The impending clinical laboratory science (CLS) workforce shortage is well documented; approximately 40% of the workforce is expected to retire in the next 10 years.1,2 Clinical laboratories across the country are understaffed and frequently have difficulty filling open positions. Many medical laboratory scientists (MLS) consistently work more than 40 hours a week or work more than one job to meet current workforce demands. Based on data from the US Department of Labor and Statistics, by 2021 there will be a projected workforce shortage of more than 150,000 clinical laboratory science professionals in the United States (roughly 39% of the total workforce need3); MLS will be the profession hardest hit among clinical laboratory science professionals (see FIGURE 1). Strategies, such as increasing laboratory automation, expanding point-of-care testing, hiring additional support staff with less education or fewer credentials, and outsourcing laboratory tests will not be sufficient to address the workforce shortage and cannot replace the crucial role of MLS in the clinical laboratory.4
In addition, the current graduation rate of MLS students from NAACLS-accredited academic programs is insufficient. This is partially due to the closure of 70% of NAACLS-accredited clinical laboratory science academic programs since 1970.4,5 The training received during the transition from student to new professional is critical; this is especially true as the laboratory is becoming increasingly complex. However, hospitals throughout the US have become reluctant to accept students for clinical rotations due to budget constraints and a reduction in available resources.3 Moving forward, the connection between medical laboratory science programs and those labs that depend upon their training and knowledge must remain strong.
Significance in Idaho
Critical Access Hospitals (CAHs) in the state of Idaho face unique challenges to the provision of health care due to the compounding effects of remote locations and rugged geography. With the exception of Alaska, Idaho boasts the most acreage of contiguously federally managed wilderness in the US, with approximately 2.4 million acres located in the central region of the state. The roads that transverse Idaho are not open year-round, and most are single lane. Thus, it is more appropriate to think of the towns and cities in Idaho as islands separated by large areas of inhospitable terrain; roughly a third of Idahoans live in remote rural areas.
The services provided by CAHs in Idaho are essential to improving access to health care in these rural, rugged, and remote areas. Of the 40 non-federally funded hospitals in Idaho, 68% (n=27) are designated as CAHs and must meet the following criteria: Less than 25 acute care inpatient beds, more than 35 miles removed from another hospital, provide 24/7 emergency care, and maintain an average stay of 96 hours or less for acute care patients.
At one time, Idaho had six independent CLS programs that graduated an average of 32 students per year. Presently, there is only one NAACLS-accredited program in Idaho (at Idaho State University) representing a decline of 83% in the state.
A Study of Staffing Shortage Impacts
To study the effects of this trend in Idaho, we sent a survey to all 27 CAH laboratory managers, of whom 21 responded. The survey focused on three domains: Hospital information, laboratory personnel demographics, and clinical laboratory education. All participants confirmed their status as a laboratory of a CAH with most (n=16) located within 50 miles of another hospital. Three hospitals are located 50-100 miles from another hospital and one is located more than 100 miles away from another facility (one facility did not indicate). The majority of hospitals surveyed had 20-25 beds (50%) with one facility indicating greater than 25 beds, and the remaining with less than 20. The survey respondents were evenly divided when it came to staffing the laboratory 24/7 versus being on call during the off-hours.
The cumulative data suggest that CAH laboratories primarily employ medical laboratory scientists: The average composition of CAH laboratories was found to be 52% MLS, 33% phlebotomists, 11% medical laboratory technologists, and 4% clinical laboratory technicians. However, the survey revealed substantial differences in the composition of laboratory personnel between individual CAH laboratories. Most noticeably, one laboratory was entirely composed of MLS, while another was staffed with one-third MLS and two-thirds phlebotomists (see FIGURE 2).
The Effects of Retirement
CAH laboratory workforce demographic information was also collected during the survey, including work experience and projected retirement. While managers are not always informed of their staff’s retirement plans, they were asked what percentage of their employees they anticipated retiring within the next ten years. Only one anticipated the retirement of 51-60% of their clinical laboratory science staff within the next decade. Three managers indicated that 31-40% of their staff would retire in the next 10 years, four managers indicated 21-30%, five managers indicated 11-20%, and eight managers indicated 0-10%. Over half of the sites selected a percentage of projected retirement well beneath the national estimate of 40% (see FIGURE 3). The survey results indicate that Idaho’s CAH laboratories are trending beneath the national retirement trajectory.
In addition to the percentage of staff retiring, participants were asked what percentage of their staff had less than five years’ experience working in CLS. The majority (45%) of CAH laboratories indicate fewer than 10% of their staff members have less than five years’ experience. Nevertheless, workforce retirements will likely leave laboratories staffed with a less experienced workforce. Of note, one site responded that 51-60% of their clinical laboratory staff had less than five years’ experience in clinical laboratory science (see FIGURE 4).
The Need for Ongoing Education
Additional data was collected regarding education in CAH laboratories. Participants were asked a variety of questions on the types of education materials provided to MLS staff and whether laboratory personnel were involved in the design and implementation of educational materials. Regarding students, the laboratory managers were asked if anyone in the laboratory is connected with the undergraduate or graduate program at Idaho State University, and if so, how are the students supported and trained during clinical rotation, and what materials are saved for future reference and training.
Approximately half of the CAH laboratories have employees with a connection to the MLS program at Idaho State University; unfortunately, most did not extend beyond having graduated from the university’s MLS program. Nevertheless, nearly all indicated their hospital supported the educational needs of MLS students; one responded that they did not know how their organization supported students, and eight indicated that they do not have sponsored employees enrolled in an MLS program. Examples of support provided include modified work schedules, materials and books, internships, clinical rotations, scholarships, and tuition reimbursement.
Although only eight managers selected clinical rotations as a way their laboratory supports the educational needs of MLS students, 19 managers (90%) said they accept students for clinical rotations. Of those who affirmed they take students for clinical rotations, half indicated that they saved specific training material for use with students during rotation. Examples include peripheral smears, proficiency samples, gram stains, digital pictures, urine crystals, and microbiology specimens. While only half of the respondents indicated that they saved material for work with students during their clinical rotation, 62% (n=13) indicated they saved unusual patient results for future training and competency, and 62% indicated they save rare patient results and/or case studies, but all admitted these materials were rarely referenced.
Cumulative results of the educational materials provided to MLS staff at Idaho CAH laboratories are as follows: 39% (n=15) competency evaluations, 32% (n=12) employer provided continuing education credits, 5% (n=2) dedicated clinical education department, and 24% (n=9) other. The “other” category included the following examples: Conference travel grants, forums, online programs, and vendor resources (eg, webinars, online training). Two managers responded that their labs supplied no educational materials and that their employees were expected to obtain continuing education of their own. 58% (n=11) of the laboratories indicated laboratory personnel were involved in the design and implementation of educational materials.
In regard to CAH laboratories’ involvement with other clinical departments, cumulative results are as follows: 9% (n=4) responded that all training of non-laboratory staff was handled by their Clinical Education Department, 40% (n=17) indicated laboratory personnel were involved in training clinical staff, 19% (n=8) noted that laboratory personnel were class instructors when classes pertained to laboratory tests, and 26% indicated laboratory personnel were routinely involved in interdepartmental resolutions and/or provided additional training when needed to help non-laboratory staff avoid preanalytical errors. Furthermore, three sites selected the category “other” and specified the following additional examples: Laboratory provides orientation for all clinical new hires; lab hosts tours, orientations, and PowerPoint presentations for new nursing staff; and lab provides competency evaluations to all medical staff performing laboratory testing.
Individual CAH laboratories face different challenges as they provide services to unique patient populations; however, all have the capacity to empower their clinical staff to take a more active professional role. Indeed, every clinical laboratory has an obligation to ensure the competency of their staff and the accuracy of reported test results. Our survey results reveal that clinical laboratories are sitting on a trove of resources and materials that, if curated appropriately, could be of great benefit not only to the individual laboratory, but to the hospital and to the profession as a whole. The ability to document site-specific clinical errors and case studies can bring intrinsic value to the instruction of staff. The power and the potential of the profession are in the hands of current professionals. Does your laboratory partner with Medical Laboratory Science academic programs? How does your laboratory partner with students and new professionals?
It has never been more imperative that new laboratory professionals receive the highest level of education and robust training. After all, they are expected to master skills, be fiercely independent with greater competency, and take on more responsibility sooner than the professionals that came before.6
1. ASCLS. (2015). Legislative Symposium. Workforce Study. Alexandria, VA.
2. US Department of Labor. Bureau of Labor Statistics. Medical and Clinical Laboratory Technologists and Technicians. http://www.bls.gov/ooh/healthcare/medical-and-clinical-laboratory-technologists-and-technicians.htm. Accessed November 10, 2017.
3. McCauley G, Meixner JA, Harwell G, and Onsomu EO. Preparation for Clinical Laboratory Practice: A Practitioners' Point of View to Enhance Students' Experiences and Workforce Needs. JBPHP: Res, Educ and Policy. 2011;4(2): 669-80.
4. US Department of Health and Human Services. National Center for Health Workforce Analysis. The Clinical Laboratory Workforce: the changing picture of supply, demand, education and practice. Available at: https://healthforce.ucsf.edu/publications/clinical-laboratory-workforce-changing-picture-supply-demand-education-and-practice.
5. ASCLS. (2016). 2016 Legislative Symposium. Workforce Study. Alexandria, VA.
6. Hammerling JA. Best Practices in Undergraduate Clinical Laboratory Science Online Education and Effective Use of Educational Technology Tools. Lab Med. 2012;43(6): 313-19. https://doi.org/10.1309/LMVB30QRE3AIEUXE.
Hollie A. Bearce, MS, MLS(ASCP)CM, is a generalist and technical lead at St. Luke’s Wood River Medical Center in Ketchum, Idaho. She studied biochemistry at the University of Washington and obtained a BS and MS in medical laboratory science at Idaho State University.
Kathleen Spiegel, PhD, MS, MT(ASCP), is a professor emeritus and founder of the medical laboratory science program at Idaho State University. Kathy earned her PhD in experimental pathology from the University of Utah, her MS in Biology from Idaho State University, and her BS in Zoology from Old Dominion University.
Rachel Hulse, MS, MLS(ASCP)CM, is the program director for the medical laboratory sciences program at Idaho State University and has worked as a certified laboratory scientist for over a decade. Rachel earned a BS and MS from the University of Utah, and holds a second MS degree from Brigham Young University.