Executive Summary ASCP Vacancy Survey 2022: Amid Growing Shortages, Organizations Take Action to Create a Stronger Laboratory Workforce

Medical laboratories have experienced workforce shortages and increased vacancies for several years due to retirements, a lack of qualified laboratory personnel, and the limited number of laboratory training programs. According to the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief, “while case numbers and hospitalization rates are declining as of March 1, 2022, and the most acute workforce challenges may be easing for the time being, many of the impacts the pandemic has had on the workforce are cumulative and may not resolve quickly.

Across the nation, the overall vacancy rate (including supervisory-level personnel) was highest for the Core Laboratory department (18.0%) and lowest for the Cytogenetics department at 7.0% (FIGURE 1). According to the survey findings, the Cytology department had the highest overall percentage (19.6%) of employees anticipated to retire in the next five years. Phlebotomy had the lowest rate of employees expected to retire in the next five years at 8.7% (FIGURE 2). Overall certification rates were highest in the Hematology/Coagulation department and lowest in the Specimen Processing department (FIGURE 3). For the Anatomic Pathology, Blood Bank, Chemistry/ Toxicology, Core Laboratory, Hematology/Coagulation, Microbiology, Molecular Biology/Molecular Pathology/ Molecular Diagnostics, and Phlebotomy departments, the percentage of respondents who reported that they are required to hire certified personnel was lower than in 2020, the difference ranging between 0.5% and 23.3% (TABLE 1).

Blood Bank, Chemistry/Toxicology, Core Laboratory, Flow Cytometry, Hematology/Coagulation, Immunology, Microbiology, and Send-Outs departments took seven to 12 months to hire staff (nonsupervisory); Cytology departments took more than 12 months; and the remaining departments surveyed took three to six months to hire. For most departments (Anatomic Pathology, Cytology, Hematology/Coagulation, LIS/QA/PI, Microbiology, and Point-of-Care), hiring of supervisors now takes more than 12 months, a longer period compared with 2020. Chemistry/Toxicology, Flow Cytometry, Immunology, and Send-Outs departments took seven to 12 months to hire a supervisor. Cytogenetics, Histology, Molecular Biology/ Molecular Pathology/Molecular Diagnostics, Phlebotomy, and Specimen Processing took three to six months to hire a supervisor, while Blood Bank took three to more than 12 months, and Chemistry/Toxicology took three to 12 months.

Positions not being filled coupled with lack of qualified staff continue to exacerbate laboratory staffing shortages three years after the beginning of the COVID-19 pandemic. According to one respondent, “2020-2022 has been the hardest time I have had in my 20 years in this field to retain and hire staff. Also, the students coming out of the schools during this time period are not properly prepared to work in the lab as they were not able to do their clinical rotations, or it was limited. It is taking longer to train/teach these new hires.” Some employers have adapted to recruitment and retention challenges by beginning to hire noncertified personnel to perform testing.¹

The qualitative analysis results from this survey show that there is an urgent need to focus not only on recruitment but equally on retention of laboratory professionals. The most common concern from respondents was salaries/benefits not keeping up with inflation and acting as a barrier in retaining staff. Competition with other laboratories offering higher pay or sign-on bonuses and travel pay has become a major contributor to the loss of staff. One respondent said, “there needs to be incentives offered to recruit, but the incentives really need to be focused on retention efforts. I honestly believe low wages and lack of recognition of the knowledge base of our professionals are the biggest problems.”

Making strides to improve visibility of the laboratory

In March 2023, the Medical and Public Health Laboratory Workforce Coalition—a coalition of more than 20 national and regional laboratory, pathology, and other healthcare associations—was formed to work toward building a more robust and diverse medical laboratory workforce. This new workforce coalition will work to increase the visibility of laboratory occupations, such as by exposing students from elementary school through college to laboratory careers; expand and improve workforce recruitment, development, and retention efforts; and increase diversity, equity, and inclusion in the laboratory workforce.² Since its inception, the coalition has put forth a full-page printed advertisement in Modern Healthcare to promote the visibility of the profession and has joined forces to urge Congress to tackle critical values | volume 17 | issue 2 April 2024 | critical values 9 the critical personnel shortages affecting the pathology and laboratory workforce.³

The ASCP Workforce Steering Committee developed new recruitment materials in ASCP’s What’s My Next resource page (www.whatsmynext.org) and attended the American School Counselor Association meeting to promote and introduce laboratory careers to school counselors teaching K-12 students. Finally, through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to support laboratory workforce development through the CDC OneLab Initiative, ASCP launched its Negotiation and Advocacy Toolbox, aimed at providing clinical laboratory directors with adaptable and practical tools to help demonstrate the value of their laboratories.4 ASCP is supporting the CDC’s rollout of the OneLab program and has created a microsite with relevant resources, including the toolbox.⁵

Recently, ASCP launched its “Grow Your Own Laboratory Team” website.⁶ Data indicate that the laboratory is suffering from a critical shortage of pathologists and laboratory professionals, which has profound implications on patient care. To address the acute workforce deficiencies, some organizations are taking action to create a more diverse and robust pipeline of needed employees by “growing their own” laboratory teams—developing training programs within their own institutions and in partnership with outside organizations to fill the immediate needs they are seeing in their own communities. ASCP provides content and resources to support growing your own laboratory team and to address your laboratory’s current needs through this resource page.

One such piece of content is the ASCP webinar series that explores the models and strategies of “growing your own” laboratory team. Topics include developing partnerships with local schools/colleges/universities or creating training materials in house; engaging with high school STEM students, developing a phlebotomy school specifically for a health system, and implementing various outreach strategies that has helped decrease turnover and open positions in the laboratory; and establishing a grow your own program in underserved areas, rural areas, or communities that lack laboratory professionals, describing what might be available online, through regional partnerships, or via international recruitment.

Conclusion

Current Vacancy Survey data underscore the persistent upward trajectory of laboratory vacancies and retirements in part due to evolving certification requirements and magnified by the challenges posed during the pandemic. These findings emphasize the critical imperative to shift our strategic focus beyond recruitment alone, recognizing that equal attention must be directed toward the retention of laboratory professionals. Addressing this urgent need for retention strategies will be pivotal in ensuring the stability of the laboratory workforce.

To read the full report, visit ajcp.com.

References

1. Garcia E, Kundu I, Kelly M, Guenther G, Skillman SM, Frogner B. The Clinical Laboratory Workforce: Understanding the Challenges to Meeting Current and Future Needs. American Society for Clinical Pathology (Washington, DC) and Center for Health Workforce Studies, University of Washington (Seattle, WA), April 2021.
2. Newly Established Medical and Public Health Laboratory Coalition to Tackle Workforce Shortages. ASCP. June 5, 2023. Accessed August 8, 2023. ascp.org/content/news-archive/newsdetail/ 2023/06/05/newly-established-medicaland- public-health-laboratory-coalition-to-tackleworkforce- shortages.
3. New Laboratory Workforce Coalition Urges Congress to Address Laboratory Shortages. ASCP. May 3, 2023. Accessed August 8, 2023. ascp.org/content/newsarchive/ news-detail/2023/05/03/new-laboratoryworkforce- coalition-urges-congress-to-addresslaboratory- shortages..
4. Toolbox | ASCP’s Support of the CDC OneLabTM Initiative. Accessed February 16, 2024. supportcdconelab.org/toolbox.
5. ASCP’s Support of the CDC OneLabTM Initiative | ASCP’s Support of the CDC OneLabTM Initiative. Accessed February 16, 2024. supportcdconelab.org
6. Grow Your Own Laboratory Team ascp.org. ascp.org/content/grow-your-own-laboratory-team.

Ms. Garcia is Senior Director, Scientific Engagement and Research for ASCP. Ms. Kundu is Senior Manager, Research and Analytics for ASCP.