College of American Pathologists
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All eyes on workforce scare—and solutions

September 2001
Jacquelyn Lloyd

At one time, the medical technology school at the University of Illinois at Chicago Medical Center turned out 40 technologists each year. In the past two decades, that number has slipped to 24. This year saw a dangerous dip.

"We have a 34-year-old program that has typically graduated 24 students a year," says Paul Schreckenberger, PhD, D(ABMM), director of the clinical microbiology lab at the UIC Medical Center and an instructor in the university’s medical technology training program. "This year’s senior class has six full-time students; we have 18 empty seats we can’t fill."

Dr. Schreckenberger isn’t alone, of course. Vacancies in medical technology schools and laboratories are at alarming highs. "We are now graduating half of the people we need to fill projected open positions. We have a shortage now, but we’ll have a major crisis soon if everything remains the same," says Kory Ward-Cook, PhD, MT(ASCP), executive director of the American Society of Clinical Pathologists Board of Registry and ASCP senior vice president.

But signs are starting to surface that all may not remain the same. In some spots, salaries are on the rise, professional organizations are at last working together on the problem, and proposed legislation may bring in new funds for education and training. Meanwhile, laboratorians are tapping their own creativity.

"At our hospital last year, the medical technologists got a 13 percent market adjustment in their salaries in an effort to stop them from leaving," Dr. Schreckenberger says. "Our situation is better, but we still are not competitive with other fields. Our starting salary is a little over $30,000, when other fields are starting new people at $60,000."

For the money, he says, we’re asking too much.

"We need people who can pass a very rigorous science curriculum and a difficult certification exam. We demand bright, studious people, and then we put them to work in a lab where they are somewhat at risk, working with serum and pathogenic organisms. All this and we pay them half of what a nurse gets, half of what an IT employee gets."

Some laboratories have used sign-on bonuses as a short-term strategy to recruit and retain laboratory staff, Dr. Ward-Cook says. "When labs couldn’t fill positions, they started offering candidates signing bonuses, which worked initially to get people on board," she says. "But lab directors found that their turnover was rising because technologists were moving from facility to facility within a 50-mile radius simply because they could get another signing bonus."

Actual salary increases, she says, could be replacing that short-term strategy. According to the ASCP Board of Registry’s 2000 Wage and Vacancy Survey, the increase in beginning rates for medical technologists was 7.7 percent, or almost four percent per year, from 1998 to 2000. Between 1996 and 1998, the increase in starting rates was 3.2 percent, or about 1.6 percent per year. Starting wage increases from 1998 to 2000 were the largest reported since the 1990-1992 comparisons.

"Salaries have gone up since 1998 more than they have in the 10 years previous combined," Dr. Ward-Cook says. "This is good news—this response is greater than inflation and will begin to help us become more competitive with other industries."

Though the pay scale hasn’t been bumped up yet at Desert Samaritan Medical Center, Mesa, Ariz., it has become a priority. "What we’re looking at first is to evaluate the pay scale for our employees, doing market research to make sure our pay is appropriate," says Linda Taggart, MBA, DLM(ASCP), administrative director of the medical center’s laboratory, Laboratory Sciences of Arizona.

Important as it is, however, pay is only a start, Taggart says. Strong communication with staff, diversity and accountability training, and "spot awards"—gift certificates for food or massages, for example—are part of the lab’s retention strategy. Goal sharing is another.

"We involve our staff in the management and success of the laboratory," Taggart says. Each year, employees develop a "corporate roadmap" containing critical success factors for the company’s growth. "The roadmap lays out key goals and strategies for the coming year, and if we meet our target goals, we may receive a goal-sharing check at the end of the year," she says. One of this year’s goals, for example, is to reduce the lab’s turnover rate. "All of our employees feel this is a critical need—it has a direct impact on everyone at every level," Taggart says.

To fill vacant positions, Taggart is looking outside medical technology programs for candidates. "We are starting to develop an on-the-job training program to qualify more general science graduates to work in the laboratory," she says. "We’re hoping to partner with our universities to help us prepare these people in areas that may be more difficult to develop on the job. When you have a staffing shortage, you don’t have that many employees you can free up to do training and education."

The career ladders at Taggart’s laboratory have taken a nontraditional twist. "It’s not based on your normal classifications, such as medical laboratory assistant, MLT, or medical technologist," she says. "It’s based more on the person’s background coming in as to where they fall on our ladder and what steps they would need to take to advance to the next higher step."

For phlebotomists, a new career ladder went into effect in May. "Phlebotomist I simply does phlebotomy," Taggart says. "Phlebotomist II is a more skilled phlebotomist who also can do some processing, has some advanced computer skills, and is able to troubleshoot nursing orders." The second level requires phlebotomy certification.

The laboratory’s technical area will see its new career ladder implemented later this year. "We’re hoping that with all three career ladders implemented, we’ll see a significant reduction in our vacancy rate and turnover," Taggart says.

The lack of opportunities to advance explains why many technologists leave the lab. "They don’t feel like they’re going anywhere," Dr. Schreckenberger says. "You’re a med tech forever." The University of Illinois at Chicago Medical Center used to have various levels of technologists that corresponded to levels of experience and areas of expertise. "We had senior technologists and bench supervisors. These weren’t big leaps in money, but they offered recognition and progression so people felt they were getting ahead," he says. But the trend in hospital labs has been to replace career ladders with horizontal organization. "The idea is to have 20 med techs and one supervisor," Dr. Schreckenberger notes.

He, too, is looking outside the field for technologists and technicians to staff the university’s microbiology laboratory.

"There are a lot of people earning degrees in microbiology but not medical technology. These people have no clinical training, so in the past they’ve been ineligible for employment in the microbiology lab. We decided to recruit them into entry-level positions as trainees or interns, and the hospital created the position of ’med tech trainee’ this year," Dr. Schreckenberger says. It requires a bachelor’s degree in a related science, and the trainees receive 95 percent of the starting medical technologist salary.

"They complete courses with specific objectives while they are being paid as full-time employees," he continues. "When they complete the program, they are hired as medical technologists and receive automatic five percent raises."

The UIC Medical Center plans to promote this new career path at institutions with bachelor’s programs in microbiology in the hopes of attracting their graduates. "We think this will be a great way to help fill the gap in our lab," Dr. Schreckenberger says. The same can be done in chemistry and hematology labs by recruiting chemistry or biology majors, he notes.

As labs innovate to get over the humps, professional organizations are crafting strategies to turn the shortage around. "For the first time, we have a notable group of organizations sitting down to work on the problem together," Dr. Ward-Cook says. "In 1998, each society was trying to do its own thing. In 2000, we realized no one society could do this alone."

The American Society for Clinical Laboratory Science convened representatives of 19 professional and government organizations at two conferences in June 2000 and last February. CLMA hosted a staffing shortage forum in March. "There is a determination to solve this problem. There is a great passion to raise our profession up again. People should know what we do and how important it is," says Katharine Ayres, MT (ASCP)CT, director of health care policy for CLMA.

Adds Dr. Ward-Cook: "The professional societies and educational programs are trying to get the word out to the public to let people know we have a workforce shortage and need to educate them about the profession." She says the ASCPBoard of Registry has just finished collecting data in this year’s survey of accredited medical laboratory science programs. "All of them are reporting that they are undertaking extensive recruitment efforts in high schools and middle schools."

Professional societies are doing the same. The local chapter of CLMA hosted a career day at CLMA’s annual conference in June in St. Louis. Forty high school and college students heard speakers talk about laboratory careers in general and describe their own jobs and career paths. Ayres expects the session to be repeated at next year’s annual meeting and expanded to other chapters.

"A major goal now is to get our local chapters involved in these efforts," she says. CLMA’s Wheatlands chapter in Kansas, for example, helped save a local medical technology program. "They donated $5,000 to the Wichita State University Foundation last May to be used for scholarships for medical technologist students. Since then, inquiries into the MT program have gone up 35 percent and the amount of applicants has shot up 15 percent. This could become a model chapter program to help address the problem of schools closing," Ayres says.

CLMA is developing a plan to help laboratory managers market the value of certified laboratory personnel to hospital administrators. "This is an important piece of the strategic plan outlined at the ASCLS Summit II," Ayres says. "We need to make hospital administrators aware of how valuable professional, well-trained clinical laboratory workers are to the institution and to quality patient care."

The American Society for Clinical Laboratory Science "got the ball rolling" with its two conferences, Dr. Ward-Cook says, and is working on recruiting young people to the profession. NAACLS is the clearing house for information on financing education. The ASCP Board of Registry’s focus is collecting and coordinating data. "We need to present a unified front to Congress, get good data, and develop a cohesive plan," she says.

Professional groups need, too, to continue to expand the definition of qualified candidates, Dr. Ward-Cook says. "People can still enter the profession and be certified through the traditional accredited program route," she notes, "but candidates also can come in through experience and get certified. College graduates can learn on the job and then pursue their certification." Forgoing certification, though, is not an option. "Our data show that certified MTs have a higher accuracy rate in performing proficiency testing—two to four times higher—than noncertified laboratory workers," she says.

Financing for education is a priority for all laboratory groups, but it’s too large a problem for any society to handle alone. "We need to address this issue collectively," Dr. Ward-Cook says, "and pursue it from all directions. We may get financing from the government or private organizations or both." Some larger hospitals are starting to offer education stipends, and Quest is interested in promoting and supporting phlebotomy training, she says, "but a major impact on the personnel shortage will require more subsidy than even the largest commercial labs can handle."

Introduced in May, the Medical Laboratory Personnel Shortage Act of 2001, or HR 1948, would expand the National Health Service Corps scholarship and loan repayment program to medical technologists and MLTs. "It broadens the scope of existing laws to help specifically address the problem of declining numbers of laboratory professionals," says Robin Stombler, government affairs vice president for ASCP, which pushed for the bill. "The ASCP provided direction in developing the content of the bill. We identified federal funding programs and used the legislation to focus them more on the laboratory," Stombler says.

Among other things, the bill would authorize $100 million in grant dollars in fiscal 2002 for allied health training programs to enable them to recruit applicants. "The Allied Health Project Grants can cover 200 different allied health professions," Stombler says. "We’re suggesting that the authorization for funding for this program be increased and a focus added on the laboratory professions."

Cecil Dunn, MT(ASCP), of Community Medical Center, Missoula, Mont., and vice chair of the ASCP Government Relations Committee, applauds the creative approach of HR 1948. "This legislation identifies a number of niches where there already is some funding and expands the applicability of those dollars to the clinical laboratory sciences," she notes.

The bill targets programs that would train personnel in antimicrobial resistance efforts, antibioterrorism, and transfusion medicine. Says Dunn, "When you talk about bioterrorism and emerging pathogens and antimicrobial resistance, it’s all great, but if you don’t have med techs to identify these bugs, you’re going to be in a real bind."

Another bill, the Medicare Patient Access to Preventive and Diagnostic Tests Act, or HR 1798, also introduced in May, would thaw the freeze in the consumer price index update for Medicare laboratory testing fees. "This legislation doesn’t mention the personnel shortage," Stombler says, "but it would likely help to alleviate it. Laboratories would start to receive an inflationary update again, bringing more money into the laboratory, which would help in increasing salaries for medical technologists and MLTs."

Dunn cautions, however, that even if these bills pass, they offer only long-term solutions to the problem of too few medical technologists. "The most immediate impact we might see out of [the Medical Laboratory Personnel Shortage Act]," she says, "is the eligibility of med tech students for scholarship and loan forgiveness funds." The bill’s other sections open up access to grant resources, but, she says, "Even if the bill passes this year, it will be several years before the rules are revised, the availability of funds is promoted, the grant applications are written and approved, and the funds are disbursed."

Jacquelyn Lloyd is a writer in Park Ridge, Ill.