Clinical and Public Health Laboratories Need You

Nov. 9, 2021

Clinical Laboratory Professional Holding PCR Tubes
Clinical Laboratory Professional holding PCR tubes.
During the fourth surge in the COVID-19 pandemic, it has been widely reported that moral injury to health care workers was a key factor in a wave of early retirements. Even before the pandemic, demographic shifts, due in large measure to retirements among baby boomers, resulted in significant vacancy rates in clinical and public health laboratories. This problem has only grown worse during the pandemic. A survey of medical microbiology laboratory directors who are members of ClinMicroNet, conducted in mid-Oct. 2021, showed that out of 515 clinical microbiology positions, 75 (or 15%) were currently vacant. More disturbing was the revelation that 56 of those 75 positions had been vacant for more than 60 days, placing great strain on laboratory staff in many health care systems. In several of those labs, all vacant positions remained unfilled even after 60 days.

Understaffing places a significant burden on the laboratory personnel who are retained. The attention to detail that is required to perform complex tasks for long (seemingly endless) hours is difficult to maintain. For some, the strain becomes too great; and they, too, leave their positions, further exacerbating the crisis. To address chronic staffing shortages, ASM and Weber State University have developed a certification program that will allow qualified individuals to obtain skills needed to work in clinical and public health microbiology laboratories.

Factors Leading to the Staffing Crisis

Lack of Awareness

For an individual to work as a generalist in a U.S. medical hospital laboratory, they are required to have a minimum of a Medical Laboratory Technician (MLT) associate’s degree or a bachelor’s degree in Medical Laboratory Science (MLS), or another biological, chemical or physical science. Importantly, most hospital laboratories also require employees to have certification such as the MLT(ASCP) or the MLS(ASCP). Public health and commercial laboratories also prefer their employees to have these credentials, but they are often not as stringent as hospital labs about the requirement. These certifications are usually (and most successfully) achieved after completion of an accredited MLT or MLS program. However, there also are work-experience routes to obtain ASCP credentials for generalists and certifications for technologists and specialists in categorical areas, such as microbiology.

The medical laboratory profession (MLT or MLS) has long been one that is not visible to many junior high, high school and college students. This profession suffers from both an upstream and downstream awareness gap. For example, in a majority of junior high and high school settings (upstream), most teachers, counselors and parents are unaware of, or do not understand, the medical laboratory profession. In general, students who are interested in health, medicine, science and math are steered toward direct patient care majors and career trajectories (e.g. nursing, medicine, physical therapy, respiratory therapy, radiation therapy, etc.) and other STEAM careers (e.g. engineering). In hospital and healthcare environments (downstream), the public rarely sees or hears about a medical laboratory professional. They are much more familiar with the healthcare providers with whom they interact face-to-face, such as nurses or physicians. The result is that an ongoing lack of awareness for medical laboratory professions contributes to substantial work force shortages in the field.

Lack of Resources and Available Training Programs

The medical laboratory programs that educate future professionals are accredited by the National Accreditation Agency for Clinical Laboratory Sciences (NAACLS). In addition to advanced didactic coursework (microbiology, hematology, blood bank, clinical chemistry, immunology, urinalysis and laboratory operations), the NAACLS standards require students to complete education in the pre-analytical, analytical and post-analytical components of test performance.

The current pandemic provides compelling examples of the application of each component of test performance. In drive-thru test sites throughout the U.S., MLTs and MLSs identified patients, collected nasopharyngeal swabs, labeled them properly and facilitated rapid specimen transport to testing facilities, all essential pre-analytical steps in test performance. Once the specimens arrived for the actual analysis at testing facilities, this same group of scientists performed 10s of millions of PCR or antigen detection tests, using standardized test protocols validated to assure highly accurate results. In the post-analytical stage, these test results were reported to care providers to guide the care of patients. These data were also utilized by public health scientists determine specific public health recommendations for school openings, mask mandates, travel restrictions, etc.

Comprehensive test performance training is almost always conducted in the hospital medical laboratory. However, a number of factors have made it difficult for programs to find clinical placements for their students to complete the required clinical training. The current trend in the U.S. is to consolidate medical laboratory services so fewer hospitals offer these core-training areas. As a result, fewer students are being accepted to clinical laboratory training programs on an annual basis. For example, the Texas State University, Clinical Laboratory Science Program received up to 50 applicants each year and only accepts 20 students annually. The limitation of clinical placements is an ongoing national issue leading to dangerous shortages for this profession.

Ironically, the consolidation of medical laboratories to one or two major hospitals within entire helathcare systems is largely driven by shortages of medical laboratory professionals in the first place. These primary issues occur in the core areas of microbiology and immunohematology (blood bank). Hospitals obviously know that they need to accept more students for clinical placements if they hope to grow the future number of employees, but they simply cannot take on those workload burdens. In the end, it’s a double-edged sword, with hospitals continuing to lose medical laboratory professionals to retirements, burn-out or changing career paths, and at especially alarming rates during the pandemic.

Improved awareness and visibility of clinical laboratory professions are necessary to ensure that those seeking this type of career path can plan their education and coursework accordingly. It is critical that students entering university or community college settings understand that the medical (clinical) laboratory major requires certain prerequisite courses prior to applying for programs that offer the MLT or MLS degree. Furthermore, high performance in these prerequisite courses is necessary to ensure that students will be competitive for selective clinical laboratory programs. Educators can help by creating pathways that direct science majors, who are interested in high demand fields, such as microbiology, to take the appropriate coursework and achieve clinical placement, which is critical to build the Technologist in Microbiology M(ASCP) categorical credential.

The Purpose of the ASM-Weber State Microbiology Certification Program

Weber State University, Department of Medical Laboratory Sciences
Source: Weber State University, Dept. of Medical Laboratory Sciences

Although the staffing shortages in clinical microbiology laboratories are currently acute, ASM has been working to address clinical microbiology staffing issues over the past 5 years. Under the leadership of Susan Sharp, Susan Harrington and Peggy McNult, ASM collaborated with Weber State University to develop a post-baccalaureate certificate program in clinical microbiology. This program, modeled after an innovative “apprenticeship” program developed at the clinical microbiology laboratory at UCLA, qualifies the graduate to take a certification examination administered by the American Society for Clinical Pathology to become a Technologist in Microbiology, M(ASCP). This credential is internationally recognized and may qualify individuals to work in 1 of the 11 U.S. states and Puerto Rico that require licensure for employment in a medical and/or public health laboratory. The M(ASCP) credential is also accepted as a certification to work in many laboratories in the remaining U.S. states. Individual state requirements vary, and applicants to the ASM-Weber State program are encouraged to consult state agencies for more information.

The program has 2 components: 3 online courses in microbiology and applied laboratory mathematics and a minimum of a 4-week clinical microbiology laboratory rotation, consistent with those done by medical laboratory science students. It was developed for the following 2 groups of individuals:

  1. Recent graduates of the over 100 colleges and universities that offer a bachelors degree in microbiology, who want to immediately pursue a clinical or public health microbiology career.
  2. Science majors who graduate with bachelor’s degrees, outside of microbiology, who wish to work in clinical or public health microbiology laboratories but have neither the appropriate experience or certification.

Benefits of the ASM-Weber State Certification Program

The program is less expensive than other programs and presents a rapid pathway for individuals to find employment in a field where they are desperately needed. In a recent salary survey, Medical Laboratory Scientists with 0-5 years of experience made on average $61,000 and likely had health care insurance and other generous job benefits. Salaries vary widely based on geography and type of institution in which an individual works. As an added advantage, most graduates will be employed upon obtaining their credential, and ultimately, all these professionals have the opportunity to enter a career that offers multiple tracks to advance. Recently, diagnostic management teams led by a Doctorate of Clinical Laboratory Science (DCLS) or others offers the option to enter a path of the medical laboratory at the intersection of direct patient care.

As with medical laboratory science programs, finding clinic laboratory training sites can be challenging. For the laboratories with long-term vacancies though, working with this program to offer 4-week training rotations in exchange for an employee who is motivated to work specifically in a microbiology setting seems a fair exchange to address seemingly intractable staffing problems.

Acknowledgments: The authors would like to thank Susan Sharp, Susan Harrington, Peggy McNult and Kandi Tait for their helpful discussions in the preparation of this article​.

Author: Peter Gilligan, Ph.D., D(ABMM), F(AAM)

Peter Gilligan, Ph.D., D(ABMM), F(AAM)
Peter Gilligan, Ph.D., D(ABMM), F(AAM) is the former Director of the Clinical Microbiology-Immunology Laboratories at the University of North Carolina Hospitals.

Author: Rodney Rohde, Ph.D., SM(ASCP), SVCM, MBCM, FACSc

Rodney Rohde, Ph.D., SM(ASCP), SVCM, MBCM, FACSc
Dr. Rodney Rohde is the Associate Director of the Translational Health Research Initiative at Texas State University.