ASCP Teams Up With State Pathology Society to Address the Workforce Shortage

On November 27, 2007, ASCP and the Connecticut Society of Pathology co-sponsored a forum on the medical laboratory workforce shortage. The event, held on the campus of Yale University, New Haven, CT, brought together a variety of stakeholders, including pathologists, laboratory directors and managers of acute-care hospital laboratories as well as reference and public health laboratories, hospital administrators, and state legislators. ASCP President, Lee Hilborne, MD, MPH, DLM(FASCP) was on hand to welcome and assure attendees that the laboratory workforce shortage continues to be a high priority issue for ASCP and collaboration, on both local and national levels, will be key to solving such a complex problem.

Each of the forum speakers addressed a different aspect of the issue. ASCP Vice President for Scientific Affairs and Executive Director of the Board of Certification, Blair Holladay, PhD SCT(ASCP) led the panel with an overview of the shortage from a national perspective. Dr. Holladay explained the shortage’s exceedingly complex etiology, including:

• CLIA regulations, which relaxed the educational requirements for those permitted to perform laboratory tests,
• the subsequent closure of NAACLS accredited training programs,
• inadequate Medicare and third party payer reimbursement for laboratory services,
• salaries that fail to be commensurate with education and competency requirements,
• lack of visibility of the profession and advancement in the profession, and
• intense competition for clinical laboratory scientists from pharmaceutical companies and industry.

Dr. Holladay stressed that given the complexity of this shortage, any truly effective long range solution will require a substantial change on many fronts, and he outlined a number of possible strategies that target these factors and that could enhance recruitment and retention efforts.

The statistics are alarming: the profession needs 15,000 new practitioners per year, yet education programs graduate approximately 5,000 students per year. Declining interest in laboratory medicine as a career over the past two decades has led to training program closures. As a result, the number of NAACLS accredited medical technology programs dropped from 709 in 1975 to 222 in 2007. Now, students who are interested in pursuing a career as a laboratory professional face limited opportunities to do so. Speaker Wayne Aguiar, MT(ASCP), MS, SM, Director of the Hartford Hospital Clinical Laboratory Education Program, reported that currently in the state of Connecticut there are only three MT training programs and no MLT programs. Further exacerbating the shortage problem in Connecticut is the fact that 10 to 25 % of the MT graduates are from out of state and leave the state to pursue their careers elsewhere.

It is clear that new training programs must be established if we are to meet the future demand for laboratory personnel. Paul Schreckenberger, PhD, D(ABMM), a Professor of Pathology and Director of Clinical Microbiology at Loyola University Medical Center, Maywood, IL, spoke of the challenges of starting a new university-based training program in a clinical laboratory setting. By utilizing resources that were already in place, including standing faculty, existing laboratory space, and a commitment to accommodate student clinical rotations from Loyola University Medical Center, no capital investment was required to get the program up and running. Dr. Schreckenberger stressed that success in recruiting students means offering flexible program entry options (students may enter the program after 1, 2, 3, or 4 years of college) as well as providing a program suitable for career changers including bachelor-degreed science majors, associate-degreed MLTs, or MTs reentering the field following an extended absence.

However, all the forum speakers agreed that as important as training opportunities are to solving the shortage, generating interest in the profession is critical to filling the seats in those programs. Stakeholders outside the laboratory, including other clinicians, healthcare administrators, legislators, and public in general, need to be made aware of the profession and its looming shortage. The medical laboratory personnel shortage has many dimensions and solving it will require a multifaceted approach. The objective of this forum at Yale was to create dialogue on a local level. Representative Peggy Sayers, Co-Chair of the Connecticut General Assembly Committee on Public Health, herself a registered nurse, commented that although she was aware that a workforce shortage did exist in the allied health fields, she had no idea that there was currently such a serious shortage of laboratory personnel.

As long as the shortage has an impact on the ASCP membership and the public safety, it will remain a pressing and high priority issue for the Society. As this newsletter goes to press, the ASCP Wage and Vacancy Survey, a tool long considered to provide the most accurate snapshot of the status of the laboratory workforce, is underway. In the coming months, ASCP ePolicy will report on its findings. Data gleaned from the survey will aid ASCP and others in the medical laboratory community in developing effective strategies to ameliorate the shortfall of laboratory professionals.

Personnel Shortages: What Can Laboratory Medicine Learn from Nursing?

For many years, laboratory medicine has faced a shortage of qualified laboratory technologists and technicians, with shortages in some states being particularly problematic. In 2004, the Bureau of Labor Statistics (BLS) estimated that there would be a demand for 15,000 new laboratory practitioners each year through 2014. Unfortunately, with fewer than 4,700 individuals graduating each year from accredited or approved educational training programs, the number of graduates from laboratory training programs would need to increase more than three fold to meet the estimated demand.

Interestingly, a recent report on allied health personnel shortages (including nursing) in California conducted by Health Workforce Solutions (HWS) for the Campaign for College Opportunity revealed that the “greatest need for current demand was for clinical laboratory scientists.” The report estimated that while the median annual shortage for those allied health professions studied was 79 percent, the annual shortage for clinical laboratory personnel in California was 559 percent. According to their findings, some health care systems in California have a technologist workforce “with an average age well over 50.”

With so many laboratory professionals nearing retirement, the question looms: “How will laboratories cope?¿ The nursing profession has also faced shortages over the years. Many of the issues believed to be contributing to the shortage of nurses—a diminishing pipeline of new students to nursing, a decline in RN earnings relative to other career options, an aging nursing workforce, low job satisfaction and poor working conditions that contribute to high workforce attrition rates, and an aging population that will require intense health care services—are also factors affecting the shortage of laboratory personnel. Following is an overview of some of the strategies employed by the nursing industry to address shortages in their field:

Strategies for Dealing with the Nursing Shortage

Some of the traditional strategies employed to address the nursing shortage have been wage increases and recruitment of international workers. However, given the complex causes for personnel shortages, experts believe these strategies are short term solutions that will have little lasting impact.i Moreover, experts believe that strategies for addressing shortages should address not only recruitment but retention too.

Recruitment strategies: Among the strategies that fit into the recruitment category are wage increases, immigration, improving financial aid opportunities, targeting underrepresented groups and minorities, and public service announcements/advertising. Many of these strategies are part of the Allied Health Reinvestment Act, which ASCP supports.

Retention strategies: Some of the retention strategies include improving workplace conditions (Stress, risk of infection, etc.), improving job dissatisfaction related to scheduling, lightening unrealistic workloads, decreasing mandatory overtime, having input on decision making, and responsiveness to staffing concerns. The HWS report indicated that career laddering, including such programs as tuition reimbursement, on-site academic programs, and release time, are often cited as a key tool for increasing retention rates.

Perhaps the most visible initiatives aimed at addressing the nursing shortage have been federal initiatives, such as the existing Nursing Workforce Development programs (Title VIII of the Public Health Service Act). Additionally, Congress is considering several bills that would, in addition to creating other programs, establish a distance education pilot program to provide grants to increase accessibility to nurse education. However, most of the recent initiatives to address the nursing shortage have been focused on the state level.

State Initiatives Overview

Many of the state initiatives to address the nursing shortage are focused on creating legislation to remove financial impediments to pursuing a nursing degree and faculty development. According to the American Association of Colleges of Nursing, “Illinois, Kansas, Maryland and Utah enacted sweeping legislation in 2006 to address the shortage of registered nurses and nurse education over the next five to ten years. Colorado, Georgia, Nebraska, Minnesota, and Texas have focused on alleviating the shortage of nurse educators, the primary obstacle faced by schools looking to expand student capacity. Other states, including Massachusetts, Missouri, and Pennsylvania, are working inside and outside of the legislative arena to launch programs involving strong collaborations between education, practice, and community stakeholders.”

Sample State Initiative: Maryland. In 2006, Maryland began awarding a total of $6 million in grants over five years to academic institutions to increase capacity with two programs, a graduate nursing faculty development program (fellowships, scholarships and living expense grants) and a competitive institutional grants initiative, the latter intended to expand capacity through shared resources, enhancing nursing school retention, and increasing the pipeline for nursing faculty. The initiative is expected to result in an increase of 500 nursing undergraduates and 250-300 students in graduate programs.

Miscellaneous initiatives occurring at the state level

• State sponsored data collection or task force (study/recommendations) initiatives: AL, AR, CT, DE, FL, ID, IN, IO, MA, MD, MI, NM, NY, SD, TN, WV
• Private initiatives: AK, ID
• Public/private collaborative initiatives: CO, HI, MA (career laddering), MN, MO (release time), NV, NC, OH, SD, WI
• Scholarships for undergraduate and graduate study: AR, SD
• Faculty development grants/stipends (institutional): AL, LA
• Loan forgiveness (service cancelable) programs: GA, MN
• Recruiting international personnel, minorities or underrepresented groups: MN, NE, OH, TX
• Minimum staffing ratios: CA, several other states have considered similar legislation
• Academic initiatives (articulation models, expanded preceptor programs, mentoring): LA, MA, MS
• H.S. guidance initiatives: DE

According to the HWS report, “developing task forces and advisory committees focused on workforce issues has proven to be effective in designing and implementing successful strategies.”

Are There Any Success Stories?

Several of the strategies undertaken by state governments appear to be having an effect. According to the HWS report, “Governor Arnold Schwarzenegger’s $90 million public-private partnership to provide funding for nurse education has already resulted in a 25 percent decrease in the projected state shortage.”ⁱⁱ

ⁱGerson, J et al. Background Brief: Addressing the Nursing Shortage, Kaiser Family Foundation, KaiserEDU.org

ⁱⁱClosing the Health Workforce Gap in California: The Education Imperative. Health Workforce Solutions. November 5, 2007