Medical Lab Worker Shortage: Interview with a Professor on Meeting the Demand
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The information we produce in the lab is essential to physicians and other healthcare providers to make decisions for their patients and how to best care for them … It’s very rewarding, interesting work and it’s meaningful.
Lisa Cremeans, Assistant Professor, University of North Carolina (UNC) at Chapel Hill
In the world of diagnostic and genetic testing, it’s an exciting time to be alive for both patients and scientists. As time goes on, doctors and scientists are able to tell more and more about your health from a vile of blood. At present, there are already more than 75,000 genetic tests available (those ordered by doctors, not direct-to-consumer genetic services such as Ancestry.com and 23andMe). Each day, there are 10 new tests introduced to the U.S. market—and that’s just within the realm of genetic testing.
Blood tests are performed in order to determine what diseases or deficiencies are causing a patient’s symptoms, or detect problems even in their absence. In genetic testing, they can even predict diseases that a patient is predisposed to and arm them with information to make smart lifestyle changes or have preventative surgery.
According to the Institute of Medicine, the contributions that laboratory medicine professionals make in their collaborations with physicians, nurses, and patients can help reduce the current trend in diagnostic errors and potentially prevent unnecessary deaths. But there is a bottleneck that stands to affect this progress: the clinical laboratory workforce shortage.
Demand for medical laboratory technologists and technicians is expected to increase by 11 percent nationally between 2018 and 2028—more than double the average increase in demand among all occupations, according to the U.S. Bureau of Labor Statistics (BLS 2019). Even more troubling is a statement from the American Society for Clinical Laboratory Science (ASCLS) that “the profession is educating less than half of the number of laboratory professionals needed.”
If there isn’t a significant upswing in the number of laboratory technicians and technologists entering the U.S. job market, there will be consequences. Wait times for patients to receive life-changing results from blood tests will likely increase, while the pressures that the labs themselves are already facing operationally—due to being understaffed—also stand to worsen.
To get to the bottom of the issue, we talked to a professor in clinical laboratory science who has witnessed the shortage and its effects firsthand.
Meet the Expert: Assistant Professor Lisa Cremeans of the University of North Carolina (UNC)
Lisa Cremeans said she has been keeping tabs on the medical lab worker shortage since she became a clinical assistant professor at the University of North Carolina (UNC) at Chapel Hill in 2013. She has more than 14 years of experience as a medical technologist, working in physician office laboratories, emergency medical services, organ and tissue donation services, and for clinical research organizations in clinical trials and post-approval pharmaceutical safety. She’s also a task force member for the ASCLS, which is seeking to address the clinical laboratory workforce shortage.
Cremeans holds her BA in clinical laboratory science, as well as a master’s in molecular diagnostic science from UNC at Chapel Hill.
Breaking Down the U.S. Clinical Lab Worker Shortage
The scarcity is being felt in hospitals and laboratories across the U.S., but in certain areas, the effect is more dramatic. The average rate of vacancies is about 7 percent among the 17 lab departments which participated in a ASCP 2018 survey. The Northeast region of the U.S. reported the highest overall vacancy rate of about 11 percent, while the Central Northwest had the lowest vacancy rate of about 6 percent. But in certain areas within these broader regions, the rates may vary.
“Rural areas are definitely feeling it, and any of the states that don’t have many training programs are also likely experiencing a harder time getting workers,” Cremeans said. This is due to workers’ tendency to find employment near their alma mater universities, on top of a general preference among the workforce for jobs in or near urban areas.
But the problem also affects some highly populated zones. “For example, Florida and Arizona, where you have more individuals of greater age, the number of individuals seeking healthcare is increased, and that’s probably more taxing for those states to provide those lab services.”
Cremeans added that in her state of North Carolina, there are only four programs in clinical laboratory science, which she says is not enough to meet the demand for the scientist-level practitioners in the state.
So, what is at the root of this pervasive problem? There are a few factors coming together to make the perfect storm.
Reason #1: A Decrease in the Number of Academic Programs
Despite the fact that the shortage of lab personnel has been a growing problem for decades, there has been a steady decrease in the number of medical laboratory science (MLS) and medical laboratory technician (MLT) programs in the U.S. since 1990.
In the year 2000, there were 263 MLS programs and 248 MLT programs. By 2017, there were 234 and 244, respectively. Zooming out to look at a wider timespan, there has been a total decrease in the number of accredited training programs of nearly 25 percent between 1990 and 2018.
This has obviously contributed to the shortage of qualified workers in the job market. Considering the long-known deficit, why would universities eliminate medical laboratory programs? Cremeans weighed in: “Basically, they are expensive to offer, so when it comes to cuts and looking at budgets … some of those cuts have been made based on how much it costs to run them. That, and they may not have high enough enrollment numbers.”
That leads to another factor that is more difficult to quantify, which is the effort (or lack thereof) of high schools and universities to introduce the career path to students.
“It goes back to promoting the profession and students having an awareness that this exists as a career,” Cremeans said. “It’s harder for some programs to recruit students into their programs.”
Reason #2: A Retiring Workforce
Another contributing factor, which is not unique to the healthcare industry, is the aging workforce—specifically, the Baby Boomer generation.
“Many of them sort of held on a bit longer because of the economy and such, but they are now entering retirement,” Cremeans said, “So, that’s caused reduction in the workforce.”
Labs have already begun to experience the effect, but the Baby Boomer exodus will continue to be felt. According to a 2016-2017 ASCP survey on vacancies in laboratories, the average expected five-year overall retirement rate for all departments was about 19 percent. An eye-popping 41 percent of respondents also said that their program director would be retiring in the next five years.
Reason #3: New Training Requirements
There have been exciting new developments in diagnostic technology, leading to improvements in preventive screening. These advancements promote faster detection and results, which is great for patients, but it also means that certain workers need to be armed with new areas of knowledge and skill sets that weren’t expected in years past.
“For example, right now there is a lot of testing that utilizes molecular analysis, looking at DNA and RNA, a much more specialized area of testing—something that individuals that were trained 20 or 30 years ago didn’t learn a lot about in their education programs,” Cremeans said. “So, it’s really kind of developing the need for a little bit of a different skill set in some areas to be able to perform the testing and interpret the results.”
When institutions are unable to find the employees capable of handling new procedures, the current staff often end up working longer hours and/or having an expanded range of duties. “These expanded duties can include cross-training in other disciplines within the laboratory,” the ASCLS said. “Although cross-trained staff may feel more valued, cross-training to fill vacancies has the potential to dilute in-depth core knowledge and expertise necessary for solving complex issues.”
In essence, the added pressure to rise to the occasion can become a burden for employees, who are already spread thin and have a potentially negative effect on the efficiency of the lab.
Interested in Working in a Medical Laboratory?
While the shortage is taxing for employers, there is an obvious silver lining to be gleaned for students and graduates: competition for candidates with the right skills. So, if you’re looking for an in-demand career in healthcare with promising job security, this could be the route for you.
“There’s a lot of stability in most institutions, in most places. With some industries, there’s a risk of losing your job with things like consolidation and mergers, and there seems to be less of that with our profession,” Cremeans said.
When considering your options, note that the medical lab scientist (MLS) and medical lab technician (MLT) tracks are distinct roles and call for different levels of education. Both require a passion for identifying problems, finding solutions, a strong sense of attention to detail, but the educational requirements and salaries differ.
MLS careers (including technologists) typically require a bachelor’s degree, while MLTs usually require an associate’s degree. Technologists and scientists generally earn a higher income and have more opportunities for advancement, but in turn, have more responsibilities. They assist other healthcare professionals such as physicians in detecting, diagnosing, and treating diseases and may draw patients’ blood or instruct patients on how to properly collect their own samples.
MLTs also play an important role in medical lab operations. Their tasks include taking care of instruments, gathering data, maintaining records, preparing and conducting chemical and biological analyses as directed by a supervisor, and assisting in all lab procedures (e.g., sample-taking, analyzing the outcomes of experiments).
Both technicians and scientists (and technologists) may choose to specialize in an area of expertise. Scientists may focus on chemistry, cytotechnology, immunology, microbiology, molecular biology or immunohematology. Technicians may choose to specialize in phlebotomy and histotechnology.
Of the 17 different departments categorized in the ASCP’s 2018 survey, the top five most in-demand specializations (i.e., those with the highest rate of vacancies) were:
- Core lab
Like any job, there are pros and cons to working in a medical laboratory. Perhaps the biggest drawback is that laboratory personnel salaries are on the lower end compared to other healthcare careers. According to the U.S. Bureau of Labor Statistics, the median annual wage for clinical laboratory technologists and technicians was about $52,000 as of May 2018, however, “Salaries really vary by institution, by region, by state,” Cremeans said.
For example, the average medical technologist (scientist) salary in New York is about $55,000, while in Kansas, it’s about $48,000, according to data from Glassdoor (2020). For technicians, the respective states’ salaries average at about $38,000 and $32,000.
“But I would say, for a four-year degree for an entry-level position, the salary is pretty good when compared to other professions,” Cremeans said, referring to the technologist and scientist track.
Medical lab staffers say that getting to work behind the scenes in a lab setting while still feeling like they are helping real patients is the true appeal of the career.
How to Help Resolve the Medical Lab Worker Shortage
According to respondents of the ASCP (2018) survey, 50 percent of lab managers said they lose personnel to better salary offers from other employers; 46 percent said it is also attributable to an increase in competition for well-trained personnel; and 39 percent said there were not enough applicants without the necessary certification, education, or skills to perform the work.
To attract applicants, institutions are offering heftier benefits packages, including health and retirement benefits; premium pay for overtime, holidays, or weekends; and tuition reimbursements. But Cremeans said there’s something else that labs can do to attract applicants: offering internships.
“There are some labs that are more than happy to host students and train them as part of their education, and there are other labs that can’t do it for whatever reason—personnel, maybe they don’t have enough staffing—or they’re just not interested in working with students. So, that can cause limitations when it comes to the clinical location requirements of these programs,” Cremeans said.
“One of the things that the academic programs try to get across to the hospitals and the clinical sites is to look at this as a return on investment. If you put time into helping train a student, it’s likely that they will turn around and accept a job position with you.”
Another potential boon to the staffing crisis would be to attract candidates from related fields of study. Those with bachelor’s degrees in various sciences who are interested in laboratory science can pursue CLS, MLS, MT, or MLT programs, as well as apply for certifications from the ASCP or American Medical Technologists (AMT). There are “4+1” programs, entry-level master’s degrees, and second-degree programs (usually two years) available in many states.
James Freeman, the vice president of research and development for laboratory diagnostics at Siemens Healthineers, suggests that students from similar educational tracks should consider specializing in laboratory sciences: “It is a great time for STEM [science, math, engineering and mathematics] students to consider a career in diagnostics,” he said, naming the fast-evolving field of in-vitro diagnostics (IVD) as a particularly good fit for graduates of STEM programs.
There should also be an effort on the part of high schools, universities, and career centers to educate students and recent graduates on this in-demand career path, in addition to labs and hospitals making the investment in students.
“One of the things a lot of individuals in the field will speak about is the lack of recognition of this really being a profession,” Cremeans said. “I think there’s just a lack of awareness. People may not even know [the career path] exists.”
To prospective students or scientific degree-holders, Cremeans recommends looking into specializing their education in medical lab training: “The information we produce in the lab is essential to physicians and other healthcare providers to make decisions for their patients and how to best care for them, so we really do provide important information and play a significant role on the healthcare team. It’s very rewarding, interesting work and it’s meaningful.”