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The Missing Piece

Baby boomer retirements and a struggling economy are contributing to a scarcity of crucial health care technicians.

 

Time: the distant (but not too distant) future, after the baby boomers have all retired.

Place: the emergency room.

Crisis: You (or your child, or someone you love) are stretched out on a gurney, awaiting lab results that will determine the diagnosis and set the course of life-saving action.

Tick. Tock. Time passes.

As your diagnosis—and your life—hangs in the balance, your urgently needed lab results may be held up because of a workforce shortage that’s been building over the last 10 years. In short, medical labs have broken under the workload; the needed clinical laboratory scientists aren’t there to do the work.

This raises the question: In these days of high unemployment and with “job creation” the clarion cry of practically every political campaign, how can laboratories, now or in the future, basic as they are to accurate medical diagnoses, be understaffed?

According to the American Society for Clinical Pathology (ASCP) Executive Vice President Dr. Blair Holladay, the situation boils down to an inversion of the rule of supply and demand. In this case, as the population ages and the demand for medical care naturally increases, there’s an increasing demand for laboratory services, yes; but the supply of medical laboratory scientists and technicians, instead of increasing with the demand, is actually decreasing.

More puzzling still, the U.S. Department of Labor Bureau of Labor Statistics, in its Occupational Handbook for 2010-2011, lists clinical laboratory scientists as a highly promising career, with “rapid job growth and excellent job opportunities” and describes an appealing career, with an attractive pay scale and employers waiting to hire.

What’s the problem?

First, some clarification. The people we’re talking about comprise two groups: clinical laboratory scientists (CLS), or medical technologists, who’ve had four years of college, earned a bachelor’s degree and added a year’s post-baccalaureate coursework and certification; and medical laboratory technicians (MLT), who are required to have two years of college and an associate degree, plus additional training and certificates. The CLS, who, in California, can earn in the $74,000 range, can analyze all body fluids and samples; the technician, who will earn a little more than half the CLS salary, may be drawing your blood or assisting the CLS. A pathologist or M.D. will oversee the whole division.

In March 2009, LabMedicine, the American Society for Clinical Pathology’s Wage and Vacancy survey stated that: “Sixty-three percent of clinical laboratories report increased competition for qualified staff as a stumbling block to hiring new personnel. Thirty-three percent report low compensation as a problem and 28 percent say that applicants are unwilling to relocate. According to the survey, medical technologists (MT) at the staff level are the most difficult to replace (63 percent) followed by medical laboratory technicians (MLT) at 38 percent.”

Twenty years ago, says Holladay, there were three times as many programs available for training lab scientists and technicians. But now, as those professionals (now in their 50s and 60s) are preparing for retirement, there are far fewer programs to train new people to fill the vacancies. The need is outstripping the demand. At some point, says Holladay, this will have an adverse effect on the speed and accuracy of getting test results to physicians—and those doctors being able to treat you—because lab professionals are increasingly overworked and laboratories are understaffed.

So what happened to all those training programs of 20 years ago?

The reduction in training programs over the last 10 years is one of the results of the increasing economic squeeze, especially on hospitals, which used to conduct the training. Medical laboratory scientist training programs, which prepare people for careers that routinely provide information that contributes to life and death decisions, are intense and rigorous. They require small classes taught by qualified professionals. And they’re expensive. “State governments can’t pay for these expensive programs,” says Holladay. “Now, with state budgets getting tighter and tighter, many have cut their programs, and that means the number of practitioners entering the field has dramatically decreased.”

Tom McHugh, administrative director for lab and pathology at Queen of the Valley Hospital in Napa, thinks the programs closed because they weren’t sustainable. “They started out primarily as hospital-based,” he says, “and took students right out of college. You would then apply through the California Department of Health to get a trainee license, then apply to a hospital, and they’d take you for a year’s internship, with small stipend, then you’d take the exam.” Simple.

He says for hospitals, it just wasn’t worth it. It was inefficient and costly to train the students—they’d have to hire staff to do the training and pay the students a stipend—and most hospitals didn’t get enough out of it. When budgets started getting tight, they found they could advertise and get someone already trained.

So many hospital training programs shut down. Now, the programs are run by the schools. In California, there are 13 programs, two of which are in the Bay Area, at San Francisco State University (SFSU) and San Jose State University (SJSU). But even universities need state funding to keep going, says McHugh. The schools themselves are often not keen on funding these programs, he says, since they fall somewhat outside their academic mission. They’re not degree programs (the trainees already have their bachelors and most aren’t going on for a masters), so it’s really more like job training. “It’s an odd fit,” he says.

He adds that he doesn’t think the general public understands what the profession is, so there isn’t much awareness of it among students choosing a career. It’s a behind-the-scenes profession, he admits, with no rewarding doctor-to-patient contact or recogni-tion. He describes likely candidates as those who love math and science, are detail-oriented and somewhat independent. It’s also good, he says, for those who like flexibility in their lifestyles. “As a career choice, you can make a good living—work nights, open a restaurant in the morning. We have a lot of people who do those sorts of things, clinical lab scientist by night, something else by day.”

While the image of the clinical laboratory scientist may lack the glamour of brain surgeon or emergency room doctor, who save lives in a very visible way, McHugh emphasizes that this “backstage” profession is really an integral piece of the health care profession. “And it’s a profession that’s rewarding, both financially and professionally, and really does help in people’s health care.”

Without a glamorous marketing “brand,” it’s the kind of profession people tend to stumble into. “I got into it by accident,” admits McHugh. “I got a bachelors degree in biology and was going to go to graduate school, but it didn’t seem right, career-wise, so I decided to look for another career, and sort of happened along this.” He started a masters degree at SFSU, and decided to simultaneously attend a CLS training program. “I volunteered to go in, and they volunteered to accept me.” It was a fit, and it’s been his career for 30 years. But, he says, like others, he sees the ominous trend.

Some may think that, with increasing mechanization, the problem will be solved, but this is a people issue, he stresses, not one that can be solved by machines. While technology enhances accuracy, it takes highly qualified people to make differential diagnoses from specimens and use that information to determine the medical problem and report that back to the physician. “Over the next five years or so, I think we’ll be in real trouble if we can’t train our people.”

California standards

“We have a problem,” agrees Holladay. “Understaffing isn’t a mere inconvenience, but can directly affect quality. It’s a crisis.

“The bottom line is,” says Holladay, “Who’s going to do the work, and where are they?”

The lucky ones are already in California. “Our shortage isn’t so acute,” says Phyllis Walker, recently retired manager of the Immunohematology Reference Laboratory (IRL) at Blood Centers of the Pacific. But, she quickly adds, the situation is still serious. “During the bad economy,” she says, “some hospitals elected to not fill vacancies. This meant when someone retired or moved away, there was no flexibility in staffing.”

While the salaries are generally “attrac-tive” in California, and the state itself—especially the Bay Area—is appealing, the job requirements in California limit out-of-state technologists from qualifying for positions here.

Walker explains that, to work in a California lab, one must be licensed by the state. To qualify for a license, the applicant must possess a bachelors degree that includes certain required courses, have completed training in a state-approved program and have passed an approved examination. Most applicants also hold national certification through the American Society for Clinical Pathology. California doesn’t recognize other states’ licenses, and qualifying for a California Clinical Laboratory Scientist license may be difficult, Walker says. This tends to discourage people from coming from out of state to work in California labs. All CLS in California must complete 12 continuing education units per year to maintain their state license. This is a good requirement, Walker continues, because it ensures individuals who work in California must maintain their competency. California has had this requirement for many years, and ASCP has recently made it a nationwide requirement for individuals who want to maintain their ASCP certification.

“If you’re a laboratory professional from out of state and you’d like to apply for employment in California,” says Walker, “you have to submit an application for a California Clinical Laboratory Scientist license to the California Department of Public Health Laboratory Field Services. There, a person in charge of personnel licensures reviews your college transcript and confirms that you’ve taken the required courses and were trained in an approved training program. Finally, you must show that you passed an approved examination within the past five years. If you took your examination more than five years ago, you must re-take an examination in laboratory medicine as well pass certain California-specific questions covering this state’s laboratory regulations.”

Walker says that San Francisco State trains 40 students per year, and those who succeed in the coursework go immediately into their hospital internships. “Hospital internships, which provide students with hands-on experience in a clinical laboratory, are required before students can obtain a license. Hospitals must commit time and personnel to train students; however, at the end of the internship, they have a source of trained staff to fill their vacancies. As students graduate from the CLS program at SFSU, almost all of them receive job offers from the hospitals where they served their internship.”

Geraldine Albee, director of clinical laboratory science internship at SFSU, confirms, “We’re a large program. We have so many affiliated laboratories. As far as jobs go, when our students complete their programs, they receive multiple job offers from hospitals, medical offices and biotech companies. Our graduates find high-paying, salaried jobs.”

The SFSU program’s clinical affiliates in the North Bay include Santa Rosa Memorial Hospital, Petaluma Valley Hospital, Queen of the Valley Hospital and Kaiser Permanente labs in San Rafael and (soon) Santa Rosa. The Clinical Laboratory Science Internship Program Newsletter for March 2010 notes that, for the class that started in the fall of 2010, 20 students have been offered internships with Kaiser Permanente in San Francisco, Kaiser Regional Labs, San Francisco General Hospital, UCSF Medical Center, California Pacific Medical Center, Highland Hospital in Oakland, John Muir Medical Center in Walnut Creek, Washington Hospital in Fremont, Stanford Medical Center and Santa Rosa Memorial Hospital.

There’s a “huge” need for these new clinical laboratory scientists, says Albee, “because the boomers are leaving. And lab scientists will be making crucial decisions that are needed—sometimes urgently—to contribute to diagnoses that will affect people’s lives.” Boomer retirements are also leading to recent graduates experiencing accelerated advancement opportunities, she says.

“As a CLS, before I became an educator,” she says, “there were many times a specimen was delivered to the lab and they needed a result now. I had to do the test and then make a decision about the specimen’s result—sometimes while the patient was already on the operating table.” She says she remembers just one such time, when a specimen was brought in, and she was the first to see that the patient had leukemia. It was hard. “We had to decide, ‘Yes, this is real,’ so we could notify the appropriate personnel so they could make decisions about the patient’s treatment.”

It’s not the kind of moment you typically see on medical TV dramas—but it could be. “Those decisions are often made under stress,” she says, and so the stringent requirements for California’s licensing, when looked at from the patient’s point of view, become a distinct asset. The CLS has a crucial link in the health care web, she continues: “The patient’s life is very much dependent on your result.”

Putting it all together

While this is a crisis, it’s not one emerging out of nowhere. The shortage has been noted, and the good news is, there are great opportunities for job-seekers—at least those who can find and complete the training. For them, jobs abound.

The December 6, 2010, U.S. News and World Report listed Lab Technician among the top 50 “Best Careers for 2011,” and third from the top of its list of best health care careers. From the job-seeker’s point of view, as they report it, the mass retirement of baby boomers is creating an increased need for health care services and opportunities for jobs. For those qualified, this can be a boon of major proportions, with about 25,000 new job opportunities expected between 2008 and 2018. Moreover, the Bureau of Labor Statistics projects that by 2012, the country will need 69,000 more CLSs (and 68,000 more MLTs) than in 2002—that’s a total of 13,700 new professionals each year.

So the drama, for the job seeker, may not be about “finding a job,” but about getting into one of the few training programs currently offered. The drama for the laboratories will continue to depend on the balance of health care need versus staffing availability.

For the patient, whose life may depend on the speed and accuracy of the lab results, the individual drama will form around the resolution of all of the above.