Clinical Lab Worker Shortage: Addressing the Gap
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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, Medical Laboratory Supervisor, University of North Carolina (UNC) Health
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.
This critical healthcare workforce is recognized annually during the Medical Laboratory Professionals Week, spearheaded by the American Medical Technologists and co-sponsored by 17 other clinical lab worker associations. It is being celebrated from April 24 to 30, 2022, bringing awareness to the essential work clinical lab workers perform. The theme for 2022 is Laboratory Professionals Get Results, which highlights their day-to-day duties as well as the vast amount of work many of these professionals have completed during the Covid-19 crisis.
Lab Week, as this week is often referred to, also has the objective of raising the public’s awareness of clinical laboratory personnel. The contribution they make to healthcare while working diligently at a laboratory bench is often taken for granted. Employers are encouraged to recognize their staff as well as put on events to elevate the visibility of clinical laboratory workers.
Demand for medical laboratory technologists and technicians is expected to increase by 11 percent nationally between 2020 and 2030—well above the anticipated 8 percent growth for all other professions, according to the U.S. Bureau of Labor Statistics (BLS 2021). 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. At the same time, 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 clinical laboratory science professional who has witnessed the shortage and its effects firsthand.
Meet the Expert: Medical Laboratory Supervisor Lisa Cremeans of the UNC Health
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. In 2021 she switched roles and became the medical laboratory supervisor at UNC Health. 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 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 disciplines, the effect is more dramatic. The average rate of vacancies varies among the 17 lab departments which participated in an ASCP 2020 survey. According to the survey results, chemistry/toxicology had the highest staff vacancy rate at 13.1 percent while cytology had the lowest at 4.3 percent. Other departments with high rates include immunology at 11.9 percent and flow cytometry at 11.4 percent.
“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 has 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? A few factors are 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. This number has held relatively steady since then with 243 MLS and 238 MLT programs in 2022. 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, the most recent data available.
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: 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.”
Medical Laboratory Professionals Week is one excellent way that clinical laboratory workers can be brought into the spotlight. Employers and professionals in the field can plan events for Lab Week to specifically inform and recruit high school and university students into this career. The American Society for Clinical Laboratory Science and the Committee for Educational Programs and Initiatives (CEPI) have created a recruitment toolkit that can be utilized just for these purposes. Materials include videos and brochures to get students excited about this field.
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 2020 ASCP survey on vacancies in laboratories, the average retirement rate has decreased from 2018. In fact, two-thirds of laboratory departments have fewer staff members retiring in 2020 than before. However, retirement rates still vary from 4.9 to 17.9 percent, which continue to have a large impact on the staffing of these labs.
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 knowledge and skillsets 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 may 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, and 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 need 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 collecting their own samples properly.
MLTs also play an essential 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 2020 survey, the top five most in-demand specializations (i.e., those with the highest rate of vacancies) were:
- Chemistry
- Toxicology
- Immunology
- Phlebotomy
- Blood Bank
- 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 lower than other healthcare careers. According to the U.S. Bureau of Labor Statistics, the median annual wage for clinical laboratory technologists and technicians was about $55,990 as of May 2020, however, “Salaries really vary by institution, by region, by state,” Cremeans said.
For example, the mean clinical laboratory technologist and technician salary in New York is about $68,630, while in Kansas, it’s about $49,810, according to data from BLS (2020).
“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 survey, 67.4 percent of lab managers said they lose personnel to better salary offers from other employers; 65.5 percent said it is also attributable to an increase in competition for well-trained personnel; and 58 percent said there were not enough applicants with 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. James Freeman, the vice president of research and development for laboratory diagnostics at Siemens Healthineers, suggests that students from similar educational tracks should consider careers 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.
Candidates with bachelor’s degrees in various sciences are often eligible for these jobs and may not even know it. In states where certification is not a requirement, labs may hire staff with bachelor’s degrees in fields like biology or chemistry without clinical laboratory experience and opt to provide on-the-job training, the ASCLS said.
In fact, as of March 2022, the only 11 states that require an MLS and/or MLT license are California, Florida, Georgia, Hawaii, Montana, Nevada, New York, North Dakota, Tennessee, Louisiana, and West Virginia. In others, lab technicians and technologists do not have to obtain such licensing.
So, perhaps the perceived crisis is not as dire as it may seem. But there should 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 investing 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 science-related degree holders, Cremeans recommends looking into roles within medical labs. “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.”
Resources for New and Aspiring Clinical Lab Workers
There are numerous associations and resources at their disposal to those who are considering a move into this career. All of the organizations listed below are co-sponsoring Medical Laboratory Professionals Week 2022 and most have resources available for those looking for ways to celebrate clinical lab workers.
Clinical laboratory science is a vast field that covers a variety of lesser-known professions such as cytotechnology, pathology, histotechnology, and more. It can be very important for clinical laboratory professionals to get involved with the organization pertinent to their profession as they can often provide continuing education classes, advocacy to advance the profession, networking opportunities with peers, and job boards.
Many of these organizations certify clinical laboratory professionals, while others are professional associations for those working in this field. Here are the top resources for clinical lab workers:
- American Association of Blood Banks (AABB)- The AABB is a professional association that helps set transfusion medicine and biotherapies standards. They also provide accreditation and education programs.
- American Association for Clinical Chemistry (AACC)- Better health through laboratory medicine is the goal of the AACC. They offer advocacy, education, and collaboration for laboratory professionals.
- American Association of Pathologists’ Assistants (AAPA)- Pathologists’ assistants work alongside pathologists in morgues, medical examiners’ offices, and other clinics. In addition to providing high-quality continuing education to maintain certification, the AAPA actively advocates for the profession and offers strong networking opportunities.
- American Medical Technologists (AMT)- As the primary sponsor for Medical Laboratory Professionals Week, the AMT is a hub for clinical laboratory scientists. With over 100,000 members, they offer numerous certifications and are actively engaged in advocacy.
- American Society of Cytopathology (ASC)- Physicians, cytotechnologists, and scientists who use cytotechnology to diagnose pathology should consider joining the ASC. They have over 3,000 members all across the US who all examine cells from various parts of the body to determine the nature and cause of diseases.
- American Society for Clinical Laboratory Science (ASCLS)- Over 9,000 clinical laboratory scientists are members of the ASCLS. Their primary purpose is to provide education programs, advocacy, and publications to advance the profession.
- American Society for Clinical Pathology (ASCP)- There are over 100,000 medical professionals that are members of the ASCP. The ASCP is one of the primary certification agencies for 23 technicians, technologists, and specialist certifications in clinical laboratory science.
- American Society for Cytotechnology (ASCT)- Members of the ASCT have access to education resources for cytotechnologists, including a quarterly newsletter, annual conferences, and continuing education.
- American Society for Histocompatibility and Immunogenetics (ASHI)- The primary objective of the ASHI is to advance the science and use of histocompatibility and immunogenetics. Members include physicians, immunologists, geneticists, and laboratory professionals.
- American Society for Microbiology (ASM)- Through medical journals, research, advocacy, and education, the ASM aims to advance and promote microbial science. They also provide professional development opportunities to help members advance their careers.
