The physician scientist: balancing clinical and research duties.

Physician scientists bridge the gap between biomedical research and clinical practice. However, the continuing decrease in number of people who choose this career path poses a threat to the advancement of biomedical science and the translation of research findings to clinical practice.

Waltzing around Sacred Cows on the Way to the Future.

Our mostly manual, agar-based clinical microbiology laboratory is slowly but steadily being redefined by automation and innovation. Ironically, the oldest test, the Gram stain test, is still manually read and interpreted by trained personnel. In a proof-of-concept study, Smith et al. (J. Clin. Microbiol. 56:e01521-17, 2018, https://doi.org/10.1128/JCM.01521-17) used computer imaging with a deep convolutional neural network to examine and interpret Gram-stained slides from positive blood culture bottles. In light of the shortage of medical technologists/microbiologists and the need for results from positive blood culture bottles 24/7, this paper paves the way for the next innovations for the clinical microbiology laboratory of the future.

[Issues Associated with the Management of Clinical Laboratories and Their Future: What is the Problem in Our Laboratory?--Chairmen's Introductory Remarks].

The management of clinical laboratories in hospitals has to be changed in accordance with the trends in the healthcare-providing system. In this symposium, six presenters talked about various issues associated with their laboratories. The issues raised included conflict between specialty and generality, phlebotomy as a duty of laboratory technologists, management of the phlebotomy section, imbalance of numbers between retirees and newcomers, and cooperation with the division of clinical research. Presenters, chairmen, and the audience were able to understand that we are now facing these issues, and we could identify some of their solutions.

[Strategies to Cope with the Shortage of Technologists: Facing the Mass-Retirement of the 'Baby-Boomer' Generation].

In Japan, the primary 'baby-boomer' generation, born between 1947 and 1949, is now in its retirement. This has caused a marked shortage of human resources nationwide. Clinical laboratory technologists are no exception, and many clinical laboratories in Japanese healthcare facilities are struggling with management because the number of new graduates, i.e., newly licensed technologists, is mostly fixed and, therefore, their recruitment is becoming more and more competitive. Our laboratory is now facing a wave of mass-retirement associated with our history. In addition, in the early 2000s, there was almost no position for new graduates replacing those retiring because of the change in the social healthcare system as well as our hospital's policy. This resulted in uneven numbers of technologists in generations, and it seemed to be getting worse. Fortunately, five years ago, the direction of social health care was changed and lots of positions became available as a result. We have been trying to recruit new graduates and experienced technologists as well, and were able to hire 18 people. Among them, 8 were non-freshmen. The generation gap has been mostly resolved. We will continue to make our laboratory more attractive not just to new graduates but also to experienced technologists, especially those who wish to return to work after a several-year absence to raise their children. We believe that this will energize our laboratory.

Factors affecting job satisfaction and retention of medical laboratory professionals in seven countries of Sub-Saharan Africa.

Effective implementation and sustainability of quality laboratory programmes in Sub-Saharan Africa relies on the development of appropriate staff retention strategies. Assessing the factors responsible for job satisfaction and retention is key for tailoring specific interventions aiming at improving the overall impact of health programmes. A survey was developed to assess these factors among 224 laboratorians working in the laboratory programme the University of Maryland implemented in seven Sub-Saharan African countries. Lack of professional development was the major reason for leaving the previous job for 28% of interviewees who changed jobs in the past five years. Professional development/training opportunities was indicated by almost 90% (195/224) of total interviewees as the most important or a very important factor for satisfaction at their current job. Similarly, regular professional development/opportunities for training was the highest rated incentive to remain at their current job by 80% (179/224). Laboratory professionals employed in the private sector were more likely to change jobs than those working in the public sector (P = 0.002). The findings were used for developing specific strategies for human resources management, in particular targeting professional development, aiming at improving laboratory professionals within the University of Maryland laboratory programme and hence its long-term sustainability.

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.

A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis.

BACKGROUND: Kenya experienced rapid scale up of HIV testing and counselling services in government health services from 2001. We set out to examine the human resource policy implications of scaling up HIV testing and counselling in Kenya and to analyse the resultant policy against a recognised theoretical framework of health policy reform (policy analysis triangle). METHODS: Qualitative methods were used to gain in-depth insights from policy makers who shaped scale up. This included 22 in-depth interviews with Voluntary Counselling and Testing (VCT) task force members, critical analysis of 53 sets of minutes and diary notes. We explore points of consensus and conflict amongst policymakers in Kenya and analyse this content to assess who favoured and resisted new policies, how scale up was achieved and the importance of the local context in which scale up occurred. RESULTS: The scale up of VCT in Kenya had a number of human resource policy implications resulting from the introduction of lay counsellors and their authorisation to conduct rapid HIV testing using newly introduced rapid testing technologies. Our findings indicate that three key groups of actors were critical: laboratory professionals, counselling associations and the Ministry of Health. Strategic alliances between donors, NGOs and these three key groups underpinned the process. The process of reaching consensus required compromise and time commitment but was critical to a unified nationwide approach. Policies around quality assurance were integral in ensuring standardisation of content and approach. CONCLUSION: The introduction and scale up of new health service initiatives such as HIV voluntary counselling and testing necessitates changes to existing health systems and modification of entrenched interests around professional counselling and laboratory testing. Our methodological approach enabled exploration of complexities of scale up of HIV testing and counselling in Kenya. We argue that a better understanding of the diverse actors, the context and the process, is required to mitigate risks and maximise impact.

The laboratory workforce shortage: a managerial perspective.

Most clinical laboratories in the nation report severe difficulties in recruitment and retention of most types of personnel. Other important factors impacting this problem include work complexities, increased automation, and a graying workforce. As a further challenge, institutional needs for clinical laboratory personnel are expected to grow significantly in the next decade. This article examines the current situation of the clinical laboratory workforce. It analyzes the different types of personnel; the managerial, supervision, and line positions that are key for different types of laboratories; the job outlook and recent projections for different types of staff; and the current issues, trends, and challenges of the laboratory workforce. Laboratory managers need to take action with strategies suggested for overcoming these challenges. Most importantly, they need to become transformational leaders by developing effective staffing models, fostering healthy and productive work environments, and creating value with a strategic management culture and implementation of knowledge management.

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.

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.

Facilitators and barriers to implementing task shifting: Expanding the scope of practice of clinical technologists in the Netherlands.

Despite recent studies confirming task shifting is both safe and effective, its implementation has proven difficult in practice. So too in the Netherlands, where legal barriers enforcing strict professional boundaries have historically limited task shifting. In recent years, Dutch policymakers have experimented with temporary expanded scopes of practice (ESP) for several professional groups, with the aim to facilitate task shifting in order to increase the overall effectiveness and efficiency of health care. The Clinical Technologist (CT), is an emerging new professional group that has received such a temporary ESP pending an evaluation. This paper reports the qualitative findings of the implementation process of providing CTs with an temporary ESP. Data collection consisted of 69 semi-structured interviews, 3 focus group interviews and 9 participant observations, conducted between September 2015 and October 2017. Analysis was conducted through an 'editing analysis style' whereby data were categorized using the conceptual framework of Grol & Wensing's implementation model. The study suggests that social features are of great importance when implementing task shifting. In situations with few social barriers, organizational and administrative barriers seem to be less dominant, thereby expediting the overall implementation process. Consequently, we recommend that policymakers should prioritize social features over organizational features when implementing task shifting.

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.

Are new CLS practitioners prepared to stay?

OBJECTIVE: This study assessed the relationship between the educational preparation and career expectations of CLS students and their subsequent retention in the laboratory profession. DESIGN: Survey participants were given a list of 32 tasks that may be expected of early career professionals. Participants were asked to rate their educational preparation for and how frequently they performed each task in their current job using a four point Lickert scale. Additional questions addressed the participants' preparation for their current jobs, career satisfaction, plans for staying in the profession, and factors that influence retention. PARTICIPANTS: The survey sample consisted of 972 Clinical Laboratory Scientists who passed the National Credentialing Agency for Laboratory Personnel (NCA) CLS examination between June 2002 and June 2004. MAIN OUTCOME MEASURES: The mean rating for the level of preparation and the frequency of use for each of the 32 competencies was calculated. The mean ratings were used to assess the educational preparation in each competency and identify areas in which the level of preparation did not match the need for that skill in current practice. Using analysis of variance, respondents' answers to questions on their number of years of experience, their plans to stay in the profession, and their job satisfaction were compared based on their perceived level of preparation and the degree to which they felt their current jobs matched their career expectations at graduation. RESULTS: The response rate was 31%. Most of the respondents felt that they were well prepared for the responsibilities of their current laboratory position. There was a good match between the respondents' ratings of their preparation in each competency and the frequency with which they were required to perform that competency. Phlebotomy and flow cytometry appeared to have more preparation than respondents felt they needed. Troubleshooting, resolving problems, and performing multiple tasks were identified as areas in which more preparation was needed. The mean number of years that respondents planned to stay in the profession was 15.5 years and the factors that were most important in keeping them in the profession included interesting work, good salaries, and advancement opportunities. The respondents who rated the match between their career-entry expectations and their current job the highest were more satisfied and planned to stay in the profession the longest. CONCLUSION: Early career laboratory professionals felt well prepared for their jobs, though teaching of some tasks could be improved to better prepare graduates for the work environment. Most respondents indicated that they were prepared to stay in the profession for at least ten years; however they indicated that interesting work, good salaries, and opportunities to advance in the profession would be important in their decision to stay. A good match between laboratory employees' career expectations at the time of graduation and their work environment appears to improve their satisfaction with their careers and their desire to stay in the profession.

Pro: Licensure necessary in the clinical laboratory.

The myths surrounding the licensure of clinical laboratory personnel are numerous, but many licensure detractors skew the facts in an attempt to convince both laboratorians and the general public that licensure of lab personnel is unnecessary. In her argument in favor of national licensure, longtime laboratory manager Diana Mass presents her case that debunks many of the so-called truths surrounding the negative impact of licensure.

In an era of scientific opportunity, are there opportunities for biomedical scientists?

Has the dramatic growth in the NIH budget affected the training and production of biomedical Ph.D.s? Examination of new survey data reveals surprising findings. Despite the need for an increased workforce to carry out the expansion in biomedical research, there has not been an increase in new U.S. doctorates awarded, and time-to-degree in the biomedical sciences is no longer increasing. Furthermore, both the frequency and length of postdoctoral appointments are decreasing for U.S. biomedical science recipients. There has been, however, continued growth in the number of foreign postdoctorals. Industrial employment of biomedical scientists continues to increase, but there has been only modest growth in tenured or tenure-track academic jobs.

Healthy workplace environments support a nurturing student educational climate.

Due to the shortage of medical laboratory scientist personnel in the United States, the successful integration of students into the Medical Laboratory Science (MLS) profession is vital. Education Facilitators are being used increasingly to assist clinical site managers in actively supporting and contributing to a healthier workplace environment, thereby inspiring students to become part of the organization. Education Facilitators associated with a single university-based MLS Program were the participant target group in a study. Face-to-face, in-depth, semi-structured interviews were conducted with five Education Facilitators at two clinical sites. The findings of this study suggest that organizational efforts to improve the learning environment for MLS students should focus on providing a supportive and nurturing educational climate. Education Facilitators' descriptions revealed an organizational leadership that communicated a commitment to provide people, space, and equipment in an effort to promote a positive clinical rotation experience. Additionally, the facilitators expressed a need to "pay more attention to students," be "willing to work with students," and make sure the students don't get "lost in the shuffle." They said that concern for a healthy work/life balance should be communicated to MLS students through day-to-day educational contact with bench technologists and Education Facilitators.