An impending lab personnel shortage is raising alarms across the industry.
The United States Bureau of Labor Statistics projects more than 24,000 vacancies for clinical lab technologists every year for the next decade, a fivefold increase in job openings since 2000. Many of the openings are expected from workers transferring to different occupations or exiting the labor force.
Pay and career mobility have long plagued the industry. Burnout, which was rampant even before the pandemic, continues. And President Trump’s Administration’s cuts in the lab community and to the broader healthcare landscape present additional difficulties.
This comes at a time when demand for lab services looks only to increase as the country’s aging population will require more care and thus more testing. All these factors are pushing the industry to a place where it desperately needs to add talent. Yet, in 2022 for instance, only 7,400 medical lab technicians and scientists earned degrees.
Meeting this moment will require a concentrated effort—funding at various government levels, improved work conditions for existing lab personnel, outreach and recruitment to current students and much more.
What’s at Stake
Many lab personnel challenges trouble Joel Mortensen, PhD, Director, Diagnostic Infectious Diseases Testing Laboratory (Microbiology and Virology); Professor, Department of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital. But high on that list is that healthcare has always been marching toward progress: Over time, life expectancies go up—not down. Treatment options increase—they don’t decrease. The lab industry is no different. Turnaround times for test results should only trend downward; the availability of tests should only increase.
“The minute we stop going forward, we start to go down,” Dr. Mortensen says. “It’s great to talk about the economics and all the rest of it until your child’s in the emergency room at 2 a.m. and someone doesn’t know what to do with a blood culture because of their training, or they’ve never seen this before, or they don’t know who to call or some other ridiculous thing. That’s not right.”
To be sure, the lab industry has seen incredible recent progress. “If you were septic, had bacteria in your blood, and this was 10 years ago, it would take labs 48-72 hours to know what the organism was and what it was susceptible to,” Dr. Mortensen says. “Ninety percent of the time today, it takes six to eight hours.”
Such advances are helping patients get treatment to reduce pain and distress much faster. But as clinics close, senior personnel retire and workers leave the industry, progress is in jeopardy, and worse health outcomes are on the table— everything from longer turnaround times to pricier tests to less accurate results. As Dr. Mortensen puts it, “If something doesn’t work, if people aren’t qualified, we’re going to hurt somebody.”
James Payne IV, M.Ed., AHI (AMT), CPT, Medical Laboratory Assisting and Phlebotomy Instructor at the BOCES2 CTE Center, Spencerport, New York, says the industry is waking up to how serious the shortage is. “It’s leading to problems where some states are potentially looking to drop things like licensure, which helps protect your scope of practice. Some areas are exploring allowing nurses and nontrained staff to oversee medical lab tests. I think that becomes dangerous. You wouldn’t want a [general practitioner] doing brain surgery. They’re not qualified to do that.”
Speaking more globally, “Antibiotic resistance is a big deal, right?” Dr. Mortensen says. “There are dramatic cases of people dying from infections for which no antibiotics can be used. That’s part of what we’re doing—we’re getting better at tracking, finding and responding to them.” Until we’re not.
Dismantling the “Hidden Profession”
One critical step is enhancing the profession’s visibility. Cherry-Ann Da Costa-Carter, MSc, MPH, MLS (AMT), RPT (AMT), Chief of Mycobacteriology at the New York City Public Health Laboratory, likens lab work to a movie’s set designer. Sure, it’s in the background, but it’s essential, she says. After all, 60%-70% of clinical decisions are affected by lab results, and 80% of guidelines aimed at establishing a diagnosis or managing a disease require lab testing, according to a report in The Clinical Biochemist Reviews.
Yet, “We’re always fighting battles for getting staffing and competing with for-profit hospitals and research institutions for salaries—and just for existing in healthcare and proving ourselves as professionals,” Da Costa-Carter says. “We’re just intrinsically people in the background. When that happens, you get overshadowed. That’s the crux of the matter.”
Payne’s guiding principle is that the industry can’t wait to be found. “There is outreach that everybody can do that wouldn’t cost a lot of money.”
As an instructor, Payne oversees a program that gives high school juniors and seniors the ability to spend two and a half hours every day learning how to work in a lab through hands-on medical laboratory/phlebotomy skills and theoretical content. In the first year, students learn about lab basics, including everything from microscope skills, micropipettors and spectrophotometers to phlebotomy principles like drawing blood from fake arms.
Payne has partnered with higher education programs and local labs to provide this real-world experience. In their first year, his students eventually spend 40 hours drawing blood on real patients for actual lab samples, giving students a chance to get certified in phlebotomy while in high school. As seniors, students study microbiological identification tests, clinical chemistry, urinalysis, genetic testing, histology, bioinformatics and more. They spend 80 hours working as lab assistants, getting the chance to become certified in medical lab assisting.
Of course, developing a program like Payne’s takes time and a lot of investment, but that shouldn’t dissuade anyone, he says. Like any major endeavor, this level of outreach and training is about taking incremental steps.
When he first started, Payne had just a handful of microscopes. He’s been slowly building the lab through whatever means he can: One year, he was able to get $17,000 in grants, allowing him to purchase a lot of equipment. Another year, he got a free microtome because a local college had a spare one lying around. Year by year, he looks to add what he can to engage students.
“If we can get it so that every student in America knows about the careers in a medical laboratory the way they know about the different disciplines of a doctor or a nurse, we’re going to be in much better shape,” Payne says.
In particular, Payne says medical lab professionals and advocates can—and should—be taking a tiered approach to growing the profession. Tier one is simple outreach, including giving talks and live demonstrations at local elementary schools, middle schools and high schools. Tier two is organizing school field trips that include mock stations so students can experience lab work firsthand. This can also be done with local and state politicians, school counselors and science teachers, and school board members. “You want to make as many advocates in the community as possible,” Payne says.
Tiers three and four of his plan include full-day shadowing, work-based learning and internships, “where they’re actually learning how to work in that section of our industry and doing pre-analytical style work or phlebotomy,” Payne says. His program prepares students to work in a lab the moment they graduate from high school.
“If every lab in the country was talking to every student around them, if they are giving students a chance to really see what it’s like to be in a lab and fall in love with that, and actively trying to make advocates, we’d be most of the way to solving the lab shortage,” Payne says.
When reaching out to younger generations, Da Costa-Carter says you should emphasize all the different career paths available. “There are so many branches you can go into—infectious diseases, environmental microbiology, biothreat response, food safety, newborn screening. Even within those areas, you have clinical diagnostics, molecular diagnostics, whole genome sequencing, wastewater testing, bioinformatics.”
The key to all this outreach is to make the work exciting, Payne and Da Costa-Carter say. Don’t invite students to a lab that’s not actively running tests, for instance. “If we can get more people to come into a lab and see what it’s like, see how we are disease detectives that help figure out what is the pathogen or the cancer hurting our patients, that’s really cool,” Payne says. “I would like to see more opportunities for people in the community to see that sort of work.”
Addressing Today’s Workforce
Of course, recruiting future employees and getting stakeholder buy-in from legislators is just one piece. Another major hurdle is retention—both of employees and expertise. Da Costa-Carter has been in the field for three decades, and one of her biggest concerns is losing the built-in knowledge of industry veterans like herself. “The people who have been in the profession for years have acquired a certain amount of expertise. They know how to run certain tests. They know how to bring new tests on with validations and verifications. They know when something is going wrong, and it’s almost like a sixth sense.”
Dr. Mortensen shares her concern. “As people with 20-30 years of really solid experience leave the field—mycology, microbiology or really specialized fields like parasitology—that’s where we’re in trouble. Because we can’t replicate that. We can’t take a college student, send them through an MLS program and suddenly give them 20 years of experience.” At Cincinnati Children’s Hospital, Dr. Mortensen helped advocate for creating a college of allied health. It’s part of his organization’s broader commitment to engaging employees by pairing theoretical skills with real-world skills. “We do a lot of continuing education here,” Dr. Mortensen says.
That includes traditional education through classes, webinars and credentialing and avenues such as encouraging employees to write journal articles. (Dr. Mortensen and his team are frequent Pulse contributors.) “We have technologists who’ve never written anything before in their lives, and now they’ve been supported to learn a new process, to dig into a question, figure out some of the English language used in scientific writing,” Dr. Mortensen says.
Whether students write or learn through other means, the overall effort is about investing in individuals. To that end, the hospital has developed an employment ladder with clear pathways for growth, including recognizing the amount of time, accomplishments (like published articles) and competency required to progress and earn a higher salary. “We have to recognize the key value of the employee,” Dr. Mortensen says. “They’re not widgets. You don’t unplug one college student and plug in the next student.”
Fighting Burnout
Beyond personal growth, consistent small gestures can help address the scores of people leaving the industry because of issues like burnout, whether that’s providing a free catered lunch during a webinar or offering education stipends. During lab recognition week, Dr. Mortensen even dressed up as Ken from Barbie to breathe a little life into the community.
“We’ve got to address these problems by whatever mechanisms,” Dr. Mortensen says. “Is it effective to have a call-in line for the hospital if you’re having a bad day? I don’t know, but it’s an effort to address an obvious need for burnedout employees. The institution, the laboratory and the middle management all need to understand and acknowledge that they can burn out and that their people can burn out. We have to be aware of it and think about how to address it.”
Understanding work patterns can help ease burnout, too, Da Costa-Carter says. “Managers have to try to rotate people as best they can. Especially if somebody’s doing a very tedious task, it’s up to you to recognize the signs of burnout and rotate them onto something else.” She says this also helps build competencies and develop staff professionally.
The check-ins, happy hours, employee recognition days or weeks, access to counselors—all of these steps to mitigate burnout and stress “aren’t new, innovative answers,” Dr. Mortensen says. And they’re not a cure-all either. But it is an acknowledgment of your organization’s effort. “Institutions have to decide if they’re in the business or not. We try to lead the institution, lead the laboratories—point the way for how you do this work. It might be hard with the budget, but if you don’t change the oil in your car, you know what the hell happens, right? You put in fresh oil so it keeps running. That’s what we have to do.”
The Why
Labs shouldn’t forget the power of an emotional appeal, either. “If your workforce understands your mission and what you’re doing, then that’s another feedback loop for them to say, ‘I have value, I bring value, I do things that are useful and have an impact,’” Dr. Mortensen says.
So while the names on the vials might be anonymous, labs must emphasize that the work has immediate real-world impact.
“In public health labs, we don’t see a patient walking through the hallways. We just get specimens,” Da Costa-Carter says. “When patients are sick, we are trying to find out what novel virus or mutated pathogen has come down the pike, and we do such crucial work. But the people remain nameless. You have to remember that you may never see a visual of the person you serve, but know that you have served so many—a whole population, a whole city, a whole state of people. I try to keep that in the forefront of my mind when I’m doing anything. I know the work we do has meaning.”