Bench press: The technologist/technician shortfall is putting the squeeze
on laboratories nationwide
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,
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
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
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
"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
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
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
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
"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
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
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
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
"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
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
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
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
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.