make up a small percentage of the hospital staff, it’s a worthwhile addition to increase options for nurses.
Staff turnover for RNs increased from 8.4% to 27.1% last year, as reported by the 2022 NSI National Healthcare Retention and RN Staffing Report. Finding solutions to staffing shortages—and consequently increased temporary nursing cost—is crucial because burnout is still a problem, just as it is in clinical laboratories and pathology groups.
Staffing specialists advise medical laboratories to expect shortages to continue
Clinical laboratory and pathology group managers are keenly aware of the Great Resignation and how it has affected lab industry staffing and recruiting. Medical technologists (MTs) and clinical laboratory scientists (CLSs) are in particularly short supply and some experts do not see this critical shortage waning anytime soon.
In an exclusive interview with Dark Daily, Maggie Morrissey, Director of Recruiting and Staffing Services at Lighthouse Lab Services, explains the multi-faceted problem labs are facing meeting recruitment goals, and how understaffing can lead to bigger matters regarding morale and job satisfaction.
Based in Charlotte, N.C., Lighthouse Lab Services is a medical laboratory consulting and recruiting firm that employs 150 people and services more than 1,500 medical laboratory clients.
In July, Lighthouse released the results of its 2022 Survey on Wage and Morale Issues among Medical Laboratory Professionals. The collected data from 1,112 respondents found that only 27% indicated their clinical laboratories were adequately or well-staffed. Forty percent of respondents believe their labs were moderately understaffed while an additional 33% felt their labs were significantly understaffed.
The primary reasons, according to Lighthouse, for staffing shortages can be attributed to:
The number of schools offering medical technology programs has decreased.
People have been retiring at a higher rate than most industries.
It is difficult to become a medical technologist/clinical laboratory scientist.
There are hurdles to jump through to become a medical technologist.
Medical technology is not a well-known field.
“[Eastern Carolina University] told us they don’t have anyone graduating from the [medical technology] program this year because of COVID. There are all these issues exacerbating the problem,” said Maggie Morrissey (above), Director of Recruiting and Staffing Services at Lighthouse Lab Services, in an exclusive interview with Dark Daily. “Making it more attractive starts at the school level. People need to be introduced to the science of medical technology. It’s not something that many students know exists as a career.” This lack of interest in training programs is a major reason for the severe shortage of medical technologists on staff at clinical laboratories around the US. (Photo copyright: Lighthouse Lab Services.)
Stagnant Pay, Low Morale, Lack of Appreciation in Clinical Labs
“The major issue that we see with medical labs across the country is that they are understaffed,” Morrissey stated. “That tracks to low morale. It’s a major issue for laboratories because when a lab is understaffed and everyone is working very hard, lab staff may not feel appreciated and their morale starts to wane, which snowballs into larger issues.”
Morrissey pointed out that individuals who work for different sized clinical laboratories have dissimilar grievances about their jobs.
“Pay continues to be a concern for all, but benefits are also important,” she said. “Pay and lack of benefits, like not being able to get time off, not having a 401K, and not having health insurance are hurdles for people working in smaller labs.”
Professionals working in medium-sized and larger labs are also concerned about pay, but they have other complaints as well.
“They feel like they are a cog in the machine and feel underappreciated,” Morrissey said. “What we hear a lot from people who work in the clinical labs of large hospitals is that they feel unappreciated by those working in other departments.”
Too Few MT/MS Training Programs to Meet Demand
According to Forbes, the US currently has a shortage of approximately 20,000-25,000 medical technologists. The approximately 338,000 technologists working in the country equate to about one technologist per 1,000 people, which translates to a vacancy rate of 7% to 11% in almost every region.
Forbes also reported that medical technologists in the US had performed approximately 13 billion laboratory tests annually before the COVID-19 pandemic. However, the pandemic added 997 million SARS-CoV-2 diagnostic tests to the existing workload.
Intensifying the problem is that currently there are only 240 medical technologist and medical scientist training programs in the US, which represents a 7% decrease since 2000. Forbes notes there are some states that have no such training programs at all.
“Having the opportunity to train to be a medical technologist is an important thing,” Morrissey said. “More universities and community colleges need to offer associate’s and bachelor’s degrees in medical technology.”
However, even with an increase in available degrees, few students are enrolling in those programs.
Morrissey suggests that clinical lab professionals contact local educational institutions to inform them of the need for medical technology degrees and determine if they can do anything to help start such training programs.
“If you are a medical laboratory in an area that doesn’t have a school that offers a degree in medical technology, I would recommend banging down the doors of community colleges to see how you can get that type of program into place,” she proposed. “It really benefits you. It is really about getting those schools to realize there is a need for medical technologists.”
Morrissey added that schools are beginning to re-add medical technology programs to their curriculum. This may translate into more available MTs and CLSs to work in clinical laboratories and relieve some of the staffing shortages.
Laboratory Automation, More Federal Lobbying Could Help
Automating some medical laboratory operations could present another solution to staffing dilemmas.
“Automation will help a little bit,” she said. “A significant number of labs are adding automation—either at the technology or collection level—so they don’t need as many technologists to run the lab.”
Additionally, regionalization of clinical labs could help with staffing issues because high volumes of samples can allow for the streamlining of staff.
“Some integrated delivery networks (IDNs) that have multiple hospitals within a city or metro area are regionalizing their clinical laboratories and using couriers to transport the samples being collected, resulting in better efficiency and productivity,” she said.
Morrissey also believes there is room for lobbying for the occupation of medical technology at both the state and federal levels. She compared the clinical laboratory profession to how the nursing profession dealt with shortages in the past.
“Nursing is in all hospital and doctor groups,” she explained. “They have very large organizations that are advocating for them at the federal and state level and labs need more of that.”
Clinical Lab Recruiting Reverting to Pre-COVID Qualifications
Though more people are testing themselves for COVID at home, Morrissey says the need for more clinical laboratory professionals will not subside any time soon.
“Before COVID, there was a huge increase in requests for toxicology reports due to drug testing and screening,” she explained. “COVID caused those needs to go away, not because people didn’t need those things, but because everyone was focusing on COVID. If an individual is not going into work, does he or she really need a monthly drug screen? The needs shifted during COVID and now they are shifting back.”
During the COVID-19 pandemic, medical labs were more willing to train individuals who had some lab experience or a background that would indicate they could perform the job duties. It is probable that recruiters will start to have more stringent requirements for potential lab employees, reverting back to pre-COVID qualifications.
Nevertheless, Morrissey believes staffing shortages for medical laboratories will continue.
“In the short term, in the next one to three years, I think it is going to get worse before it gets better,” she said. “In the medium term, automation in clinical laboratories will probably ease the staffing shortage quite a bit. Potentially, we will see more medical technology training programs pop up as the staffing shortages become a better-known issue.”
