Lab workforce crisis takes top spot

To address the more immediate problem of staff shortages, the New York State Clinical Laboratory Association is supporting what it calls a “laboratory cleanup bill,” which will allow licensees with a degree from a national accredited program and a passing grade on the ASCP medical technologist exam to qualify for a New York State license. “And then we can hire them,” Dr. Aita says.

The association’s first priority this year is to advocate for a proposed update to state regulations and get it through the approval process of the Department of Education and the regents in New York, who oversee the state’s educational requirements, Dr. Aita says. The proposed rule changes would allow New York to recognize out-of-state degree-granting programs.

“Second is the lab cleanup bill, which will allow for other avenues of career advancement,” she says. For example, rather than having to quit work to return to school and get a four-year degree to get a license as a technologist, a laboratory technician would have a pathway to use their two-year degree and take classes part-time to finish their four-year degree. “We do have a number of technicians who go on to finish their bachelor’s degree. And this lab cleanup bill will provide a pathway for that.”

The bill has the support of the health care workers union 1199 SEIU and many others. “Everybody is on board with getting these things through. So I’m very optimistic,” Dr. Aita says.

In New York City, the severe workforce shortage has led at least a few laboratories to resort to putting existing staff on three-day-week 14-hour shifts to cope, says Glen S. Markowitz, MD, vice chair for anatomic pathology at Columbia University Irving Medical Center (CUIMC). CUIMC is not among those that have done so, but for other laboratories it’s just one of the tactics—along with hiring bonuses, aggressive salaries, and retention bonuses—used to compete with other institutions for the too-small pool of potential candidates.

It’s concerning to Dr. Markowitz that even aggressive measures to raise salaries have not mitigated the problem, and that “we are beginning to hear about institutions and private labs with prolonged delays in histology turnaround time that exceed CAP guidelines.”

Dr. Markowitz is not optimistic that automation of histology will fill the workforce gap in the near future. Although a good automated system may be less than a year away, he says, mass production of those systems will take significantly longer.

“The quickest way to fix this critical problem is to consider loosening the licensure requirements,” he says. “Probably 25 percent of histotechnician positions in New York are unfilled with little potential to fill them. Many of our histotechnicians have two jobs. And it doesn’t matter if we are their first or second job; they’re exhausted.”

The shortage of histologic technicians is, in a way, a byproduct of licensure, because the required training means medical technologists are not trained to be able to step into the field. “They don’t teach histology anymore in medical technology programs, and there’s no interest on the part of medical technicians or technologists in moving over to a field they’re unfamiliar with,” says Doreen Hebert, PA(ASCP), MHS, CUIMC division administrator for anatomic pathology. She adds, “I know there’s a national shortage for histologic technicians, but it’s more prominent in New York because of the licensure requirement.”

A side effect is that overworked histotechnicians have no bandwidth to train students doing clinical rotations, Dr. Markowitz says. “If we have 30 people doing the job of 40, we can’t pull one or two of them off to train a college student. We’re just trying to get the work done every day.”

With more flexible rules, he thinks the problem could be eased. In fields that are built on apprentice frameworks, for example, people in training can work under the license of their supervisor in the laboratory, Dr. Markowitz says, and that’s a model that could be considered for histotechnicians. “A potential short-term solution would be to allow experienced, licensed histotechs, particularly supervisors, some limited capacity to train people on the job—people who don’t necessarily have the required college degree.” Dr. Markowitz says many excellent histotechs working in New York now were trained in this manner, before the current licensure requirements were established.

“Cutting a block, fixing the tissue on a slide, and staining does not necessarily require a college degree,” in his view. “You need to be highly skilled in this delicate craft, to be attentive with respect to specimen identity and established protocols, and devoted to the care of patients. These skills and characteristics don’t necessarily correlate with level of education. If we could consider limited, highly supervised on-the-job training, we could potentially fix or at least ease the problem.”

Doreen Hebert agrees that reform of licensure is a necessity. Without that, “I don’t see how we can change the current scenario.” But in addition, since states other than New York are having problems as well, “Instead of being so much behind the scenes, we need to go out and publicize what we do and what a great career option it is.”

Says Dr. Aita: “It’s a shame that we don’t have a bigger presence because a medical technologist job can be a springboard to a lot of careers. You can work in diagnostics, work for vendors, get into instrumentation, or work in the pharmaceutical industry where so much is being developed for personalized medicine. Given the opportunities for career advancement with a background in laboratory science, the sky is really the limit.”

The consortium Dr. Crawford leads is working directly with the New York State Clinical Laboratory Association, the Greater New York Hospital Association, and the Healthcare Association of New York State to advocate for change at the state level. The lab cleanup bill is the statutory fix. It now has sponsors in the state Senate and in the state Assembly. But the regulatory fix is more meaningful, Dr. Crawford says.

It’s also crucial for the pathology profession to support laboratories’ training programs “because this is the bottleneck,” Dr. Crawford says. There is a downward spiral when overworked laboratory staff can’t help train students because there’s no time for labs to offer the required clinical rotations, he says. This leads to further shrinking of training programs and then to worse shortages and more overworked laboratory staff. “Walk into any histology laboratory, any blood bank, any clinical laboratory, and you’ll see the stress,” he says. To reverse the spiral, “we have to make our laboratories available to the accredited programs so they can place their students there.”

“We have an opportunity that has emerged from the pandemic, because laboratories were publicized in a way they had never previously been in our professional lifetimes. We need to follow through. Get to school counselors. Get the pathology leadership and our medical technologist leadership out to the STEM educational programs.” A team from Northwell has done an exceptional job, he says, of showing high schoolers the career opportunities they have in laboratory services; other laboratories are doing the same. “We need to make these career opportunities more visible and more clear.”

Drawing upon his experience as a bagpiper, Dr. Crawford likens this mandate to something that marching band members do. “If you’re in a parade, and it’s your time to go, you step off. Well, we need to step off to publicize the laboratory profession. Let’s learn from one another and make some noise. Those creative programs that are doing so have wonderful stories to tell. Let’s share these stories across the entire industry. It is time to actively recruit into our profession.”

Anne Paxton is a writer and attorney in Seattle.