Lab staffing and career trends: time for cautious optimism?

Medical Laboratory Observer, August, 1987 by Kris Hallam

Lab staffing and career trends: Time for cautious optimism?

After a few years of decline brought on by prospective payment, employment levels have stabilized at many laboratories and begun to rise at a number of others. Managers and supervisors are more optimistic about job prospects in the laboratory field than they were two years ago.

Increased outpatient testing is the main reason more jobs will be available in the future, according to MLO's latest survey on lab staffing and career trends. We received responses from 288 members of our Professional Advisory Panel, all of them holding laboratory management positions.

Part I of this special report will concentrate on staffing and scheduling. In Part II, which follows, members of the management team ponder their own professional prospects and what medical technology can offer a newcomer to the field.

The most encouraging news from the staffing front is that the tide of layoffs that followed the arrival of DRGs appears to have ebbed. As Figure I shows, only one-fourth of the laboratories surveyed in 1987 reduced their staff within the last year, versus 42 per cent of those polled in a similar 1985 study. Better yet, 32 per cent of the laboratories actually gained FTEs--almost double the percentage of the earlier survey.

These figures were fairly uniform across the East, South, Midwest, and West. Laboratories in the West and Midwest saw the biggest turnaround this year; in the 1985 survey, half of them had suffered staff reductions within the previous 12 months. Independent laboratories were particularly active in adding FTEs; 45 per cent expanded their staffs.

The outlook for the future has also brightened considerably. Fully 40 per cent of the panelists (24 per cent in the 1985 survey) believe staff size will grow in the next three years. Conversely, only 14 per cent foresee staff cuts, compared with 30 per cent in 1985. The remaining panel members, 46 per cent as in 1985, expect no change in staff size.

Three-quarters of those who plan to hire more staff point to increased outpatient testing as a key reason (Figure II). Fifty-seven per cent also mention a larger in-house test menu.

When laboratories must instead cut back on staff, attrition remains the method of choice. Two-thirds of the facilities that lost FTEs in the last year did not fill vacancies (Figure III). This approach was favored by nearly 90 per cent of the labs cutting staff size in hospitals with more than 300 beds and by half the labs cutting staff in smaller institutions.

Nearly a quarter of the labs pared labor costs through cutbacks in paid hours, and the same proportion instituted selective layoffs by jobs classification.

Twenty-seven per cent of the panelists with reduced staffs cite lower workload as a reason, a much smaller proportion for this factor than the 56 per cent recorded in the 1985 survey.

On the other hand, 51 per cent attribute staff reductions to budget cuts, nearly as many as in 1985. Two-thirds of those whose staffs shrank at larger hospitals blame budget cuts, compared with half of those at smaller facilities. Budget cuts played a part in lowering FTE totals at 71 per cent of the labs with reduced staff in the South; at the other extreme, only 28 per cent of Midwestern labs with reduced staff were affected by budget cuts.

Another significant cause of staff reductions was reorganization of laboratory services, cited by 30 per cent of the labs.

As for the size of the management staff, 74 per cent of the panelists report no change this year over last year, and 78 per cent anticipate no change in the next three years. These figures were similar to those in the '85 survey.

Fourteen per cent of the surveyed laboratories--about 20 per cent of the independents and larger hospital labs--added management staff during the last year, and an equal percentage plans to add more in the next three years. Twelve per cent eliminated some supervisory positions in the last year, and 8 per cent predicted future cuts.

No clear trend emerged on the mix of medical technologists and technicians in laboratories. Sixteen per cent of the labs raised their proportion of MLTs, 13 per cent raised their proportion of MTs, and 71 per cent made no change in the mix during the last year. Over the next three years, however, 25 per cent of the panelists look for an increase in MLTs over MTs, 12 per cent look for the opposite to occur, and 63 per cent anticipate no change (Figure IV).

Among those favoring more MLTs, an Arkansas panelist remarks that they "are cheaper than MTs, and saving money is now the name of the game.' Some laboratories view MLTs as a way to get added mileage from a limited budget. An Ohio laboratory director notes that his lab plans to hire less costly technicians and increase total budgeted payroll hours to accommodate heavy demand for early-morning testing.

Many other panelists, however, laud the technical versatility of medical technologists. "Under DRGs, the laboratory staff has to do more with less, and the "less' has to be broadly trained and well educated,' one laboratory manager explains. And a coagulation/ urinalysis/immunology supervisor feels that the number of technicians in the laboratory will decline because more of them are returning to school to prepare for an MT or an equivalent registry.