Staff Shortages in Labs May Put Patients at Risk

From The Wall Street Journal | May 13, 2009

The swine-flu outbreak has focused a spotlight on a looming risk for
hospitals and their patients: a shortage of technicians to run critical
lab tests.

Vanderbilt University Hospital's lab had to pull staffers from other
parts of the hospital and ask technicians to work double shifts to test
incoming patients for swine flu earlier this month. "It was all hands
on deck for a week," says Michael Laposata, chief pathologist at the
large medical center in Nashville, Tenn.

Swine flu has had minimal impact in the U.S. so far. But in the
event of a major infectious-disease outbreak, labs at smaller hospitals
around the country "would never have enough expertise or resources to
mount a response," Dr. Laposata says. "This is a major patient-safety
issue, right behind taking out the wrong kidney or giving 10 times the
dose of a drug."

American Society for Clinical Pathology

Hospitals are concerned that a shortage of lab technicians could delay diagnostic test results.

Like
the growing shortages of primary-care doctors and nurses, the shrinking
ranks of skilled lab workers pose a potential threat to the safety and
quality of health care, medical experts warn. Hospitals say it
currently can take as much as a year to fill some job openings. And the
American Society for Clinical Pathology, which certifies lab
professionals, says average job-vacancy rates currently top 50% in some
states. The group is lobbying for federal and state funds to keep some
academic training programs alive and raise awareness of the problem.

Besides testing for deadly viruses and infections, lab technicians,
who currently number about 300,000 nationwide, perform such vital tests
as diagnosing heart attacks and identifying cancerous tumors. There is
no firm evidence to link the growing shortage of lab professionals to
an increase in errors or a national slowdown in getting results to
patients. But to head off that eventuality, hospitals and professional
groups are taking new steps to increase funding for training and to
lure new recruits.

"We're holding everything together with Band-Aids and glue today,
but five years from now it's going to be another story," says Susan
Cease, lab director for Three Rivers Community Hospital in Grants Pass,
Ore., which is owned by Asante Health Systems. She says the hospital
has been working with a local community college to provide the hands-on
lab training for graduates of a two-year medical lab technician
program. The hospital also lets its lab technicians with two-year
degrees take online courses toward a bachelor's degree.

Barbara McKenna, president of the American Society for Clinical
Pathology, says younger workers haven't been attracted to the field,
which requires the same level of education as nursing but doesn't pay
as well. Starting salaries for lab technicians range from about $27,000
to $58,000, depending on the job and level of education. And
requirements for licensing and certification of lab technicians vary
from state to state, which can make it hard to relocate, says Dr.
McKenna, who is also associate professor of pathology at the University
of Michigan Medical School.

Toiling in Obscurity

Lab workers toil in obscurity deep in
the bowels of most hospitals, and most people don't know much about the
field, says Carol Wells, director of the clinical laboratory sciences
program at the University of Minnesota in Minneapolis. "Everyone knows
what a nurse does, but no one sees the workers in the laboratory, who
are highly trained and execute the tests that are responsible for about
70% to 80% of all diagnostic and treatment decisions made by
physicians," Dr. Wells says. "If we disappeared for a day or two,
health care would grind to a halt."

Lab-science-training programs are expensive to run, and while some
new degree programs have been started, a third of the training programs
at colleges around the country have closed down over the past decade.
That bodes poorly for hospitals seeking to fill job openings. The
federal government estimates that 138,000 new lab professionals will be
needed by 2012 to replace technicians expected to retire, but only
50,000 will be trained by that time.

Quest Diagnostics, which employs about 8,500 lab professionals,
making it one of the nation's largest lab companies, currently has
about 1,200 job openings nationwide. Some vacancies can take months to
fill in areas of the country where training programs have closed, says
David W. Norgard, vice president of human resources at Quest. The
company often recruits on campuses, pitching lab work as a scientific
career for which an advanced degree is not necessary.

Agnes Tyl, 26 years old, is currently enrolled at Western Illinois
University, where she is preparing for a second career as a lab
technician. Ms. Tyl previously took some science courses in college,
but ended up getting a degree in interior design. After finding no jobs
in that field, she returned to school, where she spends time peering
into a microscope to look for abnormalities in blood cells. "I really
see the opportunity to grow and be involved in new technology that will
help in patient care," Ms. Tyl says.

Counting Blood Cells

Lab
technicians, who usually work under the direction of a pathologist,
perform tests such as analyzing blood, urine and other bodily fluids
and tissues for diseases. To diagnose a suspected heart attack, they
measure substances that signal cardiac stress or damage. They count the
number and types of blood cells to determine the presence of anemia,
leukemia and other blood disorders.

Much of the work is painstaking: Histotechnicians, for example, must
prepare sections of body tissue by cutting it into thin slices,
mounting it on slides and staining the tissue so it can be viewed under
a microscope. Patients who want to learn more about what lab
professionals do can visit labtestsonline.org, sponsored by various
industry groups.

Some labs have had to change their work practices to get by with
fewer technicians. Rather than have workers perform only one type of
test, for instance, some labs are training technicians in different
areas such as hematology and chemistry. By learning to run each other's
instruments, technicians can move between areas when the workload
requires it. Automation also is reducing the need for additional lab
personnel, but experts say the human touch is still essential.

"Many tests are automated, but that doesn't mean a lab monkey can do
them," says Dr. Wells of the University of Minnesota. "These machines
have to be carefully monitored, and if they spit out a result" that
doesn't make sense, only a skilled lab technician will catch a possible
discrepancy and "investigate what went wrong," she says.

Several Minnesota institutions are making use of a $3.2 million
Department of Labor grant to improve the supply of lab professionals.
Minneapolis-based Allina Hospitals and Clinics, with 11 hospitals and
65 clinics, is offering "fast track" training programs to attract
college graduates who have a science degree. The program requires them
to work a year in a lab and then become certified as medical
technologists after two or three years, says Jane Renken, Allina's
system manager for work-force planning.

Job Vacancies

Some hospitals are pitching a career in lab
sciences as an option for workers who have been laid off or downsized
in other fields. At Affiliated Community Medical Centers in Willmar,
Minn., which runs 11 clinics, some vacant lab jobs have taken as long
as six months to fill, causing some backups in labs. Lab manager Judith
Raske says she visits career classes at high schools, and job fairs for
laid-off workers in other fields, to pitch the notion of a career in
lab sciences.

"Young people have no idea what these jobs entail because no one sees the lab professionals," she says.

Write to Laura Landro at informedpatient@wsj.com