What Caused the Current Shortage of Medical Laboratory Technologists and What Steps Need to Be Taken to Solve the Problem

Editor’s Notes: A version of this article first appeared at CLPMag.com on September 22, 2022. Since that time, medical laboratories have made meaningful progress in addressing the shortage of qualified medical laboratory technologists, largely by combining several practical strategies rather than relying on a single solution. A major focus has been on retention, with many labs adjusting compensation, offering retention incentives, clarifying career pathways, and taking steps to reduce burnout. Labs have also redesigned workflows to ensure licensed technologists spend their time on high-value analytical and clinical tasks. 

At the same time, investments in automation and modern laboratory information system solutions have helped labs increase throughput per full-time employee by reducing manual steps, errors, and rework. Many organizations have also strengthened the talent pipeline through partnerships with MLS/MLT programs, paid internships, and expanded training and onboarding initiatives to bring new hires up to speed more quickly.

Despite this progress, the workforce challenge is far from solved. Vacancy rates remain high, retirements continue, and educational capacity has not yet caught up with demand. Sustained investment, policy support, and continued innovation remain essential to ensure long-term workforce stability for clinical laboratories.

Change, Disruption, and the Rising Strain on the Clinical Laboratory Workforce

As the Greek philosopher Heraclitus famously stated, "Change is the only constant in life." 

There’s no arguing that the world has experienced many changes 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 the industry are still being felt. 

The result has been an unpredictable demand for lab services, supply chain shortages, and, most alarming, high stress on the clinical laboratory workforce. In particular, the pandemic brought the long-standing shortage of qualified laboratory professionals into sharp focus, transforming it from a looming concern into an immediate and highly consequential challenge.

This carries significant implications for the healthcare industry, as behind the scenes at nearly every point along the care continuum stands a vital contributor: the 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 account for only a small share of annual U.S. healthcare spending, approximately 3 percent, the clinical laboratory remains a foundational pillar of the nation’s healthcare system.

Medical laboratory scientists who perform this work are 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. 

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.

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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 that person’s 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. Unless this trajectory changes, the gap will continue to widen, and the problem will become increasingly severe.

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What’s Causing the Shortage, and What Can Be Done?

Crawford and his colleagues are well aware of this disturbing trend. His top objective is to advocate for more qualified professionals to join the laboratory workforce. 

So, where to start?

According to the doctor, qualified candidates often aren’t aware of what options are available to them. 

“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 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 saw how cool laboratory science was,” he said. 

Crawford noted that many clinical laboratory training programs remain underenrolled and that the profession has a largely “mature” demographic profile, resulting in experienced laboratory professionals exiting the workforce at a faster rate than new entrants are coming in.

“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. 

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Career Growth Opportunities and Starting Salaries 

Improved publicity and awareness will certainly help, but they address only part of the challenge. To meaningfully close the gap, laboratories must also make career advancement pathways more visible and align compensation more competitively with other healthcare 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,” Crawford said. 

He 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 emphasized that a clearly defined path for advancement must be visible to attract talented individuals to the laboratory profession and to ensure a strong pipeline of new leadership as more experienced personnel retire.

“There is a great need for leadership in this profession, and experienced people who aspire to leadership can take on those responsibilities,” explained Crawford. “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 barrier that needs to be addressed if the laboratory industry is 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, its career ladder, and compensation,” Crawford said. 

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The Three Pillars of a Modern Medical Laboratory

Crawford believes process improvement, advanced technology, and qualified and talented personnel can help relieve the staffing burden that medical laboratories face. 

For him, process improvement ultimately centers on how to deploy the workforce more effectively during periods of stress, ensuring long-term sustainability by enabling every role and department to operate at its highest strengths.

“If you do the ergonomics on an experienced laboratory worker, you're likely to find that the non-productive activities for their training and expertise take up a substantial fraction of their time,” he said.

He also noted that in times of crisis, this situation is magnified.

So how can laboratory leaders drive process improvements that deliver greater efficiency across the lab?

Crawford used Northwell Health as an example, suggesting that an in-system laboratory network successfully servicing 23 hospitals and over 800 ambulatory care sites wouldn’t be possible without optimized efficiency.

“You can’t do this without standardizing your laboratory information system (LIS software), 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.”

Crawford also explained how operational informatics of the workplace can help align quantitative metrics with strategic objectives, and when optimized, huge operational improvements are possible. For example, he suggested that deploying a lab’s 24-hour workforce to match the times when routine lab specimens arrive helps alleviate potential stress points at peak operational volumes. 

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The Role of IT Support and Laboratory Information Systems 

Workforce development, retention, career growth, and technology. Crawford believes all four boxes must be checked for the laboratory community to emerge successfully from the current staffing crisis. 

So, how can IT and a modern medical laboratory information system software help solve the problem?

He said it starts at square one.

“How can we make laboratory software systems work 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 better ways to engineer the workplace and maximize the ability for people to be successful. “The IT design of technology and the laboratory information system software that supports it are both hugely important.”

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Modern, Comprehensive, and Flexible Laboratory Information System Software 

As lab operators struggle to find and retain qualified candidates who can grow into leadership roles, the importance of modern clinical and pathology LIS systems has become even more apparent. 

When done right, pathology and clinical laboratory management software 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. 

For example, labs with modern, comprehensive, and flexible LIS systems, such as the LigoLab LIS & RCM Laboratory Informatics Platform, can build and string together rules that create advanced LIS lab automation where manual processes once resided. 

The best LIS systems also maximize interoperability with electronic health records (EHR), analytical instruments, and third-party services such as laboratory billing (lab revenue cycle management), virtually eliminating the chance of data entry errors and lost specimens.

In addition to automating laboratory workflow management wherever possible and eliminating manual steps, LigoLab’s lab information system features advanced medical laboratory solutions that support fully customizable lab reports and multiple distribution channels 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, offering an all-in-one LIS software solution where lab information system and lab revenue cycle management (lab RCM) modules share the same diagnostic lab software database and infrastructure, removing prohibitive data silos and the need to synchronize between multiple disparate laboratory software systems. 

This unique arrangement also enables the laboratory billing process (RCM cycle) to start as the lab order originates, a real advantage that directly impacts a lab’s denial rate and revenue capture. 

When done right, the best LIS systems can become the lab’s de facto information department, offering the finest medical LIS software technology, plus 24/7 hands-on support. 

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What Does the Future Hold?

Although the current challenge is monumental, Crawford remains an optimist.

“I’m so enthusiastic about what we can do to help promote the value of the laboratory,” 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 my top advocacy goal is the laboratory workforce,” he concluded. 

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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 been a strong advocate for pathology and the clinical laboratory profession, working to ensure this essential discipline is firmly embedded in the next era of patient-centered healthcare. He is a founding member of Project Santa Fe, which advances the concept of Clinical Laboratory 2.0, encouraging laboratories to move away from the traditional transactional payment model to a value-based one that drives better outcomes. 

Crawford has authored more than 300 publications. He’s the 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.

Crawford received his MD and PhD from Duke University School of Medicine. He completed his post-graduate training in anatomic and gastrointestinal pathology at Brigham and Women's Hospital. That was followed by a fellowship in hepatic pathology at the Royal Free Hospital in London.