Where Is Everyone?

Vacancy rates are on the rise throughout the laboratory professions. A recent report from the American Society for Clinical Pathology (ASCP) revealed rates of unfilled roles ranging from seven to 18 percent across lab disciplines—a significant increase from 2020 throughout.¹ Not only that, but with expected five-year retirement rates ranging from 8.7 to 19.6 percent, it’s concerning that some departments are seeing hiring timelines of over a year for a single position. But why is staffing such a challenge for the clinical lab—and what can be done?

The pipeline challenge

“I think the issues with retention in the lab are multifactorial,” says Casey Schukow, a pathology resident at Corewell Health who is active in outreach and advocacy for lab-based careers. “The pandemic accelerated pathologists’ retirement and rates of burnout—and I fear that many pathology and laboratory medicine departments are still facing workflow challenges.” That’s undeniable, with ASCP studies revealing that 71.4 percent of pathologists and 85.3 percent of other laboratory personnel reported having experienced burnout in their work, with about one-third of pathologists and half of other personnel reporting burnout as a current issue.^2,3 Schukow continues, “High volume plus low labor supply essentially means that pathology and laboratory medicine personnel in many departments may have to now perform the work of two or three people by themselves, which can be exhausting after some time (especially as specimen volume has returned, or is returning, to pre-pandemic levels). Long story short, although the job market looks great from the outside, there are many questions pathology and laboratory medicine departments face that challenge their ability to recruit and retain competent, excellent professionals who can provide superior patient care while maintaining a healthy life-work balance.”

Generating interest in the lab

Schukow is optimistic that tools such as social media are helping interested applicants connect with pathology programs and residencies, but has found that raising awareness of the clinical laboratory as a career option remains an obstacle. As a result, he is a strong advocate for better exposure in medical school—and even earlier. “I had no idea about pathology and laboratory medicine until after I graduated from medical school and began my medicine (transitional year) internship. We need to reach out to high school and university students—this must be our target population for recruitment efforts moving forward.” This perspective motivates Schukow’s own work, which includes organizing the Pathology Outreach Program (POP), which visits high schools in Michigan and Illinois to showcase clinical laboratory careers and follow up with interested pupils, and supporting innovative pathology interest groups that promote the laboratory to medical students.

The benefits of a lab career are wide-ranging, from the ability to engage in clinical research to the knowledge that each result has a meaningful impact on a patient’s life. But Schukow notes that, to attract new recruits, it’s time to get back to basics. “This may be blunt, but I think there is much truth behind it: what do people want to know about any career? Salary, average work hours, practice conditions (including remote options), benefits, and purpose. Perspectives on careers have evolved to place a higher emphasis on life-work balance and self-care, which is good for the future of patient care. I know that healthcare professionals have historically faced high rates of divorce and long-term health consequences such as cardiovascular disease; I believe we are at a point in time when we can provide superior patient care and trainees can learn the necessary skills to become competent professionals without sacrificing their mental or physical health.” For him, the issue hits close to home. “I don’t want my future kids to see their father have a heart attack at 40 because of excessive work-related stress. This is an honest fear of mine that future colleagues may share.”^4,5 Schukow also points out that the rising cost of living and the lack of corresponding salary increases, especially for trainees and early-career employees, may discourage otherwise interested students from pursuing a career in the lab.

Recruiting and retaining

“For recruitment, we must go where the next generation of professionals are, both on virtual networking platforms like social media and in person at their schools,” says Schukow. “For retention, pathology and laboratory medicine departments must create cultures of honesty, integrity, and workplace comfort. Medicine is a team sport—no less so in the clinical lab. Departments with positive, uplifting cultures that promote healthy communication and collaboration between employees and leadership will thrive. Those with cultures of hostility stemming from abusive power relationships, poor healthcare culture, or inappropriate perceptions of hierarchical relationships between leadership and employees will face retention issues.”

The ASCP notes multiple reasons underpinning recruitment challenges, including a loss of educational programs, low salaries relative to other career options in research or allied health, perceived levels of stress or danger, and more.⁶ Adding to this, the American Society for Clinical Laboratory Science outlines retention challenges that include retirement, practice changes, high demands placed on lab staff, and limited options for career advancement.⁷ COVID-19 also continues to affect the industry, with clinical lab professionals reporting even greater challenges and shortages after the rise of the Omicron variant of SARS-CoV-2.⁸ It’s clear that new ways of thinking are needed to engage future generations of clinical lab professionals, make training and education more accessible, and create attractive career opportunities.

“If we want pathology and laboratory medicine to be great—not just good, but great—then we need to think about the here-and-now-and-future (i.e., Generation Z), and not the past (i.e., before the pandemic),” says Schukow. “This can only happen if we as a laboratory community think progressively and flexibly about the field and work with each other on an equal footing. Younger generations may not know as much about the diagnostic practice as older generations, but they may be keener to engage with new technologies or have better insight into what future generations of professionals may need to succeed. We must work together to keep the future of this field bright.”

References:

1. Garcia E et al. The American Society for Clinical Pathology 2022 Vacancy Survey of medical laboratories in the United States. Am J Clin Pathol. 2023:aqad149. doi:10.1093/ajcp/aqad149.
2. Garcia E et al. The American Society for Clinical Pathology’s job satisfaction, well-being, and burnout survey of pathologists. Am J Clin Pathol. 2020;153(4):435–448. doi:10.1093/ajcp/aqaa010.
3. Garcia E et al. The American Society for Clinical Pathology’s job satisfaction, well-being, and burnout survey of laboratory professionals. Am J Clin Pathol. 2020;153(4):470–486. doi:10.1093/ajcp/aqaa008.
4. Eckleberry-Hunt J et al. Is medical education ready for Generation Z? J Grad Med Educ. 2018;10(4):378–381.doi: 10.4300/JGME-D-18-00466.1.
5. Elenga N, Krishnaswamy G. A new generation of physicians—the Generation Z. Are you ready to deal with it? Front Public Health. 2023:10:1015584. doi:10.3389/fpubh.2022.1015584.
6. American Society for Clinical Pathology. The Medical Laboratory Personnel Shortage (Policy Number 04-04). https://www.ascp.org/content/docs/default-source/policy-statements/ascp-pdft-pp-med-lab-personnel-short.pdf.
7. The American Society for Clinical Laboratory Science. Addressing the Clinical Laboratory Workforce Shortage. https://ascls.org/addressing-the-clinical-laboratory-workforce-shortage.
8. Rohde RE. The omicron variant is deepening severe staffing shortages in medical laboratories across the US. January 19, 2022. https://www.clinicallab.com/the-omicron-variant-is-deepening-severe-staffing-shortages-in-medical-laboratories-across-the-us-26190.