We’re Facing A Critical Shortage Of Medical Laboratory Professionals

Behind the scenes at every hospital are indispensable medical laboratory professionals. They performed an estimated 13 billion laboratory tests in the United States each year before Covid. Since the pandemic began, they have also conducted almost 997 million diagnostic tests for Covid-19. The accuracy and timeliness of lab tests are critically important, as they shape approximately two-thirds of all medical decisions made by physicians.

As Dr. Rodney Rohde, professor of clinical laboratory science at Texas State University, said, “Lab testing is the single highest-volume medical activity affecting Americans…Simply put, every time you enter a hospital or health care facility for care, your life is in the hands of a medical laboratory professional.”

There is a critical shortage of medical laboratory professionals in the US and in Canada, to a lesser extent. Here, we are 20-25,000 short on staff, with only 337,800 practicing. That is roughly one medical laboratory scientist per 1,000 people.

Why is this? A survey of laboratory professionals by the American Society for Clinical Pathology showed that 85.3% reported burnout. An additional 36.5% complained of inadequate staffing and almost as many of a too heavy workload. Lack of recognition was cited by 14.9%.

There are vacancy rates of 7%-11% in almost every area, up to 25% in some spots.

To become a technician requires only a 2-year associate’s medical laboratory technician degree. A laboratory science degree requires an average of five years of schooling. After you gain your degree, you need to be certified by the American Society for Clinical Pathology (ASCP).

One of the problems is that while there is a great need for more lab personnel, the number of training programs is declining. There are only ~240 medical laboratory technician and scientist training programs in the US, a 7% drop from 2000. Some states have no training programs. One of the other problems in the US is that licensing requirements are different from state to state. Christine Nielsen, CEO of the Canadian Society for Medical Laboratory Science, explained that Canada requires clinical placement before licensure, but this is not a requirement in most of the US, except for CA, NY, FL, and AZ.

Nielsen said the cost of training for an MLS is ~$100,000. In Canada, unlike in the US, this education is heavily subsidized by the government. They don’t have the recruitment problem the US has, where many don’t feel the salary is worth the high investment. Medical lab professionals are paid 40%-60% less than nurses, physical therapists, or pharmacists.

In Canada, the bottleneck isn’t the disparity between debt and potential income; it is the lack of spaces to do internships.

The Bureau of Labor and Statistics “projects a nationwide need for a 13% average increase in medical laboratory technologists and technicians between 2016 and 2026, nearly double the underlying average increase in all occupations of 7%.”

Staff retention is a huge problem, particularly in the US, because of the stress and burnout issues.

Nielsen noted in Canada, “70% of our people work in public hospitals, and those are all union. That's state funding.” So one of the advantages for the lab personnel is that “you would know your schedule here, months out in some cases…and if you're the senior, you have the first choice of shifts.” That makes work-life balance more manageable, especially for parents juggling childcare responsibilities.

“Retention of workers is going to need to be a major area of focus for all employers because there are no new grads coming,” Nielsen said. “That's gonna be the game because even if we all agree today that we will increase enrollments in school, the production's not coming off the line for two to four years.”

Rohde notes that “the American Society for Clinical Laboratory Science is calling for the expansion of the Title VII health professions program – which provides education and training opportunities in high-demand disciplines – to include medical (clinical) laboratory science.” He also suggests outreach to middle and high school STEM programs, to familiarize students early with career opportunities in the medical laboratory profession.

One interim solution might also be to focus more on bringing in foreign practitioners and, through bridging programs, bring them up to equivalency in our local practices and laws and perhaps upgrade their training, if necessary.

Asked about solutions, Nielsen turned her focus back to a favorite topic, the “Choose Wisely” campaign. She said, “I believe that some focus is going to need to happen at the institutional level on how we how we order lab tests, and is it truly an unlimited shopping list or an all you can eat buffet? Or do we now need to have some guidance around appropriateness, because there's no way the lab can continue in this marathon with 25% of the staff missing.”

As mentioned in an earlier post about blood drawing tube shortages, an educational campaign, "Using Labs Wisely," part of a broader "Choosing Wisely" effort, is prominent in Canada Their suggestions include:

• Don't do annual screening blood tests unless directly indicated by the risk profile

If you do enough tests, something will come back abnormal and lead to needless further investigation. "Abnormal" results are found in at least 5% of people—though it may be their norm.

• Don't routinely measure vitamin D in low-risk adults.

Instead, just give Vitamin D supplements.

Consider if and how a test result will change patient management, which is often overlooked in routine screening labs.

For inpatients, Using Labs Wisely has two particularly useful suggestions:

• "In the inpatient setting, don't order repeated CBC and chemistry testing in the face of clinical stability. That just one blood draw per day for 'routine' daily lab testing can add up to removing the equivalent of 1⁄ 2 a unit of blood per week? The result is 20-30 blood tubes wasted, and iatrogenic anemia has a negative effect on patient outcomes."
• Don't order baseline laboratory studies (complete blood count, coagulation testing, or serum biochemistry) for asymptomatic patients undergoing low-risk non-cardiac surgery.

Shortages in Canada are severe enough that there has been talk of needing to limit outpatient testing.

Before we get to such a crisis level, we would be wise to adopt such an education campaign among both health care workers and patients, where all seem to want everything done yesterday. We would also do well to standardize certification across state lines, so there is more mobility of staff and flexibility in responding to needs.

Primarily, we need to reduce the stress and workload of the lab professionals before we reach a greater crisis. Think about how we might do so this Medical Laboratory Professionals Week.