CEO’s Corner: Findings from the 2022 Annual Survey

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By Marisa James, Chief Executive Officer, Elizabeth Swartz, IT Manager

Each fall, the NAACLS Annual Survey of Programs is disseminated to program directors of all NAACLS accredited programs. Submission of the completed survey is required annually by the accreditation standards. The survey questions have been altered only slightly over the years, so the information gathered provides trends that could be used to procure resources for you, your program, and, ultimately, the laboratory profession. It has been several years since this data has been shared with the NAACLS community. As the laboratory workforce shortage grows, it is prudent to share the number of NAACLS accredited programs and graduates, certification examination pass rates, graduation rates, and placement rates with the NAACLS community. Also included are data reflecting trends in program resources, program director turnover, and the number of programs seeking initial accreditation. This data will be analyzed and shared annually each summer. It should be worth noting that Doctorate in Clinical Laboratory Science (DCLS) Programs are omitted from most of the data shared in this article. NAACLS awarded accreditation to the first DCLS program in 2021 and graduate numbers should be ready to share next year. After all of the data is shared, I will reflect on major themes and takeaways, disclose efforts to improve the Fall 2023 Annual Survey, and communicate the role NAACLS will take regarding laboratory workforce shortage initiatives.

Accredited Program Data

In 2022, 609 total programs received the NAACLS Annual Survey. Ten (10)-year longitudinal data for the numbers of programs by program type appear in Table 1. Please note: Medical Laboratory Assistant (MLA) and Phlebotomy (PBT) programs became accredited in 2022, so the data below is for their approved status. The data reveal increases in the total number of programs from 595 in 2013 to 609 in 2022.  Regarding percentage growth, the most concentrated areas of expansion are seen with Pathology Assistant (PathA) Programs, with a 66% increase from 2013-2022, and Medical Laboratory Scientist (MLS) Programs increasing nearly 11% over the decade. The number of Medical Laboratory Technician (MLT) programs grew by almost 4%, and the numbers of Diagnostic Molecular Science (DMS), Cytogenetic (CG), Medical Laboratory Assistant (MLA), Histotechnician (HT), and Histotechnologist (HTL) programs are essentially stable. The number of Phlebotomy (PBT) programs decreased during the ten year span of time.

Table 1 – NAACLS Accredited Programs by Type from 2013-2022

Graphs 1 and 2 below display a fifteen (15)-year look back with trend lines for the various programs.  Graph 3 provides information on what type of institution each Program is based in.

Graph 1 – NAACLS Program Numbers 2007 – 2022

Graph 2 – NAACLS Program Numbers 2007 – 2022 (continued)

Graph 3 – Institutional Breakdown of Programs

Initial Accreditation and Serious Applicant Status

Between September 1^st, 2022 and April 1^st, 2023, NAACLS received 24 applications from programs seeking NAACLS Initial Accreditation from the various pathways in the prior six months. Sixteen additional programs reached Serious Applicant Status. These sixteen programs are eligible to have their students sit for the exam via the NAACLS route after successfully completing the program. In total, NAACLS will have 40 potential programs added to the laboratory profession. Graphs 4 and 5 depict the various disciplines.

Graph 4 – Initial Programs Seeking Accreditation

Graph 5 – Programs Achieving Serious Applicant Status

Number of Program Graduates 

Fifteen (15)-year longitudinal data for the numbers of program graduates by program type appear in Table 2 (click on chart to enlarge) and Graph 6. The most notable increase in graduates comes from the MLS discipline. The rise in MLS graduates is striking at a nearly 54% increase. This trend is interesting as data also reflects only modest increases in the number of programs, which implies program officials are developing innovative approaches to expand the capacity of students. Certainly, the various modes of education delivery have factored in, as well as possible administrative pressure on program officials to increase enrollments, implement more effective student recruitment strategies, and develop novel ways to supplement and enhance clinical experiences. All other disciplines have remained steady in producing the number of graduates.

Table 2 – NAACLS Program Graduates by Year from 2007-2022

Graph 6 – NAACLS Program Graduates

Benchmarks 

NAACLS collects program and student outcomes data and has set benchmarks for certification pass rates, graduation placement rates, and graduation rates. The benchmarks are:

• Certification exam pass rates – Three-year rolling average of 75% pass rate on accepted certification examinations taken within the first year after graduation.
• Graduate placement rates – Three-year rolling average of 70% finding employment or continuing education within one year of graduation.
• Graduation rates – Three-year rolling average of 70% graduation rate for students who have begun the final half of the program.

In the past three years, 20,377 students have sat for the ASCP Board of Certification exams. There were 320 individuals who sat for the AMT exams. Table 3 represents a three-year retrospective data of program average percentage rates for the three benchmarked outcomes. Percentages are stable through the three years of 2020-2022. 

Table 3 – Average of Outcomes by Program Type (Highlighted numbers fall below the benchmarks).

A 3-year retrospective of the number of programs that failed to meet the benchmarks is shown in Table 4. The data suggest that certification pass rates remain a challenge for some programs. At the same time, the great majority of students successfully graduate from programs and find relevant employment or continue with additional education. 

Table 4 – Number of Programs Not Meeting Benchmarks 2020-2022

Changes in program resources  

NAACLS collects data on relative changes in program class sizes, budgets, clinical placements, and faculty resources. In the Annual Survey of Programs, programs reported changes from year to year for these characteristics, which NAACLS monitors annually for trends (Table 5). The data suggest relatively small but positive changes in class size, budgets, clinical placements, and faculty resources for each year of the last three years. The biggest jump occurred in Clinical placements with a 4% increase from 2020 to 2021 and another 2.9% the following year in 2022. This is an encouraging trend as there are concerns in the laboratory profession about shortages in clinical facilities.

Table 5 – Programs’ Reported Changes 2020-2022

Program Director turnover         

Another striking set of data gleaned from the Annual Survey of Program results pertains to the number of new program directors approved since 2018.  Table 6 presents the turnover of Program Directors in the past five years. Anecdotal evidence suggests this is partially due to program faculty retiring from long-held positions. High turnover increases the workload of NAACLS volunteers, including self-study reviewers, site visitors, review committee members, and new program director mentors as the new program directors become acclimated to these positions. Also, it challenges NAACLS to continue to provide and increase continuing education offerings for program officials covering content about standards and accreditation processes. 

Reflections from the CEO

The percentages of NAACLS accredited programs that have successfully met benchmarked outcomes, including certification pass rates, graduation, and placement rates, have been stable over three years. Comparing the numbers of program graduates (Table 2) with trends in program resources (Table 5) suggests a significant increase in program production of graduates without the benefit of substantial increases in resources. Additionally, significant numbers of newly approved program directors within the last year reflect increased numbers of programs and a notable turnover in program directors of continuing programs. The number of new program directors creates challenges for NAACLS’ volunteers and staff to assist these new directors as they adjust to their new responsibilities. NAACLS must also provide continuing education opportunities for these individuals and other program officials.

The 2022 NAACLS Annual Survey of Programs data reveal there have been modest increases in accredited programs and graduates of most program types over the past decade. The increases are more significant for some program types, such as Medical Laboratory Scientist programs. This data opposes the common narrative that MLS programs are decreasing. While the number of MLS Programs is undoubtedly different from what it was in the 1980s or 1990s, the steady number over the past 15 years is encouraging and should be highlighted when recruiting individuals to the field. Regardless of which type of laboratory discipline, potential students do not want to hear program numbers have decreased, nor is that a good strategy for securing additional program resources from the administration, C suite, or government entities. The laboratory profession is the lynchpin in healthcare, and laboratory professionals need to showcase the brilliant minds behind the scenes to the community, students, administrators, and key decision makers. 

Future implications of NAACLS Annual Surveys

In May of this year, NAACLS representatives attended the inaugural Summit of the Workforce Action Alliance (WAA). https://www.cola.org/workforce-action-alliance/ In attendance were executives from laboratory professional associations, employers, public health laboratories, military and veteran hospital laboratories, educators, public servants, high school guidance counselors, and specialists in recruitment and retention. These laboratory leaders came together to discuss the present state of the laboratory shortage and to consider the most promising solutions to work on jointly. NAACLS will be working towards the goal to “Strengthen the data to understand the laboratory workforce”. NAACLS will utilize the Annual Survey to ascertain information from its programs. The data gleaned from the NAACLS Annual Survey has the potential to be used to help secure resources for the laboratory science field. For instance, other areas in healthcare (i.e., Nursing) have obtained financial assistance from the government simply by providing statistics to prove a workforce shortage, faculty or preceptor shortage, or other resource gaps.

Additionally, programs may be able to compare their resources to others and determine their internal benchmarks for faculty workload, student: instructor ratios, etc. We hope to continue conversations about how NAACLS can assist programs with the information they need to improve their programs.  NAACLS is committed to enhancing the Annual Survey and sharing results that can be utilized to assist with initiatives underway to help the laboratory workforce shortage.

NAACLS 2023 Annual survey preview

Please note: a list of all NAACLS Annual Survey questions will made available to NAACLS programs.

The NAACLS 2023 Annual Survey of Programs will be slightly different than in years past. Most questions will be minimally affected, but new questions will be added such as:

• Number of student applicants per cohort
• The capacity of students in your program
• Number of vacancies in your program,
• Length of hospital and/or simulated clinical rotations,
• Availability of part-time, evening, or asynchronous options, and
• Identifying the rate-limiting steps to increasing student capacity in programs.

To track trends within the profession, NAACLS will request a student to Full-time Equivalent (FTE) Faculty/Instructor ratio, such as what is shown below:

In the professional phase of the program, what is your student to FTE ratio?

In the professional phase of the program, what is your FTE (definition) faculty:student ratio in the following areas?

A follow up question will include how the organization defines FTE.

In the professional phase of the program, list the Faculty/Instructor distribution of work in Table 7.

Table 7 – Faculty and Instructor Resources

Conclusion

Last month, NAACLS accepted the invitation to join the Medical and Public Health Laboratory Workforce Coalition. https://www.mphlcoalition.org/  More than 20 national and regional laboratory, pathology, and other healthcare associations are a part of this coalition and are dedicated to building the laboratory workforce. NAACLS is committed to playing an integral role in helping alleviate the Laboratory workforce shortage in any way it can. The additional information ascertained in the Annual Survey will provide a pathway toward securing added resources for our accredited programs.