Charna Albert
August 2022—Higher wages help to fill open positions, when they can be offered, but in a labor market that’s as tight as ever, they’re often just a start. That’s why many laboratories are casting wider nets, though the hiring solutions tend to be long term.
“We’re all in the game, doing what we can to try to attract the best people,” Michael Baron, MBA, executive director of clinical laboratory operations at Wisconsin Diagnostic Laboratories, says of salaries, sign-on bonuses, and benefit packages. “But at some point we can only afford it so much. A position only brings so much value to an organization. When the cost of that position is more than what you can get back from it, that’s your limitation right there.”
He and others are looking past the traditional to alternatives. “I found that hiring a certified person is not always the best candidate. It’s truly about the person,” Baron says.
Wisconsin Diagnostic Laboratories, owned by Froedtert Health, serves more than 40 hospitals, 900 long-term care facilities, and 200 physician practices in Wisconsin and Northern Illinois. Though Baron says the technologist shortage at WDL isn’t dire—the 460-employee laboratory had 20 to 30 unfilled tech positions in June—he calls WDL’s new training programs a necessity, “because of the lack of candidates we were getting through the traditional approach.”
An MLS apprenticeship program with the state of Wisconsin, which began in January of this year, is open to candidates with a four-year degree in the sciences from an accredited college or university. The apprentices are trained on the job as they take two semesters of classroom instruction at Milwaukee Area Technical College, “so they’re working on the bench off the bat,” Baron says. As the students complete training, they’re eligible to work in the laboratory full-time as non-certified technologists and sit for the ASCP certification exam, which they’re expected to take after one year and before 30 months of the time they begin work. But they’re encouraged to take the exam sooner, Baron says. “The longer you wait, the more you forget.” And once certified, they’re eligible for an MLS level-one position within the laboratory, which comes with a salary increase. “There’s no guarantee they’ll pass,” he says, “but our instruction is to ensure they’re successful—that’s what we’re all about.”
Two apprentices began their classroom and on-the-job training this year. Baron calls them “functional techs,” who are “trained on the bench and confident.”
Baron began exploring options for a new technologist training program about two years ago, first approaching Milwaukee Area Technical College about a partnership. “They were having trouble getting instructors to support it, and then they reached out to the state of Wisconsin” about incorporating clinical laboratory science into the Department of Workforce Development’s Wisconsin Apprenticeship program, he says, noting that the state was interested already in adding to its science-related apprenticeships. Though WDL is the first and only organization to date to take advantage of the program, it’s available to laboratories statewide, and Baron expects others to sign on.
The laboratory’s MLS level-two employees train the apprentices in addition to their other work, Baron says. “Initially they weren’t accustomed to teaching as much as they are, but that’s the nature of the role now and of the world we’re in.” Some trainers have argued that the apprentices lack the background knowledge required for the job. “We kind of put the cart before the horse, in a sense, in that we brought people in before giving them the classroom,” he says. “But we had an urgent need to get staff in here. So there’s pressure on the bench tech or trainer to give more background initially, but they will catch up.” As the program becomes further established, he expects to develop a schedule that will better time the classroom instruction and benchwork.
The students aren’t required to remain with WDL after training or to compensate the laboratory should they decide to work elsewhere. Rather, he says, “we’re looking at giving them incentives to stick around.”
WDL employs a recruiting firm and is exploring different ways to fill the program’s ranks, such as attending local job fairs, conducting its own job fairs, and building relationships with local colleges. Attracting recent college graduates with degrees in the sciences isn’t difficult, Baron says, noting that the students’ other options, such as working in a research laboratory, often pay less than clinical work and may be only vaguely related to the students’ interests and experience. “So we garner a lot of interest. We’ve had no problem finding people who are straight out of college, motivated, and looking for some type of work in the science industry, and we can sell it easily in terms of giving them career certainty.”
In addition to the apprentice program, WDL is retraining non-certified technologists from within its own ranks, Baron says, with nine now in training. “We’ve been able to fill our ranks quickly in the core lab, which includes chemistry, hematology, coagulation, and urinalysis, and we’ve also been using this program in the microbiology areas” and in histology within the anatomic pathology department. Unlike the students in the apprenticeship program, the non-certified technologists receive classroom instruction on site at WDL from a trainer hired for that purpose, he says. “They’re meeting three times a week for two hours and the trainer’s providing instruction that she’s developing using CLSI guidelines and also what they recommend for CAP accreditation.” Once the technologists have completed training and passed the ASCP exam, they’re eligible for an MLS level-one position within the laboratory and a salary increase.
[dropcap]S[/dropcap]anford Health doesn’t have a formal histotechnologist training program, but the laboratory, which has sites in Fargo and Bismarck, ND, Sioux Falls, SD, and a fourth in Bemidji, Minn., has developed a way to train and funnel non-certified technicians and others into histotechnologist positions. “Since 2018 we had noticed a lack of applicants with formal training in histotechnology and a certification,” says Amanda Steier, HT(ASCP), laboratory manager of anatomic pathology at the Fargo site. After the lab had several applicants who satisfied ASCP “route two” education requirements train on the job and become certified, “we created a career ladder of sorts,” Steier says.
Sanford created a position called pathology technician, for those with four-year degrees who could perform some high-complexity testing without certification. The pathology technicians are hired on for two years, she explains—one to train and then another to study and sit for the ASCP board exam. Once they complete training and pass the exam, they’re promoted to histology technologist and receive a pay increase. “We don’t have a formal curriculum,” she says. “They just take the textbooks or other study materials we have to offer or do their own independent study.” Though the lab had six open histotech positions at CAP TODAY press time, that’s rare. “It’s been four years since we’ve had a resignation. We’ve had good success with the on-the-job training route.”
Sanford runs its own NAACLS-accredited MLS program, which produces a few graduates each year. But there’s no longer any local histotechnician program, with two having closed in the past five years. The lab also is affiliated with the University of North Dakota, which has an online histotechnician program, and three students from that program have completed their clinical work at Sanford since 2017, Steier says. “So we’ve had a combination of people who work, train on the job, or attend an online program, and some who just study independently to take the board exam.”
The lab could consider formalizing its histotechnology training efforts into a structured program, says Steier and Zahra Maqsud, HTL, QIHC(ASCP), histology supervisor, either by partnering with Sanford’s MLS program or with the university’s histotechnician program. Though there’s no classroom instruction component now, they’ve taken steps to organize the training curriculum over the past year, including giving the bench techs who are providing training the opportunity to take a formal precepting class. Says Steier: “We’ve found there are some techs who are more willing to do the training and are more open to having someone work side-by-side with them and shadow them. So we try to identify two to three of those people, who then take a formal precepting class at Sanford.” After completing the class, which is a half-day online course offered by Sanford as part of its continuing education curriculum, the trainer-techs receive a small pay increase throughout the time they spend one-on-one with students. Three trainers have completed the precepting course thus far.
The trainers have checklists of the competencies the students must learn, Steier says. “Between the new tech and the preceptor, they go step-by-step through it and then initial and date when the training happened. We start with embedding first and when they’re competent in that they move on to microtomy.”
Though the pathology technicians aren’t committed to Sanford after completing training, she says, “we haven’t had an issue with people not meeting that two-year expectation.” It helps, she notes, to hire those with ties to the area and community, “especially being where we’re located. That’s why we’re hiring people on the job. They want to stay at Sanford or in the area and they want to grow their career, but they don’t necessarily want to go to graduate school. They’re looking for an opportunity to stay where they are but grow.” They’ve had success in recruiting candidates from within the lab also, particularly from phlebotomy.
But competitive wages, too, would help, and “histotechs are underpaid everywhere,” Maqsud says, which affects career-related decisions. “If you’re looking at different programs, like a histotech program, or an MLS program, of course you’re going to think about the future. And if you see that histotech wages are lower than MLS wages, even though you’re doing the same education, you’re going to go a different route than histology.”
[dropcap]H[/dropcap]NL Lab Medicine in Allentown, Pa., began working with Health Carousel, a staffing agency, about a year and a half ago to recruit technologists from overseas. At the time, the laboratory had opened two new hospital-based labs and had 25 technologist openings, says Joshua Kubat, director of human resources. “We were looking at short-term solutions—what can we do right now to get by—but also what can we do long term to try to solve this problem of more medical technologists retiring than coming into the field,” Kubat says. “Once I reached out to them [Health Carousel] and looked at their program and what they had to offer, it made sense both from a financial aspect and in terms of building a pipeline for the future.”
“If you need someone tomorrow,” he says, “you’ve got to look at a different avenue—this isn’t that.”
One technologist has arrived in the country thus far from the Philippines and begun work as a generalist in the laboratory’s automation department, Kubat says. HNL has agreed to hire seven additional technologists, who now are in varying stages of the immigration process. The biggest delay has come from the embassies. “It seems they’re very backed up due to COVID, and that’s not something we can control.”
In the interim, he says, Health Carousel has provided the laboratory with three short-term domestic workers, and they expect a fourth to begin soon.
The interview process for the overseas candidates was “fairly seamless,” Kubat says. “Our managers were able to get a good feel for the applicants’ skills and the type of lab they’re working in now.” Interviews were conducted virtually and consisted of two rounds—one with human resources and another with the management team for the lab section that was hiring. The laboratory’s biggest need is for generalists, he says, “so we were looking at hematology, chemistry, coagulation, and blood bank.” Everyone interviewed had at least two years of experience.
The language barrier “was one of our concerns going in,” he says. “How hard is it going to be from a communication standpoint? But for everyone we interviewed, you wouldn’t have known the difference.” The technologist who has arrived already “obviously needed training on our instrumentation and the way we do things but picked it up seamlessly. They’re done with training and are working in the lab.” Some of the candidates are coming from laboratories much smaller than the HNL lab, he says, pointing to a potential difficulty. “Just think, you’re moving to a new country, everything is new, and you’re walking into a laboratory that’s probably 10 times the size of the lab you were in previously.”
Though the daily rate the lab pays Health Carousel exceeds the cost of hiring employees directly, “when you take the benefit costs and the costs of recruiting out of it, and maybe a sign-on bonus and everything else—and your lab is now properly staffed because of people coming internationally—you’re probably saving money in the long run,” Kubat says.
HNL is filling technologist positions with an on-the-job training program, too, for those with the required education. “We’re looking at internal talent and also recent college grads. You have to—the talent pool is so small.”
[dropcap]H[/dropcap]ealth Carousel began recruiting medical professionals from outside the U.S. and easing their immigration in 2004, working primarily with registered nurses and physical therapists. The company began recruiting medical technologists in 2010, and since then has placed about 75 in laboratories throughout the U.S., says Erik Schumann, MBA, chief operating officer. More than 100 have completed the credentialing and immigration processes and are being interviewed by Health Carousel customers (and can be in the U.S. within 12 months, he says), and the company’s goal is to triple that number.
Health Carousel works predominantly with acute care hospitals, Schumann says. “And those health systems typically have their own lab requirements. Oftentimes the relationship starts from us working with a potential customer for nurses,” which then extends to the laboratory.
The company, which has about 35 laboratory customers, handles all aspects of the immigration and visa process, he says, and determines that applicants have the proper credentials and licensure. All applicants must have their ASCPi or AMT certification to apply. Health Carousel assists applicants with the VisaScreen credentials assessment, which includes an evaluation of the applicant’s education, verification that all professional health care licenses the applicant holds are valid, and an English language proficiency exam, for which the company helps applicants prepare. “The goal is to make it easy for the health care professional and the organizations we work with,” Schumann says.
Laboratories that use those services are guaranteed a three-year placement. The technologists are employees of Health Carousel during that time, but about 85 percent convert to full-time employees for the organization in which they’re placed after the three-year assignment has ended. The other 15 percent tend to move to another location in the U.S. to find work, he says. Customers pay a per-hour work fee, which varies by the U.S. Department of Labor’s prevailing wage for the geographic area in which the customer is based and the area’s cost of living. “The hourly rate we charge the health care provider is all-inclusive,” he says. “It covers all required taxes, insurance, benefits, licensure, and immigration costs.” The company operates in all 50 states.
The technologists from abroad are recruited primarily from the Philippines because the curriculum there follows the U.S. model and applicants tend to have high levels of English proficiency. All applicants complete a standardized profile indicating in what lab units they have experience. “During the interview, the client can probe to see if they have the necessary skills and explore different aspects of their experience,” Schumann says. “But we do focus on nine lab areas, including hematology, histology, blood bank, micro, urinalysis, and others.” There’s no limit on the number of technologists a lab can request, he says, but three to five per lab is typical. The full recruitment-to-placement process takes about 18 to 24 months.
When the placement isn’t a good fit, “we try to address the issue before it becomes an issue,” Schumann says. Health Carousel has a clinical team and employee supervisor specialist who works with the technologists. “So we first try to remedy the performance. Or there may be a cultural issue, or sometimes it’s a fit between the employee and their manager.” Customers are guaranteed three years of work even if the original placement isn’t successful. “We give them [the customer] access to our pipeline of other available candidates, and we can also backfill that vacancy in the meantime with one of our short-term med tech travelers.”
Health Carousel is a member of the American Association of International Healthcare Recruitment and approved by the Alliance for Ethical International Recruitment Practices. The company secures living accommodations for the technologists and encourages applicants to bring their families to the country with them, Schumann says. “We have an entire program built around the financial, social, professional, and personal well-being of the health care professional.” All that is important to consider when choosing to work with an organization that does foreign recruitment, he says. “You need to be thoughtful about how you bring foreign-educated professionals to the U.S. We have a program designed to properly onboard not just the health care professionals but also the customers we serve, to ensure they’re adequately equipped to support the foreign-educated professional.”
Charna Albert is CAP TODAY associate contributing editor.