Guiding the journey from grad to lab

Although the field of laboratory medicine continues to be affected by staff shortages, directors of two new medical laboratory scientist (MLS) training opportunities hope their efforts can help fill the gap. In January 2024, Geisinger Health System in Danville, Pennsylvania, launched an MLS program, which is now in its second class of students. And this July, the University of Utah and ARUP Laboratories in Salt Lake City will open a new facility at ARUP, allowing students in the university’s MLS program, which is accredited by the National Accrediting Agency of Clinical Laboratory Sciences, to get solid hands-on experience in a state-of-the-art training lab.

“There’s always an ebb and flow when it comes to MLS programs,” said Cordelia “Cordy” Kudika, MA, CHS (ACHI), director of clinical education in the MLS division at University of Texas Health San Antonio, which has operated an MLS program since 1975. “I think it’s great that other hospital systems and other universities are opening MLS programs, because there is a huge need in our nation.” According to U.S. Bureau of Labor Statistics projections, clinical laboratories nationwide will need to fill 24,200 openings for clinical laboratory technologists and technicians each year through 2033.

Geisinger’s MLS program

In Pennsylvania, hospital-based MLS programs are the biggest source of entry-level medical laboratory scientists, said Marianne Downes, PhD, MLS(ASCP)CM, director of the Geisinger program. With a large presence in central, north-central, and northeastern Pennsylvania, Geisinger is an attractive option for people looking to extend their skills and for local universities in search of partnerships, she said. One of the only other local MLS programs takes just two trainees per year.

Geisinger’s 1-year certificate program covers “the entire spectrum of what is required of a medical laboratory scientist when they enter the profession,” Downes said. “We also have created a specific area for molecular diagnostics … as most new tests that are out on the market today are molecular tests.” Clinical rotations are sequenced so students can advance as they go, and instructors also work the bench. “That’s something unique that we did that our accreditation group thought was a benefit to the program,” she said.

So far, the program is exceeding her expectations. The two students from the inaugural class have been offered positions in laboratories after successfully passing MLS certification exams and receiving their credentials. The current class has five students, and the program plans to scale up to accept as many as 12 moving forward. Prospective participants could include both post-bachelor’s students and others enrolled in a 3+1, an accelerated degree program where students take 3 years of prerequisite courses at an affiliated university and then finish their training at Geisinger in the final year. Students have ranged in age from 20-45.

“There has been quite a bit of enthusiasm from the 3+1 institutions that we looked to create affiliations with,” Downes said. Additionally, when she was training educators, “there were so many people who were so excited about bringing the program back — people who graduated prior to 1999 still here within the system who were so eager and ready to start teaching.”

ARUP’s new training facility

In Utah, enthusiasm also has been high for the University of Utah and ARUP’s Advanced Practice Clinical Laboratory Training Center, which was built using $3 million in federal funding. In the 2,600-square-foot lab, students will complete 4-week clinical rotations (part of a required 18 weeks) working with specimens and gaining experience in blood banking and transfusion medicine, clinical microbiology, clinical chemistry, and clinical hematology, said Diana Wilkins, PhD, MS, MLS(ASCP), division chief of medical laboratory sciences and director of the graduate program in laboratory medicine and biomedical science at the University of Utah. “They will be doing quality control and maintenance procedures, and getting an immersive experience in applying quality control and quality assurance principles in the operation of complex automated instrumentation" before completing additional rotations in active clinical laboratories, she said. Equipment in the lab will include instruments for high-volume chemistry, immunology, hematology and urine testing, coagulation assays, prothrombin time and partial thromboplastin time blood tests, D-dimer tests, assays to identify microorganisms, and more.

Students are excited for the new facility, which can accommodate up to 80 of them per year. “Everybody wants to know who’s going to get to go to this lab first,” Wilkins said.

“Our hope is that we’re going to generate more interest for students, create greater awareness of medical laboratory science, not only as a profession, but also as a career pathway for students within the university,” she added. The goal is to encourage students to be lifelong learners in medical laboratory science.

Laboratory-university partnerships like ARUP’s could serve as a model for other locations looking to address the workforce shortage, said Wilkins and Jonathan Genzen, MD, PhD, MBA, chief medical officer at ARUP.

“I truly believe this will have a local, regional, and, hopefully, national impact as well,” Genzen said. “Given the need for MLS professionals throughout the country, it’s a very mobile degree.” In other words, MLS programs hold the potential not only to create jobs within communities, but also to open possibilities in different locations — or, as Genzen put it, “wherever one’s life journey takes them.”

An urgent need

Opportunities like these provide a bright light in a challenging marketplace, where lab vacancy rates continue to be an issue, according to biennial surveys from the American Society for Clinical Pathology (ASCP). The most recent survey, published in the March 2023 American Journal of Clinical Pathology, indicated that vacancy and retirement rates at U.S. medical labs were at an all-time high in 2022, said Edna Garcia, MPH, lead study author and senior director of scientific engagement and research at ASCP. This may have been because of growing fears of COVID-19 and its aftermath, particularly among supervisors close to retirement age. As a result, labs made increased use of contract staff at that time while focusing their staffing efforts on retention.

The average overall vacancy rate increased from 8.35% in 2020 to 13.82% in 2022, said David Shiembob, MBA, manager of healthcare advisory services at ARUP, citing statistics from the report. The rise was steepest for core laboratory departments, whose vacancy rates increased nearly 75%, from 10.3% in 2020 to 18% in 2022. Another concerning trend, according to Shiembob: The MLS workforce is reaching retirement age at a 78% faster rate than the overall U.S. labor market. Half of the lab specialties surveyed said they anticipated retirement rates greater than 25% over the next 5 years.

The hiring of supervisors also took longer in 2022 compared with 2020, Garcia said: “Before, it would maybe take three to six months, and from that data it was more than 12 months. It was really hard to find staff at the time because we were already having the challenge of finding qualified personnel, and the COVID-19 pandemic just amplified the issues.”

It appears that 2022 represents the peak crisis. Results of the 2024 survey, which will be published this fall in the American Journal of Clinical Pathology, indicate that staffing numbers are returning to prepandemic levels. “That still doesn’t make it better,” Garcia said. “It just means that the effects of the pandemic are going away.”

Trends in MLS programs

Between 2000 and 2023, the number of MLS programs in the country decreased from 263 to 247, Shiembob said. However, the number of MLS graduates increased over that same period, from 2,333 to 4,189, suggesting that fewer programs were putting out more qualified people.

The subsequent cessation of MLS programs threatens that progress. Hospitals that recently announced closures include UnityPoint Health St. Luke's Hospital in Cedar Rapids, Iowa which ended its 73-year-old MLS program in 2024 because of declining enrollment, and the University of Maryland in Baltimore, which will terminate its program, the largest in the state, in 2027 due to budget cuts. The capacity of current programs may not be sufficient to meet industry demand, Shiembob said.

Lack of awareness of MLS careers contributes to the problem. Because MLSes don’t engage in patient-facing care, their role is not well known among aspiring healthcare professionals. “I think what happens a lot of the time is, nobody really knows who does these laboratory tests,” said Kudika, noting her program is now graduating up to 40 students annually to help increase numbers. “A lot of people also are not familiar with the type of education that you need in order to work in a clinical lab.”

To combat this issue, ASCP, ADLM, and 26 other organizations in 2023 formed the Medical and Public Health Laboratory Workforce Coalition to build awareness of laboratory testing occupations and encourage people to consider careers in laboratory medicine. “We’re all working toward visibility, recruitment and retention, and improving diversity in the laboratory,” Garcia said.Experts with the program have been speaking with K-12 educators at STEM and academic counselor conferences to educate them about laboratory careers.

“Their students only know about being a doctor or wanting to be a doctor or a nurse,” Garcia said. “School counselors and educators are eager and willing to learn more about laboratory careers and expose these kids to other allied health professions.”

Funding is also a challenge, said Shiembob. Although some nursing programs are heavily subsidized through government funding mechanisms, he said, “that doesn’t exist as much for MLS programs. They’re a small number of students and expensive to run, so that’s one reason why some of them are closing.”

One strategy some hospitals and laboratories have employed is to hire nonlicensed staff who hold a bachelor’s degree in biology or chemistry, and then train them on the job, Shiembob said. ARUP has done this for quite a while; in fact, it’s how he rose through the ranks. “That’s pretty new for a lot of hospital labs,” he noted. “Traditionally, they’d always insist they fill the positions with licensed MLSes, and that’s a level of training they’re not used to having to do.”

Meanwhile, the trend toward hiring temporary, travel laboratory staff seems to have receded after peaking during the pandemic, said Brittany Roemmich, MT(ASCP), a clinical research specialist at Washington University in St. Louis, who previously worked a series of travel jobs. “Labs are really trying to get more permanent workers … I think that’s for the better. I don’t think hospitals should be run strictly on travelers, because there are a lot of mistakes that happen when someone’s here for just 4 months.”

Karen Blum is a freelance medical and science writer in Owings Mills, Maryland. +Email: [email protected]