Volume 79 - Fall 2001	Download

Guest Column by Anthony S. Kurec, MS, DLM(ASCP) President, Clinical Laboratory Management Association

We are pleased to provide the comments of Mr. Kurec in this issue of NAACLS News. The column represents a forward step in our efforts toward continuing dialogue with laboratory management.

In the last several decades health care has been changed in significant ways and at many levels: technical, operational, and professional. As with most businesses there are cycles that occur, one of which we are facing now: the workforce shortage of health care professionals.

While there has been considerable press coverage regarding the nursing shortage, other health professions face similar problems in recruiting. The public does not immediately appreciate this until they or a family member find that there may be delays in the diagnosis, treatment, or management of their case due to these shortages. Even worse, errors resulting from poorly trained or overworked staff receive undue attention but without recognition of the shortage that may have fostered them.

Of major concern to physicians, hospital administrators, and patients is access to timely health care. With fewer health care professionals available, patient care is compromised through the reduction of services and closure of hospital beds. The reasons for these vacancies may relate to the perception that the health care field is not as lucrative nor as fulfilling as other fields, such as computer technologies or business. Further, there are many professionals taking advantage of early retirement, thus increasing the number of vacancies.

The quality of care has been eroded because of personnel shortages. In a New York study it was found that from 11-14 percent of hospitals were forced to postpone elective surgeries, 19-25 percent had to divert ambulances due to overcrowded emergency departments, and 19-27 percent of hospitals and nursing homes had to close beds and reduce admissions. Seventy-eight percent reported shortages of technical staff, and 80-90 percent reported overtime costs.¹ While the nursing shortage is obvious to the public, shortages in the laboratory are less likely to be noticed until some horrific error occurs such as was seen recently at St. Agnes Medical Center in Philadelphia.²

Why has the field been hit so hard? Salary levels. Few opportunities for advancement. Stressful working conditions. Retirements. Lack of visibility on the health care team. Lack of a professional image. Risk of infectious diseases. Increased legal liabilities. All of these have had a negative impact on the field.

The salary levels are the number one reason why students are not interested in the laboratory and why those who have worked in the laboratory leave.The median starting salary for a clinical laboratory scientist/medical technologist is often under $30, 000, which is a sharp contrast to that for a pharmaceutical research associate or a biochemist, both of whom can expect $40, 000 or more to start. Computer science graduates start at over $45, 000 a year. Even seasoned laboratory managers pale at a median salary of just over $60, 000 compared to pharmaceutical technicians and biochemists who can expect salaries between $70, 000 and $80, 000. It is no wonder new graduates are not interested in the laboratory. For those already in the laboratory field, other opportunities may be irresistible temptations, thus the laboratory loses some of its best and most experienced individuals.

Unfortunately, few laboratory managers have the financial resources needed to appropriately adjust current salaries. Managers have had to become more creative in determining how existing personnel are used. A greater emphasis is placed on instrument selection and related throughput capacity, as well as on cross training, improved benefits, and staff flextime. On-the-job training is again common, but this type of training limits the versatility of the individual who then functions in a rather restricted environment. Using on-the-job trainees in combination with automation has been successful. However, while large volumes of work may be processed expeditiously in this way, quality issues are a serious concern and require the attention of highly skilled laboratory scientists.There are significant limiting factors because implementation of automation is expensive. Further, the physical plant of the laboratory requires an open environment and a change in how laboratorians function on a daily basis. In practice, the latter issue is often the most difficult to address.

To address staff shortages, many laboratory managers have reconsidered their test menus and now send out more of the low volume, esoteric tests or tests requiring significant amounts of manual intervention. Still, as the baby-boomer generation approaches retirement, there will be a glut of senior level positions vacated and additional ways of addressing shortages must be found. In the long term, to attract more students and to retain experienced technologists, salaries must be increased. As immediate inducements, many employers are now looking at sign-on bonuses and offering scholarships. A greater effort has been made in working with high school counselors, science teachers, and youth program leaders to direct students toward the clinical laboratory sciences. Recruitment endeavors at the grade school and junior high levels are being initiated. In all of these activities, we must emphasize that this profession is a challenging, scientific discipline that requires high-level cognitive and technical skills, and leads to a rewarding and lasting career.

With a large number of accredited clinical laboratory science/medical technology programs closing and a decreasing number of students graduating from each program, the shortfall of qualified laboratorians will continue well into the future. Some of the slack will be addressed, in part, through automation and robotics as mentioned above, but as new technologies are applied to the clinical laboratory, highly trained personnel will be required to perform more complex assays. Technologies have gone beyond the microscopic, cellular level to the level of molecules and genes. Genomic and proteomic technologies will be the new tools of the laboratorian in the future. While the fundamentals of laboratory science are still important to understand and will continue to be used for the short run, it is clear that these new technologies, in conjunction with less invasive specimen collection procedures, such as biosensors and transcutaneous procedures, will be the main tools for the next generation.

The public knows little about our profession, yet its importance is undeniably evident. It is estimated that 85 percent of a physician's medical decision about any one patient is a direct result of information obtained from the laboratory. It is critical that we raise awareness of our value to the physicians, administrators, legislators, and community we serve. It is particularly important to raise this awareness in the public policy arena such as with CLIAC (Clinical Laboratory Improvement Advisory Committee), which advises the government on technical and scientific questions related to CLIA'88 regulations. The Clinical Laboratory Management Association (CLMA) has worked hard to develop a strong relationship with this group and is making inroads into their decision-making process. CLMA has also collaborated with various organizations, including NAACLS and its sponsoring organizations, ASCP and ASCLS, to address the work-shortage issue in many ways, and we will continue to do so.

It is important that professional laboratory organizations work together more closely in responding to educational, quality, and political issues that directly impact the profession. We need to attract bright and energetic students, to develop mentoring programs that will keep them attracted, and to help to train the next generation of supervisors and managers. We need to improve the work environment and internal culture so that it promotes the profession in a positive manner and retains qualified individuals. Further, we need to offer appropriate recognition and reward systems. We must ensure that quality is never compromised in order that we sustain a profession making such a critical difference in health care.

To achieve all of this, there needs to be an ongoing dialogue among the various professional associations so that current concepts, legislative mandates, and technologies are recognized and actively promoted by the leaders of the industry and government. Opportunities must be seized now by those who can best direct and implement them before control is lost to external influences.

References:

1. Hospital Association of New York State, 2001.
2. Burling S: Philadelphia Inquirer, Aug 8, 2001.

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