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Authorizing Safety Net Public Health Programs
Subcommittee on Health
Dr. Cory Roberts MD, FASCP
Executive Summary Cory Roberts, MD, FASCP, Director of
Anatomic Pathology at St. Paul Medical Center and a partner at ProPath
Associates in Dallas, Texas, will represent the American Society of Clinical
Pathologists at the August 1, 2001, hearing of the House Energy and Commerce
Subcommittee on Health. Dr. Roberts
will discuss the shortage of non-physician medical laboratory personnel. The Problem The United States is approaching a serious
shortage of medical laboratory personnel. Vacancy
rates for cytotechnologists, the professionals who interpret cellular material
such as Pap smears, and histotechnologists, the individuals who prepare tissue
specimens, are at a disturbing high of over 20 percent. This is a cause for
immediate concern as some laboratories will not have the appropriate personnel
available to evaluate Pap smears or prepare biopsies. The number of medical technology programs
decreased from 383 in 1994 to 273 in 1999.
The number of graduates in medical technology has similarly decreased
from 3563 in 1994 to 2491 in 1999. While the supply of laboratory personnel is
dwindling, the demand for these professionals is increasing - as evidenced, in
part, by the rise in wages. Median
average pay rate increases from 1998 to 2000 were larger than comparisons for
any other time period. Only medical
technologist supervisors (at 8.6%) and medical laboratory technician staff (at
8.5%) had wage increases of less than 10%.
Histologic technicians (at 13.3%) and histotechnologists (at 15.4%)
experienced the largest increases. Given the country's aging population, the
number and complexity of biopsy specimens and the use of molecular techniques
will likely increase during the next decade. Laboratory professionals who
entered the workforce in the 1960s and 1970s will be retiring soon.
The threat of bioterrorism calls for trained laboratory professionals to
respond. The laboratory‑allied health workforce will need to be able to
react accordingly with appropriate numbers of trained and educated personnel. Current
Solutions There are grants available to help attract laboratory professionals to
the field, especially minorities and individuals in rural and underserved
communities. The Allied Health Project Grants program, administered by the
Health Resources and Services Administration, has been successful in effectively
attracting new allied health professionals into the laboratory field.
Most allied health grant projects continue after federal funding ends,
making them a long‑lasting, worthwhile investment in the future of allied
health. Statement Chairman Bilirakis, Congressman Brown,
members of the Subcommittee, my name is Cory Roberts, MD, FASCP.
I am a pathologist serving as Director of Anatomic Pathology at St. Paul
Medical Center in Dallas, Texas, and also am a partner at ProPath Associates in
Dallas. I am here today
representing the American Society of Clinical Pathologists (ASCP) where I served
as a liaison member to its Board of Directors. You may ask why a pathologist is here to
discuss the shortage of non-physician medical laboratory personnel.
Well, ASCP is a unique organization.
It is a nonprofit medical specialty society organized for educational and
scientific purposes. Its 75,000
members include board certified pathologists, other physicians, clinical
scientists, and certified technologists and technicians.
These professionals recognize the Society as the principal source of
continuing education in pathology and as the leading organization for the
certification of laboratory personnel. ASCP's
certifying board registers more than 150,000 laboratory professionals annually. I am here to attest to the shortage, provide
you with national data on the subject as well as an explanation for this
workforce shortage problem. Finally,
I would like to outline some current solutions to this growing concern. The
Problem The United States is approaching a serious
shortage of laboratory medical personnel with vacancy rates for seven of ten key
laboratory medicine positions at an all time high.
Vacancy rates for cytotechnologists, the professionals who evaluate Pap
smears and other cellular material, and histotechnologists, the individuals who
prepare tissue specimens for cancer biopsies, are at an alarming high of over
20%. The American Society of Clinical Pathologists' Board of Registry, in
conjunction with MORPACE International, Inc., Detroit, conducts a biennial wage
and vacancy survey of 2,500 medical laboratory managers. The survey measures the vacancy rates
for 10 medical laboratory positions, and compares and contrasts these data with
that from 1988, 1990, 1992, 1994, 1996, and 1998 studies. The data for 2000 was published in March 2001, and I'd like
to give you a glimpse of what was found. Vacancy rates for cytotechnologists in the
northeast average 45 percent, 16.7 percent for the east north central, and 33.3
percent for the far west. Rural
areas average a 20 percent vacancy rate for cytotechnologists, and large cities
a rather surprising 28.3 percent rate. Private reference laboratories have an average vacancy rate of 20 percent for histotechnologists, and hospitals have a 37.7 percent shortage of the same profession. The west south central region of the country has a 73.7 percent vacancy
rate for histotechnologists, and the south central Atlantic states have an
average vacancy rate of 16.7 percent. By comparison, the vacancy rate for medical
technologists will not appear to be a problem, but it too is reason for concern.
Medical technologist vacancy rate averages 11.1 percent, but rural areas
show 21.1 percent vacancy and hospitals with 100-299 beds have a rate of 17.6
percent. While the supply of laboratory personnel is dwindling, the demand for these professionals is increasing - as evidenced, in part, by the rise in wages. Beginning wage increases from 1998 to 2000
were the largest experienced since comparisons from the 1990 to 1992 studies. Pay for nine of the 10 employee positions increased at least
6.9% from 1998 to 2000, with histotechnologist pay increasing 15.8%.
Median average pay rate increases from 1998 to 2000 were larger than
comparisons for any other time period. Only
medical technologist supervisors (at 8.6%) and medical laboratory technician
staff (at 8.5%) had wage increases of less than 10%.
Histologic technicians (at 13.3%) and histotechnologists (at 15.4%)
experienced the largest increases. In Dallas, where I practice, we currently
have 12 positions available for medical technologists within the University of
Texas Southwestern medical system (this includes Parkland Memorial Hospital and
St. Paul Medical Center). There are
5 histotechnologist positions available. We
offer signing bonuses and increased wages to attract laboratory personnel to our
facility. I am reluctant to mention
exactly what we offer because, frankly, laboratory personnel are in such demand
that neighboring health care institutions will often "one-up" each other in
order to draw from the same pool of applicants. Medical
Laboratory Programs One of the logical solutions to this vacancy
rate problem is to train more students; however, the number of programs are
decreasing. For example, in
Michigan, we have seen the number of programs plummet from 27 to 8 in less than
two decades. In California, there
are no programs available for histologic technicians or specialists in blood
banking. There are only two
programs for cytotechnologists, one program for medical laboratory technicians,
and one for phlebotomists in that entire state. It is important to note that education
programs for training medical laboratory personnel are sponsored by a variety of
organizations and institutions, ranging from hospitals to degree-granting
colleges and universities. According to the Health
Professions Education Directory published by the American Medical
Association, the number of medical technology programs decreased from 383 in
1994 to 273 in 1999. The number of
graduates in medical technology has similarly decreased from 3563 in 1994 to
2491 in 1999, a 30 percent decline in five years. Assessment There are several reasons why the vacancy
rate is increasing and the number of program enrollees is decreasing.
A number of available positions are outside the traditional clinical
laboratory. Some program directors
have reported that graduates are gaining employment in laboratory information
systems companies, "dot.coms," and corporations that manufacture or
distribute diagnostic reagents, supplies or equipment. With limited resources,
hospitals have merged, thus decreasing the availability of training sites for
medical laboratory programs. Some programs have responded by increasing access
to other laboratory training sites, such as forensics laboratories, blood
centers, physician offices, and outpatient clinics.
Yet, with these shifts, the
continued demand for laboratory services is real and is expected to grow. In Florida, according to the Bureau of the
Census, the population is projected to grow by 29% by 2020, and the population
over age 65 is projected to grow by 66% in the same time period.
In Ohio, the population is projected to grow by 3% by 2020, and the
population over age 65 is projected to grow by 34% in the same time period. Given the country's aging population, the
number and complexity of biopsy specimens and the use of molecular techniques
will likely increase during the next decade. Laboratory professionals who
entered the workforce in the 1960s and 1970s will be retiring soon as the
average age for a medical technologist now is 45 years old.
The threat of bioterrorism calls for trained laboratory professionals to
respond. The laboratory‑allied health workforce will need to be able to
react accordingly with appropriate numbers of trained and educated personnel. Current
Working Solutions There are solutions to these problems.
As a professional organization, ASCP believes it holds a responsibility
to address the workforce shortage. As
such, ASCP offers scholarships to medical laboratory technology students each
year to relieve some of the financial burden of higher education, but this does
not come close to fulfilling the need. We
produce career brochures and audiovisual materials for high school students and
younger children to learn about opportunities in the laboratory.
ASCP also exhibits and advertises at the annual conference for the
National Association of Biology Teachers in an attempt to help these educators
guide interested students to careers in the laboratory. On the public side, there are grants
available to help attract laboratory professionals to the field, especially
minorities and individuals in rural and underserved communities. The Allied
Health Project Grants program, administered by the Health Resources and Services
Administration, has been successful in effectively attracting new allied health
professionals into the laboratory field. For example, the University of Nebraska
Medical Center, my alma mater, established medical technology education sites in
four communities in rural Nebraska, including a student laboratory in central
Nebraska, under an Allied Health Project Grant. As of 1999, of 69 graduates, 99%
took their first job in a rural community, and 74% took their first job in rural
Nebraska. The grants are also designed to create
successful minority recruiting and retention programs for medical technologists.
This was the focus of a University of Maryland, Baltimore project initiated by
allied health grant funding in 1991. Through utilizing a four phase design,
which begins with career awareness activities for elementary and middle school
students, this model provides a continuum of activities that progressively
focuses on identifying, retaining, and advancing interested students to the
completion of a baccalaureate degree. Because of this program, the University of
Maryland, Baltimore has attained a current 70% minority medical technology
student enrollment at a majority institution, and an average 89% student
retention rate, placing it among the highest in the country. 95% of the
graduates of this program receive immediate placement. Most allied health grant projects continue
after federal funding ends, making them a long‑lasting, worthwhile
investment in the future of allied health. I greatly appreciate this opportunity to
discuss this concern over the medical laboratory personnel shortage with you. As a practicing pathologist, who works as part of the
laboratory team with medical technologists and technicians, I know there is a
growing concern over this shortage and the data certainly bears this to be true.
Thank you again for your time and consideration.
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