CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Greg Sossaman, what is your staffing situation in New Orleans?
Gregory Sossaman, MD, system chairman and service line leader, pathology and laboratory medicine, Ochsner Health, New Orleans:
I like Stan’s description: It went from critical to meltdown over the past year. We were focused on COVID, we devoted so many resources to molecular testing, and although we didn’t take our eye off the ball, it seems to have happened quickly. Things imploded. We’re struggling in every area. We’re seeing exactly the same things others have reported—acute-on-chronic exacerbation.
Dr. Anthony
Laboratory-developed test regulation has raised its head again, and it looks as if there might be increased scrutiny. Lauren Anthony, can you comment on this development?
Lauren Anthony, MD, system laboratory medical director, Allina Health, Minneapolis: I know there are unintended consequences from this, but I, for one, would welcome LDT regulation because of the unproven and low-value LDT tests that some of the commercial laboratories are putting out there and marketing directly to clinicians and to patients. Some of these tests encroach on our nonprofit health systems because they’re marketed in ways that increase demand. They take up time and resources to address, to educate around, and to explain that the test doesn’t add a significant value or that it’s unproven.
Many of these end up being self-pay tests, and even if they’re self-pay and performed for recreational purposes, they end up encroaching on the health care system because patients want follow-up tests for a supposed abnormality that was found. Some of these places don’t provide the infrastructure to support their testing. They rely on the infrastructure of health care systems to draw their samples and provide them with a never-ending stream of specimens for which they don’t have to provide resources. Generally, commercial labs that perform tests with proven value will send a phlebotomist to a patient’s home and provide that service. Most labs offering self-pay tests say, “Take this to your doctor” and expect them to sign off on it and provide collection and processing services.
So they create expectations. They add unnecessary testing, and they invariably end up encroaching on our resources. I tell clinicians that when patients bring in these things, they can make the laboratory the bad person, and we’ll address it. We do have policies.
Sterling Bennett, tell us a little more about laboratory-developed tests and how you look at them at Intermountain right now.
Dr. Bennett (Intermountain): LDTs take a few different shapes for us. Some are what we usually think of as an LDT, where you take ingredients from scratch and develop a test that fills a need in the marketplace or in the health care arena that we cannot get elsewhere. That’s the minority of what falls under the LDT umbrella for us. Most of these are variations of what the FDA has approved, where we’re looking at different specimen types or extending the stability times or other such things. Whether the LDT regulations end up being helpful or harmful depends on what they ultimately try to regulate. If they go after tests of the type that Lauren Anthony described, ones that have low or unproven clinical utility, and the regulations require demonstration of clinical utility before the tests are marketed, the regulations could be helpful. But if they take another form, where any modification of an FDA-approved assay now has to go through seven layers of bureaucracy, that would worry us.
Tesoriero
Compass Group members have always strived to offer solutions to problems. So I would like to return to the labor problem. Does anyone have an innovative solution or a success story about how you’re dealing with the problem of staffing in the laboratory?
Richard Tesoriero, VP of business and operational performance, Northwell Health Laboratories, New York: Most recently we did a market-based survey of salaries—we needed to know where we were in the marketplace. Our goal was not to be at the highest percentile and certainly not at the lowest, but we were surprised to see we were below the 50th percentile for other systems in this marketplace. So we pushed ourselves to the 75th percentile and took that increase in June. It’s tough to float those salary increases, as Stan said, and it was substantial. Even in the support areas—accessioning, phlebotomy—the rates were below the 75th percentile, which was surprising because we thought we were aggressive. So salaries are changing significantly.
Would anyone else like to comment on their efforts to deal with staffing problems?
Dan Ingemansen (Sanford): Our leadership team is focused on establishing an environment in which people want to stay. Beyond that, it’s collaborating with all the departments that help with the onboarding process; everyone is accountable to their piece. It used to be apply for a job and you’d hear back in a week. We now have a full-court press. If an application comes in, we work with HR to not only engage with that candidate but also to work through the process as fast as possible. We know applicants are applying for multiple jobs. There’s a lot of opportunity and it makes us act quicker on any type of interest we may see.
Tell us more about how you’re working with Human Resources.
Dan Ingemansen (Sanford): Our HR department became a system service department several years ago and implemented a single software recently. We have dedicated recruiters representing the entire system who are able to talk with candidates. They know the characteristics and qualifications we’re looking for in the laboratory. The only variable is hours and facility. When they have a candidate, it’s a full-court press to review the applicant and get an offer out as soon as possible, if applicable.
That must give you a leg up in a tough market.
Dan Ingemansen (Sanford): We’re not perfect but I think we’re doing a better job. We learned through the pandemic, as we were looking to the agencies to provide staff, that if the agency contacts you about a candidate, you have hours not days to respond and get an offer out.
Janet Durham, do you have a staffing solution to share?
Dr. Durham (ACL): We’ve had a histology school for years, but what we’re trying to do for anatomic pathology now is to have a sort of continuous funnel of having people who are laboratory assistants, and who know something about the lab, be the candidates who are applying to our histology school. And for the first time we will have two different cohorts every six months, a new group so that we have a more continuous flow, because, as Darlene shared, when you’re trying to get new work, the limiting factor is having the histotechs to be able to perform that work. So we’re hoping that is successful for us this year.
Richard Tesoriero, would you say that the difficulties with histotechnologists is on a par with the difficulty with medical technologists?
Richard Tesoriero (Northwell): It’s probably more difficult with a smaller pool.
Dan Ingemansen, what is your solution for histotechnologists?
Dan Ingemansen (Sanford): We have a program in which we can take a four-year-degreed science major and surround the person with the right curriculum. After a year, the person becomes eligible for certification. That program has worked out well.
Johan Otter, can you comment on staffing issues on the West Coast?
Johan Otter, DPT, assistant VP, Scripps Health, San Diego: We have 10 openings for histotechnologists. It’s not easy because it’s not the highest-paying position and our cost of living is high. We are in a competitive environment. We’re hiring away from our other labs in town right now, and we had one start and quit two weeks later because they couldn’t keep up with the pace of work. It’s been challenging.
Dr. Otter
IVD people always say they have a lot more automation they can bring to labs to help alleviate labor shortages, and they’ve largely done a wonderful job with labor-saving automation. But I’m wondering if we’re at the end of the trail there or close to the end of the trail. What are your thoughts?
Dr. Otter (Scripps): It depends on what you can afford automationwise as well. Having just gone through a cyberattack, I can tell you automation is one thing. You still need to have people do a lot of the work, and especially at the lower end of the pay scale. Automation often takes people out on the lower end of the pay scale, but you still need to transport your specimens and you still need people to accession your specimens. You may have automation, but in particular in anatomic pathology, that doesn’t always work that well. It’s a two-edged sword, and I would say it can go either way.
Stan Schofield, can’t IVD folks help solve some labor problems beyond providing automation? That is, should they be able to offer packages of machines and technicians? Would that help?
Stan Schofield (MaineHealth): The idea is perfect, but by the time they would mark it up, it wouldn’t be affordable. And they can’t find the people now to begin with. So, yes, we’re kind of getting to the end with automation, unless you have more scope and scale and a critical mass.
Look at microbiology, for example. We’re a good-size microbiology lab, but it’s not enough to have a decent return on an investment of $3 million or $4 million worth of capital, which is nothing compared to some of the systems. The chemistry, immunoassay, hematology lines are all okay, but we still don’t have integration of full robotics. That would help. The last big area is microbiology, and there are not many choices and those choices are really expensive. So, going forward, the justification for that is almost whether you want the service, because I can’t get the bodies.
Having IVD companies hook up equipment and people is a great concept, but I don’t think they’ll ever do it. And you know what that’s called? Quest and Labcorp. Our instruments and our people, and we own you now.