Cultivate the pathology and laboratory medicine workforce is the very first of the American Society for Clinical Pathology (ASCP) 2021-2022 Patient-Centered Policy Priorities (PCPPs).1 The medical laboratory field has long been struggling with staffing shortages and the reasons myriad: a decades-long decline in medical laboratory scientist (MLS) and medical laboratory technician (MLT) academic programs,2 the inability of students to secure the education and training required for credentialing, a high rate of those retiring or leaving to pursue different careers, and the growing need for lab services throughout the healthcare continuum. There is no silver bullet approach to addressing these shortages; rather, it requires “a coordinated commitment from all stakeholders to include laboratory and medical professional organizations, clinical laboratory and hospital administrations, educational institutions, the laboratory industry, and federal and state government agencies,” according to the American Society for Clinical Laboratory Science (ASCLS).
Support schools and students
At Mahaska Health in Oskaloosa, Iowa, the lab is recruiting from local community colleges and supporting staff members in earning their certifications. Tim Schroeder, Director of Lab, notes how new skills and advancements benefits both employer and employees. He states:
A candidate for a medical lab scientist position that Radford interviewed told Radford that a career counselor at her school was discouraging people from going into Laboratory Medicine because it is a “dying, dead-end profession.” Radford’s response:
“I was APPALLED to hear that! If a career counselor in a university setting feels this way, we know we have a problem!”
“Most people have no idea what we do behind our closed doors, other than draw blood. Spotlighting laboratory careers at local job fairs and through advertising may help. Our facility has a cooperative agreement with local high schools through the school-to-work program. This allows high school students to spend weeks, or months, shadowing jobs in the lab. We have had several of these students over the years decide to choose Medical Laboratory Science as their course of study.”
As Harol points out, medical labs struggling with staffing shortages might feel they don’t have the resources to develop a program and rotation for students. He urges lab leaders and teams to think long-term at the benefits of investing in the next generation of lab professionals, including the ability to grow future team members, stating:
“It is about investing in your future. When you allow students to come through your lab, you get the first pick of ones who are good scientists. That can really pay dividends.”
“In the future, we will need to increase the number of MLT/ CLS programs in the United States,” Schroeder added. “Willingness to accept students for their clinical internships helps introduce them to your facility and have a connection when it comes time to decide upon multiple offers.”
Expand search efforts
Radford says her lab works closely with its human resources department to identify creative and innovative ways to find and retain lab staff members. “From the recruitment perspective, we are literally turning over every stone we can think of,” Radford commented. “We’re reaching out to former employees who left in good-standing, sending out messages via LinkedIn to lab professionals, and we offer a referral bonus for current staff (inside and outside of the lab).”
Marallo says his lab is advertising in local newspapers and in online job sites, reaching lab professionals beyond the U.S. borders. “We offer a substantial sign-on bonus for those who commit to staying at least two years,” Marallo explained. “We have sponsored H1B eligible foreign workers as well. These techs are from the Philippines and are excellent additions to our staff.”
Harol says that lab hiring professionals needs to be less rigid around hiring, stating, “That might mean we are not just hiring certified, credentialed, experienced scientists into those roles but we may be taking a biology or chemistry major and having them work in the laboratory to get the three months of experience that Clinical Laboratory Improvement Amendments (CLIA) regulations require so they can get up to being qualified to work in the lab.”
The COVID-19 pandemic drove the opening of many new CLIA laboratories, and new scientists qualified to work in these settings, notes Harol, presenting a “unique opportunity” to expand the lab talent pool.
“Most of the U.S. follows CLIA federal certification standards, requiring three months of lab experience, and these new scientists have gotten that during the pandemic working in COVID labs,” Harol explains. “There is an opportunity here to try to hold onto those people who came in through COVID so they don’t go elsewhere.”
“It does require the employer be a little more flexible,” Harol added. “We will send resumes of these people and the hiring lab will say, ‘they only have COVID experience.’ True, but now you have someone who has been working in a CLIA lab and liked the career. It might take some coaching and grooming but you can bring them in and help to meet your staffing needs.”
Envision travelers as team members
Short-staffed labs often turn to travelers and other temporary workers to fill the gap, as Marallo, Radford, and Schroeder explain:
“We have made a practice of hiring travelers when we are experiencing difficulties finding permanent staff,” said Marallo. “Obviously, this is an expensive temporary solution, but we consider it a necessity to avoid burnout among our regular staff.”
“Unfortunately, we have definitely had to hire travelers to help with the staffing gaps,” said Radford. “What’s really bad (and sad), though, is that we have not been able to get enough. We currently have two working with us, but we really need at least four to five to sufficiently put a dent in our staffing need. It took us several months to find the two that we have, and HR is still looking out for the additional two to three that we’re requesting.”
“We have tried travelers with mixed success,” said Schroeder. “By the time you get them signed off the competency it’s usually 1/3 to 1/2 through the first 13-week assignment.”
In many lab environments there is an “us versus them” mentality when it comes to core staff and travelers, says Harol. He suggests turning this around by viewing temporary staff as potential employees, stating:
“We place travelers, and we see that when travelers find a laboratory and town that they enjoy, they will convert. Sometimes it is even small towns, but they will become permanent employees and will stay there if they feel welcome.”
To help convert temporary staff to permanent, Harol advises lab teams to help connect them to the community. He notes how this can be something as simple as recommending a favorite local restaurant, or as formal as designating people on the team to serve as a welcoming committee.
“Everyone has been the new person — that is how they are showing up every time so just a smile and introducing yourself and making them feel welcome can go a long way,” Harol added.
Mentor those new to the field
A 2022 survey of U.S. lab professionals by Lighthouse Lab Services found morale is worse with those who have been in the field for five years or less, while the greatest job satisfaction was reported among those in the profession for 20+ years.
This quantitative research combined with qualitative insights from lab professionals that Lighthouse Lab Services gathers through its Facebook and LinkedIn groups (200+ conversations per day) leads Harol to believe there is a tremendous opportunity for greater support and mentorship of those who are new to the lab.
“Something we are seeing is that new techs sometimes feel not super welcomed into the lab, a little bit bullied by the culture,” said Harol. “There are power turf wars going on inside the lab in certain areas and benches and there is a reluctance for new techs to ask questions of older techs sometimes. They feel like they will be looked down upon if don’t know something.”
“We all know that we need every scientist in this field to stay because there is a shortage,” Harol added. “If we are making it difficult in the first five years for people coming into the field, that is not great for everybody. We need to make sure new techs feel welcome. That’s something influenceable and actionable — any lab and their whole team could do that.”
Increase pay to match worth
MLO’s 2022 Annual Salary Survey of laboratory professionals reported that the average compensation across all lab positions was $92,146, with pay dropping for many positions over 2021. Descending salary trends were seen for pathologists, microbiologists, lab directors, medical lab technicians, medical laboratory scientists, and chief/assistant and chief/medical technologists.3
“We need to advocate (even from a political perspective) a salary range for laboratory professionals that is more aligned with the clinical impact that the lab has on patient outcomes,” said Radford. “We all have heard the statistic about the percentage of clinical decisions that are made due to laboratory testing. Yet, laboratory professionals continue to be some of the least compensated health care professionals.”
Marallo’s health system performed a total review of all job categories systemwide in 2022. He shared, “This review yielded several market adjustments (increases) throughout the entire hospital, including all positions in the Laboratory, which were awarded prior to regular merit-based annual evaluation increase. So, many employees enjoyed the market increase first, and the annual increase a couple months later.”
Mahaska Health too has increased pay for lab staff members. According to Schroeder, they have bumped salaries to 100%+ of the state hospital association wage scale for all lab positions. Going forward laboratories will need to be able to pay at or above other degreed staff members with similar credentials (BS, AS).
Don’t forget that morale matters
In addition to higher pay, Marallo’s hospital rewards staff members in other ways, such as free barbeque lunch days, mobile brick-oven pizza vendors on-site, employee ice cream sundae days, celebratory cakes, and other similar activities.
“We need to ensure that work environments are pleasant physically and accommodate work life balances,” said Schroeder.
Schroeder said his lab puts forth effort to help make permanent staff feel appreciated all the time, such as limited on-call and rotating weekends. He makes the point that temporary staff members serve as a benefit to permanent staff members, allowing them to enjoy some well-earned time off. “I also limit overtime on temps and still offer the overtime to permanent staff,” he added.
The Lighthouse Lab Services 2022 Wage and Morale Survey of Medical Laboratory Professionals revealed how important morale is to lab staff retention, as Harol explains:
“Of the people who got a raise last year, 9% categorized themselves as ‘extremely satisfied’ with their job. Of the people who did not get raises last year, 10% categorized themselves as ‘extremely satisfied with their job.’ So don’t think of pay as the savior — if I can get an extra $.50 per hour for my team all the culture issues will be fixed — because that is not the case.”
According to Harol, once a lab’s culture begins to deteriorate, it can “go downhill pretty quickly.” He states, “Once your culture turns, when people are stretched really thin, and you have a parade of travelers coming through the laboratory — it is really hard to recover from that. My biggest piece of advice is retention first. Because if you can keep your current staff happy and create a good culture in the laboratory, not only are you going to have less positions to fill, it will also be easier to fill roles when people interview.”
“It has been my experience that money only goes so far in boosting morale,” said Radford. “Quality of life will eventually trump financial gains. In my opinion, it is more important to find out from the staff what they need, what they want, and what truly matters to them.”
Radford’s lab has developed two staffing committees: one for technical staff and one for support staff to “find out what matters to them and what would keep them here.” They have also established a Safety Committee, Quality Committee, and Engagement Committee (that they named “Life is Good”). Radford describes the impetus behind the committees, and their impact on the lab team:
“We were failing miserably at guessing at what would help keep them here. What better way than to give them a voice? The purpose of the committees’ inception was to give them an outlet, a voice to safely express what they see — from their perspective — that would help make their working conditions good. These committees also assist with solving troubling scheduling issues as well as ways to get more staff. While they just started a few months ago, the staff are all SO engaged. I found sitting in on their meetings quite inspiring!!”
References
- 2021-2022 Patient-Centered Policy Priorities (PCPPs). American Society for Clinical Pathology (ASCP). https://www.ascp.org/content/docs/default-source/policy-statements/2021-2022-ascp-patient-centered-public-policy-priorities.pdf, Accessed August 3, 2022.
- Clinical Laboratory Personnel Shortage. The American Society for Clinical Laboratory Science (ASCLS). https://ascls.org/workforce/. Accessed August 3, 2022.
- MLO’s 2022 Annual Salary Survey of laboratory professionals. Published February 23, 2022. Accessed August 3, 2022. https://www.mlo-online.com/management/careers/article/21257623/mlos-2022-annual-salary-survey-of-laboratory-professionals.
