An Assessment of the Workforce and Training Needs of Rural Kansas Medical Laboratories

INTRODUCTION

The Kansas Hospital Association (KHA) conducts a workforce survey annually that assesses the staffing in hospitals across Kansas. Prior to the COVID-19 pandemic, the KHA workforce survey showed a vacancy rate of 7% for laboratory personnel, which increased to 22% in the 2023 edition.^1,2 Laboratory personnel including medical laboratory technologists (MLTs) and medical laboratory scientists (MLSs) were identified within the top 10 specialties with the most vacancies and highest demand within Kansas hospitals.² The vacancy report concluded that, by 2028, there would be 2442 unfilled open positions for MLT and MLS staff in hospitals across the state.¹

These data reflect an impending critical laboratory workforce shortage of laboratory personnel and warrant further investigation. Previous literature details challenges that affect laboratories but does not offer an assessment of the workforce, and understanding this problem requires information on those who facilitate testing in rural communities, including the portion and characteristics of laboratory staff able to perform high-complexity testing (HCT). This study aimed to provide a novel assessment of the employee characteristics in Kansas’ critical access hospital (CAH) laboratories, document vacancy rates, and discern the training and education background of staff in these sites.

METHODS

Data from the Flex Monitoring website, accessed in April 2023, were used to identify all existing CAHs in Kansas.³ The KHA membership directory was then used to identify laboratory leaders at each facility who received an email containing an electronic survey link and a printable version of the questionnaire, which could be completed and returned to study personnel.⁴ Up to 3 reminder emails and a follow-up phone call were sent to encourage participation.

Study data were collected and managed using Research Electronic Data Capture (REDCap)^5,6 between May and July of 2023. There were no incentives provided to respondents.

The survey included questions about the total number of staff working within the laboratory, with subcategories by full-time employment, MLT or MLS education, employee education and certification through the American Society for Clinical Pathology (ASCP), and whether staff with other health care roles (eg, nurse, radiology technician, etc) were cross-trained to perform laboratory testing. The sufficiency of staff was assessed by asking how many open positions were available for MLT or MLS or other HCT personnel. The survey also included questions on the capacity of the laboratory to perform HCT.

Responses were summarized with basic descriptive statistics using STATA software.⁷ Some items required recoding before analysis because of questions allowing for the selection of multiple options or because of open-ended entry by respondents. This project was classified as a quality improvement study, and review was waived by the institutional review board of the University of Kansas Medical Center.

RESULTS

Testing Personnel Education Background

A total of 58 responses listed 171 different institutions where laboratory personnel received their education. Three respondents said their staff received on-the-job training or other vocational education and held no formal degrees. There were 43 separate US-based higher education institutions reported, with an additional 14 schools located in the Philippines. Of the education institutions reported, 70% of programs were accredited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) as of 2023, and 63% of CAHs employed at least 1 individual who trained at an NAACLS-accredited MLS or MLT program. Figure 1 shows the most frequently mentioned training institutions for testing personnel within Kansas CAHs.

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Figure 1.

Programs where Kansas CAH laboratory personnel received training (n = 171).

N = 82 CAHs in the study population, 58 responses to the questions, and 171 total institutions noted. Percentages may not add to total because of rounding and multiple answers per respondent. Students who matriculate at Washburn University complete their MLS training through UNMC. Similarly, students who matriculate in WATC complete their MLS training through Wichita State University. Abbreviations: MLS, medical laboratory scientist; MLT, medical laboratory technologist; UNMC, University of Nebraska Medical Center; WATC, Wichita Area Technical College.

DISCUSSION

CAHs are required to provide basic laboratory services to allow for diagnosis of acute conditions, which necessitates the presence of capable, trained staff to undertake the work.⁸ In 2022, a management report indicated that a 25-bed CAH laboratory required 300 labor hours, which is approximately 7.5 full-time equivalents.⁹ Based on this estimate, CAHs in Kansas are understaffed, with an average of 4.6 full-time employees. This shortage was endorsed by more than one-third of CAHs reporting that inadequate staffing was a problem in their laboratory and that 38% of laboratories were hiring for at least 1 MLS or MLT staff member.

Beyond testing personnel, this staffing deficiency also appeared to affect the leadership level of laboratories, as only 32% of laboratory directors were employed locally by the CAHs. This example corroborates other research in support of promoting local employees to leadership roles.¹⁰ With the majority of laboratory directors having associate or bachelor’s level training, it is important to promote education opportunities to pursue further education into graduate laboratory management programs.

One key finding was that the most common training institution for rural laboratory professionals was Barton Community College, followed by personnel trained in foreign schools. This shows the potential for investing in local resources that can support health care pipelines for laboratory staffing. Talamantes et al examined the association between attending community college and the intention to serve in underserved communities and found that students who first matriculated at a community college had higher odds of reporting their intention to serve in an underserved community.¹⁰ Increasing support for rural training of laboratory professions could increase their employment in rural laboratories and fix the gap currently filled by foreign-trained staff.

While training new professionals is needed, rural communities should also support the implementation of loan forgiveness programs for laboratory professionals who work in a rural area. A study of Kansas loan forgiveness programs for physicians found that 62.6% of providers stayed at their original site at least 1 year after completion of loan forgiveness, and of those who left their original site, 33.3% were still practicing in a rural area.¹¹ These findings support the success of this model to place practitioners in rural areas. Thus, a similar model could be beneficial to increase the number of laboratory professionals working in rural areas.

CONCLUSION

Laboratories that maintain access to essential health care within rural Kansas are facing alarming staffing concerns. Potential solutions to address this shortage include promoting rural laboratory education programs and including laboratory professionals in existing or new educational loan forgiveness options for underserved communities.

FUNDING SOURCE

This work did not receive funding, and the authors have no relevant financial disclosures.

CONFLICTS OF INTEREST

The authors report no potential conflicts that exist in relation to this project.

DISCLOSURES

The findings and conclusions are those of the authors and do not necessarily represent the official policies and positions of the University of Kansas Medical Center or the University of Kansas Health System.