by Dr. Maribeth Flaws, NAACLS Board of Directors President
As we celebrate the 50th Anniversary of NAACLS and consider the current workforce shortage, I am afraid our educational model is regressing to where it was before NAACLS and the Board of Schools were created. To illustrate this point, I would like to reflect on the history of education in our profession, using Medical Laboratory Science specifically as a case study, and discuss the role of accreditation and the current educational environment. At the end, I will suggest opportunities for us all because what I see happening in MLS will likely creep into our other accredited programs.
Laboratory testing as a part of patient care started in response to outbreaks of infectious diseases in the late 19th century. In 1919, the American College of Surgeons’ accreditation standards required that hospitals have a laboratory. The education of laboratory professionals started as “on-the-job” training before being organized into training “programs” led by pathologists. The ASCP created the Board of Registry in 1928, which led to the development of standards to normalize at least what was taught in these educational programs. When NAACLS started in 1973, standards were created to normalize how students were taught in addition to what was taught. Learning objectives in the three domains were introduced and required at different levels of Bloom’s taxonomy. Accreditation assures the quality of a program and its operational transparency. It is a public sign that a program adheres to a set of defined external standards, thus protecting students, faculty, and the public.
In 1975, there were a little over 700 accredited MLS programs. Changes in reimbursement not favoring educational programs and the consolidation of hospital systems and laboratories caused a steep decline in MLS programs from 1975 until 2000 and led to an erosion of the number of laboratory professionals needed in the market. However, from 2002-2022, the number of accredited MLS programs has stayed constant at ±240 programs. Despite the number of programs remaining stable over the last 20 years, the number of MLS graduates from accredited programs has actually increased from 3772 in 2018 to 4246 in 2022. In most cases, the increased graduate numbers were achieved without a substantive increase in program resources. Despite incredible efforts by accredited programs, we still do not have enough graduates to meet current workforce needs. According to the ASCP BOC, 21% of newly certified MLSs in 2022 were already certified MLTs working in the clinical laboratory. Thus, the impact of new MLSs being added to the workforce is, unfortunately, less than the 4246 would lead us to believe.
How are laboratory managers responding to the need for graduates from accredited programs to fill their open positions? By hiring people with an undergraduate degree in a science (usually Biology, Chemistry, or Biochemistry) and training them on-the-job if they can, avoiding the accreditation process entirely as well as the certification of the individual. This ‘shortcut’ takes the laboratory scientist’s educational background right back to where we started in the 1920s!
I see several threats to our accredited educational programs and, quite frankly, our profession if hiring non-educated, non-certified personnel continues. Laboratory science educators know how common it is for people with a B.S. in Biology or Chemistry to enter our accredited programs because they cannot find a job in other industries or get into a graduate program. They find job openings in the clinical laboratory and, in many cases, the laboratories require individuals to be certified, which requires completing a NAACLS-accredited program (Route 1). In response, laboratories have found a workaround by developing their own “training programs” to fill the knowledge gap in their non-certified employees. For example, Alverno Labs is partnering with Oak Point University to develop a “Career Accelerator Program” in which people with a B.S. in Chemistry or Biology work in the Alverno laboratory three days a week and attend classes tuition-free to learn the content two days a week, all while earning a salary for a period of about nine months. When completion of the learning is attained, the employee is eligible to move into a different and higher job class.
This setup sounds like a good system for both the laboratory and students, but what’s the problem? While the Oak Point University program wisely sees the value of NAACLS accreditation to enable the certification of its employees, not all of these job training programs will see the value of accreditation for their program or students. Devaluing accreditation has devastating consequences for our profession. If the clinical laboratories don’t require certification of their employees, we lose a subset of our target applicants resulting in decreased admissions and likely closure of accredited programs. More importantly, an increase in laboratory workers who are not properly educated dilutes our profession and professional identity, damaging our healthcare system. For what is a profession but one that “requires specialized knowledge and often long and intensive academic preparation.” (Merriam-Webster)
The downstream effects of this quick fix are widespread. We haven’t addressed how it affects those individuals in the long term. Likely, they will be trained only for their particular environment, which limits their upward mobility, especially if they leave the lab they were trained in. If future laboratory employees (we cannot call them professionals anymore) are those who are trained on the job to perform tests only in one specific laboratory, we have lost everything we have worked for in building and defining our profession and scope of practice over the last 100 years.
Yet, given these threats, I see opportunities for us with accredited programs to mitigate the erosion of our profession. Communicate with the people at your clinical affiliates about how you and your accredited program can help them educate their non-certified personnel before they start to develop their own job training program and compete with you. Increase your activities in career recruitment so that our future employees find our profession and program before they complete an undergraduate degree. Sign up as an industry professional with Pathful Connect (https://pathful.com/connect) to give virtual career presentations to middle and high school students. Get involved with your Area Health Education Center (https://www.nationalahec.org/) to promote our career to students. Share what you already do for career recruitment with others and involve your current students to expand your reach.
COLA sponsored a Workforce Action Alliance Summit a few weeks ago, gathering industry representatives from across the country to discuss the workforce shortage. NAACLS CEO Marisa James and I attended the Summit, and the group developed three goals to work on over the next year:
- Strengthen the data to understand the laboratory workforce and provide support for advocacy (i.e., secure grant funding for laboratory professionals);
- Provide a career path website for recruitment into the laboratory profession as well as the profession now; and
- Standardize titles to elevate the profession, educate the public, and strengthen the unity of our profession.
The Coordinating Council on the Clinical Laboratory Workforce (CCCLW) was started over 20 years ago to address the workforce shortage. They recently announced they are suspending operations, so COLA’s efforts seem like déjà vu. Still, anytime and any way we can get a more unified and national response to career recruitment is beneficial.
I am seriously concerned about our profession. We have worked hard to build our scope of practice, demonstrate our value to patient care and other healthcare team members, and standardize the education of future laboratory professionals. We cannot go back to where we were before NAACLS started 50 years ago. If we do nothing, we could lose it all, and our patients will be the ones to suffer.