The American Society for Clinical Pathology 2022 Vacancy Survey of medical laboratories in the United States

Abstract

Objectives

To determine the extent and distribution of laboratory workforce shortages within the nation’s medical laboratories.

Methods

The Vacancy Survey was conducted through collaboration between the American Society for Clinical Pathology (ASCP) Institute for Science, Technology and Public Policy in Washington, DC, and the Evaluation, Measurement, and Assessment Department and ASCP Board of Certification in Chicago, IL. Data were collected through an internet survey distributed to individuals who were able to report on staffing and certifications for their laboratories.

Results

Results of the ASCP 2022 Vacancy Survey show increased overall vacancy rates for laboratory positions in all departments compared with 2020. Overall retirement rates for laboratory professionals increased across most departments.

Conclusions

Current Vacancy Survey data show continued increases in the numbers of laboratory vacancies and retirements as well as changes in certification requirements, with trends amplified during the pandemic continuing into the present. Qualitative analysis results showed that there is an urgent need to focus not only on recruitment but—equally important—on retention of laboratory professionals.

Key Points

• Current Vacancy Survey data show the COVID-19 pandemic’s continued effects on medical laboratory vacancies, retirements, and certification requirements.

• The laboratory community must build a stronger and more resilient workforce for the future.

• The Medical and Public Health Laboratory Coalition is encouraged to intensify its focus on solutions-based discussions in support of the laboratory workforce.

INTRODUCTION

Medical laboratories have experienced workforce shortages and increased vacancies for several years due to retirements, a lack of qualified laboratory personnel, and the limited number of laboratory training programs. These shortages and vacancies were compounded with the arrival of the COVID-19 pandemic and the massive increase in laboratory testing volumes. Since the onset of the COVID-19 pandemic, its effect on the health care workforce continues to affect personnel shortages, health worker burnout, exhaustion, and trauma.¹ The reduction in the labor force across many health care positions at this time was the result of early retirements, safety concerns, and a reduction in immigration.² According to the US Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief, “while case numbers and hospitalization rates are declining as of March 1, 2022 and the most acute workforce challenges may be easing for the time being, many of the impacts the pandemic has had on the workforce are cumulative and may not resolve quickly.”

When the American Society for Clinical Pathology (ASCP) examined the effects of the COVID-19 pandemic on laboratory staffing in 2020, many laboratory departments reported decreased lab testing volumes and decreased staffing through furloughs, staff reassignments, and shift adjustments.³ There was no significant change in lab personnel salary, and students encountered difficulties finding clinical rotations, which delayed graduation.^4,5 In 2022, results of the ASCP survey on the impact of COVID-19 on laboratories that aimed to determine salaries and staffing changes presented a different set of challenges: The field started experiencing increased utilization of contract staff; an upsurge in testing demands (COVID-19 and other tests); and increased overtime, with staff averaging an additional 17.8 hours per week.⁶ An employer focus on retention was also highlighted during this time, with employers developing various retention strategies to maintain laboratory staff.^3,6

The ASCP has conducted its Vacancy Survey to determine the extent and distribution of workforce vacancies within the nation’s medical laboratories for 35 years. Since its inception, this confidential survey has been administered every 2 years and served as the primary source of information about staffing of laboratories for academic, government, and industry labor analysts. Results from past surveys have shown that laboratory medicine is a rapidly evolving field, and the survey has evolved in response to changes within the profession.

Each administration of the Vacancy Survey also represents an opportunity to improve its methodology so that it can collect current relevant data while maximizing survey participation. New questions were added to the 2022 survey to examine some of the factors affecting vacancy rates. The ASCP continues to gather questions, comments, and suggestions from our members regarding the profession, with the goal of better understanding staffing and vacancy rates through this informative survey.

METHODS

The ASCP 2022 Vacancy Survey was conducted through collaboration between the ASCP Institute for Science, Technology and Public Policy in Washington, DC, as well as the Evaluation, Measurement, and Assessment Department and the ASCP Board of Certification (BOC) in Chicago, IL. The Vacancy Survey Working Group, whose members broadly represent the field of laboratory medicine and pathology, critiqued the report. The survey includes both quantitative and qualitative components; email invitations to complete the survey online were sent to laboratory personnel on May 3, 2022, through Key Survey. The survey was closed on June 14, 2022. Partner organizations were also invited to participate in distributing the survey to obtain a larger scope of the current issues the laboratory workforce faces. To maximize participation, the survey used snowball sampling, in which respondents were asked to forward the survey invitation email to other individuals currently practicing in the field.

Most of the names on the initial email recipient list were derived from the ASCP email database and included individuals from the categories Lead, Supervisor/Manager, Educational Program Director, Educator, Laboratory Director, and Educator/Lab Director who can report on vacancies, anticipated vacancies, and laboratory team members’ certification and credentialing status.

The following partnering entities participated in the survey:

• Association for the Advancement of Blood & Biotherapies (formerly the American Association of Blood Banks)

• Association for Diagnostics & Laboratory Medicine (formerly the American Association for Clinical Chemistry)

• America’s Blood Centers

• Association for Molecular Pathology

• American Medical Technologists

• Association of Public Health Laboratories

• American Society of Cytopathology

• American Society for Clinical Laboratory Science

• American Society of Cytotechnology

• American Society for Microbiology

• National Society for Histotechnology

• Philippine Association of Medical Technologists-USA, Inc

The ASCP 2022 Vacancy Survey sought to collect staff-level and supervisory-level data for the following laboratory areas:

• Anatomic Pathology (including nonpathologist professionals)

• Blood Bank (Immunohematology)

• Chemistry/Toxicology

• Core Laboratory

• Cytogenetics

• Cytology

• Flow Cytometry

• Hematology/Coagulation

• Histology

• Immunology

• Laboratory Information System/Quality Assurance/Performance Improvement (LIS/QA/PI)

• Microbiology/Virology/Infectious Disease

• Molecular Biology/Molecular Pathology/Molecular Diagnostics

• Phlebotomy

• Point-of-Care

• Send-outs

• Specimen Processing

The ASCP survey administrators recognize that there is no standard approach for how laboratories are organized and that laboratory departments hire staff with a variety of certifications and credentials. The ASCP gave survey participants the opportunity to report on the certifications that exist or are sought for the laboratory departments under their supervision. We collected data on changes in testing, staffing, and retention of laboratory professionals during the COVID-19 pandemic in this survey. Both qualitative and quantitative analyses were performed using IBM SPSS Statistics software.

RESULTS

The primary objective of this research was to estimate the vacancy rates within medical laboratory departments. Overall, this survey presented data from 814 respondents across the United States who currently hold a management-level position or a human resources position and reported being able to discuss the vacancies, anticipated vacancies, and certifications/expertise of medical laboratory staff at their current place of employment. These respondents provided data on 22,344 employees across the United States.

The respondents represented various laboratory facilities (academic and nonacademic hospitals with fewer than 100 beds to those with more than 1000 beds; national, regional, and local reference laboratories; academic institutions; government facilities; blood centers and blood banks; military, US Department of Veterans Affairs, and Veterans Health Administration facilities; public health laboratories; research laboratories; and industry, equipment, and pharmaceutical laboratories) Table 1. Of all the departments surveyed, the core laboratory department had the highest representation of medical laboratory personnel at 16.0%, while the flow cytometry department represented the fewest laboratory personnel at 1.7% Table 2. By region, the South Central Atlantic had the highest number of respondents at 23.8%, and the Central Northwest had the lowest number of respondents at 12.0% Table 3. The top 10 states with the most respondents were (in descending order) Texas, New York, Pennsylvania, California, Illinois, Florida, Ohio, Missouri, North Carolina, and Tennessee. Most participants (37.3%) reported that the approximate medical laboratory testing volume in their laboratory or institution per year was more than 100,000 tests. Of this, only 16.4% of respondents indicated that anatomic pathology testing represented more than 50,000 tests per year.

TABLE 1

Distribution of responses, by facility

Response	No. (%)
Hospital-based laboratory with 300-499 beds	120 (14.8)
Hospital-based laboratory with 100-299 beds	108 (13.3)
Hospital-based laboratory with 500-749 beds	95 (11.7)
Hospital-based laboratory with <100 beds	80 (9.9)
Hospital-based laboratory with ≥1000 beds	57 (7.0)
Clinical outpatient laboratory	53 (6.5)
Hospital-based laboratory with 750-999 beds	53 (6.5)
Independent private laboratory	52 (6.4)
Reference laboratory	43 (5.3)
Military facility, VA, VHA	28 (3.5)
Blood center or blood bank	24 (3.0)
Research laboratory	17 (2.1)
Government facility (eg, department of health, FDA, prison, or state hospital; medical examiner’s office; public health laboratory; community health center; health department)	15 (1.8)
Public health laboratory	14 (1.7)
Industry, equipment, pharmaceutical (eg, chemical suppliers, in vitro diagnostics manufacturer, pharmaceutical company, medical device manufacturer)	10 (1.2)
Retail laboratory (direct to consumer)	1 (0.1)
Other	41 (5.1)

FDA, US Food and Drug Administration; VA, US Department of Veterans Affairs; VHA, Veterans Health Administration.

TABLE 2

Employees represented, by department

Department	No. (%)
Core Laboratory	3571 (16.0)
Blood Bank (Immunohematology)	2471 (11.1)
Microbiology/Virology/Infectious Disease	2332 (10.4)
Phlebotomy	2174 (9.7)
Chemistry/Toxicology	1417 (6.3)
Hematology/Coagulation	1376 (6.2)
Anatomic Pathology	1291 (5.8)
Histology	1169 (5.2)
Specimen Processing	710 (3.2)
Molecular Biology/Pathology/Diagnostics	693 (3.1)
Point-of-Care	655 (2.9)
Cytology	622 (2.8)
Cytogenetics	581 (2.6)
LIS/QA/PI	470 (2.1)
Immunology	444 (2.0)
Send-outs	444 (2.0)
Flow Cytometry	369 (1.7)
Other	1555 (7.0)

LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

TABLE 3

Distribution of responses, by region^a

Region	No. (%)
South Central Atlantic	193 (23.8)
Northeast	162 (20.0)
Far West	138 (17.0)
Central Northeast	119 (14.7)
Central Southwest	102 (12.6)
Central Northwest	97 (12.0)

^aRegions: Central Northeast (Illinois, Indiana, Michigan, Ohio, Wisconsin); Central Northwest (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota); Central Southwest (Arkansas, Louisiana, Oklahoma, Texas); Far West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming); Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont); South Central Atlantic (Alabama, Delaware, District of Columbia, Florida, Georgia, Kentucky, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, West Virginia).

Across the nation, the overall vacancy rate (including supervisory-level personnel) was highest for the Core Laboratory department (18.0%) and lowest for the Cytogenetics department (7.0%) Figure 1. According to the survey results, Blood Bank (18.9%) had the highest staff vacancy rate (for purposes of this report, the term staff means nonsupervisory-level personnel) in the nation, while Cytogenetics (7.5%) had the lowest Figure 2. The highest supervisor vacancy rate occurred in the Molecular Biology/Molecular Pathology/Molecular Diagnostics department (14.8%), and the lowest supervisor vacancy rate occurred in the Immunology department (0%) Figure 3.

FIGURE 1

Overall vacancy rates, by laboratory department. LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

FIGURE 2

Staff (nonsupervisory) vacancy rates, by laboratory department. LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

FIGURE 3

Supervisory vacancy rates, by laboratory department. LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

According to the survey findings, the Cytology department had the highest overall percentage (19.6%) of employees anticipated to retire in the next 5 years. Phlebotomy had the lowest rate of employees expected to retire in the next 5 years at 8.7% Figure 4. For staff-level personnel, the retirement rate was highest in the Cytology department (17.7%) and lowest in the Molecular Biology/Molecular Pathology/Molecular Diagnostics department (7.8%) Figure 5. The supervisor retirement rate is highest in the Send-outs department (41.7%) and lowest in the Anatomic Pathology department (12.0%) Figure 6.

FIGURE 4

Overall retirement rates (anticipated in the next 5 years), by laboratory department. LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

FIGURE 5

Staff (nonsupervisory) retirement rates (anticipated in the next 5 years), by laboratory department. LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

FIGURE 6

Supervisor retirement rates (anticipated in the next 5 years), by laboratory department. LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

Recent data suggest that medical laboratories are having more difficulty finding staff. For Cytology, it takes more than 12 months to fill staff-level vacancies, whereas for the Blood Bank, Chemistry/Toxicology, Core Laboratory, Hematology/Coagulation, Immunology, Microbiology, and Send-outs departments, it takes 7 to 12 months, on average. For other departments, the typical time frame needed now to hire staff is 3 to 6 months. Data from the 2020 survey showed that on average, it took 3 to 6 months to hire staff-level personnel.

For supervisors, most laboratory departments reported that it took 3 months to more than a year to fill vacancies. This time frame represents an increase compared with the 2020 data, which found that it took 7 months to a year to fill supervisor vacancies. The top 5 departments using agency, traveling, or contract staff were Core Laboratory, Chemistry/Toxicology, Phlebotomy, Molecular Biology/Molecular Pathology/Molecular Diagnostics, and Hematology/Coagulation.

Table 4 shows a comparison of regional vacancy rates between 2022 and 2020. The Northeast region reported the highest overall vacancy rate in 2022 compared with other regions (15.8%); the Central Southwest had the lowest vacancy rate in 2022 (9.9%) Table 4. Regarding the vacancy rates of the 5 departments with the most respondents, by region (Core Laboratory, Blood Bank, Microbiology, Phlebotomy, and Anatomic Pathology), data revealed that vacancy rates in Core Laboratory were highest in the Northeast (23.5%) and lowest in the Central Southwest (11.3%). Vacancy rates in the Blood Bank were highest in the South Central Atlantic (20.0%) and lowest in the Central Northwest (13.7%). In Anatomic Pathology, the Central Southwest (15.8%) had the highest vacancy rates, while the Central Northwest had the lowest rate (7.9%). The Microbiology department had the highest vacancy rates in the South Central Atlantic (17.2%) and lowest in the Central Southwest (9.1%). The vacancy rate in Phlebotomy was highest in the Central Northeast (14.4%) and lowest in the Central Southwest (9.2%) Figure 7. The regional distribution of states is shown in Table 3.

TABLE 4

Vacancy rates, by region^a

Region	2022 Vacancy rate, %	2020 Vacancy rate, %	∆, %
Northeast	15.8	10.0	5.8
Central Northeast	15.2	10.2	5.0
South Central Atlantic	14.8	8.8	6.0
Far West	14.4	9.3	5.1
Central Northwest	12.7	7.1	5.7
Central Southwest	9.9	5.3	4.6

^aRegions: Central Northeast (Illinois, Indiana, Michigan, Ohio, Wisconsin); Central Northwest (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota); Central Southwest (Arkansas, Louisiana, Oklahoma, Texas); Far West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming); Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont); South Central Atlantic (Alabama, Delaware, District of Columbia, Florida, Georgia, Kentucky, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, West Virginia).

FIGURE 7

Departmental (top 5 with the most respondents) vacancy rates, by region.

Laboratory Departments

Anatomic Pathology, Nonpathologist Professionals

The total vacancy rate for Anatomic Pathology (nonpathologist professionals) was 10.5% Figure 1. This department had a staff vacancy rate of 11.4%; the supervisory vacancy rate was 1.2% Figures 2 and 3. Results also revealed that 10.0% of all Anatomic Pathology employees were expected to retire in the next 5 years. Staff and supervisor retirement rates for Anatomic Pathology were 9.7% and 12.0% (the lowest rate among all departments surveyed), respectively Figures 4-6.

When hiring for the Anatomic Pathology department, most respondents reported the preferred credentials or certification were ASCP BOC Cytologist (CT), Histotechnician (HT), Histotechnologist (HTL), Medical Laboratory Scientist (MLS), Pathologists’ Assistant, and Specialist in Cytology (SCT). Also, 45.2% of the respondents from the Anatomic Pathology department indicated that their department required hiring certified individuals Table 5.

TABLE 5

2022 vs 2020 rate of respondents who indicated that certification is required when hiring laboratory personnel in their department

Department	Are you required to hire employees who are certified?a (% yes)
	2022	2020	Difference
Anatomic Pathology	45.2	58.9	‒23.3
Blood Bank	74.7	80.4	‒7.0
Chemistry/Toxicology	65.1	75.0	‒13.1
Core Laboratory	68.8	73.0	‒5.7
Cytogenetics	32.5	—	—
Cytology	91.5	89.1	2.7
Flow Cytometry	65.2	—	—
Hematology/Coagulation	70.9	71.2	‒0.5
Histology	39.8	39.3	1.2
Immunology	70.2	61.7	13.7
LIS/QA/PI	52.4	41.9	25.1
Microbiology	64.0	70.0	‒8.5
Molecular Biology/Pathology/Diagnostics	48.7	56.8	‒14.3
Phlebotomy	22.8	23.0	‒0.9
Point-of-Care	64.4	53.3	20.8
Send-outs	27.8	25.9	7.4
Specimen Processing	17.2	13.6	26.7

LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

^aValues in bold reflect the departments whose requirements to hire certified employees decreased.

Data showed that 51.2% of supervisors and 47.1% of staff in Anatomic Pathology laboratories were certified Table 6. Although night, weekend, and double shifts were very difficult to fill, the respondents found overtime and holiday shifts to be of average difficulty to fill. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

TABLE 6

Rate of certified staff (nonsupervisory) and supervisors

Department	Certification rate, %
	Overall		Staff (nonsupervisory)		Supervisory
	Rate	Total No.	Rate	Total No.	Rate	Total No.
Anatomic Pathology	47.4	1760	47.1	1594	51.2	166
Blood Bank	80.6	2422	80.4	2169	82.6	253
Chemistry/Toxicology	71.6	1513	71.5	1405	73.1	108
Core Laboratory	76.7	3775	75.3	3468	91.9	307
Cytogenetics	72.1	741	70.1	680	93.4	61
Cytology	76.3	729	74.7	655	90.5	74
Flow Cytometry	70.9	385	71.3	331	68.5	54
Hematology/Coagulation	83.0	1427	82.2	1321	92.5	106
Histology	56.7	1247	54.7	1151	80.2	96
Immunology	76.8	487	74.4	441	100.0	46
LIS/QA/PI	65.2	250	57.7	194	91.1	56
Microbiology	72.2	2296	70.7	2106	88.9	190
Molecular Biology/Pathology/Diagnostics	54.5	792	54.1	662	56.9	130
Phlebotomy	42.0	2286	41.2	2148	54.3	138
Point-of-Care	81.1	646	79.4	586	98.3	60
Send-outs	61.0	423	61.0	423	NA	NA
Specimen Processing	34.5	750	31.5	698	75.0	52

LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement; NA, not applicable.

Blood Bank (Immunohematology)

The overall vacancy rate for Blood Bank was 17.8% Figure 1, with staff vacancy rates at 18.9%, the highest of all departments surveyed, and supervisor vacancy rates at 9.0% Figures 2 and 3. Survey respondents working in blood banks indicated that they anticipated an 18.1% overall retirement rate in the next 5 years, the highest of all departments surveyed. Staff members had an anticipated retirement rate of 17.2% compared with 25.8% for supervisors Figures 4-6.

Respondents from blood banks preferred the following ASCP BOC certifications when hiring employees: Technologist in Blood Banking, Specialist in Blood Banking, MLS, and Medical Laboratory Technician (MLT). Overall, 74.7% of the respondents reported that their department required certification for laboratory positions Table 5. According to the survey results, 80.4% of staff and 82.6% of supervisors working in blood banks were certified Table 6. Blood Bank evening (2:00-10:00 pm) and overnight shifts were difficult to fill, while night (10:00 pm to 6:00 am), weekend (Saturday and Sunday), and double shifts were very difficult to fill. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Chemistry/Toxicology

The total vacancy rate for Chemistry/Toxicology was 17.3% Figure 1. The vacancy rate was 18.0% for staff and 8.3% for supervisors Figures 2 and 3. Results also revealed that 15.9% of Chemistry/Toxicology employees were expected to retire in the next 5 years. The retirement rates were 15.0% for staff and 28.0% for supervisors Figures 4-6.

Most of the respondents from the Chemistry/Toxicology department preferred to hire employees with ASCP BOC MLS, MLT, Specialist in Chemistry, and Technologist in Chemistry certifications. Also, 65.1% of the respondents indicated that certification was a prerequisite by their department for all candidates Table 5. Within Chemistry/Toxicology, data showed that 71.5% of staff and 73.1% of supervisors were certified Table 6. Overtime shifts were difficult to fill, while night (10:00 pm to 6:00 am), weekend (Saturday and Sunday), and double shifts were very difficult to fill according to respondents. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Core Laboratory

The vacancy rate for the Core Laboratory was 18.0%, the highest among all the departments surveyed Figure 1. The total vacancy rate for staff was 18.7%, and the supervisor vacancy rate was 11.7% Figures 2 and 3. Results also revealed that 16.1% of the total Core Laboratory department employees were expected to retire in the next 5 years. The retirement rate for staff was 14.9% and was 28.5% for supervisors Figures 4-6.

When hiring employees for core laboratories, most respondents reported ASCP BOC MLS and MLT as the preferred certifications. Survey results showed that 75.3% of staff and 91.9% of supervisors were certified Table 6. More than two-thirds (68.8%) of the survey participants reported that certification was a prerequisite by their department for candidates Table 5. Evening (2:00-10:00 pm), night (10:00 pm to 6:00 am), double, holiday, overtime, and weekend shifts were very difficult to staff in this department. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Cytogenetics

The vacancy rate for Cytogenetics was 7.0%, the lowest among all the departments surveyed Figure 1. The staff vacancy rate was 7.5%, the lowest staff rate among all departments surveyed, while the supervisor vacancy rate was 1.7% Figures 2 and 3. Survey respondents from the Cytogenetics department indicated that they anticipated a 12.0% retirement rate within the next 5 years. The staff retirement rate was 10.8%, and the rate for supervisors was 25.0% Figures 4-6.

The certification of choice when hiring staff in the Cytogenetics department were ASCP BOC MLS and Technologist in Cytogenetics. The rate of respondents indicating that certification was a prerequisite for hire was 32.5% Table 5. Also, 70.1% of staff and 93.4% of supervisors were certified Table 6. Evening shift (2:00-10:00 pm) was difficult to fill, while night (10:00 pm to 6:00 am) and double shifts were very difficult to staff in this department. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Cytology

The vacancy rate for Cytology was 13.2% Figure 1. Total staff and supervisor vacancy rates were 14.5% and 1.4%, respectively Figures 2 and 3. Survey results showed that 19.6% of Cytology personnel were expected to retire in the next 5 years. The staff retirement rate was 17.7%, the highest rate of all the departments surveyed, and the rate for supervisors was 35.6% Figures 4-6.

Respondents from the Cytology department preferred cytologist ASCP BOC CT and SCT certifications when hiring. Also, 91.5% of the respondents indicated that certification was a prerequisite for all candidates, and this department had the highest rate of respondents reporting that they require certification for candidates Table 5. Survey results showed that 74.7% of staff and 90.5% of supervisors were certified Table 6. Night (10:00 pm to 6:00 am), weekend (Saturday and Sunday), and double shifts were very difficult to fill according to respondents. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Flow Cytometry

The vacancy rate for Flow Cytometry was 12.1% Figure 1, with a staff vacancy rate of 13.6% Figure 2. The supervisory vacancy rate was 2.0% Figure 3. Survey respondents from the Flow Cytometry department indicated that they anticipated a 12.8% retirement rate in the next 5 years. The staff retirement rate was 11.5%, and the supervisory retirement rate was 20.8% Figures 4-6.

Respondents from Flow Cytometry preferred ASCP BOC MLS certification when hiring staff. The rate of respondents indicating that certification was a prerequisite for hire was 65.2%. Survey results showed that 71.3% of staff and 68.5% of supervisors were certified Table 6. Day shifts (8:00 am to 4:00 pm) were reported to be difficult to fill, evening shifts (2:00-10:00 pm) were difficult to very difficult to fill, and night shifts (10:00 pm to 6:00 am) were very difficult to fill. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Hematology/Coagulation

The vacancy rate for Hematology/Coagulation was 16.6% Figure 1. Total staff and supervisor vacancy rates were 17.7% and 2.0%, respectively Figures 2 and 3. Survey respondents from the Hematology/Coagulation department indicated that they anticipated a 16.7% overall retirement rate in the next 5 years. Staff members had a retirement rate of 16.0% compared with 24.7% for supervisors Figures 4-6.

Most of the respondents from the Hematology/Coagulation department preferred to hire staff with ASCP BOC MLS, MLT, Technologist in Hematology, and Specialist in Hematology certifications. In this department, 70.9% of the respondents reported that their department required certification when hiring staff Table 5. Also, 82.2% of staff and 92.5% of supervisors were certified Table 6. This department also had the highest rate of certified staff among all the departments surveyed. Evening shifts (2:00-10:00 pm), weekend (Saturday and Sunday), and overtime shifts were difficult to fill, while night (10:00 pm to 6:00 am), holiday, and double shifts were very difficult to fill according to respondents. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Histology

The total vacancy rate for Histology was 13.2% Figure 1. The staff vacancy rate was 13.8%, and the supervisory vacancy rate was 4.5% Figures 2 and 3. Results showed that in the next 5 years, this department anticipated a retirement rate of 12.3%. Staff members had a retirement rate of 11.6%, comparatively lower than the rate for supervisors, which was at 20.7% Figures 4-6.

When hiring employees in the Histology department, most respondents reported ASCP BOC HT and HTL as the preferred credentials. Also, 39.8% of the respondents from this department indicated that certification was a prerequisite by their department for candidates Table 5. Survey results also showed that 54.7% of staff and 80.2% of supervisors in the Histology department were certified Table 6. Day shifts (8:00 am to 4:00 pm) were reported to be difficult to fill, while evening (2:00-10:00 pm), night (10:00 pm to 6:00 am), weekend, double, and holiday shifts were very difficult to fill. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Immunology

The vacancy rate for Immunology was 16.0% Figure 1. The total vacancy rate for staff was 17.6% and for supervisors was 0% Figures 2 and 3, lowest among all departments. Results showed that in the next 5 years, this department anticipated an overall retirement rate of 18.2%. The staff retirement rate was 17.3%, while the supervisor retirement rate was 26.7% Figures 4-6.

The certifications of choice when hiring staff in the Immunology department were ASCP BOC MLS, MLT, and Technologist in Immunology. In this department, 70.2% of the survey respondents reported that certification was a prerequisite in their department for candidates Table 5. According to the survey results, 74.4% of staff and 100.0% of supervisors were certified (reported to be the highest certification rates for supervisors among all departments surveyed) Table 6. Night (10:00 pm to 6:00 am), weekend, double, overtime, and holiday shifts were very difficult to fill in this department. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Laboratory Information System/Quality Assurance/Performance Improvement

The vacancy rate for LIS/QA/PI was 13.2% Figure 1. The vacancy rate for staff positions was 15.9% and 3.5% for supervisors Figures 2 and 3. Survey respondents from the LIS/QA/PI departments indicated that they anticipated a 14.0% overall retirement rate in the next 5 years. Staff members had a retirement rate of 11.9%. The supervisor retirement rate was 21.4% Figures 4-6.

Most of the respondents from the LIS/QA/PI departments preferred to hire staff with ASCP BOC MLS and MLT certifications. In these departments, 52.4% of the respondents reported that their departments required certification when hiring Table 5. Survey results also showed that 57.7% of staff and 91.1% of supervisors in the LIS/QA/PI departments were certified Table 6. Night (10:00 pm to 6:00 am), weekend (Saturday and Sunday), double, overtime, and holiday shifts were very difficult to fill in this department. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Microbiology

The total vacancy rate for Microbiology was 13.9% Figure 1. The staff vacancy rate was 14.4%, and the supervisor vacancy rate was 8.1% Figures 2 and 3. Results also revealed that 15.1% of Microbiology department employees were expected to retire in the next 5 years. The staff retirement rate was 14.1%; for supervisors, the retirement rate was 25.1% Figures 4-6.

When hiring staff in the Microbiology department, most respondents reported ASCP BOC MLS, MLT, Technologist in Microbiology, or Specialist in Microbiology as the preferred certifications. Also, 64.0% of supervisors indicated that certification was a prerequisite in their department for candidates Table 5. Survey results showed that 70.7% of staff and 88.9% of supervisors in the Microbiology department were certified Table 6. Day shifts (8:00 am to 4:00 pm) were difficult to fill; evening shifts (2:00-10:00 pm) were both difficult and very difficult to fill, while night (10:00 pm to 6:00 am), weekend (Saturday and Sunday), double, overtime, and holiday shifts were very difficult to fill in this department. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Molecular Biology/Molecular Pathology/Molecular Diagnostics

The vacancy rate for Molecular Biology/Molecular Pathology/Molecular Diagnostics was 13.4% Figure 1. The vacancy rate for staff positions was 13.2% and for supervisors was 14.8%, the highest rate among all the departments surveyed Figures 2 and 3. Survey respondents from the Molecular Biology/Molecular Pathology/Molecular Diagnostics department indicated that they anticipated an 8.9% retirement rate in the next 5 years. Staff members had a retirement rate of 7.8% (the lowest rate of all departments surveyed) and 17.1% for supervisors Figures 4-6.

Most of the respondents from the Molecular Biology/Molecular Pathology/Molecular Diagnostics department preferred to hire employees with ASCP BOC MLS, MLT, Technologist in Molecular Biology, and Specialist in Molecular Biology certifications. Also, 48.7% of the respondents from this department indicated that certification was a prerequisite by their department for candidates Table 5. Survey results showed that 54.1% of staff and 56.9% of supervisors in the Molecular Biology/Molecular Pathology/Molecular Diagnostics department were certified Table 6. Weekend shifts (Saturday or Sunday) were difficult to fill in this department, with the night (10:00 pm to 6:00 am) and double shifts being very difficult to fill. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Phlebotomy

The vacancy rate for Phlebotomy was 11.9% Figure 1. The vacancy rate was 12.0% for staff positions and 10.4% for supervisors Figures 2 and 3. Results showed that 8.7% of employees in Phlebotomy were expected to retire in the next 5 years, the lowest rate of all departments surveyed. The staff retirement rate was 8.4%; the rate for supervisors was 14.1% Figures 4-6.

The ASCP BOC certifications of choice for new staff-level employees in the Phlebotomy department were Medical Assistant and Phlebotomy Technician (PBT). In this department, 22.8% of the survey participants indicated that certification was a prerequisite in their department for candidates Table 5. Results showed that 41.2% of staff and 54.3% of supervisors in the Phlebotomy department were certified Table 6. Evening (2:00-10:00 pm), holidays, and weekend (Saturday and Sunday) shifts were difficult to fill in this department, with the night (10:00 pm to 6:00 am), double, and overnight shifts being very difficult to fill. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Point-of-Care

The total vacancy rate for Point-of-Care was 12.8% Figure 1. The staff vacancy rate was 14.0%, and the supervisor vacancy rate was 1.7 Figures 2 and 3. Results also revealed that 13.9% of Point-of-Care department employees were expected to retire in the next 5 years. The staff retirement rate was 11.7% and for supervisors was 33.3% Figures 4-6.

When hiring staff-level employees in the Point-of-Care department, most respondents reported that the preferred ASCP BOC certifications were MLS and MLT. Also, 64.4% of supervisors indicated that certification was a prerequisite in their department for candidates Table 5. Results also showed that 79.4% of staff and 98.3% of supervisors in the Point-of-Care department were certified Table 6. Night (10:00 pm to 6:00 am), weekend (Saturday and Sunday), holiday, and double shifts were very difficult to fill. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Send-outs

The total vacancy rate for the Send-outs department was 15.2% Figure 1. The staff vacancy rate was 16.4%, while the vacancy rate for supervisors was 2.7% Figures 2 and 3. Results also revealed that 15.2% of all Send-outs employees were expected to retire in the next 5 years. Staff and supervisor retirement rates for the Send-outs department were 12.8% and 41.7% (the highest rate of all departments surveyed), respectively Figures 4-6.

When hiring for the Send-outs department, most respondents reported ASCP BOC MLS, MLT, and PBT as the preferred certifications. Slightly more than one-quarter of the respondents from the Send-outs department (27.8% Table 5) indicated that they were required by their department to hire certified individuals, and 61.0% of staff were certified Table 6. Night (10:00 pm to 6:00 am), holiday, overtime, and double shifts were very difficult to fill. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

Specimen Processing

The overall vacancy rate for Specimen Processing was 12.8% Figure 1. The staff vacancy rate was 13.7%, and the rate for supervisors was 2.0% Figures 2 and 3. Survey results showed that 10.4% of personnel in Specimen Processing were expected to retire in the next 5 years. The staff retirement rate was 9.8%; for supervisors, it was 17.3% Figures 4-6.

Respondents from the Specimen Processing department preferred ASCP BOC MLS, MLT, and PBT certifications when hiring staff-level employees. In this department, 17.2% of the survey respondents indicated that certification was a prerequisite in their department for candidates, the lowest rate among all departments surveyed Table 5. Certification requirement rates for this department were low, however, in part because the certification exam for these personnel categories did not exist until 2016, when the ASCP BOC created the Medical Laboratory Assistant exam. Survey results also showed that 31.5% of staff and 75.0% of supervisors in the specimen processing department were certified Table 6. Evening (2:00-10:00 pm) and double shifts were very difficult to fill in this department. (Shift options provided in the survey were very easy, easy, neither difficult nor easy, difficult, very difficult, not applicable.)

DISCUSSION

The Current Laboratory Workforce

Results of the ASCP 2022 Vacancy Survey showed increased overall vacancy rates for laboratory positions in all departments compared with 2020 Figure 8. Blood Bank, Chemistry/Toxicology, Core Laboratory, Flow Cytometry, Hematology/Coagulation, Immunology, Microbiology, and Send-outs departments took 7 to 12 months to hire staff (nonsupervisory); Cytology departments took more than 12 months; and the remaining departments surveyed took 3 to 6 months to hire. For most departments (Anatomic Pathology, Cytology, Hematology/Coagulation, LIS/QA/PI, Microbiology, and Point-of-Care), hiring of supervisors now takes more than 12 months, a longer period compared with 2020.⁷ Chemistry/Toxicology, Flow Cytometry, Immunology, and Send-outs departments took 7 to 12 months to hire a supervisor. Cytogenetics, Histology, Molecular Biology/Molecular Pathology/Molecular Diagnostics, Phlebotomy, and Specimen Processing took 3 to 6 months to hire a supervisor, while Blood Bank took 3 to more than 12 months and Chemistry/Toxicology took 3 to 12 months.

FIGURE 8

Overall vacancy rates (2020 vs 2022), by laboratory department. LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

When asked what the main laboratory workforce concern was that year, 29.1% of respondents reported the need for better salaries for laboratory personnel and increased efforts to heighten the profile of the laboratory profession in the medical field. Filling vacancies was equally concerning (20.4%), exacerbated by the staffing challenges laboratories faced during the pandemic. The third top concern respondents reported was staffing the laboratory with qualified laboratory professionals (15.3%).

Tables 7 and 8 show comparison of the 2022 retirement rates with previous survey results. Overall retirement rates (for those who anticipated retiring in the next 5 years) for laboratory professionals increased across most laboratory departments Table 7. Retirement rates for staff in most departments had also increased Table 8. Retirement rates for supervisors had increased for the following departments: Anatomic Pathology, Blood Bank, Cytogenetics, LIS/PI/QA, Molecular Biology/Molecular Pathology/Molecular Diagnostics, Phlebotomy, and Send-outs. The retirement rates in Chemistry/Toxicology, Core Laboratory, Cytology, Hematology/Coagulation, Histology, Immunology, Microbiology, and Specimen Processing had decreased Table 8.

TABLE 7

Overall retirement rates, by department since 2016^a

	Overall retirement rate, %
Department	2022b	2020	2018	2016
Anatomic Pathology	10.0	8.3	13.0	15.8
Blood Bank	18.1	14.2	17.3	21.0
Chemistry/Toxicology	15.9	20.4	18.3	22.9
Core Laboratory	16.1	16.3	17.1	20.7
Cytogenetics	12.0	9.2	15.7	19.9
Cytology	19.6	17.1	16.3	17.7
Flow Cytometry	12.8	6.0	20.5	17.4
Hematology/Coagulation	16.7	16.7	19.2	23.8
Histology	12.3	12.0	11.8	17.0
Immunology	18.2	15.3	16.2	22.1
LIS/QA/PI	14.0	13.0	27.1	28.3
Microbiology	15.1	14.3	17.4	20.1
Molecular Biology/Pathology/Diagnostics	8.9	10.0	11.2	14.7
Phlebotomy	8.7	6.7	9.6	10.8
Point-of-Care	13.9	11.9	13.5	24.7
Send-outs	15.2	10.4	13.6	18.2
Specimen Processing	10.4	7.9	11.6	14.7

LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

^aData from 2016 to 2022, gathered from past American Society for Clinical Pathology Vacancy Surveys.

^bValues in bold are for the departments with increased retirement rates in 2022 from 2020.

TABLE 8

2022 vs 2020 nonsupervisory staff and supervisory staff retirement rates

Department	Retirement rate,a %
	Staff (nonsupervisory)			Supervisory
	2022	2020	Δ	2022	2020	Δ
Anatomic Pathology	9.7	8.1	1.6	12.0	10.0	2.0
Blood Bank	17.2	13.0	4.2	25.8	24.3	1.5
Chemistry/Toxicology	15.0	17.9	‒2.9	28.0	39.0	‒11.0
Core Laboratory	14.9	15.1	‒0.2	28.5	32.1	‒3.5
Cytogenetics	10.8	8.6	2.2	25.0	14.3	10.7
Cytology	17.7	13.9	3.8	35.6	43.6	‒8.0
Flow Cytometry	11.5	4.9	6.6	20.8	NA	NA
Hematology/Coagulation	16.0	14.6	1.4	24.7	38.1	‒13.4
Histology	11.6	11.2	0.4	20.7	21.3	‒0.6
Immunology	17.3	13.2	4.1	26.7	33.3	‒6.7
LIS/QA/PI	11.9	12.0	‒0.2	21.4	15.9	5.5
Microbiology	14.1	12.8	1.2	25.1	30.9	‒5.7
Molecular Biology/Pathology/Diagnostics	7.8	10.0	‒2.2	17.1	10.0	7.1
Phlebotomy	8.4	6.3	2.0	14.1	13.3	0.7
Point-of-Care	11.7	8.0	3.7	33.3	33.3	0.0
Send-outs	12.8	9.0	3.8	41.7	20.0	21.7
Specimen Processing	9.8	6.5	3.3	17.3	25.0	‒7.7

LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement; NA, not applicable.

^aValues in bold are for the departments with increased retirement rates in 2022 from 2020.

Data also showed that 97.2% (89.9% in 2020⁷) of supervisors had not had layoffs of any laboratory professionals in the departments they supervised within the past 6 months of participating in this survey. Furthermore, 93.6% (83.8% in 2020⁷) did not anticipate layoffs of any laboratory professionals in the departments they supervised in the next 6 months.

When open positions were not filled relatively quickly, respondents indicated that the positions were either left open (72.1% [57.8% in 2020^7]), assigned temporarily to other staff (67.4% [63.9% in 2020^7]), reposted (46.6% [42.9% in 2020^7]), assigned to temporary personnel (23.7% [17.5% in 2020^7]), permanently assigned to other staff (20.9% [21.6% in 2020^7]), or eliminated (19.5% [25.4% in 2020^7]).

New Technologies

The percentage of participants who indicated that new technologies caused changes to their staffing needs within the past 6 months showed a slight increase (24.0% in 2022 vs 21.9% in 2020). When asked to identify the types of technologies causing the greatest changes to their staffing needs, respondents reported that molecular testing caused the greatest change at 57.4%, followed by automation at 35.4%, LIS at 30.8%, point-of-care at 10.8%, and electronic health records (EHRs) at 7.7%.

Molecular testing volume continues to increase and requires the need for more specialized staff to perform these tests. At the time of the survey, staff continued to perform COVID-19 testing, and there was an increased need for laboratory professionals to perform these tests. One respondent indicated that “next-generation sequencing is the basis for all of our molecular assays and the data analysis for our clinical applications is extremely complex. A strong background in molecular fundamentals is crucial in any candidate for a certified/licensed position in our lab.” With the arrival of the pandemic, “the need for molecular testing went through the roof. This required dedicated staff to handle the workflow, and the additional duties to the off shifts, which increased the stress levels.” When asked what the impact of automation has been on staffing, respondents reported that it helped alleviate routine tasks and provided more time for staff to focus on other laboratory work. From the 2022 Vacancy Survey, respondents indicated that LIS and EHR continue to drive increased need for more laboratory professionals with LIS skills. For example, 1 laboratory manager reported that they need more “MLS/LIS integrated knowledge” to keep the systems running.

Hiring, Recruiting, and Retaining Laboratory Personnel

When hiring personnel, respondents reported the following challenges: better pay and benefits at other laboratories (78.3%); increased competition for well-trained personnel (75.9%); applicants without the necessary certification, education, or skills to perform the work (53.1%); delay in filling positions because of the need for justification from administration (48.0%); budget constraints (39.1%); position subject to hiring freeze (18.6%); and delay in immigration paperwork (7.9%).

Hiring personnel also indicated that their top challenge in recruiting personnel for open positions in the laboratory was better pay and benefits at other area laboratories (78.4%). Other challenges included increasing competition for well-trained personnel (76.8%), lower compensation than other professions requiring similar education or training (62.0%), applicants not possessing the necessary education and skills to perform the work (60.7%), compensation level (59.8%), less desirable working conditions than other labs (14.9%), full-time employment not available (6.6%), hospital eliminating key employee benefits (5.0%), and concerns about biosafety (3.8%).

As for retaining staff, the top 3 issues included better pay and benefits at other area laboratories (75.1%), workload/stress (67.6%), and limited potential for advancement or additional compensation (60.0%). Other challenges affecting retention included lower compensation than other professions requiring similar education or training (56.1%), retirement (47.9%), scheduling issues (43.9%), personnel issues (37.0%), pursuing other opportunities outside laboratory medicine (36.2%), change of career (31.8%), moved to another department or section of the laboratory (26.4%), less desirable working conditions compared with other careers (25.9%), less desirable working conditions compared with other labs (18.3%), commuting issues (18.2%), hours reduced to fewer than 40 per week (5.8%), hospital eliminating key employee benefits (4.5%), and concerns about biosafety (3.9%).

In addition to health, retirement, and pension benefits as well as premium pay for overtime, holidays, or weekends, the top perks offered to laboratory personnel included tuition/continuing education reimbursements, sign-on bonuses, and referral bonuses Table 9. When hiring managers were asked how much of their total laboratory budget was allocated to laboratory staff labor/personnel, they indicated that it was 33.9% on average.

TABLE 9

Perks institutions offer to all employees (select all)

Response	No. (%)
Medical benefits	780 (95.8)
Dental benefits	746 (91.6)
Pension/retirement benefits	671 (82.4)
Tuition reimbursement	603 (74.1)
Premium pay for overtime, holidays, or weekends	593 (72.9)
Sign-on bonus	411 (50.5)
Referral bonus	409 (50.2)
Free or subsidized employee parking	375 (46.1)
Pay/reimbursement for certifications or qualifications	247 (30.3)
Flexible work hours	236 (29.0)
Performance bonuses	230 (28.3)
Pay/reimbursement for continuing education	223 (27.4)
Bonuses not directly tied to work (including holidays and profit-sharing bonuses)	141 (17.3)
Pay/reimbursement for professional memberships	119 (14.6)
Laptop, tablet, or other mobile device	117 (14.4)
Uniform allowances	90 (11.1)
Transportation allowances	82 (10.1)
Commuter shuttle	57 (7.0)
Telecommuting	46 (5.7)
Company phone	44 (5.4)
Free or subsidized childcare or elder care	40 (4.9)
Company car	9 (1.1)
Free or subsidized room and board	4 (0.5)
Other	41 (5.0)

On average, respondents who reported that there have been voluntary or involuntary terminations in the departments they supervise in the past 6 months (yes = 55.7%; no = 44.3%) indicated that more than half of the terminations were voluntary resignations (64.1%), with 12.2% involuntary. The top 3 reasons for voluntary resignations included leaving for another position within the field (67.9%), leaving the field (34.0%), and retirement (34.0%). Other reasons included relocating (31.2%) and family obligations (24.8%).

Certification

Overall certification rates were highest in the Hematology/Coagulation department and lowest in the Specimen Processing department Figure 9. For the Anatomic Pathology, Blood Bank, Chemistry/Toxicology, Core Laboratory, Hematology/Coagulation, Microbiology, Molecular Biology/Molecular Pathology/Molecular Diagnostics, and Phlebotomy departments, the percentage of respondents who reported that they are required to hire certified personnel was lower than in 2020, the difference ranging between ‒0.5% and ‒23.3% Table 5.

FIGURE 9

Overall certification rates, by laboratory department. LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

Data also revealed that 56.9% (54.2% in 2020⁷) of the respondents reported that they hire noncertified personnel to perform the following responsibilities: preanalytic (nontechnical) processes (88.1% [93.2% in 2020^7]), analytical testing–low complexity (59.6% [47.7% in 2020^7]), analytical testing–moderate complexity (42.1% [30.0% in 2020^7]), and analytical testing–high complexity (28.3% [23.6% in 2020^7]).

The education levels of staff employed in the laboratory who are not certified varied widely: The highest percentages had a bachelor’s degree (43.3%) or a high school education/GED (34.4%), followed by an associate degree (15.8%). Only 6.5% had an advanced degree (master’s degree or higher).

Data showed that 12.7% of respondents hired foreign nationals, a decrease of approximately 2.7% from 2020 (15.3%), with preference for ASCP BOC MLS and MLT certifications. The ASCP will continue to collect data to analyze these trends.

Summary

Results of the 2022 ASCP Vacancy Survey show that vacancy rates are higher in all departments compared with the 2020 report Figure 8. Retirement rates for most of the departments surveyed also increased, except for Hematology/Coagulation, Core Laboratory, Chemistry/Toxicology, and Molecular Biology/Molecular Pathology/Molecular Diagnostics departments, suggesting that the field is experiencing another wave of retirements, possibly due to the pandemic Table 7. Certification requirements for hiring decreased for the Anatomic Pathology, Blood Bank, Chemistry/Toxicology, Core Laboratory, Hematology/Coagulation, Microbiology, Molecular Biology/Molecular Pathology/Molecular Diagnostics, and Phlebotomy departments, suggesting hiring managers’ difficulties in recruiting qualified and certified laboratory personnel in these areas Table 5.

The 2020 Vacancy Survey results provided us with a snapshot of how the COVID-19 pandemic shifted our workforce trends through furloughs, staff departures, and early retirements.⁷ Current Vacancy Survey data illustrate the pandemic’s continued effects on laboratory staff vacancies, retirements, and certification requirements. In comparing vacancy rates from past surveys (from 2014 to 2022), data show that the current vacancy rates are at their highest level thus far Table 10. Table 6 shows that the retirement rates increased again for most of the departments surveyed, a trend we last observed in 2018. Although certification requirement rates do not show significant decline, departments such as Histology, Microbiology, and Phlebotomy have seen decreasing credentialing rates since 2014.

TABLE 10

Vacancy rates, 2014-2022

Overall vacancy rate	2014, %	2016, %	2018, %	2020 %	2022, %
Anatomic Pathology	10.4	4.7	7.4	5.5	10.5
Blood Bank	10.8	8.4	9.3	10.4	17.8
Chemistry/Toxicology	10.8	9.0	8.7	12.7	17.3
Core Laboratory	12.3	7.5	10.4	10.3	18.0
Cytogenetics	2.0	5.0	10.9	5.0	7.0
Cytology	3.4	4.8	7.1	3.9	13.2
Flow Cytometry	4.3	9.2	8.0	10.1	12.1
Hematology/Coagulation	7.2	8.5	9.7	8.5	16.6
Histology	9.7	5.6	8.4	8.6	13.2
Immunology	8.7	6.7	11.5	11.2	16.0
LIS/QA/PI	0.0	11.0	6.4	10.3	13.2
Microbiology	9.2	5.9	10.1	6.7	13.9
Molecular Biology/Pathology/Diagnostics	13.0	5.3	5.7	7.3	13.4
Phlebotomy	15.9	8.1	13.2	11.1	11.9
Point-of-Care	6.1	6.2	4.0	5.8	12.8
Send-outs	5.4	6.6	7.4	6.8	15.2
Specimen Processing	9.8	9.1	7.7	7.7	12.8

LIS/QA/PI, Laboratory Information System/Quality Assurance/Performance Improvement.

Qualitative analysis results from this survey show that there is an urgent need to focus not only on recruitment but equally on retention of laboratory professionals. The most common concern from respondents was salaries/benefits not keeping up with inflation and acting as a barrier in retaining staff. Competition with other laboratories offering higher pay or sign-on bonuses⁵ and travel pay has become a major contributor to the loss of staff. One respondent said, “there needs to be incentives offered to recruit, but the incentives really need to be focused on retention efforts. I honestly believe low wages and lack of recognition of the knowledge base of our professionals are the biggest problems.”

Positions not being filled coupled with lack of qualified staff continue to exacerbate laboratory staffing shortages 3 years after the beginning of the COVID-19 pandemic. According to 1 respondent, “2020-2022 has been the hardest time I have had in my 20 years in this field to retain and hire staff. Also, the students coming out of the schools during this time period are not properly prepared to work in the lab as they were not able to do their clinical rotations or it was limited. It is taking longer to train/teach these new hires.” Some employers have adapted to recruitment and retention challenges by beginning to hire noncertified personnel to perform testing.⁵ A focus on alternative pathways into laboratory careers has been suggested: “[W] e have to figure out a better way to train non-traditional scientists in the medical lab sciences and get them certified.” Other concerns from respondents included the need for more advocacy and visibility and how to communicate to their C suite the need to address burnout, stress, and work-life balance.

Current Activities and Next Steps

The report from HHS ASPE indicated that the effects of the pandemic will likely persist for years to come, and “addressing these impacts as well as the underlying challenges that pre-dated the pandemic can help build a stronger and more resilient health care system for the future.”¹ Preparing a resilient medical laboratory workforce for the future will require developing a supportive environment for laboratory professionals; an increased focus on the generational differences in laboratories to effectively recruit and retain younger laboratory staff; and for educational institutions and programs, laboratories, and laboratory organizations to come together to align with the needs of lab professionals.⁵

In March 2023, the Medical and Public Health Laboratory Workforce Coalition—a coalition of more than 20 national and regional laboratory, pathology, and other health care associations—was formed to work toward building a more robust, diverse medical laboratory workforce. This new workforce coalition will work to increase the visibility of laboratory occupations, such as by exposing students from elementary school through college to laboratory careers; expand and improve workforce recruitment, development, and retention efforts; and increase diversity, equity, and inclusion in the laboratory workforce.⁸ Since its inception, the coalition has put forth a full-page printed advertisement in Modern Healthcare to promote the visibility of the profession and has joined forces to urge Congress to tackle the critical personnel shortages affecting the pathology and laboratory workforce.⁹

The ASCP Workforce Steering Committee developed new recruitment materials in ASCP’s What’s My Next resource page (https://www.whatsmynext.org) and attended the American School Counselor Association meeting to promote and introduce laboratory careers to school counselors teaching K through 14 students. Finally, through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to support laboratory workforce development through the CDC OneLab Initiative, ASCP launched its Negotiation and Advocacy Toolbox, aimed at providing clinical laboratory directors with adaptable and practical tools to help demonstrate the value of their laboratories and better advocate for needs to C suite and hospital administration. The ASCP is supporting CDC’s rollout of the OneLab program and has created a microsite with relevant resources, including the toolbox.

Acknowledgments

Contributor: Matthew Schulze, ASCP Institute for Science, Technology and Public Policy, Washington, DC. Reviewers: Alexandra Brown, MD, FASCP, ASCP Institute for Science, Technology and Public Policy, Washington, DC; Michelle Campbell, MS, MLS(ASCP)^CMMB^CM, SC^CM, Mayo Clinic, Rochester, MN; Amy Spiczka, MS, HTL(ASCP)^CMSCT, MB^CM, CPHQ, ASCP Board of Certification, Chicago, IL; Jeannette Wallen, MBA, HT(ASCP)QIHC, MNGI Digestive Health, Minneapolis, MN.