What Caused the Current Shortage of Medical Laboratory Technologists and What Steps Need to Be Taken to Solve the Problem
December 6, 2023
NOTE: A version of this article first appeared at CLPMag.com on September 22, 2022.
As the Greek philosopher, Heraclitus famously stated, "Change is the only constant in life."
There’s no arguing that the world has experienced a lot of change over the last few years. This is especially true for clinical laboratories providing diagnostic services for laboratory medicine, anatomic pathology, and molecular medicine, where pandemic-driven disruptions that upended many aspects of how the industry operates are still being felt. The result has been unpredictable demand for services, supply chain shortages, and, most alarming, high stress on the clinical laboratory workforce. In particular, the pandemic brought into sharp focus the shortage of qualified laboratory professionals, a looming challenge that is now dramatically in play.
This has major implications for the healthcare industry, because behind the scenes in support of nearly every stage of the healthcare continuum is a medical laboratory scientist. In the United States, approximately 14 billion laboratory tests are performed annually in more than 260,000 Clinical Laboratory Improvement Amendment (CLIA)-certified laboratories. Although laboratory services only comprise a small fraction of annual U.S. healthcare expenditure (approximately 3 percent), the clinical laboratory remains an essential part of the healthcare system. The medical laboratory scientists who perform this work are either clinical laboratory technicians and technologists, histotechnologists, or cytotechnologists.
“What has happened is an affirmation of what has been true since the beginning of the laboratory profession: our laboratories save lives,” said Dr. James Crawford, Senior Vice President for Laboratory Services at Northwell Health and Professor and Chair of Pathology/Lab Medicine at the Donald & Barbara Zucker School of Medicine at Hofstra/Northwell. Dr. Crawford is also a founding member and Chairman of the Board at Project Santa Fe, the originator of the concept of Clinical Laboratory 2.0.
Staffing Shortage: A Growing Concern Years in the Making
It’s commonly known that lab-based diagnostic testing is the highest-volume activity in the medical industry. Nearly every time a patient enters a healthcare facility, laboratory testing is performed as part of their care. Unfortunately, the laboratory industry is experiencing a significant shortage of qualified personnel even as the need for their services grows daily.
It is estimated that the industry is short between 20,000 and 25,000 laboratory technologists, with roughly 335,000 such professionals currently employed nationwide. That’s one technologist for every 1,000 U.S. citizens, a shortfall of about 7 percent. Unfortunately, unless things change, the gap is only going to get wider and the problem more acute.
What’s Causing the Shortage, and What Can Be Done?
Dr. Crawford and his colleagues are well aware of this disturbing trend. That’s why his top goal at the moment is advocating for qualified professionals to join the laboratory workforce.
So, where to start?
According to the doctor, qualified candidates often are simply not aware of the options available.
“Nursing, physician assistants, and other healthcare professions have received more publicity coverage, especially over the last 20 years,” he observed. “In recent times, the visibility of the laboratory profession has been poor, being virtually unknown to school counselors, both at the high school and college associate degree level. In general, it takes knowing someone or being influenced by someone in the field to get hooked.”
That was the case for Dr. Crawford, who fell in love with laboratory science thanks to his uncle, a research scientist who took him under his wing when he was just a grade school student.
“Through my uncle, I was able to see how cool laboratory science was,” he said.
Dr. Crawford noted that many clinical laboratory training programs are incompletely filled and that the profession, in general, has a “mature” demographic, meaning that the exit rate of experienced lab techs is higher than the entry rate of young people coming into the profession.
“I think we have to look at ourselves and say, “Have we done the job we need to do to publicize our profession? To me, that is the clarion call of our time,” he said.
Career Growth Opportunities and Starting Salaries
Improved publicity and awareness will surely help, but that’s only part of the equation. To attack the problem and close the gap, career growth opportunities need to be more apparent, and salaries need to be more competitive with other health professions.
“We have to make it clear that it’s an exciting job, one that has true career growth potential, and one that compensates on a competitive basis,” said Dr. Crawford.
Dr. Crawford used the example of a laboratory technologist potentially spending a career at the same workstation for 40 years as unappealing to a young person. He said a clear path toward advancement must be visible, both to recruit talented individuals into the laboratory profession and to ensure that there is leadership as the older personnel retire.
“There is a great need for leadership in this profession, and experienced people who aspire to leadership can take on those responsibilities,” Dr. Crawford explained. “We need to make it evident what is already true: that medical laboratory scientists can grow into roles like manager, director, senior director, assistant vice president, vice president, and even beyond.”
Being competitive in terms of starting salary is another large barrier that needs to be addressed if the laboratory industry is to be able to change the trend and hire the best and the brightest. The average cost for a degree in medical laboratory science is roughly $100,000, a prohibitive figure when you also consider that medical lab technologists are routinely paid significantly less than other medically trained professionals like nurses, physician associates, physical therapists, and pharmacists.
“I think there is an effort now that has not previously occurred, but we have to see it through, and seeing it through means getting to the frontlines of the educational pipeline and making the necessary adjustments in terms of awareness of the laboratory profession and its career ladder, and compensation,” Dr. Crawford said.
The Three Pillars of a Modern Medical Laboratory
In addition to qualified and talented personnel, Dr. Crawford believes that both process improvement and advanced technology can also help relieve the staffing burden that medical laboratories are facing.
For Crawford, process improvement boils down to what can be done to effectively deploy the workforce, both under times of stress and to help ensure sustainability, where all personnel and departments can play to their strengths.
“If you do the ergonomics on an experienced laboratory worker, you're likely to find that the non-productive activities for their level of training and expertise take up a substantial fraction of their time,” he said.
Dr. Crawford also noted that in times of crisis, this situation is magnified.
So how can lab operators achieve process improvement and thereby create greater efficiency within the laboratory?
Dr. Crawford used Northwell Health as an example, suggesting that an in-system laboratory network successfully servicing 23 hospitals and over 800 ambulatory care sites would not be possible without optimized efficiency.
“You can’t do this without standardizing your laboratory information system, your equipment, your SOPs, your reagents, and the proficiencies and competencies of your personnel,” he said. “ It’s not one size fits all, since you want to have a high degree of alignment with individual health system site needs, so you can flex and adjust as needed while always serving the institutional mission.”
Dr. Crawford also explained that the operational informatics of the workplace can help align quantitative metrics with strategic objectives, and when optimized, huge operational improvements are possible. As an example, he suggested that deploying a lab’s 24-hour workforce to match the times that routine lab specimens come in helps alleviate potential stress points at peak operational volumes.
The Role of IT Support and Laboratory Information Systems (LIS)
Workforce development, retention, career growth, and technology. Dr. Crawford believes all four of these boxes need to be checked if the laboratory community is to emerge successfully from the current staffing crisis.
So how can IT and a modern laboratory information system (LIS) help solve the problem?
Dr. Crawford said it starts at square one.
“How can we make sure that the laboratory software works most efficiently, with as few keystrokes as possible, and with limited opportunity for key entry error? That’s the starting point,” he said, noting that there are always ways to better engineer the workplace to maximize the ability of people to be successful. “The IT design of technology and the LIS system that supports it are both hugely important.”
Modern, Comprehensive, and Flexible Laboratory Information System Solutions
During these difficult times, as lab operators struggle to find and retain qualified candidates who can grow into leadership roles, the importance of a modern laboratory information system has become even more apparent.
When done right, a lab’s medical LIS can be part of a long-term solution to the staffing crisis by helping to reduce reliance on skilled personnel for time-consuming manual tasks. As an example, labs with modern, comprehensive, and flexible LIS systems like the LigoLab LIS & RCM Laboratory Informatics Platform can build and string together rules that create laboratory automation where manual processes once resided. These LIS systems can also maximize interoperability with EHRs, instruments, and third-party services that all but eliminate the chance of data entry errors and lost specimens.
In addition to automating laboratory workflow and removing manual steps, LigoLab’s LIS software platform also supports fully customizable lab reports and multiple distribution channels, both based on customer preferences. All that’s required is a bit of training, and lab personnel can configure these preferences themselves. No IT background is needed.
LigoLab’s value proposition extends beyond laboratory information system functions as well, offering an all-in-one pathology lab software solution where lab LIS and lab revenue cycle management (RCM) modules share the same united software database and infrastructure, thus removing prohibitive data silos and the need to synchronize between multiple disparate laboratory software systems. This unique arrangement also allows for the laboratory billing process to originate as the lab order originates, a real advantage that directly impacts a lab’s net collections.
When done right, modern LIS systems such as LigoLab Informatics Platform can become the lab’s defacto information department, offering the best and latest in pathology lab reporting software technology, plus 24/7 hands-on support.
What Does the Future Hold?
Although the current challenge is great, Dr. Crawford remains an optimist.
“I’m so enthusiastic about what we can do to help promote the value of the laboratory in the delivery of healthcare,” he said. “Medical science is spectacular, and I would like to think that the ability of our society to combine access to healthcare with population health, while addressing social determinants of health to help the human condition, would be a draw for the leaders of tomorrow to join our profession.”
“The potential is there, and we’re capable of doing it. That’s why right now, my top advocacy goal is the laboratory workforce,” he concluded.
Dr. James Crawford, MD, PhD
Senior Vice President, Laboratory Services Northwell Health
Professor and Chair, Pathology and Laboratory Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Chairman of the Board, Project Santa Fe Foundation - Clinical Laboratory 2.0
Throughout his distinguished career, Dr. James Crawford has actively advocated for the specialty of pathology and the clinical laboratory industry, helping to ensure that this vital component is part of the next era of “patient-centered” healthcare. Dr. Crawford is a founding member of Project Santa Fe, which is advancing the concept of Clinical Laboratory 2.0, encouraging laboratories to move away from the traditional transactional payment model to a value-based one, and one that drives better outcomes for the populations we serve.
Dr. Crawford has authored more than 300 publications, and he serves as editor-in-chief of Academic Pathology, the official journal of the Association of Pathology Chairs (APC). He was the 2021 recipient of the Distinguished Service Award from this society.
Dr. Crawford received his MD and Ph.D. from Duke University School of Medicine, and he completed post-graduate training in anatomic pathology and gastrointestinal pathology at Brigham and Women's Hospital, followed by a fellowship in hepatic pathology at the Royal Free Hospital in London.