Out with the Old: The 2024 Clinical Lab Experience

Over the past few years, clinical laboratory medicine has been in transition. Along with the progression from analog to digital and now algorithmically aided workflows are changes affecting the body of lab professionals itself. The estimated 344,200-strong US clinical lab workforce,¹ still recovering from facing one crisis—the COVID-19 pandemic—is being pressed on all sides by many others. Job satisfaction is being overshadowed by high levels of stress and burnout² while well-documented shortages are likely to be fueled further by large volumes of expected retirements and a limited influx of new personnel—leaving two vacancies unfilled for each laboratorian hired.³ How did these challenges impact lab professionals in 2024 and what should the field expect moving into the next year?

A year of continued challenges…

The severe lack of qualified medical personnel—particularly the decades-long shortage of medical laboratory professionals—continued to pose a challenge in 2024. Rodney Rohde, chair of the Medical Laboratory Science (MLS) Program at Texas State University, and Angela Tomei Robinson, clinical advisor and laboratory advocate, explain:

“Short staffing causes stress, burnout, and affects the turnaround time and quality of patient care, especially where outsourcing is overused. Hiring also continues to be costly for facilities that are forced to continuously train and retrain new employees due to high turnover rates.”

To counteract the outflow of laboratorians who are retiring or leaving the discipline, labs looked to bring in new laboratory professionals. However, in some cases, the focus was on quantity rather than quality. “We know that there are improved quality standards of care when laboratory testing is performed by qualified, board-certified medical professionals,”⁴ Rohde and Robinson say. “A major recent concern has been the short-term misguided hiring of less qualified personnel who do not have the educational curriculum and clinical internships that would give them the clinical knowledge and technical skills needed to perform accurate, precise, high-quality laboratory testing,”

Alongside these short-term solutions, Rohde and Robinson highlight the problems affecting MLS educational programs. “A key issue that continues to hinder the growth of MLS academic program numbers for college majors is the difficulty of obtaining clinical placements for our students in hospitals and reference laboratories,” they say. “Likewise, the consolidation of key areas—microbiology and blood bank—places stress on academic programs to admit higher numbers.”

…and progress

But 2024 did see improvements as well. “Fortunately, increased media attention brings public awareness,” Rohde and Robinson say. “Coordinating health and career fairs, summer immersion and volunteer shadowing programs, and innovative high school science curricula does attract young STEM minds, which can then finally discover MLS as a degree with a career in health care and public health, as well as a solid strong foundation for many careers within and beyond the laboratory.”

This progress wasn’t limited to those yet to enter the field. “Recent 2024 surveys demonstrate some improvements in staffing, and with staffing improvements come morale improvements,” the two experts highlight.⁵ According to the most recent data from the American Society for Clinical Pathologists, there’s also been a 16.4 percent decrease in burnout, with the proportion of those who reported feeling burned out—although still sizeable—falling below half the total number of respondents.⁶

“Placing focus on employees’ well-being encourages teamwork and has the ripple effect of improving an organization’s productivity,” Rohde and Robinson add. “Compensation that improved on the basis of education and experience was also observed as necessary to attract, recruit, and retain qualified medical laboratory professionals.”

Rohde and Robinson also point out major revisions to policies and regulations affecting the clinical lab in 2024 that resulted from the advocacy, collaboration, and networking of medical laboratory professional societies.⁷

This includes pushback against corporate lobbying to lower the barrier of entry for right-to-practice licensure. For example, in New York State, the standards for licensure were maintained, but revised to ensure that no qualified medical laboratory professionals were unintentionally disenfranchised.

Recent updates to the Clinical Laboratory Improvement Amendments (CLIA) were another victory. “Although federal CLIA regulations have always failed at mandating higher entry-level personnel standards, only recognizing ‘testing personnel’ based on the complexity of laboratory testing, they were recently revised due to prompts from professional societies. This included the final determination that nursing and physical science degrees are no longer equivalent to biology, chemistry, and medical laboratory science degrees.”

Other major lobbying efforts the two experts lauded include stopping severe cuts to laboratories with the pause of the Protecting Access to Medicare Act (PAMA) and acquiring bipartisan support for the Saving Access to Laboratory Service Act (SALSA). SALSA would rectify the key issues with PAMA by addressing unfair pricing for clinical laboratory tests, among other areas.

2025… and beyond

Although they anticipate that the new year will bring challenges, Rohde and Robinson believe that there will be options and opportunities for the clinical lab when quality long-term solutions are implemented.

“Fortunately, many of these solutions exist at the bench,” they say. “One example is the use of laboratory assistants for pre- and postanalytical testing phases to relieve the workloads of medical laboratory professionals who can focus on the analytical phases. Another is the use of tools such as automation and autoverification to assist the independent judgment and cognitive expertise of medical laboratory professionals. The value of the laboratory must continue to be brought to the forefront of health care.”

Additionally, to further increase the field’s visibility—both to attract future generations of medical laboratory professionals and to increase public awareness—Rohde and Robinson believe that a unified identity is needed. “Standardization of name is crucial to identifying the profession and professionals. More facilities and universities need to convert to ‘medical laboratory science’ and ‘medical laboratory scientists/technicians.’ The Texas State University MLS Program is a great example of this recent name change.”⁸

Finally, although progress continues to be made on the legislative front, there is more work to be done.

“Many laboratory organizations still oppose the FDA’s oversight of laboratory-developed tests and new legislation supports this opposition,” Rohde and Robinson mention as one example. As another, they add that further support through expanded legislation to include the laboratory with Title VII (educational funding) and Medical and Public Health Laboratory Workforce Coalition efforts addressing workforce shortages is needed. They add that the most recent legislation introduced in Washington, DC, that addresses these areas is the Medical Laboratory Personnel Shortage Relief Act.

Finally, both experts urge more medical laboratory professionals to become actively involved in advocating for themselves, their profession, and, ultimately, the patients they serve:

“Professional societies seek increased memberships for strength in numbers to lobby support. Nurses boast over 90 percent compared to the laboratory’s less than 50 percent. More advocating for the laboratory is the key; patient care deserves no less!”

References:

1. U.S. Bureau of Labor Statistics. Clinical Laboratory Technologists and Technicians. August 29, 2024. https://www.bls.gov/ooh/healthcare/clinical-laboratory-technologists-and-technicians.htm.
2. E Garcia 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.
3. MJ Louzon, RM Martin, Addressing the laboratorian shortage. J Appl Lab Med. 2024;9(1):172–174. doi:10.1093/jalm/jfad080.
4. B Gray et al., Associations between American Board of Internal Medicine maintenance of certification status and performance on a set of Healthcare Effectiveness Data and Information Set (HEDIS) process measures. Ann Intern Med. 2018;169(2);97–105. doi:10.7326/M16-2643.
5. AT Robinson. Severe shortages of qualified medical laboratory professionals. Biomed J Sci Tech Res. 2023;48(3):39710– 39713. doi:10.26717/BJSTR.2023.48.00765.
6. E Garcia, I Kundu, K Fong. The American Society for Clinical Pathology’s 2023 wage survey of medical laboratories in the United States. Am J Clin Pathol. 2024; online ahead of print. doi:10.1093/ajcp/aqae130.
7. AT Robinson, RE Rohde. “Workforce in the shadow of healthcare – an update on the survival status of laboratory medicine and public health. Biomed J Sci Tech Res. 2024;54(5):46311–46317. doi:10.26717/BJSTR.2024.54.008604.
8. Critical Values. What’s in a Name Change? Why Texas State University’s Program is Moving from CLS to MLS. April 16, 2024. https://criticalvalues.org/news/all/2024/04/16/what-s-in-a-name-change-why-texas-state-university-s-program-is-moving-from-cls-to-mls.