Long-Term Solutions to the Laboratory Workforce Shortage

As of November 2022, there are an estimated 2 million open healthcare jobs in the US, and another 2 million are projected to be added by 2031. Though the CDC’s Division of Laboratory Systems estimates that more than 14 billion tests are performed annually in the US, which inform more than 70 percent of diagnostic medical decisions, the severe staffing shortages continue.

Though we often hear about physician and nursing shortages, in reality, the is­sue affects dozens of healthcare professions, including dramatic shortages in laboratory medicine and public health, said laboratory advocates and experts Angela Tomei Robinson, MS, MLS(ASCP)^CM, and Rodney E. Rohde, PhD, SM(ASCP)^CM,SV^CM, MB^CM, FACSC, in their recent article published in the Biomedical Journal of Scientific & Technical Research. 

Some of the proposed short-term solutions such as on-the-job training unfortunately involve lowering personnel standards without meeting educational and internship requirements, Robinson told Today's Clinical Lab. Fortunately, in their recent article, Robinson and Rohde outline several quality long-term solutions being implemented to attract, recruit, and retain qualified board-certified medical laboratory scientists and technicians.

Here are some opportunities for plausible long-term solutions to severe staffing shortages:  

Attract, recruit, and retain: outreach and mentorship

Top of list for Robinson and Rohde is expanding outreach. In their experience, career days and health fairs spark interest with high school students, as well as with educators and guidance counselors. Likewise, introductory training courses, as well as immersion experience programs, teach skills and provide career shadowing opportunities. 

Other initiatives to raise awareness with students include the recent $250 million initiative from Bloomberg Philanthropies to build new high schools in the US with specialized healthcare classes and work-based learning programs at partner health systems. These specialized schools will also provide students with opportunities to earn industry-recognized credentials and certifications so that they can enter the healthcare workforce immediately after graduation.

     

Similarly, Harvard’s Boston Children’s Hospital internship program allows high school students to learn about and gain experience in all areas of pathology, including anatomic, molecular, research, and administrative operations, while earning a decent wage and a letter of recommendation for college. According to John Baci, the executive administrative director of anatomic pathology at Boston Children’s Hospital, the program has encouraged many students to opt for pathology- and laboratory-based careers and has also helped recruit staff to their laboratory.

Along with providing grants to educational institutions and scholarships to matriculated students—innovative programs and strategic affiliations, as well as bridge initiatives, can help support and mentor college students such as general science majors to achieve the educational status of board-certified MLT and MLS, say Robinson and Rohde. 

Some of the institutions that integrate curriculum programs with facilities and universities include: 

• the ASM-Weber State University microbiology certificate program, 
• the University of Utah/ARUP Laboratories advanced MLS training, 
• the University of North Dakota/Mayo Clinic online MLS program, 
• SUNY Cobleskill/Memorial Sloan Kettering Cancer Center histotechnician associate’s program, and 
• the Oak Point University/Alverno Laboratories MLS program for people who already have undergraduate degrees in biology, chemistry, or microbiology.

Additional collaborations include the NeoGenomics Laboratories NeoUniversity Histology Training Program and the newly launched Wisconsin Diagnostic Laboratories MLS apprenticeship program. 

The key is offering support and mentoring with a provisional timeline so that prospective candidates may acquire the necessary education and training to become board-certified medical laboratory professionals who can then contribute to the workforce. 

Nonetheless, traditional NAACLS programs through which most accredited MLS and MLT professionals graduate must also continue to be supported alongside the new and emerging curriculum programs.

Maintain quality over cost effectiveness

The financial burdens placed on healthcare institutions demand cost effectiveness, and proposals to workforce shortages often suggest lowering the quality standards of hiring qualified and board-certified licensed medical lab professionals. But compromising quality processes is not a viable option to provide quality patient care. Analytical errors along with preanalytical and post-analytical variables are costly to institutions and facilities and potentially to the lives of patients.

Some effective solutions to address these needs include the following:

• Expanding the use of automation and autoverification as tools to assist with the independent cognitive judgment of medical laboratory professionals. 
• Utilizing trained laboratory assistants for preanalytical and postanalytical phases of testing.
• Incorporating the Choosing Wisely initiative and hiring professionals with a Doctorate of Clinical Laboratory Sciences (DCLS) for diagnostic management teams, or DMTs, to ensure appropriate test ordering and/or ensure appropriate interpretation of laboratory tests. 
• Elevating the voice of laboratory leadership and providing them with opportunities to speak and collaborate with senior executives and managers, as well as other medical professionals and leaders. 
• Supporting leadership so that they can provide helpful resources to their staff and help create a positive working environment that promotes teamwork. 
• Providing medical laboratory professionals with compensation commensurate with their level of education and experience to help reduce staff turnover and the continual cost of hiring and training new staff.

Legislative actions

Other major hurdles to the laboratory medicine industry include legislative measures that cut funding to laboratories and education programs. 

Oppose PAMA and support SALSA

Last November, U.S. Congress passed a bill delaying the Medicare cuts outlined in the 2014 Protecting Access to Medicare Act (PAMA) until January 2025—the third time PAMA has been delayed. The PAMA cuts would have effectively cut reimbursement up to 15 precent for more than 800 medical laboratory services. However, the delay is not a long-term solution. 

Bipartisan support of SALSA (Saving Access to Laboratory Services Act) is needed in 2024 to permanently stop severe cuts to laboratory services, said Robinson and Rohde in their recent article. 

The Saving Access to Laboratory Services Act is a bill originally introduced in 2022 by Senator Richard Burr (R-NC) to update reporting requirements and payment methodology enacted under PAMA. Both the House (H.R.2377) and Senate (S.1000) versions of the bill were reintroduced in March 2023. SALSA would establish a new authority within the Centers for Medicare & Medicaid Services to collect private market data through statistically valid sampling from all types of clinical laboratories, explained Jesse Day, MHA, BSc, MLS(ASCP)^CM in a Thought Leadership article last fall. The bill would ensure that market rates are accurate, provide a reduction in the reporting burden, and protect labs and Medicare from dramatic decreases in reimbursement with a gradual, phased approach, he said.

SALSA represents a permanent solution and is supported by more than 60 organizations that represent patients, providers, hospitals, and clinical labs. More resources are available at StopLabCuts.org. 

Support right-to-practice state licensing for medical lab professionals

Support adding right-to-practice state licensure for medical laboratory professionals. Currently, only nurses, pharmacists, physicians, and physician assistants have right-to-practice state licensure that mandate entry-level standards, body of knowledge, and scope of practice with accredited programs and national board certification. While medical lab professionals can seek certification with a certifying body, such as the American Society for Clinical Pathology, only about a dozen US states currently require licensure—most states still fail to license medical laboratory professionals and instead rely on the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) to ensure quality of testing.

Laboratory advocacy

      

Finally, Robinson and Rohde advise medical laboratory professionals to get involved in laboratory advocacy efforts, such as by joining medical laboratory societies and helping them raise awareness of the profession and increase their membership—presenting a strong united voice helps gain media attention, public awareness, industry respect, and legislative support.

Rohde has recently led the effort to change the name of his Texas State University program from “clinical” to “medical” laboratory science. “Having taught thousands of students over a 30-year career in public health and medical laboratory academia, as well as my role as an associate adjunct faculty for Austin Community College, it’s very common when I talk to students that they are either totally unaware of our college major and profession, or they’re confused about it,” said Rohde in an interview for the American Society for Clinical Pathology publication Critical Values. Increasing awareness and visibility of the program’s new name is critical, he says.

Despite well-known workforce challenges, it’s clear there are several potential solutions to resolve the crisis. However, because the quality standards of personnel set the quality standards of the testing upon which clinical decision-making relies, any viable long-term solutions must maintain those standards, says Robinson.