Executive Summary ASCP Vacancy Survey 2020: Comprehensive Strategies Needed to Address the Future of the Laboratory Workforce

Key Points

• The COVID-19 pandemic has disrupted the staffing of laboratory personnel and the stream of incoming graduates entering the workforce.
• There is a need to use the spotlight on the laboratory resulting from COVID-19 to cultivate the future of the laboratory profession as a whole and individual specialties.
• Addressing the current and future needs of the laboratory workforce requires a collective effort by stakeholders at all levels, within the laboratory field and outside institutions.

The COVID-19 pandemic changed the work environment of many, if not most, laboratories.¹ Results of the 2020 ASCP vacancy survey show that vacancy rates are lower in most departments compared with the 2018 report, except for blood bank, chemistry/toxicology, flow cytometry, LIS/QA/PI, molecular pathology, and point-of-care (Figure 1).² Retirement rates for most of the departments surveyed continue to decline, suggesting that the largest wave of retirements has passed (Table 1). Certification requirements continue to increase for the anatomic pathology, cytology, and chemistry/toxicology departments, suggesting that hiring managers need more qualified and certified laboratory personnel in these areas (Table 2).

For most departments, hiring supervisors now takes between three months to a year, a longer time period compared with three to six months in 2018. Blood bank, chemistry/toxicology, hematology/coagulation, immunology, microbiology, and point-of-care departments take at least a year to hire a supervisor. When asked what the main laboratory workforce concern is this year, 14.2% of respondents reported the need for better salaries for laboratory personnel and increased effort in heightening the profile of the laboratory profession in the medical field. Filling vacancies was equally concerning (14.2%), exacerbated by the staffing challenges laboratories have faced during the pandemic. The third top concern respondents reported is staffing the laboratory with qualified laboratory professionals (10.4%).

When open positions are not filled relatively quickly, respondents indicated that the responsibilities of positions were assigned temporarily to other personnel (63.9% [15.7% in 20183]), left open (57.8% [46.0% in 20183]), reposted (42.9% [28.6% in 20183]), eliminated (25.4% [15.0% in 20183]), permanently assigned to other staff (21.6% [11.3% in 20183]), or assigned to temporary personnel (17.2% [15.7% in 20183]).

Qualitative analysis results from this survey indicate the need for more qualified laboratory personnel, solutions to staffing challenges, and pay commensurate with education and experience. According to some participants, it is becoming more difficult to find qualified staff and retain them, especially for certain shifts and in rural areas. The pandemic only exacerbated the challenges that laboratories face in filling open positions, with many staff opting to retire early or leave the field altogether. One laboratory manager said, “I have lost 25% of my staff in the last six months and have another 10% scheduled to retire this year. Even in normal, non-COVID times I would be unable to even hire at this pace, much less onboard and train. We are a large, well-respected medical institution in a highly desirable area. I cannot imagine what smaller rural labs are experiencing. I am worried that our standards for education and certification are at risk.”

The ASCP Vacancy Surveys show that the field is experiencing staffing challenges due to multiple factors. While one of the main issues in hiring, recruiting, and retaining laboratory professionals is dissatisfaction with pay, there are other factors that drive them to leave their laboratory jobs or pursue other careers. From our job satisfaction and well-being study, almost two-thirds of our participants (n ~ 3,500) are somewhat to very satisfied with their current jobs in the lab (somewhat to very dissatisfied, 37.2%; not sure/don’t know, 0.1%).³ Approximately two-thirds of the respondents agree that their professional values are well aligned with those of their department leaders and those of their institution/organization. Most agree to strongly agree they feel they have produced worthwhile accomplishments on their job (87.5%); enjoy their work as a laboratory professional (85.5%); feel valued by their colleagues (70.8%); feel empowered to make work-related decisions (67.2%); and generally feel energetic at work (62.5%).³

Recently, the MIT Sloan Management Review released an article titled, “Toxic Culture Is Driving the Great Resignation,” revealing employee data on the top five predictors of attrition and four actions managers can take in the short term to reduce attrition.⁴ Similar to two of the “Top Predictors of Employee Turnover During the Great Resignation” listed in the article, the biggest issues we hear now more than before based on our data are the “toxic corporate culture” and “failure to recognize performance,” especially during the pandemic. Many of our laboratory professionals do not feel supported by the C-suite. While the field is receiving more recognition and some support from administration now because of its important contributions to healthcare during the pandemic, enhanced laboratory workforce support is still needed. Our data show that less than half of our study participants agree to strongly agree that they feel valued by professionals outside their team (49.8%) and feel respected in the field of pathology (47.2%).³ It is imperative that pathology and laboratory medicine examine the causes that affect staffing and develop comprehensive solutions. Medical laboratory administrators and leaders should also collaborate with their human resources (HR) management and HR information systems to address laboratory workforce needs.¹

In the 2018 vacancy report, the laboratory community was encouraged to develop strategies to advocate for better salaries for laboratory personnel at both the local and national levels in addition to focusing on laboratory staffing issues.⁵ The most recent report by Garcia et al¹ suggests that addressing the current and future needs of the laboratory workforce requires a collective effort by groups of stakeholders at all levels, including laboratory employers, laboratory training programs, health care executives/hospital administrators, and professional organizations. The report also suggests that “there is an opportunity to leverage the spotlight on the lab due to the COVID-19 pandemic, to cultivate the future of the laboratory profession as a whole as well as the individual specialties.”¹ To create a resilient professional laboratory workforce, creating a supportive environment for laboratory professionals is key.¹ According to one participant, “Medical Technology organizations need to take advantage of the current COVID-19 situation to promote and show the importance of Medical Lab Professionals in the healthcare cycle. We also need to push legislation for more recognition and pay raises to get closer to what nursing staff or even radiology techs get paid. By doing that, we will be able to encourage and win more high school graduates to select studying clinical laboratory science more frequently.”

ASCP and the ASCP BOC have been working on a number of fronts, including data collection/analysis, federal legislative and regulatory advocacy, and state legislative and regulatory advocacy, to support workforce development, staffing, and the laboratory profession. The ASCP is developing a Laboratory Workforce Steering Committee to focus on promoting visibility both in the training and employment branches of the laboratory. We continue to investigate and collect data on job satisfaction and impact of culture on burnout in the laboratory so we can shine more light on how to address the staffing challenges in the field.

References

1. Garcia EC, Kundu I, Kelly MA, et al. The clinical laboratory workforce: understanding the challenges to meeting current and future needs. https://ascpcdn.s3.amazonaws.com/static/ISTP/Siemens_ Clinical+Laboratory+Workforce_Brochure_042721.pdf. Accessed September 28, 2021.
2. Garcia E, Kundu I, Kelly M, Soles R. The American Society for Clinical Pathology 2020 Vacancy Survey of Medical Laboratories in the United States [published online ahead of print, 2021 Dec 1]. Am J Clin Pathol. 2021;aqab197. doi:10.1093/ajcp/aqab197
3. Garcia E, Kundu I, Kelly M, Soles R, Mulder L, Talmon GA. The American Society for Clinical Pathology’s Job Satisfaction, Well-Being, and Burnout Survey of Laboratory Professionals. Am J Clin Pathol. 2020;153(4):470-486. doi:10.1093/ajcp/aqaa008
4. Sull, D., Sull, C. and Zweig, B., 2022. Toxic Culture Is Driving the Great Resignation. [online] MIT Sloan Management Review. Available at: https://sloanreview.mit.edu/article/toxic-culture-is-driving-the-great-resignation [Accessed 11 February 2022].
5. Garcia E, Kundu I, Kelly M, et al. The American Society for Clinical Pathology’s 2018 Vacancy Survey of Medical Laboratories in the United States. Am J Clin Pathol. 2019;152:155-168.