Salaries, schools, students—all eyes on workforce

Next week we’re going to simplify our build within Epic—we will be standardized to Cepheid’s SARS-CoV-2/flu/RSV test at all of our laboratories for symptomatic patients. We will have a separate test code for SARS-CoV-2-only testing for those who may be traveling or contact tracing. Within our Cepheid order, the provider can select the analyte or analytes they’re interested in. Although the analyzer will run all four targets, our team will only result the analytes ordered.

A frequent question is what to do with positive results from tests not ordered. I’m wondering what others are doing with those results.

John Waugh, what are you doing at Henry Ford?
John Waugh, MS, MT(ASCP), system VP, pathology and laboratory medicine, Henry Ford Health System: We have order sets that are together so physicians see what is in the order set when they create the order, so we’re not coming back behind them and we did that intentionally. We did not want, for example, RSV orders to accompany seasonal influenza last year or COVID testing. We’re billing and reporting only on what was ordered at that time.

We now have a mandatory vaccine policy and it has a September 10 date on it. We’ve seen our share of protests at five hospitals, and we still need about a quarter of our employee population to get vaccinated in a short period.

I’m watching a couple of leading indicators here: Are the employee health clinics packed with people going in there to get their vaccinations, and if they have a two-dose system are they getting in there in the next couple of weeks or so? The other leading indicator I’m watching is whether people are drawing down vacation time banks, maybe in anticipation of leaving the organization.

From the start our organization has taken the position, it’s your choice, your decision. You don’t have to divulge your vaccination status unless you choose to do so. There have been a lot of listening sessions—tell us what’s on your mind, what your concerns are. That has helped move the needle for some, but others made up their mind early and are cemented into a position. So this is a polarized situation and not unique to Detroit.

We have stopped presurgical testing of vaccinated patients.

Let me turn now to a topic we spent time on in our call last month—staffing and the economics that get pulled into it. I’m assuming the headlines don’t make a laboratory or hospital a more attractive place to go work, and I have to assume the financial incentives are still first and foremost in people’s minds. Stan Schofield, is that true in your experience now?
Stan Schofield (MaineHealth): Absolutely. We just rolled out our new comp program and we’re waiting to see the results. The approximations are eight to nine percent for lab medical technologists and up to 15 percent for phlebotomists. Unprecedented numbers but it’s not just the lab—the entire health system rolled out more than $65 million in comp adjustments. Of 23,000 employees we have 3,700 openings at the system level, and of them more than 800 nurse openings. We’re not alone in this. We’re doing a big hiring blitz and having a job fair next week to promote the new wage package. For the people who left in the past three or four months, it is all about money. I can confirm that.

Is the shortage now so serious that they’re saying despite the reimbursement, revenue, bottom-line conditions, we need to increase wages because if not we won’t be able to pursue our mission?
Stan Schofield (MaineHealth): That’s part of it. The other part is we didn’t get any slack on the budget requirements. The financial requirements of the system haven’t been waived, we’re not getting much relief, and it will be an interesting year if PAMA comes in with a full cut. We’ve always been a successful, strong financial performer. We’ll just have to see. We budgeted a low COVID testing volume for the year because we weren’t sure. If this surge continues, it’s only going to help us financially but it’s not going to help us operationally with staffing.

Dwayne Breining, talk about the labor and financial issues and the pressure to continue offering service at the level you do.
Dr. Breining (Northwell): It’s similar here. Even before COVID we were seeing a steady increase in the number of open positions. I think New York has an older workforce than much of the rest of the country, so it’s even worse. And there are four or five big medical systems fighting over the same labor force, so there’s a bit of an arms race mentality as well. We just offered a new comp regional salary base and ideas to keep ahead, so that’s going to keep spiraling.

COVID has led a lot of people to consider their work-life balance. Some of those who had extended their careers well past the time when they were eligible for retirement have rethought that. And a lot of our techs juggle two and sometimes three jobs. It’s a buyers’ market; they can work as much as they want. And a lot of people are considering that work-life balance and whether they want to continue doing that. It’s good for them but bad for us in terms of keeping the lab running at the current rates.

Steve Carroll, does this labor crunch sound familiar to you?
Dr. Carroll (MUSC): We have been fighting over labor for months. Like others, we were seeing problems before COVID but COVID seems to have kicked it into overdrive. And it’s across the board; it’s virtually every kind of position. We have shortages in microbiology and hematology. HLA was a problem; histotechnology is a major problem now. And a big part of it is salaries. We had not been paying at the level of some of our competitors so they were recruited away to community hospitals. We were paying them lower wages to do a harder job and that’s not sustainable. So I had to make the case that we have to get our salaries up, and we’re in the process of doing that.

The other thing long term is the pipeline. Training programs have been contracting across the country, but if we don’t have people coming through those training programs, we’re going to have real long-term problems. So I’m now making the pitch that we have to reinstitute many of these programs. Every time we do a CAP inspection the pathologists at the places we’re inspecting ask me why we’re not training these people. They have a point—we have a responsibility to do it.

The training pipeline problem seems to be a nationwide one.
Dr. Breining (Northwell): We are opening a medical technology training program with Hofstra where we opened the medical school a few years ago.

Right before COVID we had started a community outreach type of thing. We had always been involved with the high school students, but we realized by high school a lot of students have already decided to forgo math and science. So we reached out to every middle school science teacher to invite them and their students to come through our new, shiny, state-of-the art laboratory for tours. Our team was great; they had kids learning how to do point-of-care testing and other such things. It was phenomenal, well received, and then COVID hit so it was put on the shelf. We’re hoping to start it up again, but with what’s going on with delta, I think we’re going to be waiting a few more months.

Barron’s this weekend had a cover story on how the U.S. is going to be in for a long-term labor shortage. Is training within our own systems going to be adequate, or do we need a change in paradigm about the career, the career path, and the eventual outcome of that kind of employment?
John Waugh (Henry Ford): We’re looking at reopening our school of medical technology. It’s a long road but I think it’s essential, as Dr. Carroll said, that we train people in these fields. We have the capacity to do it, and we’ve done it before. It’s challenging, but I’m not about to give up the field of pathology and laboratory medicine lightly. It’s an essential resource for the health system. We started this process pre-COVID; it got stalled and I’ve got it back on a restart. But there are not enough qualified people coming forward, unfortunately. I don’t know if that fully answers your question, Bob, but that’s some of our situation on the ground.

That does answer my question in the following way: You can open all the medical technology schools you want to, but if the word of mouth about the profession is that you’re going to be underpaid and overworked and don’t have a nice career path for promotion, it might all be in vain.
John Waugh (Henry Ford): You’re right, but I don’t know that we have any other choice but to try. If we continue to have shortages and we hire as we’re doing in some respects now—we’re hiring agency people to fill positions at big premium pay, and we have an international relationship whereby students are trained offshore—the price is going to get higher.

Market adjustments are not hard—all you need is money. But there are a lot of people standing in the money line with us on this one. At the executive level of our laboratory team, I have to fight hard to make the case, and not just hope, that somebody recognizes our people.

We’ve spoken often about the silos and splintered groups we have in the field of pathology and laboratory medicine. We have the IVD vendors on one side. We have multiple laboratory organizations, each pursuing important agendas of their own for their own memberships. Sterling Bennett, do you think there’s a need for more coalition building to help solve some of these problems like labor?
Sterling Bennett, MD, MS, senior medical director, pathology and laboratory medicine, Intermountain Healthcare: Yes, there’s a need for more coalition building. It’s unlikely we’ll see a consolidation of the organizations because, as you said, they exist for certain reasons, but I do think they could cooperate and join in unified efforts that might help us get through the current situation.

Stan Schofield (MaineHealth): A great example of cooperation is the Compass Group, but we can’t solve each other’s staffing and training problems. It’s going to take legislative and financial relief to make the career path financially viable against the high costs of a college education and the debt that comes with it. But hospitals and health systems don’t have the money—there’s just too much cost that’s not being covered operationally and financially by the patients and the insurance companies and the government. It’s a tough combination, and the government doesn’t want to pay more because it is paying too much now. And the private insurers are tired of the cost shifting, so they’re not going to do anything to raise operational expenses by higher reimbursement to pay higher salaries.

Greg Sossaman, would you like to comment on this issue?
Dr. Sossaman (Ochsner): Not to disagree with Stan, but I do wonder about the ability of the larger health systems, like the groups on this call, to partner with local community colleges or other universities for training programs. We partner with our academics group here, which established a training program for physician assistants at a local university. They saw an opportunity to talk to university students who were interested in perhaps medical or pharmacy school but probably weren’t going to make it into those graduate schools and to divert them to other kinds of programs. With that in mind, we are partnering with them to help them start an MT school. Things like that are opportunities in our larger systems. We know we’re going to need to make our own. So I think and hope there are other opportunities.

Looking for additional funding from the government is problematic. The advocacy that many of the large organizations like CAP do is aimed at reimbursement for physicians and other services—the clinical lab fee schedule, for example. The educational dollar piece has been left out for many years. There’s a well-known retirement cliff that we’ve already gone over in many areas. I know we have. I do think it would be wonderful if some of the larger organizations could come together to focus on this issue in a much larger way. A group like Compass has a lot to add to that, too, because many of our members have done the things we’re looking to do. Those are creative and valuable solutions.

Sam Terese, you’ve done a lot to help train people to work at Alverno, and you have an eye and an ear for a lot of different systems and the overall economic problems that Stan Schofield described. Give us your impressions about the discussion we’re having.
Sam Terese, president and CEO, Alverno Laboratories: We have two medical technology programs, an MLT program, and a histotech program. We’re adding another medical technology program. We have programs for training biology-degreed–level people to be technologists. So we are doing as much as we can to add to the labor pool on the supply side.

On the demand side you have to ask if the lack of labor is going to drive consolidation. This is not just a laboratory question. Go across any number of industries and you’ll notice that the hours are aligned to an eight-hour day, because that’s all the labor we have available.

There’s just not as many people, like those who had been extending their work lives into their 70s but who have now changed course because of COVID. I wonder what is going to happen on the demand side, the need to reduce and where it will be felt. My fear is that it will be felt more in rural health and we’ll see accelerated closure and disparities of care based on zip code. It’s a concern on where we’re headed.