According to the 2019-29 labor projections overview and highlights released by the U.S. Bureau of Labor Statistics (BLS) in September 2020, “Employment and real output growth are projected to slow from 2019 to 2029. One in four people will be ages 65 and older in 2029, contributing to slower projected growth in the labor force and a continued decline in the labor force participation rate. The aging population is expected to continue to drive strong demand for a variety of healthcare services, with 3.1 million jobs projected to be added in the healthcare and social assistance sector through 2029.” 1 What was not included in these projections (because BLS developed them before the pandemic) are the effects of COVID-19 on the country’s population health and economy.1
When the pandemic spread throughout the United States this year, the nation’s health and healthcare systems were not immune to its effects. Healthcare personnel, especially frontline workers, were tasked with caring for the growing number of patients with COVID-19. At the same time, they had concerns about contracting the virus and keeping or losing their jobs. In addition to treating thousands of Americans affected by the virus, hospitals and healthcare systems faced financial challenges including: the effect of COVID-19 hospitalizations on hospital costs; the effect of cancelled and forgone services caused by COVID-19 on hospital revenue; the additional costs associated with purchasing needed personal protective equipment (PPE); and the costs of the additional support some hospitals are providing to their workers.2
The spotlight then turned to the field of laboratory medicine. Across the country, laboratory professionals have been and are working tirelessly to perform complex diagnostic tests for COVID-19 and develop innovative testing methods.3 In order to provide a view of how laboratories across the country are affected by the pandemic, and what strategies they used to maintain lab operations, the American Society for Clinical Pathology (ASCP) collected laboratory workforce data between June and July 2020. Individuals with a management-level or human resources (HR) position were asked to answer questions on whether there have been changes in testing, staffing, and retention of laboratory professionals during the COVID-19 pandemic.
When asked about how the COVID-19 pandemic affected testing volumes in laboratories, 61 percent of survey respondents indicated that they experienced decrease in testing volumes (Figure 1).4 While 49 percent of respondents indicated that their institutions did not increase staffing, those that decreased staffing did so primarily through furloughs, with an average length of greater than one month (Figure 2).4 Laboratories also encountered hiring freezes and slowdowns at this time (69%).4
To accommodate the current workload in many laboratories, laboratory staff were mainly reassigned to COVID-19 specimen processing (30%), reassigned to other areas of the laboratory (26%), added to the “labor pool” at their institution (21%), and relocated from their usual duties to perform SARS-CoV-2 testing (20%) (Figure 3).4 At the time this survey was released, many of the respondents reported that some of their staff had to be quarantined due to COVID-19 exposure or symptoms. 4 The staff absence was accommodated mostly through internal coverage that either required overtime or no overtime for different laboratories.4 In order to retain the level of staffing laboratories currently have, majority of institutions offered shift adjustments/flexible scheduling/split teams/rotations, offered paid time off, and reassigned or cross-trained staff (Table 1).4 Since this survey was deployed in the summer of 2020, it is certain that many factors that affect laboratory staffing have changed and continue to change.
|Shift adjustment/Felxible scheduling/Split teams/Rotation||57||23.8|
|Paid time off||29||12.1|
|Other responsibilities (test validation, insp[ection preparation, QA projects, SOP revision, research, etc.||12||5.0|
|Employee assistance/unemployment benefit/PPP||10||4.2|
Numerous peer-reviewed journal articles and other sources of mass communication (eg, news, social media) indicate that medical laboratory practitioners, which include pathologists, laboratory professionals, and pathology residents, are critical members of the healthcare team. Their work impacts almost every aspect of patient care, from diagnosis to prevention and primary care. 5-7 They also play a vital role in improving patient outcomes, promoting effective test utilization, ensuring laboratory quality, and public health. 5-7 However, the ASCP Well-Being Report on medical laboratory practitioners, released pre-COVID-19, showed high rates of feelings of burnout.5-7 Some respondents considered changing careers completely, getting a similar position in a different clinical laboratory, employment in a related field, and retiring, as a result of burnout.5-7
In September 2020, the ASCP Virtual session, “Job Satisfaction, Well-Being, Burnout, and Diversity in the Laboratory” provided open discussions with medical laboratory personnel about their overall well-being. They indicated that already existing feelings of burnout have been exacerbated during the pandemic. Others shared that many of them were tasked to perform thousands of COVID-19 tests while having a laboratory functioning with less staff due to furloughs or absences. Some conveyed that those who have been considering retirement decided to retire, while others had concerns about going to work and contracting the virus.
Past ASCP workforce studies strongly reiterate the need for more laboratory professionals in the future. Results showed that retirement, new technologies, and recruitment/retention challenges are the main contributors to this shortage. The current pandemic, a phenomenon no one anticipated, is now contributing to the laboratory staffing as well. The BLS labor projections pre-COVID-19 already suggest that the role of laboratory professionals will be more essential than ever. The pandemic might have just accelerated the future shortage the field of laboratory medicine will face.
Data from the ASCP Vacancy Survey 2018 suggest that a vigorous recruitment campaign should be put in place now to address the shortage in the future.8 In addition to recruitment of future laboratory personnel, there is also a critical need to focus on the retention of laboratory professionals currently working in the field.8 Strategies advocating for better salaries for laboratory personnel at the local and national levels should be discussed. This involves partnerships between pathologists, laboratory professionals, and professional societies to develop a solution.8 While the main concern in the medical laboratory has been the need for pay commensurate with education and experience, it is important that the field also concentrate on the multigenerational differences between laboratory personnel as it relates to retention.8
Results of the ASCP Vacancy Survey 2020 will be published in the coming year and will include detailed COVID-19 staffing data. The ASCP 2020 Virtual discussion participants also suggested including data on the relationship between burnout and the COVID-19 pandemic in the laboratory, something that we will perform in the next iteration of the study. For those who are experiencing stress and burnout at this time, ASCP developed resources on stress and burnout, available via the ASCP website.9,10 Future initiatives include augmenting these resources and identifying ways to strengthen efforts to support the medical laboratory personnel.