For more than 30 years, stakeholders in the clinical laboratory profession have been calling attention to the growing shortage in personnel, and rightly so. Every year, more than four billion medical laboratory tests are performed in the United States. Laboratory diagnostic testing is the largest single medical activity in terms of volume, and those tests have a critical role to play in healthcare as approximately 70 percent of the interactions that physicians have with patients are influenced by test data run through a diagnostic laboratory.
About 60 percent of the healthcare workforce in the U.S. is made up of clinical laboratory professionals running those very tests.1 Yet at the same time that new tests are being developedto aid diagnoses and monitor health conditions, the number of people available to perform these tests is falling rapidly.
While much of the conversation has focused on ways to recruit and retain clinical laboratory professionals, the developers of hardware and software diagnostic technology also have a responsibility to assist laboratories with these challenges. Clinical lab directors should expect the medical device industry to look at laboratory automation through a new paradigm and consider where the laboratory professional’s workflow can be served by innovative ideas and approaches.
The scope of the shortage
In 2016, the U.S. Bureau of Labor Statistics forecast demand for 12,000 new clinical laboratory professionals each year to meet rising demand for their services.1 However, according to The American Society for Clinical Laboratory Science (ASCLS), just 5,000 laboratory professionals are entering the workforce on an annual basis.1
Making the situation even more difficult is that increasingly, newer generations of potential clinical laboratory professionals are choosing other professions instead. The average age of the clinical laboratory workforce has been increasing. According to ASCLS, as far back as 2004, the average age of a certified medical technologist was 43 years old, and the profession was aging faster than the U.S. labor market as a whole.1
In an April 19, 2018, story in Biotechnology Focus, the Canadian Society for Medical Laboratory Science (CSMLS) reported that the most serious shortage is in rural and remote communities, but with 50 percent of clinical laboratory professionals becoming eligible for retirement in the next 10 years, the shortage could easily spread to more populated areas.2
Many reasons for the shortage
According to the American Association for Clinical Chemistry (AACC), multiple forces are contributing to today’s staffing challenges. Retirement rates among clinical laboratory professionals are increasing, the number of new students graduating from clinical laboratory programs is declining, schools are closing, and the number of training programs has dropped more than 15 percent. Nevada, Vermont and Wyoming each have only one National Accrediting Agency for Clinical Laboratory Sciences (NAACLS)-accredited laboratory educational program. Some medical laboratory science programs could accommodate more students but are unable to because of difficulties in finding clinical placements for students to complete their training.3
Beyond capacity and institutional challenges, an even tougher problem looms: a combination of lack of interest and awareness among college students to enroll in clinical science programs. According to a Walden University study, 4 college students are less aware of careers in clinical laboratory sciences, and as a result, historical stereotypes about the profession offering low pay, limited career growth, and little impact on patient care prevail.
Some institutions have reduced requirements for medical technology students. According to the AACC,3 the University of Minnesota’s Center for Allied Health Programs reduced the time that students in its medical laboratory sciences program spend on trials from 22 weeks to 12 weeks. This reduction was due to inadequate staffing at healthcare organizations to support 22 weeks of training, and further reductions to eight weeks were being considered.
Hardware and software partners
Streamlining training requirements, better marketing, and more effective career and vocational information and materials are all meaningful and constructive solutions. But an obvious contributor to solving these challenges seems to be consistently omitted: the companies that develop, market and support the medical devices and software that clinical laboratory professionals rely on. The diagnostic industry has a responsibility to embrace the challenge of the shrinking workforce and find solutions that will help modernize the day-to-day workflow of clinical laboratory professionals and help them work smarter, not harder.
A decade ago, a good portion of a laboratorian’s day was dedicated to necessary, manual tasks, such as sample archiving and system maintenance. But students don’t invest four to eight years learning the complexities of pathology to then sort thousands of tubes or troubleshoot equipment.
Technology partners owe it to laboratory professionals to help them focus their expertise on what ignited their passion for the profession in the first place—the diagnostic part of their work. Specifically, they should work with their customers to look for ways to automate tasks along the diagnostic work flow—to help today’s smaller workforce to do more with less, or, more grammatically speaking, do more with fewer—fewer staff members.
Consistency, efficiency and reliability
Hardware and software should be reducing the need for manual intervention. Clinical lab directors need to be bold and think big. Just imagine:
•Loading a sample onto an automation line and not having to touch it again until it is ready to be discarded
•End-to-end ethylenediamine tetra acetic acid (EDTA) automation
•Encapsulating complete blood count (CBC) analysis, complete with a six-part white blood cell count (WBC) differential
•Blood smear preparation and staining
•Digital image analysis
•Glycated hemoglobin (HbA1c) analysis and sample sorting and archiving.
What if the CBC analyzers could calibrate themselves every time a Quality Control (QC) was processed and make technical support staff aware of instrument issues in real time? If this can be combined with multi-disciplinary track connectivity, total laboratory automation starts to become a reality.
Solutions for laboratory generalists
Discipline specialists are becoming a thing of the past, yet much of the technology on the market is still geared toward the specialist. The future of laboratory professionals is about generalists. In that context, laboratorians should be able to not only flag the sample result from instrument A, but automatically direct it to instrument B, increasing the sensitivity and specificity of the final result. Additional modules should be included, such as an automated slide maker and stainer, complete with an integrated digital image analysis. Laboratorians should ask their vendors not only how much can be automated, but how much can be automated on the sample’s first pass through the instrument.
QC, maintenance and training
While we often think about automation in terms of day-to-day tasks performed by a clinical laboratory professional, automating the QC, calibration, and maintenance of laboratory hardware presents another world of possibilities. By utilizing cutting-edge “internet of things” connectivity, technology can be leveraged to provide innovative solutions:
•What if quality monitoring could be flexibly displayed on any platform or web browser, providing the lab with a snapshot of its instruments’ QC status on a single screen?
•What if an instrument could be calibrated every time a QC was processed?
But let’s not stop there. What if the instrument not only alerted the customer to the health of the instrument, but alerted technical support staff to instrument issues in real-time, who in turn provided proactive support?
Clinical lab directors also should expect vendors to be innovative in their approach to training laboratory staff on the use of their instruments. New technologies can take the very best of conventional training, such as live, instructor-led learning, sharing information and performing hands-on exercises, and real-time Q&A with expert instructors, and combine it with streaming high-definition, high-quality live video over the internet from studios equipped with the same instruments that staff are learning to use in their laboratories.
That’s the kind of reinvention that the lab should look for from vendors as part of the response to staffing shortages. Between staffing difficulties and constant downward pressure on reimbursement rates, the new normal has to be a continuous focus on advancing and increasing automated processes, removing opportunities for error and increasing speed.
All of these innovations will not only help address the staff shortage that clinical laboratories face, but will also allow laboratory professionals to concentrate on the diagnostic and analytical work that they do best.
1. American Society for Clinical Laboratory Science. Clinical laboratory personnel
2. Currie M. Growing concern over impact of unfilled medical laboratory professional positions. Biotechnology Focus. April 19, 2018.
3. Scott K. The laboratory workforce shortage demands new solutions. CLN. Nov. 1, 2015.
4. Funnye-Doby C. Awareness of clinical laboratory sciences and shortage
of clinical laboratory scientists in the 21st century. Walden University. November 2016.