For the past few decades, medical laboratory technology has been characterized by rapid and dramatic innovation, including the development of new tests and advances in equipment and testing techniques. Information technology has revolutionized data transfer by decreasing the time it takes to order and receive test results and by creating opportunities for research using Big Data sets. These new technologies are having a profound impact on the medical laboratory workforce[i]. Yet, despite these exciting developments, the profession continues to fall short as a career choice, leading to the current workforce shortage.
The Scope of the Labor Shortage
The BLS (Bureau of Labor Statistics) reports that employment of medical laboratory technologists and technicians is expected to grow by 13%, from 330,600 in 2010 to 373,500 in 2020[ii]. This translates into about 11,300 laboratory technologist/technician job openings annually through 2018 (including 7,000 through attrition as well as 4,300 new positions). Unfortunately, the programs preparing tomorrow’s laboratory workforce are training only about a third of what is needed. Fewer than 5,000 individuals are graduating each year from accredited training programs[iii]. Compounding the problem, since 1990, the number of laboratory training programs has decreased almost 25%.
Supply and Demand Issues Affecting the Laboratory Workforce[iv]
Decreased Workforce Supply
There are many reasons for the continued shortfall in qualified laboratory personnel, and these can be categorized as “retirement, recruitment, training and retention” issues. While serious issues, all of them can be addressed through constructive actions and long-range planning. They include:
More of the baby boom generation is reaching retirement age, which will affect the shortage in three ways: by expanding the demand for healthcare, by causing a huge loss of experience and by increasing the shortage of laboratory professionals.
Clinical laboratory work remains the hidden profession. Laboratory workers are not commonly viewed by the public, thus recognition of their role and responsibility in patient specimen collection and processing is limited. This lack of recognition for the vital contribution the laboratorian brings to patient care is another problem faced by the profession. As a result, there is a lack of public knowledge about professional lab opportunities. Relatively few people know about the variety of careers available in the medical field other than doctors, nurses and, occasionally, paramedics.
Another recruitment issue for laboratory personnel is uncompetitive wages. Though increasing, they have not kept pace with those of other allied health professions. Also, requirements for licensing and certification of lab technicians vary from state to state, which can make it hard to relocate[v].
Training: The continued closures of Clinical Laboratory Programs
According to the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS), school closings in the past 15 years have reduced the number of medical laboratory scientists/clinical laboratory scientists (MLS/CLS) and medical laboratory technicians/clinical laboratory technicians (MLT/CLT) being trained annually. This has created the situation where too few replacement professionals are graduated each year to make up for the combined number leaving the workforce.
Job satisfaction is tied to workload, recognition and, again, to salary. In many institutions, shortages cause the remaining workforce to have to carry out the same volume of tests as a fully-staffed lab. Technicians are asked to work overtime, double shifts often, with skeleton crews, and are still expected to maintain the same turnaround times. This can lead to exhaustion, burnout and increased potential for error[vi].
Increased Demand for Qualified Personnel
Meanwhile, the need for qualified laboratory personnel continues to grow as a result of a number of factors. These include the convergence of profound shifts in population demographics, (those over 65 will more than double between now and 2050), legislative and regulatory reforms (Affordable Care Act), major advances in medical diagnostics and treatments (Molecular Diagnostics; Personalized Medicine), and advances in Information Technology, and Resource Utilization.
The Affordable Care Act
The increase in demand for health care services brought on by mandates of the Affordable Care Act (ACA) could overwhelm the health care system, including medical laboratory operations, if it is not adequately prepared to handle the massive influx of newly insured patients. These changes will significantly lower the uninsured population, reducing “the number of nonelderly people without health insurance coverage by 14 million in 2014 and by 29 million or 30 million in the latter part of the coming decade.
Explosive advances in the areas of molecular-level and genetic testing are dramatically changing clinical practice. The National Institutes of Health (NIH) Genetic Test Registry currently has more than 7,000 orderable tests for approximately 3,000 conditions and 6,300 genes. The number of conditions for which genetic tests are available has nearly doubled in the past two years. However, patients will only fully realize the benefits of this rapidly developing technology if there is an adequate laboratory workforce equipped with the new skills required to perform the complex assays of the future
Advances in laboratory information management systems have led to new career opportunities throughout the laboratory. A thorough understanding of laboratory diagnostics, workflow, and the specific needs of other clinicians providing patient care are essential for developing systems that will streamline data housing and transfer, reduce error, monitor and improve work processes, and serve as a tool to better inform both clinicians and patients.
Technological advancement of laboratory testing, emerging pharmacogenomic and proteomic testing, digital imaging, and greater laboratory automation could significantly change the qualifications required of the next generation of laboratory professionals.The increased volume of clinical testing and the growing menu of available clinical tests, often using new testing platforms, have the potential to influence not only the numbers and types of laboratory professionals needed but also their knowledge and skill set. Increasingly sophisticated diagnostics will require interpretation management. The coming milieu could necessitate the need for both generalists as well as specialists. The evolution could mean the opening of new and different career paths and scopes of practice.
Test Utilization – ACA Initiatives
Another issue that can have a profound impact on the demand for laboratory professionals is test utilization. Accountable Care Organizations (ACOs) and, to a somewhat lesser extent, patient-centered medical homes (PCMHs) are among the ACA initiatives to reduce unnecessary utilization of laboratory tests. The Electronic Health Records Incentive Program and the Physician Quality Reporting Program are other examples of ACA initiatives to address utilization.
In summary, with the steady decrease in the number of medical laboratory programs and graduates, along with the increase in the complexity and volume of work, changes need to be made to bring more candidates into the employee pool. Employers and the general public need to be alerted to the possible ramifications regarding the lack of qualified lab personnel. Delays in the diagnosis of illnesses, inaccurate or incomplete test results and potential delays in treatment could result. Because of low enrollments and financial viability issues, the future for educators could mean the closing of even more established training programs[vii].
Where Does the Profession Go From Here?[viii]
The ASCP Task Force on the Laboratory Professionals Workforce considered all of the above issues and made the following recommendations:
- Promote the role of laboratory professionals to patients, other providers, health care administrators, educators, policy makers, and the public at large, as an integral part of the clinical care team in a transitioning health care system.
- Using objective, care-driven data to assess workforce supply and demand to provide projections for future needs to inform programs and policies that will meet the needs of an evolving health care system.
- Engage in outreach opportunities that promote STEM education to support and promote the development of high-level skills critical to the performance of quality laboratory testing and management, as well as bolster the pipeline of potential candidates for the profession and leadership in health care. More attention and resources need to be given to high school counselors, science teachers and clinical laboratory educators to attract students and adults to laboratory science careers.
- Develop and incorporate new products and information into educational programming via multiple platforms (web, conferences, publications) that will enable laboratory professionals and pathologists to be at the forefront of health care.
- Seek and support initiatives that promote the development of a qualified workforce through quality education programs that reflect advancing technologies, maintaining high standards for certification of laboratory professionals and laboratory accreditation programs that incorporate personnel standards.
- Promote a legislative and regulatory agenda to consider coordinating state and federal personnel and testing standards to remove unnecessary barriers to intrastate employment of well-qualified laboratory professionals.