Transitioning medical laboratories demand flexibility

June 1, 2009

Edited by Carren Bersch

Alton Sturtevant, PhD Marti K. Bailey, MT(ASCP) Lawrence J. Crolla, PhD

With the retirement of an estimated 13,000+ medical lab scientists each year for the past nine years, we have witnessed a “brain drain” of sorts in the medical laboratory. The impetus behind automating the lab is partly based on the loss and non-replacement of most of these workers. As in other industries, automation of equipment does not necessarily mean, however, that the quality of “interpretation” of results will be as accurate as in the past. We spoke with MLO's “Management Q&A” panelists to find out what is happening in the lab right now. The discussion ranges from whom to recruit for today's lab, to meshing traditional lab workers with tech-savvy new MLTs and MTs, to molding a “brain trust” of older mentoring or part-time techs for training purposes, to competing with industry for new graduates. The panelists also address the advantages of large and small labs, and other benefits that new lab employees might encounter in today's environment.

Alton B. Sturtevant: Certainly a number of
experienced personnel are leaving the field due to retirement, but I do
not see it as a doomsday situation. Our concern over the experience of
those leaving is an anxiety produced somewhat by the new people coming
to us from sources other than the traditional technology-training routes
like medical-technology programs. A potential lab tech should have at
least an associate degree with a science orientation, although the more
college education, the better. Ideally, the person should have completed
a formal laboratory-training program, although training by experience in
a laboratory setting as a “trainee” would also be acceptable. Those
people are usually a step or two ahead of persons not having that
training in quality control, writing procedures, and troubleshooting
issues. On the other hand, this new breed of techs tends to be savvier
with regard to computerization and automation, and can be of great
benefit in today's lab. A person will do well in today's ever-changing
medical laboratory environment if he is adaptable to rapid change,
energetic, embraces technology, and has the ability to be a team player.
We must create an environment that can blend the new with the long-time
techs to make a smooth-running team. Open-minded leadership, competitive
salaries, help with day care, good healthcare benefits, time off,
limited overtime for those that do not want it, and a focus on
teamwork can all work to help us to attract and retain staff.

Larry Crolla: The same type of person we have hired
in the past is who we would hire today — MTs who are ASCP-certified and
MLTs. Just because we have adopted automation, the job requirements, as far
as ability to evaluate the quality of the results, has not changed. We
require a minimum of two years of college and MLT training, and most
employees would need a bachelor's degree and MT(ASCP) certification. The way
labs are changing, future techs may require some specialty certification
such as molecular in addition.

Marti Bailey: Our recruiting efforts focus on MTs,
MLTs, or those with a bachelor's in biology. Recruiting has been difficult
with applicants so limited. We do not have the luxury of looking for
specific types of workers. Our hiring process has stringent guidelines,
which require all qualified applicants to be interviewed and selection to be
made based on standardized interviews and carefully documented ratings.

Sturtevant: As a lab manager obtains new employees,
he should attempt to find team members who can complement one another:
leaders, followers, troubleshooters, procedures writers. We do not always
have the luxury of finding personnel who immediately exhibit these traits,
so to find and develop these skills is incumbent upon the manager/leader. It
can be helpful to assign all technical employees a “piece” of the department
soon after their initial employment — specific instrument, quality control,
or something else — to encourage responsibility and teamwork, and to
determine future leadership roles.

Crolla: Variety is necessary to build a good

Bailey: Diversity of expertise would be great;
however, we are in a beggars-can't-be-choosers situation. Frequently, our
advertised positions receive no response the first time around. The
candidates are just not out there, so when we do get responses, we
generally do not have much of a pool from which to select. Our staffing
situation has reached the point in January where we were hiring temps,
particularly for our third-shift positions.

Sturtevant: Regarding the “brain trust,” in an
attempt to retain experienced employees, I try to assign duties based on
experience and individual ability to adapt to change, to demonstrate “people
skills,” to exhibit an ability to train. I also look for their tolerance for
Generation-X traits and their work ethic. When I have an experienced
tech who just likes to work hard and not get involved with phases of
the team effort, I let that person work with fewer opportunities to mentor
newer techs.

Crolla: We do the same sort of thing in our
laboratories, too.

Bailey: We maintain a group of trainers from our
experienced employees. These are folks who are willing and able to train new
staff. Not all techs are created equal in this respect.

Sturtevant: Many times the experienced techs find new
energy and motivation by teaching and showing the new techs the ropes. These
mentors can help mesh the traditional breed with the new techs into a
smoothly functioning team. It takes a special group to make this happen, and
I feel lucky when this becomes a reality.

Crolla: We are trying to retain older lab pros, even

Bailey: Unfortunately, our HR policies are
restrictive enough that we cannot replace the employee and still keep her on
as part-time without having a new, “casual” position approved.

Sturtevant: The lab does seem to lose some employees
to industry for a change of pace, financial, travel, or upward-mobility
reasons. The industry serves labs, so who better to work with current lab
personnel than former lab employees. This migration seems to be inevitable
as you find and recruit highly skilled personnel. When one of your team
members decides to leave, wish her well and hope that she will be a
“recruiter” for your laboratory because of her good experience.

Crolla: We have lost techs over the years to
industry, since they usually do not have to work weekends and because
industry pays better. No formal plan that I know of exists for retention,
outside of making sure salaries are competitive with other hospitals in the

Bailey: Our basic mode of advertising is on our
hospital website and, occasionally, in local papers. We have a business
agreement in place with our local community college to serve as a practical
training site for its MLT students. This has provided us with a pool of
potential candidates we have the opportunity to observe pre-hire, which has
benefitted our recruiting situation. We have found that the perceived
prestige of working for our university medical center, along with our
hospital's generous educational benefits, is no longer carrying us. We have
lost a good many exceptional candidates due to salary. Candidates are
looking for top dollar for their labor. There is virtually no negotiation
for our open positions. They are what they are. For instance, we have been
turned down for day-shift positions because they include working third-shift
weekends. We are in the process of trying to get approval for sign-on
bonuses for techs.

Sturtevant: In order to attract and maintain adequate
personnel, the salaries, as Larry says, must be competitive. Other
attractions such as innovative shift schedules — seven-on/seven-off (i.e.,
seven 10-hour days on with seven days off) or four 10-hour days — can be
beneficial to the lab and enticing to personnel.

Crolla: Our organization does not have any special
“perks” yet, and we still advertise in local newspapers as well as on the
Web. The only demand job candidates make is for shift availability.

Sturtevant: There are advantages to hiring to both
smaller as well as larger laboratories. As a former lab director of 400+
techs, I also know that the larger laboratories have advantages to offer
employees: more specialization, more automation, more volume, and more
computerization without direct patient or physician contact. There are
highly skilled technologists, supervisors, managers, pathologists, and
doctoral-level personnel available for interaction and skill development.
Personnel with generalized science education can work and learn within these
environments in order to expand their marketability for future employment
within the field. This is a great attraction for many.

As the current director of five smaller limited-test-menu
laboratories located within large multispecialty medical groups, I focus on
the benefits of working in a smaller physician-based laboratory: the ability
to perform testing in more specialties, such as chemistry, hematology,
coagulation, serology, urinalysis, and others; to perform a variety of
assays is a plus to many people. Techs in my labs are not required, however,
to give up their desire to focus on one specialty, even though they are more
generalists. The intensity of the job is present but less so than in a large
highly automated lab. These techs also are allowed more physician and
patient contact than would be available in many lab environments. As
director, I also provide one-on-one training to the supervisors and
technologists through discussing procedures and reacting to questions but
usually through review of QC and proficiency-testing issues. This is
especially important in environments where automated QC and daily review by
more highly trained and experienced personnel are lacking. This also can be
a benefit to the techs as they are developing in their fields or as more
experienced techs are given more depth or new insight into the laboratory
science. Do not get me wrong — these techs are highly skilled and
experienced, but do not have daily contact with doctoral-level personnel and
usually grow through and look forward to the stimulus of this experience.

Crolla: Lab automation works, and we can use other
resources to draw blood so the techs do not have to do routine blood draws.

Bailey: We are implementing new front-end automation in order to
make ends meet. We seem to have a core of old-timers who are satisfied
to stay where they are until they retire. We try to do as much as
possible to recognize our employees and provide them with good working
conditions; but in the face of having requests to refill vacant
positions denied or postponed, along with recruiting difficulties, I
would have to say this recruiting situation is as bad as I have seen in
my entire 40-year career.

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