Compass Group looks in all directions to solve the crisis
Identifying and sharing best practices and strategies to help ensure the survival of the not-for-profit laboratory industry. That’s the chief function of The Compass Group, which consists of laboratory leaders from 18 not-for-profit integrated delivery network health care systems. When the group’s members met recently in San Diego, they answered questions put forth to them by CAP TODAY publisher Bob McGonnagle. Here’s an edited transcript of what they said about the shortage of talent in clinical labs and succession planning. Last month: their thoughts on the value of labs and how to make that value known.
CAP TODAY: The talent shortage that plagues a lot of laboratories worries everyone. This talent shortage includes what I think is a screaming shortage of good clinical pathologists employed and on the ground in laboratories. How acute is the talent shortage within your laboratory operation, and what do you think the immediate and then long-term future is going to be for this shortage?
Chris Nicholson, administrative director of laboratory services, Scripps Health, San Diego: We actually don’t have an acute shortage of clinical laboratory scientists in San Diego. We have very few openings at our five hospitals. If we have an opening and it’s not on the night shift, it could be filled fairly quickly. Our problem is the talent that we have is 50-plus years old on average. In most of our hospitals we have no one who is 20 or 30 years old, a few in their 40s, and everybody else is 50 plus. We even have some people now who are in their 70s working.
It is common in hospitals to have around a 15 percent turnover rate. In our laboratories, far less than five percent leave. So when you don’t have an acute shortage and positions aren’t turning over, we are judged not to have a problem. And that causes other problems: We don’t get paid as well. Hospitals tend to increase salary ranges for hard-to-fill positions. The clinical laboratory scientists are now being paid like someone with a two-year degree and they all have four-year degrees—that’s sad.
I sit on the college advisory board trying to start an MLT program in San Diego. The colleges have little interest in providing new programs because our community college system is underfunded and has waiting lists for nursing and other much-desired programs. They want hospitals to pay them to provide the MLT program. That’s a problem for us because we have to come up with $25,000 to $50,000 a year to support an MLT program.
Joanne Bratush, administrator, Pathology and Laboratory Medicine Institute, Cleveland Clinic: We have a number of openings, and we have a lot of difficulty attracting medical technologists. It may be the area. But I think what Chris Nicholson says rings true in that we have been demoted. Our CEO thinks medical technologists are entry-level individuals who just come out of high school and ‘Oh, wow, they really have to have a baccalaureate degree?’ Shame on us for not being out there promoting the fact that these people are of a high caliber and we do need that type of talent in the laboratory.
In general, yes, schools are a good idea. Somehow we still have to be able to promote our profession much better than we have in the past. The Gen-Yers and Gen-Xers don’t look at the laboratory as being a place in which they can contribute to patient care, and I think we have to really get out there. We also have to be more flexible in trying to attract these people. We’re very regimented now because we have to cover this shift and that shift. We have to come up with more creative ways of attracting people to the laboratory.
Thomas Tiffany, PhD, president, Pathology Associates Medical Laboratories, Providence Health and Services, Spokane, Wash.: The number of clinical laboratory science training programs in the country is down to about 222. The number of CLS graduates per year is about 1,900. But the average number of graduates per year is 8.5 or 8.6, when we’re heading into the baby boom retirement era.
There may be pockets where there’s not a problem, but nationwide we are not able to keep up with the demand. There is a definite shortage and it will grow. We train 14 a year and four additional MLTs. We now have shortages in microbiology, and we pump a lot of work into micro. We’re at a point now where we may not be able to put more work into our systems if we cannot get good microbiology technologists. The CLS programs don’t train cytogeneticists, so we have problems now because we’re asking for cytogenetics people. And where do we get histologists with so few histo programs? This is a very serious problem. We have to look at the way we’re training people and change the way we’re training them.
Robert Stallone, vice president, Laboratories, North Shore-Long Island Jewish Health System, Lake Success, NY: In New York the talent shortage has been exacerbated by a recent licensure law, where the state now requires that anyone performing testing has a license in medical technology. This means that people from our former pools of talent, who were biology and chemistry majors and whom we trained to be technologists, will no longer be able to become technologists. People have to complete a full medical technology program to get a license in the future, under the current law. And histotechnologists have to have a general medical technology license. And that is how the current law stands, and obviously this can lead to things that keep us up at night.
Salaries are going to have to change, schools are going to have to rev up, but what are we going to do in the meantime? Necessity being the mother of invention, one of the possibilities and one of the ways we have to go solutionwise is to take a look at all the individual functions that a clinical laboratory scientist does in each area of the lab. We will find that a large proportion of what they do is something that can be redistributed and packaged into other jobs that other people can do for them. That could be coming in the morning and getting their specimens, that could be starting up the equipment, that could be keeping the equipment running, that could be working their pending worksheets.
And if that 20, 30, or 40 percent of what a technologist does can be repackaged, then the technologist can focus on reviewing quality control, releasing results, using their brains and working on the more complex testing. It’s going to be a change in how we do things, but at the end of the day, that will result in a technologist who will be considered to be a higher-level member of the organization, one who warrants a higher salary. And you won’t need as many of them.
Maybe these types of out-of-the-box solutions, which many people are pursuing in one way or another already, are where we should be focusing some of our energies in parallel to revving up the schools.
Susana Savino, laboratory system administrative director, Florida Hospital, Orlando: We at Florida Hospital are affiliated with two medical technology programs, and I always get calls from other places in Florida or other schools asking if their medical technologists could rotate through our program—and I don’t have enough room. But I know of other hospitals that are not doing their part. I’m putting five histologists through, and I am affiliated with three or four different programs, and I’m taking five each year, but there’s more people who want to go into it and I just don’t have the room.
If we wanted to do something as an industry, all of our hospitals should reach out. That’s where as an industry we’re not doing our part.
Stephen Bowers, administrator, Regional Medical Laboratory, St. John Health System, Tulsa, Okla.: We certainly experience the technical shortage in the laboratory. Our opening rate is in the range of six to 10 percent right now. We have tried and are currently doing many things, one of which is that we’re identifying and bringing in some of these talented individuals who have science degrees but are not able to use and apply them as they thought they would be able to when they got out of school.
We have a medical technologist specialty program that we will plug them into. And over the course of a year or two, depending on what section they’re in, they can sit for a specialty certification in that particular section, and that’s been successful for us. We’re just about a year or 18 months into it, but that’s helping us.
We also are bringing in lab technician or lab assistant sort of training. We found over the last few months that we have to take the load off of the medical technologists if they’re going to be able to train them. That means not having them tracking down lost or hemolyzed specimens. We need to let them do the reporting and the QC of the technical results. We need to have them doing the more technical tests others can’t do.
And, in fact, recently we picked out one person in each of the technical sections who is highly thought of and has a lot of experience, and we talked to them. One of the takeaways from that, from one of the individuals, was, ‘Help me get rid of the garbage so that I can do what I really should be doing.’
We had been trying to do that, but it just came to light that we need to put more effort into it. We need to increase our numbers of people who do the support sort of activities, so the technologists can do what they’re trained to do. What we’re talking about is optimizing their technical abilities and getting away from this emptying the trash, so to speak.
David Gardiner, chief operations officer, Intermountain Central Laboratory, Salt Lake City: As a non-laboratorian coming into the industry, it’s become obvious to me that there’s no good function or process for leadership at the lab director-type level. We’re asking lab services to have a paradigm shift in being more competitive and thinking more outside of the box and more progressively, and in communicating and interrelating with clinical operations and patient outcomes and improving business. Those concepts have been cultivated and taught and mentored at that type of leadership level.
There’s potentially a vacuum there that could be filled with getting those concepts and those skill sets out to technicians so they have the aptitude to also lead. There’s always been a chasm between the notion that if you come to work in the lab you’re going to stay on the bench for 35 years and the transition to leadership.
Where’s the jump? What happens when you retire? Who are you going to mentor to take your place? That’s part of the talent pool we need to think about—more broadly than just getting our overall workforce intact. Because those are going to be the people who actually push the strategic direction and push lab services to that next paradigm.
Mark Johnston, CEO, Outreach Advantage, Pathology Associates Medical Laboratories, Providence Health and Services, Spokane, Wash.: Interestingly, I read an article on the way down here in CIO magazine which dealt with the generational gaps between baby boomers, Gen-Xers, and Gen-Yers. And with my being in the technology side of the business, to me hunting for talent is nothing new. Finding talented technology people, especially on the development side, has been a struggle ever since I’ve been in that piece of the business.
I don’t want anybody to be offended when I say this, but the opinion of the Gen-Yers and the Gen-Xers of the baby boom generation is that the baby boom generation has not done enough to cultivate the leadership—they’ve kind of held it back from the Gen-Xers.
The Gen-Xers and Gen-Yers are civil-minded and socially conscious. The whole thinking of the recruitment process, how we structure the jobs and how we incent these people to pull them into this industry, needs to be turned on its head and reevaluated. And the same for leadership development programs. The way we pitch the role of the technologist in high schools has to change. These people expect a different work-life balance, they expect a lot of different things that are not in the current mindset of the baby boom generation.
This is not a problem just for the lab industry. It’s a sociodynamic that’s happening now in this generational shift. It’s manifesting itself in the tenure of people in the labs, the age of them, the inability to recruit them. There are opportunities here. We have to get this into the core of our thinking.
Bradley Brimhall, MD, MPH, TriCore Reference Laboratories, Presbyterian Hospital System, University of New Mexico Hospitals, Albuquerque: I can speak primarily about clinical pathology, and there is definitely a shortage of people who are prepared. We published a paper recently in the Archives (Brimhall BB, et al. Arch Pathol Lab Med. 2007; 131: 1547– 1554). Less than one percent of the 200-plus respondents thought clinical pathology training was adequate. I think most people would consider that to be unacceptably low. Management skills were part of what was missing from the preparation. To many outsiders, laboratory testing appears to be commoditized. I don’t think it’s commoditized in the way that wheat and soybeans are commoditized. It’s more the way a business or stock market may appear to be commoditized. In other words, the price per share of General Motors stock changes over time, just as the price of an ounce of gold or a barrel of oil changes. But unlike a barrel of oil, it’s the level of more sophisticated information around the product that becomes important. For example, financial statements, market analyses, operational performance measures, and the talent of the management team must be considered, among other things, in evaluating the meaning of a stock price. For the investor, the price is really only one consideration.
In the financial industry, so many institutions are focusing on a financial counseling type of model. In other words, they’re saying we’re not only brokering your purchase of shares of stock, but also we can actually help you do better financially as a whole. A similar model could apply to clinical laboratories.
I was in the UK a few years ago to discuss evidence-based laboratory test utilization. The National Health Service was interested in ideas on decreasing unnecessary testing and extracting more clinically useful information from the tests that are done. Even with universal health care under the National Health Service, I don’t think the health care system matters as much when it comes to best use of medical resources. Payers all want to control utilization and make more rational decisions about test ordering.
We in the lab industry have the opportunity not only to demonstrate value in terms of the information we provide but also to compete on cost. Any talk of cost competition on the part of smaller labs may be sort of heretical. Providers and payers tend to focus on the cost of an individual test. They’re not focused on how the laboratory can help improve the office visit, the patient encounter, or the entire spectrum of patient care.
The lab has a role to play. The doctors are overloaded with information. Making the information easier to access and use is going to improve patient care and will reduce the cost to the payers and hospitals. So we have a unique opportunity that will require new approaches to training and laboratory management on the part of pathologists.
Conrad Schuerch, MD, chairman, Geisinger Medical Laboratories, Geisinger Health System, Danville, Pa.: I would agree that it’s very hard to get good clinical pathologists to engage with the rest of the health care organization to improve overall patient care. We don’t have many people who are good at it and who have the personality to be out there interacting and saying we own what happens to the patient. So the focus for the pathologist needs to become more outcome-based. We need to provide the infrastructure for outcome measurement, which is important across all kinds of clinical services, both outpatient chronic care and inpatient high-intensity care. The lab is central to those outcome measurements. We need to have a standardized database to work from that’s credible for long-term measurement. We need to collaborate with others in designing the programs that will measure how our care is serving the patient.
We do lack talent, and as we move to molecular, we’re going to need more talent. And all of this information needs to be given to the clinician in a foolproof manner. Pathology has to step into that area and be the black box for complicated information to make it actionable. The answer, at the end, has to be what the practitioner should do next. And where are the pathologists who can do that? It’s a complicated assignment, and that’s the challenge for the profession in the future.
Ronald Workman, MD, vice president of system laboratory operations, Sutter Health System, Sacramento, Calif.: It’s difficult to estimate the future needs of the lab workforce by extrapolating the staffing patterns of today, and that’s based on several factors. One is that there still is today substantial productivity improvement opportunity in the lab operations of the country, based on national benchmarking information from companies like Solucient.
Another is that the technology evolution-revolution in the laboratory—that allows lower-paid and lower-educated workers to do things that maybe more highly educated workers are doing today—has a long way to run. But even though it is difficult to estimate what the needs are going to be, there are some things we can know and do.
One of the things we can know, and we are at the point where we have to be honest with ourselves about this, is that the clinical lab scientist or medical technology profession as we’ve known it in the past is going to go away in large measure and will never come back. The number of medical technologists and clinical lab scientists that this country is going to need and will produce is going to be dramatically smaller than it was in previous years.
We also have to recognize that the laboratory worker of the future who will be present in the largest numbers is the laboratory assistant—the person with the high-school or the associate degree, some on-the-job training, and some competency assessment. And that’s predominantly who is going to be working in our laboratories.
There are also important things we can do to try to ensure that we have the talent and leadership we’re going to need, even though we can’t predict how many it’s going to be. There is a relationship between the perceived value of lab services and the laboratory workforce and talent shortage we have. And that relationship comes at the level of the awareness and the perceptions of the CEO and the senior leadership in health care.
Laboratory services and the value of them, and what goes on in the laboratory, for the most part exist below the radar screen of the CEO, who may have very little knowledge about them. Partly, it’s because we do a good job so only the problems rise to that level. If we do a good job of keeping problems under control, there’s a lack of awareness. And therein lies part of the origin of the compensation problem we have with our laboratory staff and our clinical lab scientists—there’s a lack of clinical urgency or awareness of any problem at the level of the CEO and the senior leadership.
Senior leadership has been aware of nursing‘s problems and issues. The long-term result of that in California is that a nurse with 10 years’ experience makes almost three-quarters of what a primary care physician makes. And that is anywhere from 60 to 100 percent higher than a medical technologist/clinical lab scientist with the equivalent amount of experience. So there is a relationship between the value question and awareness of a problem at the CEO level and the workforce shortage and compensation problems in the laboratory. What can we do about that?
First, we need to have some idea what is in our CEO’s mind about the value of the laboratory and the laboratory service. If we’re not comfortable with that, then we need to identify what is keeping our CEO awake at night and how the lab can help, and begin to communicate the contribution of lab services, including, as Dr. Schuerch mentioned, helping to improve outcomes.
Second, even though we can’t predict with much precision what the future needs for talent and leadership are going to be, we can look into our own communities and make certain we understand the points of entry into the pipeline. That means understanding what clinical lab scientist and MLT and other kinds of laboratory service training schools are in our communities and how they are functioning and being funded.
If there is not a point of entry and a pipeline, then we have to get together with other health care leaders in our communities to address the root causes of that and create the funding. The aim is to have enough training programs that are going to be alive and well when the demand does come and the compensation levels do rise.
We have to think not just about traditional pipelines that go through our community colleges or our state universities but also about alternative entries and pathways. For example, the student who has a science degree but never thought of working in a laboratory—how do we take that person and look at their transcript and identify the couple of courses they might need and get them the funding for those courses and into some type of clinical site where they can get the internship training they need? How does our health system sponsor that person, and what type of service commitment do we need to get from them in return?
CAP TODAY: How does our discussion of the talent shortage relate to thoughts about succession planning in the laboratory?
Priscilla Cherry, president of laboratory services, Fairview Health Services, Minneapolis: It’s all in sync with succession planning. We’re going to have to think about how Generation Xers and Yers can be showcased differently. The new generations want to be more visible. So as I think about my succession planning and the talent that’s there, I have to ask how I am going to move that talent from where they are, on the bench, to out there with the clinicians taking care of the patients. I won’t need as many of my CLSs or my MTs touching instruments.
When I listen to some of the older technologists talk, and I’m one of those older techs, I’m amazed at the knowledge in their heads. They’ll say, ‘Why did that doctor order that? Doesn’t he know that . . . ?’ And that information is not transmitted to the clinicians who are ordering five tests because they knew those five older tests but needed to order only one to get the necessary diagnostic information.
I have to get my baby boomer generation to think outside the box. How can I get that technologist to say, ‘Okay, look at this scattergram on this hematology instrument and this retic and tell that doctor it’s working—he doesn’t have to give that patient blood?’
That’s what’s going on in my head about succession planning. How do I make it attractive? Once I can figure that out, maybe I can attract someone into the profession and then concentrate on more of the management-type skills in addition to the interpretive skills. You may end up with a technologist who does higher-level things that they actually have learned to do but we haven’t been promoting.
Susana Savino, laboratory system administrative director, Florida Hospital, Orlando: We saw a need for succession planning because our workforce is getting older. We have a program that we call Reach for Successful Planning, and we had some criteria and we had everyone apply. We have about 40 people, but we were going to take only 10 from each hospital. We ended up taking 12, and it runs the gamut of phlebotomists to supervisors. They meet every other Friday, and we have several topics of management and different speakers. We also have each director as a mentor, so we’re mentoring them. During budget week we’re going to take them along with us and have them help us prepare the budget. We have a 10-month program, and we couldn’t believe the number of employees who wanted to be in the program.
Now you’re seeing these people who had their nose to the grindstone say, ‘I want to do something else.’ It even affects your general workforce. When I was talking to one of the mentors I met with as part of the program, she said, ‘You know, now I get why it makes a difference to the hospital that I produce a good turnaround time, because I get the whole continuum of flow.’ They’re starting to see this. ‘I get why finance is a problem. I understand now why you can’t dole money out to us.’ Then they go back to their coworkers at the bench level and say, ‘Hey, this is the reason why.’ It comes from our mouth a lot of times, but it’s better coming from a coworker.
Thomas Allerding, MD, medical director, Pathology Associates Medical Laboratories, Providence Health and Services, Spo-kane, Wash.: The steps we take to avoid the commoditization of laboratory services will also help us with personnel shortages. The key is for laboratorians at all levels to develop strong consultative relationships with our clients and pa-tients.
Clinicians suffer from information overload, and our ability to integrate, correlate, and interpret lab data is a valuable service for them. It makes us partners in their practice of medicine. At the same time, it makes our own jobs much more interesting and attractive to folks who may be thinking about a career in laboratory medicine.
Providing great service keeps us at the center of patient care and helps us attract and retain clients. Providing great service is also professionally rewarding and helps us attract and retain talent. If we just sit in the lab cranking out reams of data, we’ll lose on both counts.
CAP TODAY: At the CAP there is an initiative to talk to the pathology residency programs about producing the kind of pathologists you need to have working in your networks.
Do you feel that in some ways your laboratory world lacks a consensus and focus from all the many associations you belong to? Are your associations working together for the common good?
Therese Snyder, vice president of laboratory medicine operations, Geisinger Medical Laboratories, Geisinger Health System, Danville, Pa.: I’m not a laboratorian by history, and I started working for laboratorians about 15 years ago, and from the time I started working for you I heard about your impending medical technologist shortage. There has been no concerted effort from one or from a collection of organizations to take this story to the public and educate young people about laboratory science.
There’s an ambivalence. Ron Work-man said that potentially we’re not going to need as many medical technologists in the future, and until the leaders in the lab get a clear definition of what they are going to need, and they estimate clearly what those numbers are, what categories of workers those are, how are they going to take that story forward?
The associations are not doing anything for us. I get more help, frankly, from human resources. In our organization in recent years, human resources has done a great job trying to help us push salaries and to attract people.
Thomas Tiffany, PhD, president, Pathology Associates Medical Laboratories, Providence Health and Services, Spokane, Wash.: No, they’re not working together, and more specifically, I don’t think there is a good focus or understanding of the types of talent we need to be training for new types of testing. People who are skilled in PCR, skilled in the whole next generation, skilled in sequencing—where are we going to get that kind of talent?
John Spinosa, MD, PhD, pathologist and chief of staff, Scripps Memorial Hospital, La Jolla, Calif.: The discussion we’ve had about Generations X and Y is not at all limited to the laboratory and pathologists. It’s a common theme echoed by all the older physicians, and it’s manifesting itself in specialization. We have hospitalists now and intensivists and it’s all under the moniker of shift work. People want shift work. As hard as it is, we have to be less judgmental about what that means because it just is—and it’s not anything that’ll shift.
Part of it is our fault because talent rises based on the opportunity to show you need to have talent. Maybe we need to look internally—are we providing leadership opportunities? Florida Hospital did a great job of showing there are people who will pull forward if you give them an opportunity to lead.
It’s almost an open market where you have to put in effort to create an opportunity and say here’s something we don’t do well or here’s an opportunity, let’s go for it. The professional societies have lost focus in a way, and what they’ve started focusing on is maintaining the status quo, and that’s not where leadership’s going to be developed.
It’s in opening up and exposing some of your warts: ‘We don’t do this well, we do this,’ instead of ‘We can’t allow this to happen.’ Some things are going to happen just because the market’s demanding that it happen, and instead we should look at it as an opportunity.
Ronald Workman, MD, vice president of laboratory operations, Sutter Health System, Sacramento, Calif.: The professions and the laboratory industry have been fragmented. Most of the associations are struggling for identity and membership. We’ve not had an association that would stand up and try to produce a solid, overarching position. And our jobs have become more complicated and more consolidated, so we generally don’t have the time to get behind many of their initiatives.
When things blow up or begin to fall apart, the lab industry will respond—but until then, there are too many factions and too many different interests. You have the hospital labs, the commercial labs, the academic labs, the clinic labs. You have licensure, nonlicensure. You’ve got a couple of associations that were well positioned and well meaning but that are slowly dying.
You don’t have students coming into the field. In the past there weren’t as many career choices for people as there are today. You can do four years of science and medical technology preparation, or you can do four years in computer science and start out with three times the salary and not have to handle biologic materials.
Associations had good inten-tions. Everyone around the table belongs to at least three or four professional societies, each of which, as with any organization, can have only a few—at the most five—areas of focus and effort. And many of those societies do have some value and some success with that focus and effort.
They just don’t have the resources, they don’t have the lobbying ability or strength in every area, and they certainly don’t have the membership now that they had 10 or 15 years ago when they probably could’ve done something collaborative if they’d come together. Today, it seems they’re too weak and fragmented. It’s going to be an individual lab effort at the individual work site to get your patients’ care covered and the work done.
The reason the Compass Group exists is because there is no single organization, whether it be physician- or management-based, looking at the operational best practices, at the human resource needs, at the value and quality of laboratory and pathology services, in the communities we serve. It actually is the reason we chose our name, namely that the professional organizations we all belong to aren’t showing us an overall direction. We came together to act collaboratively and collectively to try to show the way.