American Association for Clinical Chemistry
Better health through laboratory medicine
November 2009 Clinical Laboratory News: The Workforce Challenge

CLN Banner Logo

November 2009: Volume 35, Number 11

The Workforce Challenge
Will Simplified Credentialing Speed Change?
By Bill Malone

The recently-completed U.S. American Community Survey shows that the recession is having a profound impact on housing, property values, immigration, and of course, household income. But the woes of the recession might turn out to be an opportunity in disguise for the long-lamented lab workforce shortage. Working as a medical technologist (MT) or medical laboratory technician (MLT) is becoming a more attractive career option as college students take a hard look at which careers can offer job security and a good chance of finding an opening, especially considering the common perception that healthcare is recession-proof. However, even with interest in healthcare careers getting a boost from the struggling economy, educators who have been cultivating enthusiasm for lab training programs say it’s now the labs’ turn to proactively help tackle the shortage they struggle with daily, and avoid a worse crisis down the road.

Though many training programs have closed over the last 30 years, in fact the most urgent “limiting factor” in producing more trained lab scientists is the lack of clinical labs willing to train students during their clinical internship, explained Susan Gross MT(ASCP), chair of the Coordinating Council on the Clinical Laboratory Workforce (CCCLW). CCCLW is a coalition of 17 lab organizations working together to ensure a high quality workforce. “I know many training programs could handle more students, but there aren’t clinical sites for them. It’s frustrating because we’re getting students interested in the lab field, but some programs can only take them if they can place them in a clinical lab for their clinical training,” said Gross. “My biggest fear is that labs are taking less qualified people to fill the gap—that they’re lowering their expectations instead of putting their efforts into training the next generation.”

Despite hiring freezes, shrinking budgets, high vacancy rates, and other headaches labs are facing, stakeholders are cautiously optimistic that the extensive efforts of lab groups to promote lab careers are starting to pay off, with more interest in the profession and increasing numbers of students registering for educational programs and taking certification exams. On top of these accomplishments, the merger of two top credentialing agencies is raising hopes that a more coherent and unified image for lab professionals will emerge to draw potential students and more respect from the public.

A Delayed Crisis

As bad as the workforce shortage looks now, with a vacancy rate for MTs at about 10% according to the latest American Society for Clinical Pathology (ASCP) Wage and Vacancy Report, the workforce shortage predicament could potentially be exaggerated when the economy begins to recover. The recession has caused many lab scientists to delay retirement because their investment accounts got hit by Wall Street losses, explained Kay Doyle, PhD, MT(ASCP), chair of the department of clinical laboratory and nutritional sciences at the University of Massachusetts Lowell and director of the medical technology program for more than 25 years.

“If this is the case, it delays the bulk of the retirements that are coming, because clinical labs, like nursing and teaching, had large numbers from the baby boom generation that are now looking at retirement,” said Doyle. “Now things have changed. The country is only producing about one-third to one-half of what the projections say we’ll need. So people work overtime, or work two jobs, and labs say they can’t find the people to do the work.” Currently, many labs are actually not looking to hire as many people, but not because they don’t need them. The economy has made them more cautious about hiring, or has forced them to freeze hiring altogether. However, the job market for lab scientists is still exceptional, despite the cutbacks, said Doyle.

Laboratorians nearing retirement—or perhaps delaying retirement—are the mentors that young laboratorians need most for their clinical training, Gross emphasized. “The current laboratorians who are going to retire in the next 5 to 10 years are saying, ‘we don’t have the staff to train interns,’ or ‘we don’t have an empty position, why should we train them now?’ You can’t look at it like that, as these are the labs that will be needing staff after retirements. Even if you hire one in every four you train, you can still break even financially because of the cost of turnover and hiring.”

In the same way that labs expect quality to remain high despite staffing, budgets, or other factors, Gross wants labs to think about training new laboratorians as part of succession and retention planning. This includes training interns as well as developing the leadership skills of their current staff. “When budgets get tight and people aren’t there, it’s not an excuse to lower educational expectations or reduce quality in the lab,” said Gross.

Though some schools that educate MTs and MLTs say they can now draw larger numbers of students, the loss of clinical sites for internships during tough times has essentially put a lid on more rapid growth for the programs that are doing well. “We’re being told that in some areas of the country, people are filling their classes, which they hadn’t been doing for a while. But the point they make in the next breath is that their classes are not as large as they could be, because when there was a shortage, they lost clinical sites,” said Elissa Passiment, CLS(NCA), executive vice president of the American Society for Clinical Laboratory Science (ASCLS). “So while the good news is that they’re filling their programs, the programs’ capacity is smaller than it should be. So there’s an uptick, but the capacity is still not large enough to fix the problem that we’re having with the shortage.” ASCLS participates in the CCCLW.

Passiment believes that the profession is starting to see the fruits of some of the public relations campaigns that lab groups have put together to try and attract more people to the profession. Educators also report that the popularity of television shows like CSI and NCIS drives more students to explore careers in science, even beyond forensics. Another encouraging trend for labs is interest from immigrants to the U.S. who see jobs in healthcare as a practical career choice to steer their children into. “Healthcare tends to be one of the first places that the first or second generation looks to for educating their children,” said Passiment. “So if you talk to educators in states with a large immigrant population, there is a significant influx of minority students. So that’s another positive that is working for us.”

What’s in a Name?

On the certification front, one challenge has been that with so many agencies offering MT and MLT credentials, students were unsure which test to take and lab managers have struggled to set standards for employment. MT and MLT designations are offered by several organizations, including American Medical Technologists (AMT), the American Society for Clinical Pathology Board of Registry (ASCP-BOR), and the National Credentialing Agency for Laboratory Personnel (NCA). Beginning in October, two of these certification organizations have merged—ASCP-BOR and NCA (See CLN, October 2008). Leaders from ASCP-BOR and NCA hope that the new organization, called the ASCP Board of Certification (BOC), will simplify the credentialing process for students and empower the profession with a more unified voice.

“Having a standard credential instead of having two different ones is going to increase credibility and recognition by other healthcare professionals, as well as the public,” said Kathleen Becan-McBride, EdD, MT(ASCP)cm, chair of ASCP-BOR. “There was so much alphabet soup beforehand. Now we’re down to unification in one credential that will also help students and employers.” Even though they were both closely in line for entry level competency, there still were some differences between ASCP and NCA. To be on the safe side, students would routinely sign up for both the ASCP and NCA exams, not knowing whether once they graduated, a hiring manager might be more attuned to one board or another.

Forming a larger certification agency will also help strengthen the image and reach of lab professionals, said Becan-McBride. “I think it says something about the profession coming together and becoming more unified, knowing that for patient advocacy, we have to become unified in the future with the way healthcare is changing so dramatically. It really shows the unification through the new board structure too, enabling us to work within a larger expanse of the public and profession.” The BOC Board of Governors will be composed of five ASCP Fellows (pathologists), five ASCP laboratory professionals, four representatives of ASCLS, two representatives of the Association of Genetic Technologists (AGT), and eight representatives from eight other participating societies, including AACC. There will also be one public representative on the board.

The ASCP suffix will be attached to all BOC certifications. Current and active certifications will be transferred to the ASCP BOC, but no examination will be required for the transfer. Medical technologists (MT) and clinical laboratory scientists (CLS) will be called medical laboratory scientists (MLS), with the designation MLS(ASCP).

Changing the name of the designation became significant in the process because lab professionals have always struggled for recognition and status among other healthcare professions. Medical technologist is the original and most common designation, with clinical laboratory scientist being introduced more recently by NCA. “We have found that clinical laboratory scientist has definitely been more descriptive than medical technologist. Medical technology in this country has for a while now really stood for the devices, so when you tell somebody that you’re a medical technologist, it didn’t really help, especially when recruiting in to the profession,” explained Passiment. “If you tell somebody that you are a laboratory scientist, it meant more to young people, because ‘scientist’ is something they get.” The newest iteration was conceived as part of the unification of NCA and ASCP, with the logic that ‘medical’ gets even more traction with the public than ‘clinical.’ In addition, most other countries use the word ‘biomedical’ or ‘medical’ to describe lab professionals.

In the short term, these name changes might lead to more confusion, said Kathy Cilia, MT, director of marketing at AMT, which also participates in the CCCLW. “AMT will likely stay with the MT designation for now because that is how the profession is currently known in the industry, and what employers accept,” she said. “Even with the new designation, the MT name will be in use for the foreseeable future.”

An Example of What Works

One of the most remarkable success stories in taking on the workforce shortage comes out of Minnesota via the state’s Healthcare Education Industry Partnership (HEIP). Created by the Minnesota State Colleges and Universities with funding from the Minnesota legislature in 1998, the effort includes a clinical laboratory workgroup that has met monthly since the program’s inception to talk about lab workforce needs. The group includes lab managers from the state’s larger healthcare systems, as well as rural lab managers, educators, recruiting agencies, reference labs, the state hospital association, and department of health. “It’s truly an amazing group of people who come together with no other goal than to make sure that we’re doing the right things to adequately meet the staffing needs in the future,” said Valerie DeFor, HEIP director. “There’s no competition, and it’s very open, supportive, and collaborative.”

One of the group’s recent achievements was helping secure a $2 million U.S. Department of Labor grant for St. Paul College. The money will go toward creating an online program for lab staff without Bachelor’s degrees so they can earn degrees online while performing their clinical experience requirements at work. HEIP is also applying for money from the stimulus package, the American Recovery and Reinvestment Act.

One of HEIP’s primary areas of focus has been building awareness and interest among students. HEIP and the lab workgroup created a tool kit for lab professionals to visit K–12 classrooms and explain what laboratorians do. “One HEIP staff member focuses on the K–12 program, getting the message out that healthcare is the job of the future, there is a job for anyone in healthcare, and getting them to think beyond a doctor and a nurse,” said DeFor. “We also do a lot of work helping schools advance the curriculum and stressing math and science so that they are prepared to be successful in health career education at the post-secondary level. So they know about the lab, and hopefully they are more prepared to chose a lab field and be successful when they do that in college.”

But HEIP has done more than just get laboratorians involved. The group also has seen concrete results from its efforts. Minnesota, unlike most every other state, has seen an expansion in educational capacity for the clinical lab. The University of Minnesota program—although threatened with closure in 2003—essentially doubled its numbers. Two other state schools are pursuing NAACLS accreditation and are planning to expand, and the state’s 2-year MLT programs have had increases in students. “I think that’s a testament to HEIP’s work, and especially that clinical laboratory work group that is so committed. Without that group, we wouldn’t have the synergies that it brings. And so while one person may need to be advocating for lab issues, it makes a difference when it’s everyone sending the same message. And they know they have the support of other people to move things forward,” said DeFor. “Simply the fact that in the middle of a staffing shortage for almost every lab, I have these people to come every month and give up half a day to work on these issues—they wouldn’t do that if it wasn’t valuable and if we weren’t making a difference for them.”

With its educational programs in full swing, HEIP’s major challenge remains a lack of clinical sites for students to complete their internships. “Our message now is that, while Minnesota has done a fabulous job on the educational side with maintaining and expanding lab programs, we need help from the provider community in getting additional clinical sites for students because we’re really, really struggling with that right now,” said DeFor. “Some of the labs say, ‘well, we’re short-staffed.’ They are, but they’re always going to be short-staffed if they don’t take students.”

To that end, an HEIP member developed a concept called preceptor training that helps labs accommodate students and be more confident in training them. Preceptor training is a short class that explains what it takes to train students, what a lab can expect of them, and how they can help them learn. “What we heard from a lot of our provider partners is that ‘we probably could take a student, but we don’t know if we can teach,’” said DeFor. “The preceptor training helps alleviate any fears that the staff would have helping a student along.”

What’s In It for Labs?

While educators and other advocates for lab science students hope laboratorians get involved in workforce efforts because they care about their profession, they also underscore the fact that labs have a lot to gain from taking interns, including previewing prospective employees and pushing incumbents to keep up their knowledge and skills.

Since most interns find jobs at their clinical sites, lab managers are able to see their work ethic and how they fit with the rest of the staff well before they have to make a decision about hiring the person, explained Passiment. “For those labs that take on multiple students, they will tell you that it works really well for them because they have their choice of who they want to fill any empty spots they have,” she said. “The other advantage is that, for you to be able to train, your own staff really has to be up-to-date. So you get this additional benefit, and it doesn’t cost you very much.” There is also a financial benefit. Advertising for an open position can cost much more than $20,000, well below the cost of spending some extra time with a student.

Once the laboratorians who actually train students get over the fear of a new responsibility, often they find it’s an enjoyable and rewarding experience, said Gross. “It makes it more than just a job, and both sides learn from the experience. It’s just the idea that there is something new to do that is scary.”

Doyle hears much of the same sentiment from labs in Massachusetts. “People enjoy having students because they feel it keeps them on their toes. It works out really well for both students and the clinical site, because the students have already been working there, they know the people, they know how the place operates, and if they take the job there it’s because they really want it,” she said. “Plus, they’ve already had some employee training.” At the University of Massachusetts, Doyle is also able to entice labs with vouchers for course tuition at the university if they take lab students, as well as offering access to audioconferences to help the labs with continuing education.

Whether or not labs, educators, and other stakeholders can work together to prevent a worse workforce crisis will make a huge difference to the future of the profession, said AMT’s Cilia. “However, as labs struggle with cost containment, we may see a new model emerge that includes fewer, more specialized MTs working alongside of MLTs that do the majority of lab testing,” she said. “That may be the reality we need to face in the future."