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					PROGRAM REVITALIZATION: STRATEGIES for SURVIVAL

Published by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) 8410 W. Bryn Mawr, Suite 670 Chicago, Illinois 606631-3415 Phone: 773.714.8880 Fax: 773-714-8886 Email: naacls@naacls.org http://www.naacls.org

February 1999 i

Dear Colleague: NAACLS has received repeated requests for information to assist programs targeted for possible closure. In its strategic planning, NAACLS recognized the numbers of programs that have been terminated, especially CLS/MT programs. This document has been prepared to support all programs in their revitalization efforts. Although this text is written primarily to assist faculty and directors in Clinical Laboratory Science/Medical Technology, it is also intended for use by Clinical Laboratory Technician/Medical Laboratory Technician, Histotechnology, Histologic Technician, Pathologists Assistant, Cytogenetic Technology, Phlebotomy and Clinical Assistant programs. Many of the strategies apply equally to these and other professions. Considerable gratitude goes to the members of the Program Revitalization Task Force. Their collective efforts and talents made this project possible. Special thanks are made to: Chris Barczak, Saint Elizabeth Medical Center, Edgewood KY. Linda Comeaux, Arapahoe Community College, Denver CO. Lester Hardegree, Armstrong Atlantic State University, Savannah GA. Carol McCoy, University of Wisconsin-LaCrosse, LaCrosse WI. Karen Myers, HealthONE, Denver CO. Linda Ross, University of Tennessee, Memphis, Memphis TN. Other associates across the country are willing to assist you. You may contact NAACLS, ASCLS, ASCP, any of the task force members, or myself. We wish you a successful journey, if indeed, you need to use the planning strategies outlined in this document.

Kathy V. Waller, PhD, CLS(NCA) Task Force Chair Member, NAACLS Board of Directors

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TABLE OF CONTENTS Chapter One: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Chapter Two: Program Survival Strategies Checklist . . . . . . . . . . . . . . . . . . . . . . .6 Chapter Three: Recruitment: Marketing the Profession of CLS/MT . . . . . . . . . . . . . .14 Chapter Four: Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Chapter Five: Vacancy Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Appendix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..30 CLS/MT and CLT/MLT Program Cost Analysis Form. Costs Associated with Replacing a Clinical Laboratorian Questions to be Asked in Starting or Continuing a Laboratory Science Program. Sample Letters. NAACLS Statistics.

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Chapter 1 INTRODUCTION Problem Definition In the last 25 years, over 40 percent of NAACLS accredited Clinical Laboratory Science/Medical Technology (CLS/MT) programs have closed, resulting in approximately 50 percent fewer graduates. Initially, this reduction was not as critical as one might expect. Twenty-five years ago the numbers of programs and graduates were at a peak. The laboratory itself was a revenue center and there were few attempts to control health care costs. The attrition rate for laboratorians was also greater than today. In a female-dominated profession, women left the work force to raise families or advance to other careers. The vacancies then were filled by new graduates. During the next 10 to 20 years dramatic changes occurred in the health care industry including       the advent of DRGs and the Prospective Payment System the congressional passage of CLIA 88 increased pressure from insurance companies in the forms of capitation, HMOs, etc. decreased federal and state reimbursement downsizing and mergers of health care institutions increase in dual income and single parent households, meaning more working mothers and fewer job vacancies

The demand for CLS/MT practitioners has been cyclical. Lack of accurate data regarding the future demands for the CLS/MT has resulted in unrealistic predictions. Forecasters indicated the baccalaureate-level individual would function only in supervisory roles with less educated individuals performing the routine tests. Throughout the United States this has not occurred, primarily because of increasing federal regulations, demands for quality assurance, and superior quality control in health care and in industry. Within the next 10 to 15 years a large number of CLS/MTs will retire. Thus, there is a significant concern as to how these vacancies will be filled. A problem we face today is the continual decline in the number of CLS/MT programs preparing individuals to enter the workforce. This problem is most acute in hospitalsponsored programs. Hospital-sponsored programs no longer have sufficient staff to provide education and training. In addition, university-sponsored programs are experiencing budget cuts as well as the loss of clinical sites. To understand WHY this decline has occurred, we must look at both hospital-sponsored programs and university-sponsored programs separately, because their reasons for closure or threat of closure can be different. 1

Background Let us trace first the development of CLS/MT programs. As one of the oldest allied health professions, we can trace the very early beginnings to on-the-job-type training. As the level of testing increased in complexity, the need for laboratorians with a science background became apparent. A rapid progression from  2+1 to 3+1” occurred. By the early 1970s individuals could sit for the Board of Registry certification examination only if a degree with appropriate course work and clinical training were obtained. Prior to 1970 the majority of accredited CLS/MT programs were sponsored by hospitals. Relatively fewer universities sponsored CLS/MT or other allied health programs. The Allied Health Training Act was passed by Congress in the late 1960s. Under this act, centers with three or more allied health programs, a minimum of 20 students, and granting at least an associate degree were eligible for federal funds. As a result we saw the emergence of Colleges and Schools of Allied Health. Many allied health programs traditionally housed in hospitals moved to an academic setting. Clinical Laboratory Science/Medical Technology was one of the few baccalaureate programs in which the majority of programs remained in the hospital setting. During the past 25 years, the number of university-sponsored programs has increased; with the number of hospitalsponsored programs still slightly outnumbering university-sponsored programs. However, university-sponsored programs have larger class sizes. In the late 1970s, federal funding for allied health programs ended. Colleges and universities with allied health programs were no longer receiving federal financial assistance. This was the beginning of belt-tightening in allied health programs housed in academic institutions. However, hospital-sponsored programs were eligible for Medicare pass-through education funds. As long as a hospital was the provider of the program prior to October 1989, it was eligible to receive money. This support is decreasing as the government continues to cut the Medicare budget. Since hospitals with CLS/MT programs are able to fill vacancies by recruiting their own new graduates, they can reduce recruitment and orientation costs. Thus a measurable savings is realized. University-sponsored program officials cannot demonstrate cost benefits to their institutions as easily. WHY?: University-sponsored Programs Over the years universities and colleges funded by state tax dollars have seen a decline in support. Today, only about 30 percent of a state-funded college or university’s operating budget comes from state monies. With the decline in state support, universities and colleges have been forced to make difficult decisions. In the past, as funds were decreased, cuts were made across the board. Today, cuts are often made programmatically. Programs with low student/faculty ratio and resulting higher program expenses are in jeopardy. This is especially true in academic health science centers, where many of the allied health programs are located. Furthermore, programs in medical schools may be eliminated when clinical income, derived from physician practices and used to support education, is reduced. 2

Clinical Laboratory Science/Medical Technology programs are expensive, due to the costs of personnel, equipment and supplies. Also, the breadth of the profession requires faculty with expertise in a variety of laboratory areas. The faculty in university-sponsored programs are concerned with producing competent Clinical Laboratory Science/Medical Technology professionals while maintaining research productivity for themselves and the program. In addition to teaching responsibilities, faculty are expected to conduct scholarly and service activities. Thus, a dilemma arises—how can university-based faculty teach well, engage in research and grantsmanship, and provide service? Often CLS/MT faculty teach extensively, but do not have the scholarship when compared to colleagues. Decisions of whether or not to retain a program may be made based upon the following criteria:     Centrality of program to the mission of the university; Overall quality of faculty, curriculum, and graduates; Extent of demands (current and future) for graduates, research, and service in the area; and Program costs.

Thus program directors and faculty in university sponsored programs need to ask themselves:             Is our program central to the mission of the university? How does our research productivity compare to other programs? How do our enrollment figures compare with other programs? What is our success rate in being awarded grants? How much scholarly activities come from our faculty? What is our level of scholarly activity in furthering the body of knowledge of the profession? What is our level of publications? How well are we preparing our graduates for roles in health care, including academia? What is the perception by administrators and the public of the quality and significance of our program? What is the reputation of our program? What are our program’s costs? What is the need for CLS/MT and CLT/MLT practitioners in our state?

Why: Hospital-sponsored Programs If hospitals see a cost saving from recruitment and orientation of graduates, WHY are so many hospital-sponsored CLS/MT programs closing? Often closures result from quick, short term decisions based on misinformation and false assumptions. The reasons for termination are complex and varied, including: 3

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Lack of knowledge or understanding by the hospital administration of the true costs of a CLS/MT program; Lack of knowledge or understanding by the hospital administration of the full range of benefits a CLS/MT program provides-both tangible (i.e. reduced recruitment and orientation costs) and intangible (i.e, community perceptions, lab morale, and employees continuing education which may reduce personnel needs); Increasing laboratory automation; Constant pressure on staff to handle an increasing workload, resulting in less clinical teaching time; Downsizing and merging of hospitals and clinics to meet the demands of insurance companies and their HMOs; and Misperceptions of future demands for CLS/MT personnel.

Similar to the university-sponsored programs, program directors must take an in-depth inventory of their programs and answer the following questions:              How often do you communicate program information to laboratory and hospital administrations? Is the program central to the mission of the hospital? What does the program really cost the hospital? (Here, one needs to emphasize costs that would remain, without the program). How much does the program save in recruitment and orientation costs? How can the program be modified to be more cost efficient while maintaining its high quality? How dedicated is the staff to maintaining the program? How can the curriculum be adapted to ease the pressure on staff who teach? What would be the negative effects of discontinuing the program? Are there community benefits from the program? Is there still a need locally and regionally for the program? What is the employment rate of graduates? How many graduates has the hospital hired? Include average tenure. How will automation affect the program and future jobs?

These are but a few questions to help initiate a Revitalization Process for hospitalsponsored programs. The need for CLS/MTs will only increase as their roles are continually expanded and redefined. It cannot be stressed enough that CLS/MT education is a tremendous foundation for careers both inside and outside health care. Skills are developed that cannot be taken away, and that apply to other situations, anywhere in the world. Program revitalization is an essential element that all program directors should consider a priority. Do not wait until someone considers it for you. 4

Chapter 2 Program Survival Strategies Checklist A Note to Our Colleagues No program is immune to closure, but several major steps can be taken to help prevent this from happening. A proactive approach involving advanced planning can help secure a program’s future. Anecdotally, the major reasons given for why programs close are 1) low student enrollment; 2) high costs; and 3) not fulfilling the institution mission. s These issues can be addressed. If enrollment is low, recruitment efforts must be intensified. This is so important that the next chapter focuses entirely on student recruitment. Relative to cost, compared to many other allied health programs, CLS/MT and CLT/MLT programs are considered expensive. It is difficult to compare program costs because the programs are very different from, for example, health information or dietetics. A form is included in the appendix of this document to allow you to work through the actual cost of your program so that you can determine cost per student. The important point is to know your costs and to understand what drives them. You can begin to address the question of whether your educational program will remain viable by determining if the program philosophy and goals as well as operating practices are aligned with those of the sponsoring organization and the communities it serves. Program administrators must take a proactive stance. Do not wait to act until program closure threatens. If you are not thinking about the potential threats to program survival while your program is sustaining itself and, perhaps, even growing, you are overlooking a critical component of evolution - that some educational programs die a natural death. What follows is a strategies checklist, tools to assist you as you draft your own strategic plan for ongoing survival and revitalization. You may find some of the strategies are specific to a particular organization or locale and have no bearing on your educational practice. We hope you will find ideas that can be adapted specifically to your own situation. We view this list as an organic document, the result of the committee’s shared knowledge and joint brainstorming. It should grow and change with revisions that reflect the successes others have had with their own programs. We hope you will share with us your reasons for what works and what did not work. Strategies Breaking a complex process down into strategic components takes something away from the larger whole. Identifying the parts of a complex process allows one to focus on specific activities in order to devise a concrete plan for program revitalization. As deans, directors, faculty, we should work to frame our strategies within a more comprehensive whole. This would include the values and vision of our organization, the policies and procedures that constrain us, the needs of the community we serve, and the realities of tight budgets and limiting resources. As a place to begin we offer you the 5

following strategic categories in the form of a checklist to help you develop focus for ensuring program health and sustainability. Know the mission and vision of your sponsoring institution.     Determine how your program aligns with that of the sponsoring organization. Be proactive in initiating discussions with administration about this alignment. Be visible, be visible, be visible. Know the political terrain; determine who are the decision makers and their positions and base for decision-making.  Make part of yearly goal setting and program evaluation, an assessment of this alignment.  Get the program involved and involve faculty in activities that are congruent with the organization’s mission, whether the activities are in the areas of service, research, education, or community outreach.  Determine the needs of your clients and customers: administration and staff, trustees, faculty, current students, prospective students, alumni, parents of students, accreditation organizations, governmental agencies, health care community, and the general public. Turn to the local community you serve for data and support.  Form an advisory committee - make sure all relevant players are represented.  Work with and through clinical sites.  Turn most frequently to those who employ your students; examine skill mix required by employers.  Determine the needs of potential employers.  Expand numbers of clinical affiliates in terms of geographic area covered. Be creative about types of sites; include POLs, research facilities, industrial or reference labs, public health departments, walk-in clinics, HMOs, etc.  Determine the barriers that prevent some clinical sites from lending their support.  Make curricular modifications with employers in mind.  Collect data on jobs available in your region and how and where your graduates are filling positions.  Ask the employment community for support: philosophical support, out-dated equipment, clinical site participation, courtesy faculty.  Ask the pathology community for support: philosophical support, resources, involvement as program medical directors and lecturers.  Get coverage for the profession through local media publics: newspapers, magazines, radio and television stations. Understand professional demographics. 6

At your program level  Collect statistics on your own program and publish them annually: numbers applying, enrolled, graduated; GPAs, scores on national board exams; employment trends.  Track qualitative changes in graduates.  Analyze program trends in light of state and national trends; make appropriate adjustments on an ongoing basis.  Publish an alumni newsletter and keep track of alumni.  Know what your graduates are doing professionally and where they are employed.  Determine if graduates are still working in the field 5 years after graduation; if not find out why they left the field.  Publish data on employment trends.  Analyze performance of graduates on national board examinations; publish this data, if good. At a state level  Gather statistics annually on program and student numbers in the state and neighboring states.  If there are program closures, determine why other programs have closed.  Form an educators’ group and have regular meetings with an agenda focused on at least one specific item within program survival or revitalization.  Perform annual salary surveys - the information is vital for graduates, and also for recruitment purposes. At a national level  Collect and reference published data on national statistics and trends.  Percent changes in program closures/openings over the last 5 years.  Numbers of students entering programs over the past 5 years.  Numbers of professionals leaving the field due to retirement and attrition  Decline or increase in supply of graduates.  Enlist the help of various national organizations in collecting comprehensive demographic data.  Keep informed of national trends, not just in laboratory science, but across health care.  Keep abreast of the Bureau of Labor Statistics data on current numbers and projections for health care professionals.  Know the factors that may lead to attrition from the profession.  Numbers of science majors across the country.  Effects of salaries on job satisfaction.  Relationship of salaries and education/skills/job responsibilities. 7

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Professional recognition and public awareness of the field. alternative opportunities for those in science work hours job mobility and career opportunities issues of professional autonomy and independence job stress physical work environment and perceived hazards stratification of employees with varied skill levels on the job.

Be aggressive in identifying program costs and how resources that pay for the program are allotted.  Be actively involved in short and long-range planning; assess whether you are on target with plans.  Perform a cost analysis of the true costs of your program to the sponsor. Include both direct and indirect costs (a form is included in the appendix).  Determine your cost per student.  Determine the impact of a program’s productivity on the larger department.  Know the sources of funding for your program.  Institutional support, including commitment of a chief administrator and board of directors.  State funding.  Medicare pass-through for allied health (hospital-based programs).  Tuition.  Student laboratory fees.  Grants.  Grants from pharmaceutical companies and industry.  Endowments.  Donations.  Programs for special categories of students.  Fund raising.  Other services you might market: providing educational services, consulting, producing marketable educational products; teaching in other programs.  Perform a costs-benefit analysis of the services you offer.  Assess a dollar figure on non-revenue generating benefits.  Recognize that good business management procedures are an absolute necessity in keeping cost-benefit ratios in line.  Work in collaboration with other programs to share services in a more cost effective manner.  Form a consortium in which multiple programs work in conjunction with one another to share program resources and costs.  Explore alternative methods of delivering program content that is more cost 8

effective: self-instructional modules, computerized instruction, shorter clinical rotations. Form collaborative networks with:  Other educators.  Form a state or regional consortium.  Participate nationally in educators conferences and professional societies.  Communicate via e-mail on a listserv. To subscribe, e-mail <mailserv@apsu.apsu.edu>. Type this message (with no subject, no automatic signature): <subscribe CLSEDUC-L>. Employers.  Work closely with potential employers.  Ask employers what they desire in your graduates.  Identify employers, other than hospitals, that will hire graduates. Example: pharmaceutical companies have discovered the benefits of hiring a CLS/MT to do research studies and clinical trials. Contact colleagues in industry and in computer information systems for possible hirings. Pathologists.  Keep them informed of trends and involved in the educational process.  Ask pathologists to assist in negotiations with administrators. The public.  Inform the public of who we are; talk with civic organizations, PTA, and high school science clubs to explain the profession’s value.  Be active in health and school fairs while including information on the profession for the public.  Get involved in writing op-ed pieces for local newspapers and publications. Academic and clinical institutions.  Maintain close contacts with those with whom you partner in the educational process.  Expand these contacts to include the dean of allied health, the dean of the medical school, the provost, or vice-president.  Serve on university/college/hospital committees such that your presence and contributions to the institution are noted. Make yourself and your faculty indispensable to the organization. High school and college career counselors. Legislators.  Keep abreast of relevant regulations and legislation.  Maintain contact with the legislative offices of national professional organizations.  Support politicians who espouse our values, through contributions, fundraising, and participation in their campaigns. Those active in professional organizations. 9

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 Alumni.  Alumni are excellent resources to promote your program to the public and to potential students. Alumni can assist with high school career days; judge science fairs; participate in an advisory group; and raise monies to support the program. Focus on recruitment.       Develop a recruitment plan, including a budget. Refer to Chapter 4. Know the demographics of the population you educate and focus recruitment appropriately. Define your enrollment goals and objectives so they are in line with institutional recruitment strategies. Recruitment requires a personal touch: contacts via visits, tours, mail, phone, thank you notes, and e-mail. Work with career counselors and advisors at the high school and college level.  Provide them with information on how students are accepted into your program, career opportunities, salaries, etc. Know your competitors: compare what CLS/MT and CLT/MLT has to offer potential students in relationship to other professions that students might be considering (e.g., a chemistry or biology degree, radiological technology, respiratory therapy, physical therapy, occupational therapy, biotechnology, etc.).

Enhance current efforts.        Target junior high school and high school students. Form collaborative relationships to support science education in junior high schools and high schools. Expand contacts with colleges and universities. Move recruitment beyond the traditional biology or life sciences major to include other science curricula. Target students in non-science curricula who are interested in health care; work with non-science advisors to make science requirements part of the non-science curriculum. Work with placement offices for science and non-science graduates who cannot find a job. Increase program diversity by offering an alternative academic pathways: e.g., a part-time program.

Be responsive to student needs.    Schedule and offer curricula to serve student needs. Price your offerings so they are affordable to the students you serve. Promote your offerings in such a way that a target population will be aware of your services. 10

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Provide an avenue for CLT/MLT students to articulate to the baccalaureate level. Offer alternative ways for students to complete their curriculum in CLS/MT and CLT/MLT. Offer additional career options once the basic program has been completed, e.g., add on certification in certain areas such as molecular diagnostics and information systems.

Concurrently identify problems that affect student recruitment.      Determine if enrollment is associated with demographic changes. Look at an optimum level of enrollment in relationship to current enrollment. Evaluate whether your curricula are outdated, on target, and/or futuristic. Determine which competitors are offering a high-quality product. Examine your application and admissions process.  Do you handle inquiries smoothly and efficiently?  Does the office staff respond promptly and thoughtfully to requests for information?  Do you regularly review this process?  Does your admission procedure encourage qualified applicants to contact you year round?  Do you inform applicants of their admission status within your school in a timely manner?  Do you communicate actively with admitted students until they have entered the program? Determine if your faculty, curricula, and resources permit you to compete for the quality of student needed to be successful in your program. Be realistic about the student population you serve: if you serve students who enter with weaker academic backgrounds and skills, are you offering them the remediation and support they need to succeed? Determine if current financial aid programs can off-set student concerns regarding costs of education.

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Use Innovative Teaching Strategies.   Expand the curriculum to attract other science majors. Include a track in biotechnology and/or laboratory information systems. These courses can also be used as continuing education offerings for practicing professionals. Restructure the curriculum, if necessary, to allow for articulation from the CLT/MLT to the CLS/MT level. Often, the CLT/MLT can test out of basic courses and parts of the internship to allow for a modified, yet relevant experience. Utilize state-of-the-art technology to alleviate heavy teaching loads. Students can use self-instructional modules, computer tutorials, on-line web courses, and 11

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distance learning. Reconfigure the curriculum to reflect current and future practice. The CLS/MT graduate should be competent in utilization of laboratory services; laboratory instrumentation, equipment, and tests; regulations and standards; financial functions; planning human resources; education; leadership skills and teamwork; and information systems. Collaborate with other programs in the area. Hospital programs, especially, can share lectures to avoid duplication of efforts. A consortium of area programs is another option. The NAACLS Essentials do not require a clinical experience. If clinical sites are a major problem, consider restructuring the curriculum to reduce the number of weeks spent in clinical rotations. Give credit or reduce time required for students who also currently work in particular areas of the laboratory, and can exhibit competency.

Focus on retention.         Assess how responsive you are to your student body: courses, quality of instruction, library and computer resources, advising, tutorial assistance and remediation, job-placement services, and career advising. Assess the past record on retention; examine factors related to student attrition. Survey students who leave voluntarily. Relate issues of retention and attrition to admission and enrollment criteria. Provide an environment that provides the academic and social conditions that will foster professional and personal growth. When recruiting and admitting students, ensure there is a good-student to institution matchin terms of students’ interest, abilities, support services, etc. Refer students to other institutions if a match does not exist. Facilitate the student’s transition into the institution through activities that smooth the way, through appropriate orientation. Create a sense of identity with the program. Provide counseling from the very beginning: academic advising, counseling, and career placement.

Hospital-Based Programs. In addition to what has been stated:  Charge tuition or partial reimbursement from affiliated universities that charge tuition.  Promote ability to recruit and train from within to hospital-based programs and clinical sites. Bissonette reported the average total cost for replacing an employee of the clinical laboratories of The Ohio State University Hospitals to be $16,100 per position in 1988. Refer to the appendix for additional data on costs associated with replacing a clinical laboratorian. 12

Evaluate your strategies and actions. For example, use a SWOT technique.  Evaluate your strengths, weaknesses, opportunities and threats to success. Change what doesn’t work.

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Chapter 3

Recruitment: Marketing the Profession of Clinical Laboratory Science/Medical Technology
The Invisible Profession In the spring of 1989 a conference was held in Chicago sponsored by the American Society of Allied Health Professions and funded by a grant from the W.K. Kellogg Foundation to address the issue of marketing allied health professions to prospective students and to the general public. A panel of hospital, advertising and insurance representatives presented different perspectives to help identify an allied health image and market that image to students, health care providers who employ them, and to the consumers of health care services provided by clinical laboratory scientists/medical technologists (CLS/MT) and other allied health professionals (Olsen). The profession of Clinical Laboratory Science/Medical Technology finds itself nearly 10 years later in the same predicament as it was in during the 1980s - without a marketing plan for the profession. We did not heed the call to market ourselves like the physical therapists and other Allied Health professionals did. When President Clinton required extensive physical therapy following a knee injury, the American Physical Therapy Association (APTA) placed a full page ad in USA Today (June 2, 1997) to educate the public about rehabilitation and the physical therapist. The APTA has pursued a vigorous public relations and advertising program to increase the visibility and enhance the image of the PT profession. They estimate that 80 million consumers have been reached via the advertising campaign. Small wonder students have an understanding of what PTs do, where they work, and who they are as health care professionals. If clinical laboratorians do not take the lead in touting their profession, no one else will. Too few people know who clinical laboratory practitioners are or what they do. Our profession is neither particularly glamorous nor lucrative. How then do we capture the attention of potential laboratorians? To answer this and other questions we must look at ourselves and recognize what we have as a profession to offer prospective students. Why Do People Enter Our Profession? First, we must identify why people enter the profession and why they stay. Results of a 1995 survey of 184 Tennessee clinical laboratory professionals (both CLS/MT and CLT/MLTs) indicated that the factors having the most influence on them to enter the profession were that they: (1) wanted to help others, (2) wanted to work in health care but not directly with patients, (3) liked laboratory work in high school, and (4) desired security in finding employment (Wyatt). Of the 167 lab professionals who stayed in the field, five factors were identified:    They sincerely liked laboratory work. They enjoyed contributing to the welfare of others. Laboratory work stimulated their intellect. 14

 They liked interacting with other health care professionals.  Salary and benefits were good. In 1995 a survey of clinical laboratory scientist/medical technologist practitioners in South Carolina revealed that 73.8 percent were “satisfied” or “very satisfied” with their chosen profession and 69.1 percent were satisfied with their current employer. These findings indicated that the majority of respondents were generally satisfied with significant elements of their employment (Jones). The results of these surveys indicate that prospects for recruiters include those students who like laboratory work, who wish to be in a helping profession but may not want direct patient contact, and who desire a satisfying work environment. Who Are the Individuals Most Likely to Enter the Profession in the 1990s and Beyond? A successful recruitment marketing plan requires that the target audience be identified. High school science students, university science majors, those with a BS degree in biology or chemistry, CLT/MLTs wishing to complete their BS degree were the groups determined most likely interested in a career in CLS/MT. Faculty advisors, college career counselors and high school counselors have been recognized as having influence on student career choices. Emphasis should also be placed on recruitment of talented and qualified minorities, males, nontraditional adult students (those seeking a career change or reentering the job market) and technically eligible disabled students. Developing a Marketing Plan It is the structure of CLS/MT and CLT/MLT recruitment that is not working. Rudmann reported that 43.8 percent of program directors surveyed at 47 university-based CLS/MT programs did not have a designated recruiter and that only minimal dollars and time were spent in recruiting applicants. Few programs have a designated recruiter, let alone a marketing plan. A marketing plan is a written summary of a program’s marketing efforts. It contains information about the program, its history and services, the major stakeholders in the program, and competition. As part of the marketing plan, specific measurable objectives should be developed (e.g. increase the applicant pool by a factor of 1.5 by the year 2000). The marketing plan also has a system for evaluation of efforts and projected costs. As Hassel indicated, a marketing plan is needed to tell you where the program is going, the plan to get there and whether progress has been made. The marketing plan of a CLS/MT and CLT/MLT program should include:       Institution/Program Mission Statement Analysis of the Present Situation Goals and Objectives Competition Program Alignment Promotion 15

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Budget Evaluation

Case Study: The UT, Memphis Marketing Plan The mission of the University of Tennessee, Memphis (UT, Memphis) is to improve human health through education, research, and public service, with an emphasis on improving the health of Tennesseans. The College of Allied Health Sciences (CAHS) at UT, Memphis has six programs: Cytotechnology, Dental Hygiene, Health Information Management, Medical Technology, Occupation Therapy, and Physical Therapy. As a College, we chose not only to target individual students for recruitment, but also those who had influence in their career choice. Many university faculty advisors do not promote the profession of Clinical Laboratory Science/Medical Technology or other allied health programs, because they feel we are “stealing” their good science majors. Funding is often based on the number of graduates a university has in a given year. However, jobs for graduates with a BS in Biology or Chemistry are few. We chose to focus on getting the attention of career counselors who guide students in career planning, not just selecting courses for the next term. The Department of Clinical Laboratory Science/Medical Technology at UT, Memphis consists of the Program in Cytotechnology and the Program in Medical Technology; the latter is a 2 + 2 university-based program with 10 clinical affiliates in Memphis and 13 throughout the state of Tennessee. As the largest program in the state, up to 25 students are accepted each year. In 1997, faculty believed that the quality and quantity of our applicant pool had slipped. We thought that if the quality of applicants improved, then the attrition rate would decrease. We had done a good job at attracting minority, foreign-born and nontraditional students, but we knew that there were many science majors who did not know our profession existed. Goals of the recruitment effort were to increase the number of viable applicants and improve the overall GPA of accepted students. Major objectives were to: (1) establish and build relationships with the faculty advisors and career counselors at feeder institutions and (2) develop a polished “sales presentation”. Competition included those universities who wanted to graduate their science majors (without job opportunities locally), other CLS/MT programs in the state who were 3 + 1 years and a hospital that offered other 4 year allied health programs. The program was firmly aligned with job providers because we had a strong relationship with laboratory managers and supervisors in the region, and we were the only B.S. degree granting program within a 200 mile radius. Our alumni association, however, needed further development to assist us with recruitment efforts. To promote our program and profession, materials were designed, including a new colorful program brochure with several photos of laboratory scientists in action, a web site with information about the profession of Clinical Laboratory Science/Medical Technology and the UT, Memphis program in particular, and a recruitment poster with a self-addressed mail-in card. Interested students had to pay the postage thus investing a little something of themselves. An on-screen and 35mm slide presentation was developed 16

for use with large or small groups. We developed a database of key contacts at all feeder institutions with names, titles, addresses, phone, fax and e-mail information. We had a secretary phone the campuses for this information and also made a number of unannounced visits (“cold calls”, as we say in the sales profession) to the counseling centers to get the information we needed. We then scheduled time with them (usually 1-2 hours in the early morning) to present our sales presentation in groups. We brought muffins and fruit to morning sessions. In addition to educating the career counselors about the profession, several presentations were made to members of university biology and pre-health science clubs about allied health professions and clinical lab sciences in particular. Many of the students do not know of all the opportunities available to them other than the traditional doctor, dentist, nurse, pharmacist options. We set up tables in the lobby of the biology and chemistry buildings of a large feeder institution (with their permission, of course) and distributed literature to students changing classes. During registration at a local technical college (associate level) we display recruitment materials, as well as, visit faculty, career counselors and job placement personnel. UT, Memphis faculty are released from other duties to perform these tasks. The College of Allied Health Sciences at UT, Memphis invited faculty and career counselors from a large transferring institution to our campus for a continental breakfast, question and answer session and tour of facilities. We provided information to themabout the numbers of students we accepted from their university, the average GPA of the classes and updated news about the application process. The face-to-face meeting of CLS/MT faculty with faculty advisors provided a great opportunity for us to educate and interact with them. The concept involved building relationships with key people at the major transferring universities would provide a steady stream of applicants. A similar faculty-advisor conference was offered for a larger group later in the year by all the Colleges at the University of Tennessee, Memphis. Monies necessary to fund recruitment events, travel, faculty release time and materials came from the program, the college, alumni contributions and the university; efforts are currently underway to streamline recruitment efforts and maximize dollars spent. Evaluation: What Worked and What Didn’t Although the number of applicants increased by only one percent, an alternate list was established for the first time in many years. The average entering GPA for the accepted class improved by two percent. As a result of the development of a CLS/MT web site, three to four e-mail requests for information are being received each month. We anticipate an increase as more students at the high school and university level have improved access to the Internet and become more technoliterate. To date, one to two postcards are received each month from the recruitment poster. A survey was developed to gather information about how qualified applicants learned about the profession of CLS/MT and UT, Memphis; who were the key people influencing 17

their decision; and how college advisors assisted them in pursuing their career choice. As indication of how the personal touch matters in recruitment, 76 percent of the applicants interviewed revealed that they had met or spoken with UT faculty member directly. Our contacts at the transferring universities have provided most helpful in recruitment efforts (47% of those surveyed obtained information about CLS/MT from college advisors), but clearly this is an area that needs more work. Alumni of the UT, Memphis receive a quarterly publication produced by the College of Allied Health that updates graduates about the program and seeks contributions to the Ann Bell Scholarship fund. Plans are underway to continue to utilize alumni in recruitment efforts throughout the state of Tennessee. Additional Recruitment Strategies Cooperative Efforts In 1996, the Tennessee Society for Clinical Laboratory Science/Medical Technology produced a brochure concerning the profession that has been used to recruit students to all the CLS/MT and CLT/MLT programs in the state. It has been distributed at high school career days and provided to high school guidance counselors. Cooperative strategies such as this will be more effective and reach more prospective students, over time. A profession-wide response to recruitment efforts must be addressed because of individual program resource limitations. Advertising • Media advertising on a national (with the help of professional organizations) and local level is definitely needed.  National Medical Laboratory Week is an excellent reason and time to contact local TV and radio stations to inform the public of whom we are and what we do.  Consider a billboard or poster on mass transit systems for hundreds of people to see each day.  The Internet is a superb means to reach the world. Key word searches about laboratory medicine, medical technology and Clinical Laboratory Science/Medical Technology will bring up numerous Websites with e-mail addresses for interested prospects to contact.  Produce colorful and “cool” literature pieces, brochures, and posters to advertise your program. • Create a variety of AV resources to use with this generation—slides, video tapes, on-screen computer presentations.  Develop public services announcements to tie in with National Diabetes Week, the Arthritis and Lupus Foundations, hemophilia and other high profile diseases, and local blood drives. Personal Contacts - The Selling of CLS/MT • Identify career counselors and faculty advisors at each transferring institution and 18

•  •     • • •

make a sales presentation to them about the profession. Brainstorm and implement innovative recruitment ideas using willing laboratory managers and supervisors as well as staff laboratory scientists/technologists serving on a recruitment task force. Promote CLS/MT in high schools - via panel discussions with guidance counselors, participation in visits to science fairs, biology and chemistry classes, (e.g., put your interest in science to WORK). Make use of continuing education workshops for high school math and science teachers as well as high school guidance counselors. Use new graduates as recruiters; use older students as mentors. Sponsor an Open House, campus and laboratory tours. Set up a booth at local Job Fairs Get involved with the Health Careers Opportunity Program (HCOP) in your area to recruit minorities into clinical laboratory science/medical technology. Identify persons with a BS degree in Biology or Chemistry who have been unsuccessful in finding jobs. Often they are willing to spend extra time to attain a degree in CLS/MT, where salaries are considerably higher. Contact applicants not quite competitive enough to gain admission into dental, pharmacy or medical school. Solicit the help of alumni, parents of graduates and other interested parties to contribute to scholarship funds.

In summary, pursue every opportunity presented as a recruitment event. Whether speaking to a church group about women’s health issues, talking to high school students about what they plan to do when they grow up, or explaining just what it is we do for a living - speak up and sell the profession of Clinical Laboratory Science/Medical Technology. Resources Hassel, PL, Palmer, DR. Marketing allied health educational programs: Eight low cost steps you need to know. 1992. Santa Clara, CA: Eagle Publishing and Communications. Jones, WJ, Johnson, JA, Beasley, LW, Johnson, JP. Allied health workforce shortages: The systemic barriers to response. J Allied Health 1996; 25(3): 219-232. Lacroix, KA, Bean C, Chandler T. Critical issues in Clinical Laboratory Science/Medical Technology education. Clin Lab Sci 1993; 6: 37-40. Lehman, DC, Wilson D, Ciulla A, Hingston M. Recruitment strategies used by an allied health education program to increase student enrollment. Clin Lab Sci 1995; 8(2): 102-106. Lux, MF, Beck, CE, Smith R. Recruiting students to medical technology. Lab Med 1997; 28(6): 374-378. 19

Olson, RE (1989). Marketing the allied health professions. J Allied Health 18(3):415-418. Rudmann, SV, Ward, KM, Arnold, DM. (1992). Student recruitment strategies: A national survey of university-based Clinical Laboratory Science/Medical Technology programs. Clin Lab Sci 1992; 5(2): 104-105. Wyatt, D, Davis BG. 1995 Tennessee Laboratory Practitioners Survey Report of Results. Memphis: University of Tennessee, Memphis, Program in Medical Technology, July, 1996.

20

Chapter 4

CASE STUDIES
A. Linda Comeaux, CLS(NCA), MT(ASCP) Arapahoe Community College Denver CO

Here is a list of the challenges I have encountered in the last five years within the CLT/MLT program at Arapahoe Community College and the processes I have used to overcome them. All, at the time, seemed threatening to the survival of the program. I. The moment I took over the program I faced decreasing clinical sites, poor student performance in internships and a low pass rate on the ASCP and NCA certification exams. Clinical sites: To increase participation of clinical sites I made numerous “house calls” and phone calls to our existing sites so that they would get to know me and learn to trust me. I also started giving tokens of our appreciation, such as candy, other college promotional items and an annual appreciation dinner with door prizes. I also wrote to practically every medical facility in the Denver metro area, introducing myself and giving information about the program and our need for more clinical sites. I asked for their help and followed up with a call. I created a packet of information that included the content of every MLT course to show exactly what our students were learning and how much we needed community support and again sent this to all the facilities. Over the years we have increased the number of clinical sites by 5 or 6. Poor internship performance: Again, after many house calls and meetings with our dean, students and the clinical instructors, I established and published a standard of performance for internships to get everyone on the same page. I had tremendous support from our dean and gained support and patience from clinical instructors as well. Some students did not make it through the process and were dismissed from the program. Since that first year, no other student has been dismissed due to poor internship performance. I additionally formulated a contract between the student and the program outlining standards of performance and consequences if these standards were not met. Pass rate on certification examinations I reviewed the curriculum content and made a few changes. The largest impact, however, was in the revision and reestablishment of the credibility of our comprehensive exams. I asked members of the medical community to author the three exams and established a solid policy and pass rate for students taking them. Since this change the pass rate on both of these national exams has been between 95 21

100%. Summary for I: Strategies for program survival concerning these issues included: 1. Personal contact to establish program credibility in the community and to build strong support for and provide aid to the student recruitment process. 2. Educating the community (inside and outside of our institution) about the program, again aimed at gaining support and promotion. 3. Establishing solid/fair policies within the program to maintain excellence and high quality graduates. 4. Making necessary curriculum changes/alterations to keep students at the top of the totem pole. II. Next, I experienced not only the lack of, but the complete absence of blood bank internship sites. No matter how much massaging or how many house calls I made, the blood bank facilities said NO. Lack of Blood Bank Sites I brought my concerns to the Colorado Medical Laboratory Educators Consortium including my colleague, Karen Myers. Karen has some extraordinarily innovative ideas and today our blood back rotation is better than it has ever been. Karen, who is the Program Director of the HealthONE School of Medical Technology/Clinical Laboratory Science offered to “simulate” a clinical blood bank in her educational facility. For one week in the summer, all of our students in the blood bank rotation go to her facility, where she has designed a curriculum that provides hands on/real life experiences for students. Every student coming out of that rotation has said that is the best—and hardest— experience each has ever had. It not only prepares them for blood banking, but they have also gained problem solving skills. Summary for II: 1. Utilize all resources. If an area consortium is not established, start one. 2. Trite, I know—but: “Think out of the box.” What seemingly is impossible, may turn out to be the best possible solution. III. Over the last couple of years enrollment has been decreasing and is now very low. I have been informed that if this trend continues in the next few years I will be forced to close our program. More recruitment, more educating the community, more exposure to the profession will result in more students in the seats.All of these require more time and personnel. Again with the support of our dean, I have contracted a recruiter and a project assistant. The recruiter is helping us to formulate a five year plan in marketing and recruitment for the program. She is a clinical laboratory scientist/medical technologist and is helping to 22

double our presence at career days, job fairs and school presentations. The project assistant is helping with curriculum revision, updating program materials and establishing clinical contacts. She is also a program consultant. Each of these individuals is not on salary, but will be paid a preestablished sum of money when their tasks are complete. Monies are coming from mine and the dean’s budget. Collaboration- Other attempts to increase enrollment are via collaboration efforts. a. We have established a laboratory assistant course for current MLAs working in the field who have no formal laboratory education. Since the recent enactment of the NAACLS approval for clinical assistants we are hoping to create an approved Clinical Assistant Program. b. We are also in the process of creating an articulation agreement with a four year institution that will soon begin a CLS/MT program. The curriculum will be innovative and the intent is to have CLS/MT students attend our program for the first two years and complete their CLS/MT degree at the university. We are still at the drawing board stage, but the hope again, is to increase both schools enrollment. Summary for III: 1. 2. Recruit and get help doing it. Collaborate creatively - and get help again.

B. Linda L. Brinkley, CLS(NCA), MT(ASCP) Shoreline Community College Seattle WA Recruiting for CLT/MLT students is indeed a challenge in today’s educational workplace. With the demands of teaching lecture and laboratory classes, participating on college committees, updating our curriculum and serving as Program Director for Shoreline Community College’s CLT/MLT Program, I have used a variety of recruiting techniques. Our faculty members are available for high school career days, and often are asked to present interesting features of our profession at local high schools senior biology classes. The students were most interested to hear the circumstances that lead up to the E. coli 0157H outbreak and tracking by our state’s public health laboratory. Simple topics and slides from general diseases such as iron deficiency anemia and sickle cell anemia are favorites, since many students have studied these topics in science classes. This always leads to a lively group discussion. The programs at Wenatchee Valley, Portland and University of Alaska, Anchorage also make career day presentations and “show and tell visits” at area high schools. Some of these programs place ads in local newspapers or display at shopping malls. The UAA program ran a commercial that they reported was effective. 23

Our program faculty members have been asked to be workshop presenters for a conference called “Expanding Your Horizons,” held every spring on our campus. High school women from surrounding schools attend several short classes of their choice, and hear about the interesting careers woman have in our community, related to health and science fields. This conference always has a wonderful motivational speaker as well. During each quarter, CLT/MLT informational meetings are held on different days and times, at which we discuss job opportunities, the different levels of laboratory practitioners, admission into the program, CLT/MLT professional curriculum and clinical training, and certification. This monthly meeting has allowed us to speak with several students at a time, and often answer their questions. Meeting dates and times are posted around the campus, mailed to people who inquire by phone and are also posted in the counseling office. Our Introduction to Laboratory Procedures class has no prerequisites, and often is taken by students who may transfer to a four year institution or may change to a nursing, biotech or chemistry technology pathway. With topics such as safety, basic laboratory math, phlebotomy, spectrophotometry, determination of hemoglobin and hematocrit, and basic urinalysis, this class appeals to other students than medical laboratory applicants. At the end of this class we conduct an optional tour of a clinical laboratory. The staff at participating hospitals have been kind to provide tours to these students. Many of the community colleges have brochures, posters, home pages and information about the profession in their quarterly/semester schedules and web pages. In addition, some may have a selected advisor or admission specialist who specializes in health care programs or advising science major and transfer students. The Washington State Board for Community and Technical Colleges has a career brochure that lists all the Professional-Technical programs in the state and in which colleges these programs are housed. These have proven to be good resources for students who are unsure as to which vocation/profession to pursue. At our past state spring meetings, each CLS/MT and CLT/MLT program was asked to bring a poster highlighting their program and current students. We have displayed these posters at all coffee breaks. It was wonderful to advertise our programs and actually see faces of soon-to-be new graduates who will be entering our workforce. I hope this is a project that will be continued. Many attendees at the meeting were reminded of the fine educational programs that are available in our state. Sacred Heart Medical Center hosted a breakfast for Spokane Community College faculty and counselors to inform them of clinical laboratory careers, and followed up with small tours of their laboratory. Another unique recruiting tool is participating in a yearly conference call with MIOW (Montana, Washington and Oregon) Clinical Laboratory Science/Medical Technology schools and college advisors. This call is traditionally organized for fall, and an agenda is mailed ahead of time. This year, Craig Linke, Educational Coordinator from the CLT/MLT Program at the University of Montana organized and conducted the call. As a group we discuss program numbers, concerns, successful strategies, application and 24

admission/selection dates and any additional topics the group may deem important. As a result of participating in this conference call, the CLT/MLT programs have given informational sheets about their programs to applicants who have not been selected into the CLT/MLT programs. This information is an additional source to applicants of our program. Recruiting is an essential part of a successful program. I sometimes think our best advertisers are our recent graduates who are very enthusiastic about the profession. The problem is keeping track of them during their first four to five years of employment. People are very mobile in today’s society. We need to share successes and failures with one another and continue to try every avenue to recruit students. This requires not only good time and resource management, but also a firm commitment to try a variety of activities throughout the year.

C. Kathy Doig, Ph.D., CLS(NCA), MT(ASCP) Michigan State University East Lansing, Michigan e-mail communiqué Here’s an idea for academic programs. You know MSU has this different program—MT major without accredited program as well as our CLS/MT major which is the NAACLS accredited program. We have about four times as many MT majors as CLS/MT majors. That’s what keeps this program alive...we would have been gone long ago trying to provide a program to 35 students with six faculty. However, the MT majors (about half seek clinical programs after graduation, others are pre-med, etc.) keep our student credit hours high. They are unlikely to cut a program serving 350 students. So, I suggest that academic programs develop a major that is not accredited and is based on their lecture courses (so they don’t have to teach tons of labs to these extra students - we used to do that but stopped) and it is appealing especially to pre-meds to keep their overall numbers up. D. Barbara Fricke, MS., CLS(NCA), MT(ASCP) University of New Mexico Albuquerque, NM e-mail communiqué A few years back, after getting a new department chair who thought CLS/MT programs should be in Allied Health Colleges and not in the Department of Pathology, we needed to win her over. I saw the need to educate her as to who we were so that she would see us as a viable part of the department and a needed program for the state. Our new chair was a researcher, not a real clinical/anatomical pathologist. 25

We did a 2-3 hour “indoctrination” session for her. We went armed with information on CLS/MT programs in our area, the number in the nation, and the results of a state wide survey of clinical laboratories that said they would need employees at the BS level in the coming years. We also listed how much teaching we did for other areas of the School of Medicine, the nursing program, the local CLT/MLT program, and the programs involved with an interdiscipline training program at the School of Medicine. Somehow it worked. I do not feel the threat of closure as much as I was feeling before our meeting with her. However, now is not the time to feel safe, since the money for health education is always shorter than what is needed in this state. E. Pat Ellinger, MSEd, MT(ASCP), SBB Hennepin County Medical Center Minneapolis, MN e-mail communiqué My survivor story is rather short and to the point. HCMC’s Laboratory Director has rather emphatically told hospital administration that as long as there are medical students and residents at this institution, there will also be allied health education. Education is stated in our institution’s mission statement, along with patient care and research, and we have to remind people of that every once in a while. Not to say that it isn’t a struggle to get adequate time for our teaching staff to prepare, update and present their material. We have a very dedicated staff, most of whom are willing to spend some of their own time in order to be prepared to teach. (Our lab has an accredited CLS/MT program and we are a clinical site for CLT/MLT, cytogenetics, histology and phlebotomy students). F. Pat Letendre, MEd., RT(CSMLS) University of Alberta Calgary, Alberta e-mail communiqué In an earlier post in the spirit of devil’s advocate, these questions were posed: How do you convince a clinical laboratory with a bare-bones staffing to take students for an internship—    When it can barely do patient-related work? When the laboratory does not need the graduates to meet its projected staffing needs? When many graduates will go on to careers outside the clinical laboratory?

Some of the strategies that we have used locally:  Training CLS/MT students has a significant payback in keeping staff on target 26



 

with SOPs and up-to-date with current theory. People learn more effectively when they teach others (something that all teachers know). Students ask questions that keep staff on their toes. Sloppy habits improve under the watchful eyes of the students. Affiliation with a CLS/MT program means that there will be a supply of students to do needed method development, method evaluations, and other research in their senior year. For example, over the past few years the laboratory scientist in the blood bank has used our students to do research projects on the ABS 2000 and HCV lookback/traceback protocols, to name but two. Examples abound in all disciplines and many of the projects have had a practical payoff by translating into improved methods in the departments. The teaching materials prepared for competency-based training programs can be adapted for staff orientation and competency assessment. As quid pro quos for clinical placements, instructors from the didactic program can volunteer to present or coordinate continuing education sessions, assist with cross-training of staff, help teach residents in the departments, help review SOPs, and generally make themselves useful to the laboratory, all the while keeping their own skills fine-tuned.

I’m sure that there are other ways to help convince clinical laboratories that having students about is to their advantage.

G.

Another case study: Bruce WA, Bruce JM, Paur RA. A New Paradigm for Clinical Laboratory Science/Medical Technology Education: A Case Study for Survival and Growth. Clin Lab Sci 1997;10(1):38-42.

27

Chapter 5

Vacancy Rates
Vacancy rates for clinical laboratory personnel vary across the nation. Informally, many hospitals, clinics, public health, industry and other laboratories are reporting serious personnel needs. There are several resources to help determine vacancy rates for your state and area of the country. The ASCP Board of Registry’s Wage and Vacancy Survey of Medical Laboratories (1996) reported that shortages in laboratory personnel had largely been alleviated. This report is in contrast to what appears to be occurring now where large pockets of shortages exist. The BOR study is conducted biannually and can be accessed at < http://www.ascp.org/BOR/survey.html.> State hospital associations are another source for vacancy rates. State associations can be accessed from the American Hospital Association web site at <http://www.aha.org.> The Bureau of Labor Statistics compiles vacancy rates and projection figures for clinical laboratory personnel. Data can be acquired from state bureaus of labor statistics. The national website is <http://stats.bls.gov.> The 1998-99 Occupational Outlook Handbook for Medical and Clinical Laboratory Technologists and Technicians is found at <http://stats.bls.gov/oco/ocos096.htm#outlook.> For example, in Colorado, the Department of Labor and Employment distributes surveys to administrators of hospitals and other medical/clinical settings. They review staffing patterns and apply that information to the industry growth. Projected demand for CLS/MTs in Colorado: The estimate for 1996 was 1887: the projected estimate for 2006 -- 2282. That is a need for an additional 395 CLS/MT practitioners. The annual growth rate is estimated at 2.1 percent. Projected demand for CLT/MLTs in Colorado: The estimate for 1996 was 1891: the projected estimate for 2006 -- 2303. That is a need for an additional 412 CLT/MLT practitioners. The annual growth rate is estimated at 2.2 percent. This type of information can help justify the need to maintain programs to educate future clinical laboratory practitioners. Without such programs, vacancy rates will escalate.

28

APPENDIX

1

CLS/MT and CLT/MLT PROGRAM COST ANALYSIS 1999 - 2000 Budget Year Type of Program: CLS/MT 2+2 Univ/College 3+1 Hosp _____ 4+1 Other

Type of Program:

CLT/MLT Associate Certificate Other

Numbers of Students in Program (1999) Numbers of Graduates in Program (1999) If you have a graduate program, list numbers of students (1999) List number of graduates (1999) Expenses: Direct Costs (Round to $100) Total Faculty Salaries and Benefits # FTEs = Total Staff Salaries and Benefits # FTE = Total Graduate Student Stipends and Benefits Telephone and Fax Office Supplies Photocopying and Printing Postage and Overnight Service Computers, Service and Software Travel Continuing Education Laboratory Supplies Equipment Purchase Equipment Repair/Maintenance Memberships and Subscriptions 2 $

NAACLS Accreditation fee Others, specify _______________ Total Direct Costs $ ______________

Indirect Costs (estimate)

$

To include office and laboratory space, lighting, heating, housekeeping, library, etc. Note: for the NIH, indirect costs average 40-50% of direct costs. Other, specify Total Indirect Costs TOTAL COSTS Cost per Student (Total Costs  Total Students Cost per BS Student (Total Costs  Total BS Graduates) Capital Assets: $ $ $ $

$

Equipment for Teaching Labs (current value) Teaching Microscopes (n = Computers (n = ) Printers (n = ) Scanner Fax Machine Copy Machine Office Furniture Miscellaneous TOTAL ASSETS Resources $ )

_ _

3

Total Tuition generated by all students % of tuition program receives Grants (total to include indirect cost recovery) Fund-raising Medicare Pass Through Costs Other TOTAL INCOME $

$

4

Costs Associated with Replacing a Clinical Laboratorian. Benefits Associated with Educating a Clinical Laboratorian.
by Karen R. Karni, Ph.D., University of Minnesota 1968: “As a generalization, it is viewed that the minimum cost of replacing a competent worker probably ranges, from 300 to 700 times the hourly rate for that position.” Therefore, if a laboratorian is paid $15.00/hour:  the minimum cost of replacement is $4,500. the maximum cost of replacement could be $10,500. Analyzing and reducing employee turnover in hospitals. New York, Training, Research and Special Studies’ Division, United Hospital Fund of New York, 1968. 1975: Comparison of turnover of hospital employees. Costs for replacing a senior clinical laboratory technician/medical laboratory technician were 64% higher than for replacing a licensed practical nurse. Over 90% of those costs were for training. Tsui A. A report in turnover analyses and recommendations. University of Minnesota Personnel Services, Unpublished Data, 1975. 1988: Bissonette reported the average total cost for replacing an employee of the clinical laboratories of The Ohio State University Hospitals to be $16,100 per position. Bissonette C: A study to determine the cost of employee replacement in the clinical laboratories at The Ohio State University Hospitals (thesis).Columbus, 0H, The Ohio State University, 1988. What are the results of laboratory turnover? Costs for overtime for remaining personnel; Filling in by supervisors or temporary personnel; Costs for recruitment, selection, orientation, training and supervision of new personnel; Decreased productivity by new employees; and Lowered morale and burnout caused by under staffing. In contrast, if one has a program or affiliate in Clinical Laboratory Science/Medical Technology, a potential supply of new employees exists. Costs associated with selection, orientation and training are considerably less, due to the students’ familiarity with the institution, and the organization’s familiarity with them. Start-up productivity should also be higher.

5

QUESTIONS TO BE ASKED IN STARTING OR CONTINUING A LABORATORY SCIENCE PROGRAM by Karen R. Karni, Ph.D., University of Minnesota 1. Does the program support the mission and strategic plan of the sponsoring institution? Ex: Does the institution have a mission to provide needed practitioners for the state or region? Are faculty also expected to engage in research and/or provide service? 2. What is the kind of organization or institution in which the program is housed, e.g. academic health center, 4-year college or university, technical or community college, hospital, etc.? What is the organization’s commitment? 3. What is the usual length of the program, e.g., 12 or 18 months, 2 years, 4 years, master’s level, certificate? 4. What is the curriculum, e.g., content areas and contact hours required by the profession and accrediting agencies? (This includes prerequisite, professional, and clinical (practicum) courses.) Can the sponsoring institution provide needed prerequisite science courses including laboratories, and professional courses required for the program? Can it obtain/maintain sufficient clinical sites? 5. Is there an appropriate balance between professional course work and clinical rotations, together with general education courses? 6. What are the numbers and kinds of faculty needed to teach the curriculum (an essential administrative/faculty mix)? What is the availability of faculty within the constraints of other administrative, research, and service needs? What are the numbers and kinds of persons to supervise clinical rotations/practice. Are there sufficient numbers and kinds of faculty to provide prerequisite coursework? Are there appropriate faculty available for hiring, for example, in a specific geographic area? 7. What is the relationship between the program and the delivery of health care, e.g., clinical faculty who both practice and teach? Do clinical faculty have sufficient time/resources for teaching and supervision? 8. What are the space, equipment, and supplies needed for instruction, including faculty offices, lecture rooms, laboratories, libraries, computer facilities/computer-assisted instructional materials, specific discipline-related equipment, instruments, supplies, and the like? 9. What support staff is needed, e.g. professional practitioners (teaching/supervisory), secretarial, laboratory teachers, laboratory attendants, etc.? 10. What are the sources of resources—financial, space, equipment, and supplies? 6

What is the balance among tuition, legislative or private sources, grants, donations, and the like? Are they adequate? 11. What are the optimal numbers of students to make the program cost effective? 12. What do faculty/staff/students/graduates contribute to their profession and to their communities? Are they visible within each?

7

Sample Letters Date University President Address Dear President ( ):

As president of a professional association, I am writing to urge your reversal of the proposal to close the Clinical Laboratory Science/Medical Technology Program at ( ). My reasons follow:     This potential closure will adversely affect the numbers of laboratory practitioners in your state. The CLS/MT program at your University is ranked among the top programs (of 300) in the nation. If it closes, we will lose educational leaders and researchers who have contributed to the profession and to this Society. It appears that actual costs for running the program are not great, in comparison to similar university-based programs, as well as within a university of your size. If the program is eliminated, an important and needed undergraduate offering will be eliminated from your institution.

Let me elaborate upon these points. Currently there are approximately 350,000 laboratory professionals practicing in this nation. Several thousand are in your state. Your institution provides approximately ( ) percent of the new graduates in the state. In a 1996 survey, the national vacancy rate for baccalaureate-level clinical laboratory scientists/medical technologists was reported at 7 percent. For (state) that rate was ( )percent. While health care institutions are down-sizing, merging and closing, numbers of laboratory personnel are needed. They are also aging. Indeed, it is predicted that an acute shortage of clinical laboratory scientists will be occurring in the United States and surely in (state). The CLS/MT program at the ( ) has a ( )-year history. It is rated highly among all programs, and faculty have contributed significantly to the profession and our Society. We would hate to lose them from our ranks. In addition to my role as ( ) of ( ), I am also a faculty member in clinical laboratory science/medical technology at (University). Our program is housed within the (School of Allied Medical Professions with eight other allied health units). This structure provides us with an organizational structure as well as the resources to support our research, service, and teaching efforts. In comparison to our program, that at ( ) is not expensive, and should be able to be accommodated within your Health Sciences Center. It is my understanding that about ( ) senior students are currently in the program, with 8

about ( ) undergraduates interested in becoming clinical laboratory scientists/medical technologists. Should this program cease to exist, an important career opportunity will be eliminated from undergraduate program offerings. This would also appear to be in conflict with national trends, which emphasize undergraduate education. In conclusion, I urge your affirmation of this fine program that certainly enhances the reputation of ( ). It also provides competent and caring laboratory practitioners for the state. I urge your continuation and enhanced support of a program of purpose, quality, and necessity. Sincerely,

(Name) cc: Secretary of the Board of Reagents Chancellor Dean of College of Medicine Chair of Department of Pathology CLS/MT Program Director

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Sample Letter

Date University President Address Dear President ( ):

It has come to my attention that the Clinical Laboratory Science/Medical Technology Program at the University of ( ) in (city) has come under some level of internal scrutiny, and indeed is scheduled to be phased out at the end of ( ). I am writing to express how important this program is to Clinical Laboratory Science/Medical Technology education and how much it contributes to the image of the University of ( in the Clinical Laboratory Science/Medical Technology community.

)

If I am not mistaken, the program at the ( ) is the only campus-based baccalaureate program in the state and therefore fulfills a certain component of the university’s mission to the people of (state). Beyond making that observation, it is not for me to say that on these grounds this program should be continued. However, on other grounds, such as the unassailable reputation that this program has, and the national standing of several of its faculty, I would urge you to consider the consequences of discontinuance of this program. As a faculty member in ( ), I realize that there are many calls on the limited resources of a public university. I am also aware of the deep feeling for public service that the University of ( ) must feel in its obligations to the citizens of your state, and in this case, to the health care professional community that serves (state). We have struggled against the imperatives of the day that may have argued against maintaining these kinds of commitments here. Fortunately, reflection and consideration of the consequences have made these kinds of actions less likely; even in light of long range planning, cost reduction and minimization of programmatic duplication. On the grounds that your institution has a great reputation in (state), and is well recognized in our field throughout the nation, I ask that you make every opportunity available to carefully evaluate the consequences of such an action as is being considered at the ( ) regarding this program. If I may be of any further service in providing background or a contextual framework to your deliberations, I would be most happy to do so. My sympathies are with you for the difficult circumstance in which you find yourself, and my hope is with the people of (state) and the clinical laboratory professional community, both of whom deeply need this resource.

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Sincerely,

(Name)

copy to: Chancellor CLS/MT Program Director

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