Now that we've looked at the laboratory network and how laboratories interact with partners that perform testing and users of the laboratory we also need to focused on who it is that are working in these laboratories this is going to help us understand some of the constraints that are put on testing that's done very widely and some of the quality concerns that we have about testing we also are going to look at this because the clinical laboratory as you will see makes up a large part of the workforce however. That's the same pool of candidates that public health laboratories to use in order to staff their testing personnel So let's look at First of all. What some of the people are the levels are that we have of the laboratory staff the first is the phlebotomist these are people with that collect specimens particularly blood specimens from the veins or fingers of people these are people that are probably have a high school diploma and some training on the job or in a community college type setting where they get some training specifically in Fla bottom mean very limited scope of practice medical laboratory technicians have generally an associates degree they have limited responsibilities in the laboratory of what they can perform based again on federal regulations of the laboratory and these are. People who will have an associates degree and I work under the direction our in the direct directly under the supervision of someone with more education and training generally a laboratory scientist if the medical lab technician does work alone they can only do very simple. Us. The medical laboratory scientists goes by other names clinical laboratory scientist medical technologist lot of different names for the same group of people they can be generalist in which they can work in any part of the laboratory or they can have a specialty in one area of the laboratory like histo technology where they're looking at tissue specimens sayto technology looking specifically microscopically at the arrangement and type of cells to determine if there's cancer present blood baking microbiology chemistry hematology you can be a specialty specialist in any one of these areas of the laboratory. How do they get there so as I said phlebotomist just have a on the job training usually medical laboratory technicians are going to have an associate's degree with or without an internship and these internships are going to be hospital based medical laboratories scientists can come by way of that title and those responsibilities by several different pathways the most common and the traditional way is to get a bachelor's degree in medical technology or clinical laboratory scientists from an accredited university based laboratory program for example at Michigan State University where I teach there is a biomedical lab science program people get an associate the excuse me they get a bachelor's degree in clinical lab scientists science after they have completed an internship the internship and the education program are both accredited by holes which is an agency that oversees the education of laboratory personnel. When you've completed a bachelor's to. And an internship then you're eligible to sit for an examination the most commonly used examination is through the American Society of clinical pathology a C P But there are certainly other certifying organizations out there in other areas for example fertility laboratories they have a examination through an entirely different agency American. Board of bio analysis so there are lots of those out there. So a. Meth lab science can also get a degree in say chemistry or microbiology and then get on the job training with that they can after a certain period of time which is dictated by the certifying agency then they are able to sit for an examination so they can get the same credentials after their name as somebody who's gone through the traditional M.L.S. university based training or they can graduate and get experience and then go on to sit for a certification exam generally they are only going to get a certification in a specialty area whereas people coming out of the traditional M.L.S. track are going to get certifications as generalists which means that they can work in any area of the laboratory. I show you this this is a graph that shows us the number of graduates from accredited programs over of forty year period what I would like you to note here is that until about intil the eighty's the number of people graduating were increasing and then after that into the nine eighties to the ninety's it started to drastically decrease the reason for this was that during that time period laboratories came under a lot of. Strained to save money because of the way that Medicaid was going to reimburse labs no longer were they going to pay hospitals for each service each test each X. ray but they were going to reimburse for the diagnosis so appendicitis one flat rate so laboratories then transition from being a money making center within hospitals to actually in some cases being a deficit generating Because if you need a lot of lab tests there's some complication you're going to run up the cost of providing the care whereas the reimbursement remains flat. So it was difficult for laboratories they had to downsize the number of people that they had and when they downsized the staff number that made it very difficult then for them to continue to provide slots openings in to provide the internship experiences so as a result of that there was no need to graduate people in these programs that the there was no place to place them so programs closed and we saw a real reduction of that up until the mid two thousand what's changed and why it's coming back up again is because it's been so expensive to pay overtime because of understaffing that there's been a realisation an acknowledgement that we do have a crisis we do have a workforce shortage and we need a larger pipeline we need to train more people in laboratory science. I show you this because it shows very clearly that while we are slowly growing from two thousand and nine to two thousand and twelve in the number of graduates that are coming out of programs certified programs we're also seeing a shift from people with from being pretty. Only people with bachelor's degrees to people with associates degrees so this is in part due to the acknowledgment that with more. Automation in the laboratory that you don't need as many people with the high level of expertise and education that you have with A A C L Last summer clinical lab scientist medical lab scientist so we're seeing a shift in that composition of the workforce. So how are these people regulated there are some cases some states that are going to provide licensure but this is variable from state to state for example of. California and New York regulate the right to practice laboratory science in their states they have requirements that you must have certain education and experience some of their none of them require that a S.E.P. examination but they certainly accept it in the case of California you actually have to sit for an additional examination in order to work in their public health laboratory as a microbiologist so very licensee is rather strict in that regard. Certifying agency is one that endorses a professional competency so I mentioned a C P Before they look at someone's experience their education and passing an examination before before you become a certified M.L.S. with them a medical lab scientist and then there's on states and that required just registration which means that you send in your credentials they put your name I think knowledge you as a professional and then you are able to practice this would be the case for. Georgia. And which you just have to say that you're doing this they look at your credentials and then they give you a registration in their state in order to work in a laboratory Now this is the these regulations generally are only going to require this of people who are working in labs that are regulated by the federal laws which I'm going to go into in more detail later but there are not any regulations on people that for example that work in an Environmental Laboratory or a food testing laboratory those are strictly up to the managers and the administrators to determine what kind of qualifications and experience they want and they're testing personnel for the most part these these licensing and certification requirements if there are any in a an employer decides to use our only because our only applied to people doing testing of human specimens. This is important this is a take home message here labs are regulated not personnel so in no case here that I gave you these examples of licensing certification or registration. Other than those few states that require it there's no federal law that requires. Laboratory personnel to be licensed or certified or educated in any certain way there are testing personnel requirements that are associated with how hard the test is how complex the test is to do but personnel themselves don't have any specific certification that they need and this is one thing that makes this profession very different than other health professions if I say are an M.D. respiratory therapist physical therapist you know we all understand what it took to be. Able to call yourself that professional in the case of a medical lab scientist First of all we can't even agree on what we call these people Second of all we don't agree on what it takes in order to be qualified to do that work so this is another identity crisis within the profession. Where these people working by and large they work in hospital laboratories we see a. Large chunk of them that work in reference laboratories I mean there just are more hospitals so even though the number of employees per laboratory is much lower lower than a reference or commercial laboratory the still the sheer numbers are going to be driven by the hospitals doctor's office will be employing people with the technology the technician degree more frequently than people with the bachelor's level training and that is because they're doing simpler Tass academia and again this is one of the areas that people with these skills and abilities are very sought after and so they go into research laboratories they are sought because not just because of their technical skills but because of their understanding of quality systems and their ability to apply those then to research testing and then government would include public health laboratories that the state and local level but also at the federal level so the F.D.A. the E.P.A. and so on they all employ people that come out of this same labor pool and that's the take home message is that as people go work through their education and. Internship and start to make decisions about where they want to work sometimes public health is not even on their radar and they often don't even become aware that there is such a thing as a whole system up. Public Health Laboratories until several years into their their professional experience so that's one way in which public health laboratories are working now to address a workforce Shorey age is by making sure that they are integrated with the educational process enough so that students are aware of them as an option as a ploy meant. So why do we see so few people coming into the profession why is there a workforce shortage well as I said there are fewer slots for training but also pay we can't fill up as many slots for training as we have anyway we have people that want to get into these slots but they can't get there but more importantly we have a lot of people who make the decisions not to come into the profession strictly because of the pay so here these are the median ranges of salaries from a two thousand and twelve the most recent statistics available from the Bureau of Labor Statistics and you can see that the median range is for a medical and clinical laboratory technologist someone out with a bachelor's degree about fifty seven thousand dollars a year. If you're someone who's interested in science and technology you may not make the decision to go into clinical laboratory science as opposed to chemist who's making seventy three thousand or a bio and biomedical engineer ninety three thousand dental hygienists seventy one thousand it's almost twenty thousand dollars to pay difference for median wages. Even someone in the medical profession Ahrens making sixty five almost ten thousand dollars a year more than a medical laboratory scientist and then you have your my favorite makeup artist making sixty six thousand three hundred thirty. So. Again you know the laboratory field sometimes is like Rodney Dangerfield we get no respect you we license and certify dog groomers and tattoo artists but not people who are doing cross matches a bad blood a result can cost a life we don't pay people as much to do this critical testing as we do make up artists so understandably this is not always an attractive choice for people to make as a career they go into other things so but is that OK I mean there is automation and so maybe we need fewer people and actually actually to do this testing so maybe this declining number of. A laboratory trained people in the workforce maybe that's OK well not as it turns out the Bureau of Labor Statistics actually predicts that this field is going to grow more so than other professions in fact they predict that it's going to grow by twenty two percent. In the next ten years their reason for that is the aging of the population as people age they develop more chronic diseases more chronic diseases require more management management requires more testing so laboratory the share number of laboratory tests is going to increase which is going to again cause higher demand Secondly another major issue is not just that we don't have enough now and that we're going to be growing but that we're an ageing group of people so the average age of a medical lab scientist across the country is forty two years old when we look at the data for specific professions fields are subspecialties within the laboratory profession we can see that for example. A specialist in bio banking S.P. B. is forty seven degrees said pretty seven years. Molecular biologist thirty six Well one difference between these two press oppressions is that the whole specialty the whole science of molecular biology emerged in the ninety's and early two thousand so of course people that are that are in that specialty however have worked shorter period than people who have been on in a lab like the blood banking where this is been a specialty for for many decades so the other problem that we have is not just specialists and they're aging but also that managers and the most experienced staff are also very gray and if we look at the statistics on those those people are are largely in their late fifty's and early sixty's so we're going to see a real change over where our more experienced after going to flip into management positions which is going to be leaving gaps on the bench for people to do the testing and we don't have a clear and sufficient pipeline to get people into those positions so yes I would predict that there is going to be a workforce shortage I also say Bring it on because not until there's a workforce shortage is there going to be pay parity and that's when we'll actually see more stable workforce pipeline in this profession is when we have parity and we have the right size of. The right number of programs that are training people to get into the profession. So what have we done about this to try to recruit people into it well we've tried to start standardized nomenclature the Association of Public Health Laboratories as a project in which we're trying to get people to all acknowledge that someone who's doing. Testing and syphilis testing in Michigan has the same title as somebody who is doing similar testing in Wisconsin so that if that person moves they have an actual career path and latter that is flexible from one agency to another we're looking at people who are already interested in the science technology engineering and math majors and making them aware of the laboratory profession as a career option and then again pay parity and still we get pay parity recruitment is always going to be a problem we also need to look at alternative pathways to qualification if we strictly lie on what worked in the thirty's and forty's education internships certification exam you're good to go if we continue to look up that way we're probably going to not be flexible enough and really address the needs of today's students we need more online options for example for education we need more ability to work in rural areas to do internship rather than travelling and setting up a household in a urban setting where there is a large hospital willing and able to take on the train we have to work at succession planning and if you are one of those laboratories that managers that is considering retiring and you have people of your age or of a decade or so younger than you on your work for years those people need to be aware of where in their community they can recruit and they should be involved in the education process at some level as much as they can so that they know who those people are that are coming out qualified and ready to work and so they consider working in your laboratory. And then again retention has always been a problem with the laboratory career. The medical laboratory science profession because these people have critical thinking skills they have been trained in quality assurance they know how to. They have technical skills they pay attention to details so these are the same sort of qualities that are demanded in a lot of different areas and so people jump from laboratories science into computer science they jump from lab science into pharmacy other health care professions it's a Often we see people going directly from their internship into professional school like medical school or. Dental school without ever really working in the laboratory profession at all or working for a very short amount of time in the laboratory profession and then jumping into. Another medical profession or public health. So in summary the public health workforce is originates from the same pool as the clinical laboratory workforce so we have to be vested in the same interests of laboratory as there's the clinical hospital laboratories have in building and maintaining an adequate workforce and administrator of any public health agency is going to need to know if they have adequate laboratory capacity and competency in their community as well as in their specific agency typically traditionally the path to becoming a laboratory professional has been a bachelor's degree followed by an internship both of those by an accredited agency and then eligibility to cert to sit for a certification examination however there are alternate pathways to becoming a laboratories professional and they are and we need more we need more ways in which to do that. Labs are not are regulated not laboratory personnel so laboratory personnel are not required to have any particular education requirement they are not for example a degree in medical technology or lab science they are not required to have any examination or certification these are dealt with under the regulation of the laboratory and they're given some very general guidelines in those regulations on what sort of education and experience people have to have. There is a looming laboratory workforce sorted starters that's due to the ageing of the workforce the increased demand for testing and tighter pipeline into the profession thank you.