Inside Track: Help Wanted

Biennial ASCP vacancy survey captures a profession in transition

Interview by Steve Halasey

Clinical laboratorians who sense that there has been a gradual increase in the number of empty chairs in their facilities are probably correct, according to recently published findings of the 2014 vacancy survey by the American Society for Clinical Pathology (ASCP).¹

According to the survey, clinical laboratories throughout the United States are seeing vacancy rates climb as baby boomers who held off retiring during the great recession are now handing in their retirement notices. Areas of medical laboratories that have the highest number of staff will be hardest hit by anticipated retirements over the next 5 years, including chemistry (with the highest anticipated retirement rate, at 23.60%), hematology (19.51%), microbiology (19.48%), and blood banks (19.19%).

Conducted every 2 years among laboratory professionals who hold management level or human resource positions, the ASCP vacancy survey serves as a primary research source for industry, labor, government, and academic analysts. Overall, this year’s 1,353 respondents represent 33,162 medical laboratory employees across the United States. The survey findings show that overall vacancy rates increased in all departments of the medical laboratory, except for cytology and cytogenetics. It also shows higher anticipated retirement rates for both staff and supervisors.

To find out more about the results of the ASCP survey, CLP recently spoke with Barbara Caldwell, MS, MLS(ASCP)^CM, SH, administrative director of clinical laboratory services at MedStar Montgomery Medical Center, Olney, Md, who served on the ASCP vacancy survey committee.

CLP: The survey reveals considerable disparities in the vacancy and retirement rates among various laboratory departments and functional areas. Why do such disparities exist?

Caldwell: The highest vacancy rates recorded in the survey are in the field of phlebotomy. Of all the specialties covered by the survey, that’s the field that has the least stringent educational requirements, and it tends to be on the lower end of the pay scale. Consequently there is a lot of turnover in that area, which leads to a higher vacancy rate. The dichotomy exists that although the field of phlebotomy requires the least training, these individuals are extraordinarily valuable. Not only do they procure the specimens that laboratory work depends upon, but they act on the front line and are often viewed by our patients as the image of the laboratory profession.

On the other end of the spectrum are the fields of cytogenetics, cytology, and flow cytometry, where the staff are typically very highly specialized and trained. I suspect that salaries are much higher at that end of the spectrum, and that no doubt contributes to lower vacancy rates.

CLP: Is there a natural flow of advancement within the laboratory profession? Do people typically start in one position and gradually become certified for more-demanding positions?

Caldwell: There is something of a career ladder, if you will, though technically it might not be considered a formal career path. There are definitely folks who have started out as phlebotomists and made their way into the technical realm.

ASCP’s membership spans the spectrum from phlebotomists to pathologists, and in between are technicians and technologists, who are either 2-year certified medical laboratory technicians or 4-year clinical laboratory scientists. We have both masters- and doctoral-level scientists, as well as both pathologists and pathology assistants—and many subspecialists in between. It’s a very diversified field, which is why the survey includes so many sections and so many different statistics in each section.

This year, the survey reveals overall vacancy rates that should certainly raise some concern. And in some areas the projected retirement rates over the next 5 years are downright alarming—as in the case of blood bank supervisors, at 38.46%.

These numbers suggest that we’re heading into a perfect storm scenario, with the number of people entering the profession dwindling just as large numbers of professionals are retiring. That doesn’t paint a very optimistic picture for our profession over the next 5 years.

CLP: Generally speaking, it takes much longer to fill supervisory positions than it does to recruit entry-level staff. What are the prospects for current employees to advance and fill the pipeline for supervisory positions? Are there enough qualified and interested people to fill the supervisory ranks without leaving staff positions open for extended periods?

Caldwell: As a professional association, ASCP has really been trying to address this growing need. For instance, the ASCP 40 under Forty program recognizes and supports new leaders in the field, and gets them into the limelight. When I look around my laboratory, I’m always thinking about succession planning, and trying to identify technologists with aptitude and talent to nurture and mentor for possible leadership roles.

We do really need our best and brightest to step forward very soon. But I am worried that there’s going to be a gap until all of our stakeholders—including our profession as well as our hospital administrators and state legislators—figure out how to increase the number of professionals entering our field. We know the vacancies are hitting now, and we know that the projections are for a shortage of lab professionals—so we really need to put a lot of effort into recruitment. In New York, ASCP’s collaboration with the Clinton Global Initiative offers a good example by providing scholarships to help individuals pursue careers in laboratory medicine.

ASCP has come up with a variety of tactics to help increase the number of individuals applying to laboratory professions. One of the more successful programs has been the ASCP career ambassador program, sponsored by Roche Diagnostics, Indianapolis, Ind, which sends lab professionals into the community to engage high school and college students at all kinds of venues. They have enthusiasm for the laboratory medicine profession, and they relay that passion to the younger crowd. (For more information, see the companion article, “What’s My Next” Outreach Program Targets High School Students.”)

But we need everyone’s eyes to focus on this problem, so that we will have enough phlebotomists, and technologists, and all of the different specialties of the laboratory to fill in the ranks.

CLP: Is succession planning an area covered in the courses of ASCP’s lab management university?

Caldwell: Yes, most formal laboratory training programs present students with a bit of lab management, so that they can understand administrative and regulatory issues, and the behind-the-scenes aspects of lab management. ASCP’s Lab Management University (LMU) was launched in 2013 to add onto this knowledge and exposure, helping to teach or reinforce the leadership and hands-on strategies that are so necessary in our field.

Without this kind of organized exposure, people will learn by the ‘sink or swim’ method, which is not particularly efficient. But since courses for LMU are taught by staff with actual laboratory experience, the program has really caught on well.

CLP: The report observes that laboratory medicine is a rapidly evolving field, which of course creates its own set of complexities. What is the overall impact of advancing technologies on vacancy and retirement rates?

Caldwell: Today’s clinical lab environment is very dynamic. Labs are highly technical, and each instrument has its own lifespan, so we are constantly changing, upgrading, and consolidating platforms. It’s more important than ever that laboratorians become change masters and chief problem solvers. That said, technologies are helping us cope to a certain extent with the increasing vacancy rate.

To maximize their efficiency, labs are doing their Lean studies and workflow analyses, and they’re purchasing the best analyzers and consolidating instruments to minimize their footprint in the lab. But they still need highly qualified and educated laboratory professionals to run those instruments. Technologies are helping us, but they are also increasing the need for highly qualified laboratory professionals. One of the difficulties in hiring new staff is finding applicants that are well qualified for our positions. To be successful at the fast pace at which current laboratories are working, candidates really need the clinical background, the solid rotations, and experience. Although technologies are helping us, they are certainly not replacing our need for such highly qualified individuals.

Right now, ASCP is working to develop career ladders. The association’s council of lab professionals has proposed to create a new employment level called ‘clinical laboratory assistant,’ which has not existed previously. The position would be less trained than a laboratory scientist, but able to help with some of the duties and responsibilities that lab scientists have, so that they can focus on higher complexity tasks.

CLP: Advanced lab instrumentation emphasizes greater automation, higher throughput, faster turnaround times, and better results—all hopefully delivered at a lower cost. But does the tradeoff between those efficiencies and the significant investments in training they require make the whole arrangement a wash—just offsetting savings in one area with expenses in another? Do we know whether technologies are really improving efficiencies in the lab—and how much?

Caldwell: Labs that have undergone a Lean analysis have necessarily focused on how the core lab concept can make use of technologies to improve efficiencies, and how to physically structure automation to make the lab’s workflow as efficient as possible. When labs have implemented such efficiencies, Lean studies enable them to know how their productivity has improved, and whether adding instrumentation has enabled them to reduce full-time equivalents (FTEs). In general, studies do show that automated instrumentation enables labs to reap efficiency and productivity benefits, and to reduce their required FTEs here and there. Obviously, automation permits technologists to reduce their hands-on time for those tests so that they can perform other tasks.

That said, it is certainly underappreciated how much more time lab professionals must spend on regulatory compliance as a result of increasing regulatory mandates. Many labs are certified by the College of American Pathologists (CAP), whose latest checklist includes 1,589 changes from past standards. Compared to the requirements that applied to labs 20 years ago, it’s mind boggling what we need to do now—and what extra resources are needed—to keep up with the complexities and sophistication involved in running today’s laboratories.

CLP: From the point of view of an individual pathologist or technician, is it difficult to keep up with the rapid turnover of technologies? Is there a need for continuing education even at the level of brand-specific expertise?

Caldwell: The need may not be quite brand-specific, but there is an inordinate amount of crosstraining, retraining, and sharing of individuals going on. For example, my hospital is part of a 10-hospital system that shares laboratory scientists. We have also tried to standardize the main instrumentation in all of our laboratories, making it easier for technologists with the same job descriptions to help alleviate some staffing problems.

Most of us who are in clinical laboratories love science and learning new things, and we embrace the excitement that comes with new technologies. But those technologies bring with them a whole host of requirements necessary to keep operators trained—continuing education, competency assessment, proficiency testing, and more. For every new test system, we have to evaluate technologists six different ways.

It has become very complex to keep staff fully trained and certified so that they are qualified to work in a clinical lab. Nevertheless, most technologists really do embrace new technologies, and there’s not a lot of pushback in that regard.

CLP: Is it worrisome that laboratory staff are increasingly devoted to serving highly sophisticated machines—with more staff time focused on installation qualification, calibration, quality control, maintenance, and so on—rather than the other way around? Does such a focus detract from staff capabilities when working with patient specimens?

Caldwell: Well, yes and no. Those of us who have been in the field for a while were always used to sticking our heads inside analyzers to fix things. That was just part of the job, necessary to maintain all the quality control functions that go along with assuring quality results.

But with our new technologies, some of those functions have become much more automated and easier to accomplish. In some cases, problems can even be resolved by way of virtual connections with the manufacturer, who may know that an analyzer is having a problem even before it comes to the attention of lab staff. The manufacturer may even call and say, “You’re having a slight drift of this or that; let’s look at this together.” In this regard, technologies have improved significantly, and overall this has been a good thing.

But like every unit in every hospital, we do have a greater focus on quality metrics than ever before. We are measuring process improvement in all kinds of areas, and we have dashboards for all kinds of things. So there has been a shift, and nowadays we not only need to provide good turnaround times, we also need to ensure that our quality metrics are in order.

But labs also collaborate with clinicians all across the hospital’s various disciplines—whether it’s the stroke committee, the sepsis committee, or the pharmacy and medication management committee, for example—because labs are part of almost every initiative that goes on in hospital and research environments. It’s a day and age when laboratorians are getting outside the walls of the laboratory more and more to interact and collaborate with their partners across the organization.

Right now, lab organizations are working with clinicians across the country to improve effective test utilization. Locally, I’m trying to involve our laboratory scientists and our staff in these activities outside of our own hospital. In terms of succession planning, these kinds of efforts help to identify staff who gravitate toward such activities, and it can help to bring out leadership qualities that can be further developed.

CLP: It sounds as though your institution has anticipated some of the recommendations in the recent Institute of Medicine report on diagnostic errors, which highlighted the need for greater collaboration and involvement of laboratory professionals with the rest of the healthcare team.

Caldwell: Well, we’re certainly trying. My goal is to have the laboratory be highlighted in as many ways as possible, because otherwise the public doesn’t really understand what goes on behind the scenes to obtain their laboratory results. It’s important to raise awareness, to conduct tours, and to explain that without the clinical laboratory, doctors wouldn’t know what’s going on with a patient who has strep, or a septic patient, or a patient on an anticoagulant therapy who needs to be monitored.

Labs are certainly underrecognized, but to our physicians and patients we are as important as food and water. We’re constantly trying to highlight the importance of the laboratory.

CLP: The vacancy study identifies several areas where labs are having trouble hiring, in part because of issues related to pay, candidates’ required certifications and skills, and competition among labs to attract candidates. In today’s cost-competitive environment, how are labs dealing with those issues?

Caldwell: Because there are fewer candidates in the pipeline, there is certainly competition for applicants, and some of that competition results in heightened pressure for higher pay. Some workshifts are difficult to fill, and that exacerbates the problem. At the moment, I have two full-time night shift vacancies, and I’m concerned that, according to the vacancy survey results, I may be looking at 6 months before the positions can be filled. At some point, I will need to look at the possibility of filling the positions temporarily through an agency, which could increase our costs significantly.

In terms of what labs can do about it, personally I am sharing the ASCP vacancy survey with my administrators so that they can see what is going on across the nation. They need to be engaged to make sure that our institution doesn’t lag behind in salaries, and they should also be considering what can be done for hiring bonuses. In order to create an attractive place to work we need to be out front, offering the most that the market can bear.

Money isn’t everything. People will come to work for an institution because of its quality and its reputation. But money is certainly also important.

CLP: The survey also identified retention as an area of concern, with respondents mentioning opportunities for advancement, concern over the workload or stress, and, of course, better pay, as factors that would contribute to an employee’s decision to stay or leave. Labs not only have to compete to hire people, they also have to compete to keep them.

Caldwell: Exactly, and each lab needs to do its best to create a positive working environment. I’m very lucky, because our institution has a laboratory recognition program that encourages our staff to carry out ‘above and beyond’ tasks and duties, and then provides them with formal recognition for doing so. The program’s elements and expectations are pretty stringent, and candidates have to apply each year. We give applicants credit for going into the community to perform activities, and I am always blown away by the wonderful things that our staff do.

It’s important for labs to promote a culture that makes people want to come to work, because it is a stressful environment. Nowadays, it’s not as easy to work in a laboratory as it used to be. Many days, staff need to have roller skates to get to everything on their plates. So it’s important that we do what we can to make the job fun and make the lab a great place to work.

CLP: Is the current 3- to 6-month hiring cycle identified by the survey significantly longer than it has been in the past?

Caldwell: In my experience, it is longer. It just makes sense that when you have fewer applicants, they’re spread more thinly, and it just takes longer to fill each position.

CLP: When there is a vacancy, sometimes the work is handed to other staff, permanently or temporarily; sometimes an agency is used to fill the position on an interim basis; and occasionally a lab will cease offering the services performed by the vacant position. No matter which way labs respond, they’re bound to cause stress among their staff. Is there any magic bullet that labs are using to prevent these problems?

Caldwell: I wish we had a magic bullet, but we don’t. In practice, the answer tends to be ‘all of the above.’ Generally what lab directors do is to ask who can help to fill in the vacant shifts. Labs can also try to work short-handed by putting supervisors on the bench, but that means that they don’t get their own tasks done. That practice looks good to administrators because it spreads out the stress and reduces FTEs, but they’re not being reduced for a good reason.

The upside of calling on an agency is that they will come in and help out. The downside is that there is still a significant training period. Labs will still have to backfill during that training period, and the costs are quite high. So calling on an agency will definitely hit you in your wallet.

CLP: The survey projects that over the next 5 years, as much as 20% to 25% of the profession will be retiring. How long will it take to fill the pipeline with new job candidates for all of the significant levels where there are vacancy problems?

Caldwell: The good news is that there are opportunities for mid-level seasoned techs to move into management positions, and with training mechanisms such as ASCP’s Lab Management University there is better support than in the past. In most institutions across the nation, including hospitals, we do an enormous amount of leadership training, and we’re always identifying and nurturing new leaders with both formal and informal mentorship programs. So there are opportunities for those who are already in the profession.

But to get new laboratorians into all walks of our profession, we have to start in high school, or even in middle school, by getting students to know about the opportunities in the profession of laboratory science. And then, we need to encourage those who are interested to be successful in the college science prerequisite classes that lead into our profession. There are a lot of varied opportunities in our profession—including research, working at Red Cross, developing products, working in a hospital or physician office lab, or even working in a veterinary clinic—but we basically need to start by getting the word out about what is a laboratory scientist. I think ASCP is doing that.

Whether we are looking at a 4-year or 6-year pipeline to fill the coming vacancies may be a matter of perspective. But certainly we need to keep our laboratory science schools open, keep their enrollment up, and keep students graduating and moving into the field. And on the employment side, we need to convince administrators that salaries need to be at least commensurate with those in nursing. We used to be commensurate with nursing, but now we’re not anywhere near that salary base.

Will the shortage of candidates help to drive the salaries up? Yes, but that’s not the easiest route to filling vacant positions. We really don’t want to go through that fire to get there.

Laboratory scientists always get done what needs to be done, so I think we will get to the finish line in one piece. But we do have some hard work to do to sustain our profession.

Steve Halasey is chief editor of CLP.

REFERENCE

1. Garcia E, Ali AM, Soles RM, Lewis DG. The American Society for Clinical Pathology’s 2014 vacancy survey of medical laboratories in the United States. Am J Clin Pathol. 2015;144(3):432–443; doi: 10.1309/AJCPN7G0MXMSTXCD.