The American Society for Clinical Pathology's 2018 Vacancy Survey of Medical Laboratories in the United States.

OBJECTIVES: To determine the extent and distribution of workforce shortages within the nation's medical laboratories. METHODS: The survey was conducted through collaboration between the American Society for Clinical Pathology's Institute of Science, Technology, and Policy in Washington, DC, and the Evaluation, Measurement, and Assessment Department and Board of Certification in Chicago, IL. Data were collected via an internet survey distributed to individuals who were able to report on staffing and certifications for their laboratories. RESULTS: Results show increased vacancy rates for laboratory positions across all departments surveyed. The overall retirement rates are at its lowest, suggesting that the field has already experienced loss of personnel with a vast amount of experience. CONCLUSIONS: Focus on retention of qualified and certified laboratory professionals would be crucial factors in addressing the needs of the laboratory workforce. The field also needs to intensify its efforts on recruiting the next generation of laboratory personnel.

Geographical distribution of radiotherapy resources in Japan: investigating the inequitable distribution of human resources by using the Gini coefficient.

This is a pilot study that aims to elucidate regional disparities in the distribution of medical resources in Japan. For this purpose, we employed the Gini coefficient (GC) in order to analyze the distribution of radiotherapy resources, which are allocated to each prefecture in Japan depending on the size of its population or physical area. Our study used data obtained from the 2005 and 2007 national surveys on the structure of radiation oncology in Japan, conducted by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO). Our analysis showed that the regional disparities regarding the radiation oncologists and radiotherapy technologists were small, and concluded that such resources were almost equitably distributed. However, medical physicists are inequitably distributed. Thus, policymakers should create and implement measures to train and retain medical physicists in areas with limited radiotherapy resources. Further, almost 26% of the secondary medical service areas lacked radiotherapy institutions. We attribute this observation to the existence of tertiary medical service areas, and almost all of prefectures face a shortage of such resources. Therefore, patients' accessibility to these resources in such areas should be improved.

The brain-to-brain loop concept for laboratory testing 40 years after its introduction.

Forty years ago, Lundberg introduced the concept of the brain-to-brain loop for laboratory testing. In this concept, in the brain of the physician caring for the patient, the first step involves the selection of laboratory tests and the final step is the transmission of the test result to the ordering physician. There are many intermediary steps, some of which are preanalytic, ie, before performance of the test; some are analytic and relate to the actual performance of the test; and others are postanalytic and involve transmission of test results into the medical record. The introduction of this concept led to a system to identify and classify errors associated with laboratory test performance. Errors have since been considered as preanalytic, analytic, and postanalytic. During the past 4 decades, changes in medical practice have significantly altered the brain-to-brain loop for laboratory testing. This review describes the changes and their implications for analysis of errors associated with laboratory testing.

Against all odds: diagnosing tuberculosis in South Africa.

Clinical and logistic systems to support the timely diagnosis of tuberculosis are currently not preventing large numbers of tuberculosis deaths in South Africa. Context-appropriate systems for the diagnosis of tuberculosis are entirely dependent on effective and responsive management of human resources and an uninterrupted supply of clinical materials. Attention to these components of the tuberculosis program is urgently needed before new diagnostic technologies can be expected to impact on tuberculosis mortality in resource constrained settings.

Impact of New York State's new licensure regulations for laboratory professionals on staffing of clinical laboratories.

Licensing of laboratory professionals has been a controversial issue for the individuals working in these professions for many years. In New York State (NYS), licensing of laboratory professionals has been debated for over three decades and did not become law until 2005. The NYS licensure law stipulates specific educational requirements that include course work as well as curricular content areas. In addition to these educational requirements, the licensure law stipulates successful completion of a certification examination for new licensure applicants. To determine if the new legislation in NYS has had a demonstrable impact on the ability to recruit qualified laboratory professionals, a survey tool was developed to gather baseline data for a longitudinal study on the same topic. A 20 item survey along with a letter of explanation and a self addressed return envelope was distributed by mail to managers and/or supervisors of laboratories in 150 hospitals that ranged in size from small community hospitals to large medical centers across the state of New York. Questions were created addressing each of the following categories: day to day laboratory staffing, increased cost of recruiting to the facility after licensure law, impact on ability to cross train and staff evenings and weekends, and impact on patient care. It is apparent from the survey results that the employers have already started experiencing difficulty to staff certain laboratory vacancies especially for Clinical Laboratory Technologists (CLT) and fear that this trend might continue over the years not only pertaining to CLT but also to other laboratory vacancies such as Histotechnologists-Histotechnicians and Cytotechnologists. The impact of the NYS licensure law on staffing, facility costs, patient care, and laboratory professionals are discussed.

An examination of the supply and demand for clinical laboratory professionals in the United States.

Medical technologists (MTs) and technicians fill key roles in blood centers and hospital transfusion services. There is a concern that the number of new technologists and technicians entering the field is insufficient to keep up with demand created by the retirement of current personnel and continuing technological innovation. The American Society for Clinical Pathology reported in March 2009 that laboratories across the United States were struggling to fill MT and medical laboratory technician (MLT) positions. A survey of "positions available" advertisements from several months of the ABC Newsletter revealed that 35% were for MTs compared with 22% for physicians and 43% for all other positions. While not a scientific study, on the surface, this would indicate that blood centers are not immune from the struggle to fill positions within their laboratories. This paper will examine current trends in the United States as it relates to staffing for these positions and conclude by proposing actions that blood centers can take to help ensure an adequate supply of qualified MTs and MLTs in the future.

Improving quality of patient care in an emergency department: a laboratory perspective.

The purpose of our study was to improve the quality of care in an emergency department (ED) as measured by length of stay (LOS), total turnaround time (TAT) for laboratory result reporting, and the blood culture contamination rate. Data were included for patients who had at least 1 of 5 laboratory tests performed as part of their care. The study was conducted in 2 phases. First, phlebotomy was performed by a dedicated phlebotomist or nonlaboratory personnel. The second phase added a dedicated laboratory technologist. There was a significant reduction in total TAT for all tests (at least 46 and 75 minutes in the respective interventions), and blood culture contamination rates dropped from 5.0% to 1.1%, although the overall LOS did not change. Estimated cost avoidance is more than $400,000 annually. Quality of care in an ED is improved when samples are collected by a dedicated phlebotomist, but overall LOS does not change.

Planning for pandemic influenza: effect of a pandemic on the supply and demand for blood products in the United States.

BACKGROUND: Influenza causes episodic pandemics when viral antigens shift in ways that elude herd immunity. Avian influenza A H5N1, currently epizootic in bird populations in Asia and Europe, appears to have pandemic potential. STUDY DESIGN AND METHODS: The virology of influenza, the history of the 1918 pandemic, and the structure of the health care and the blood transfusion systems are briefly reviewed. Morbidity and mortality experience from the 1918 pandemic are projected onto the current health care structure to predict points of failure that are likely in a modern pandemic. RESULTS: Blood donor centers are likely to experience loss of donors, workers, and reliable transport of specimens to national testing laboratories and degradation of response times from national testing labs. Transfusion services are likely to experience critical losses of workers and of reagent red cells (RBCs) that will make their automated procedures unworkable. Loss of medical directors, supervisors, and lead technicians may make alternative procedures unworkable as well. CONCLUSIONS: Lower blood collection capacity and transfusion service support capability will reduce the availability of RBCs and especially of platelets. Plans for rationing medical care need to take the vulnerability of the blood transfusion system into account.

Changing educational paradigms in transfusion medicine and cellular therapies: development of a profession.

The transfusion medicine profession can be easily compared and contrasted with an early 1900 ironclad ship operating in the rough seas of the 21st century. Without modifying the old ship to today's standards, even the captain and crew will begin to expect the ship to meet its demise. The unfortunate passengers, on the other hand, do not expect that they are on an old obsolete ship and, instead, are innocent victims stuck on a doomed course. The old ironclad ship must change into a sleek cruiser and utilize the latest available technology so that its well-educated and competent captain and crew can safely navigate even the most challenging waters. The transfusion medicine profession must transform itself into a state-of-the-art ship so that it, like the refurbished ironclad ship, can be set on cruise control through the open seas. The question facing our industry is do we have the courage to utilize modern technology and to commit the funds necessary to develop, implement, and maintain our existence? It is difficult to plot a steady course into the future because of existing challenges that stand ready to sink our profession, including economic wrangling over regulation, technologic changes, generation conflict, and political differences that threaten our excellence. The primary purpose of this article is to focus on the educational needs that affect all personnel involved in transfusion medicine. In addition, this article will address potential adverse outcomes and investigate possible resolutions to avoid the "sinking ship." Within the next 5 to 7 years, without a corrective course of action, our profession will be at the bottom of the clinical ladder, remembered more for its demise and tragic ending than for its accomplishments. It is hoped, successful implementation of changes in educational paradigms in transfusion medicine may lead to a renaissance within our workforce-generations working together, each sharing and learning from one another.

Wage increases in the clinical laboratory: how are workers faring against inflation and in comparison to other health professions?

High vacancy rates in the clinical laboratory profession have led to the use of wage increases and financial incentives to attract and retain workers. American Society for Clinical Pathology (ASCP) surveys indicate that wages for Medical Technologists and Medical Laboratory Technicians have been steadily rising in the past few years following years of little or no increases. When adjusted for inflation, the real wage increases have even modestly exceeded the inflation rate. However, wages in the clinical laboratory remain lower than in several other allied health professions with comparable educational preparation. Achieving competitive wages will be important in addressing the long-term need to attract more students to the clinical laboratory.

Creating a future laboratory workforce: a California group's success.

In early 2001, a small group of hospital lab administrators, educators, and hospital council and health occupations leaders in the South San Francisco Bay Area, seeing no end to the area's laboratory workforce shortage, developed an ambitious plan to increase the number of clinical laboratory scientists (CLSs). Here is how they convinced administrators from 15 area hospitals to fund it.