The Call to Action addresses national, regional, immediate and long-term efforts required to change the health human resource (HHR) shortage of medical laboratory technologists (MLTs) within Canada.

The quality of and degree to which medical laboratory professionals (MLP) impact patient’s health decisions by performing laboratory tests, supporting the use of point-of-care devices and strengthening clinical conversations with evidence-based information, counts on you to help change the HHR shortage.

The government is not leading an initiative to help supplement the national HHR shortage for MLTs. Without a national effort to change our profession’s situation, MLPs will experience greater hardship in the workplace. Other health professionals, who are not qualified in medical laboratory science, will need to overtake some of our responsibilities (task shifting) in order to provide the best patient care possible. Alternatively, our patients will see a decline in laboratory testing services, with potentially negative impact on their health.

The public and CSMLS have strong expectations of the testing produced by Canada’s health care workforce. We believe MLPs are integral to this process and that informed and committed MLPs, laboratories and academic programs are central to taking action.

We have an opportunity to change the outcome of the HHR shortage. As a nation of medical laboratory stakeholders who contribute to patient care and health care team decisions, we need to fix this immediately unfolding, complex and negative scenario today.

What the evidence tells us:

• 1) MLPs are faced with workload burdens due to increased precarious employment positions and the associated health care system spending recession, even in the face of increased automation within laboratories and workforce shortages. MLAs are a vital resource is supporting the work of MLTs and vice versa.
  • a. Precarious positions have been noted as a technique to supplement budgetary restraints in the lab according to stakeholder discussions.
  • b. Workload measures continue to show an upward trend in the profession. Ontario had projected a 1.8% per year increase for lab tests between 2005 and 2010; however, an actual increase of almost 4% per year was experienced, resulting in the number of tests going up faster than workforce capacity.¹
  • c. Newly Certified Graduate Survey data for 2017 reveals a consistently high number of precarious positions for MLTs who have entered the workforce within a year of CSMLS certification. Although 95% of MLTs held a position at the time, only 48% held a permanent full-time position; the remainder held part-time, temporary or casual positions. Note the situation is even worse for MLAs, who only held permanent full-time positions 16% of the time.
  • d. Mental health issues in the workplace due to the work environment and workload burden for MLPs are at a critical state [Mental Health in Our Profession – Defined].

  ¹Sweetman A (2015). LABCON lunch plenary (Canadian Society for Medical Laboratory Science, CSMLS, Montreal), “Exploring the predicted increase in lab testing and the impending shortage of lab professionals”

• 2) There is an MLT workforce shortage currently, and it will worsen as baby boomers retire. The current and future shortage is not supplemented by a corresponding increase in student seats within academic programs. Evidence examples:
  • a. Data released in 2015 showed that approximately 40% of MLTs in Canada were 50 years of age or older. In 2010, the Canadian Institute for Health Information (CIHI) identified that approximately half of all MLTs would be eligible to retire in 10 years, with the greatest impact felt in Canada’s rural and remote communities. Data has shown that the greatest loss within the MLT workforce was associated with those who are 21 to 30 years post-graduation. There was not a corresponding increase in the number of MLTs obtaining certification in any age category.
  • b. In 2015, there were 19, 840 MLTs in the Canadian workforce according to CIHI and 586 reaching certification per year (five-year average). Using these values as an approximate measure to demonstrate potential HHR shortage impact, if half of the population were eligible to retire, that would result in 9, 920 MLT positions needing to be replaced. Using a ten-year replacement plan with all data remaining consistent across time, Canada requires 992 newly CSMLS-certified MLT graduates per year. The country only has 59% of the graduates required, meaning that approximately 400 additional student seats need to be created. The majority of these seats should be created early within the 10-year plan.
  • c. Based on a five-year average using CIHI data, 10% of MLTs work in rural or remote areas in Canada. Thus, approximately 100 of the 992 student seats should be focused on rural or remote position expectations. Given the HHR shortage impact being felt most in these areas and the general difficulties to fulfill such positions, CSMLS recommends at least 20% of the student seats (200) should have expectations of rural or remote positions, including long-distance relocation for work, regardless of the province in which they are trained.
  • d. At the time of the environmental scan of academic programs in 2016, only two MLT programs had plans to increase student seats in the future.
• 3) Student training is impacted by the HHR shortage, and there is a recognized change in training quality.
  • a. A survey of recent graduates identified a qualitative theme of HHR shortage as impacting student training during clinical placement as well as the safety domain as their main concern for dissatisfaction.
  • b. Verification from educators and employer representatives across Canada on this topic was obtained at the Forums (2016 and 2017).
• 4) The number of laboratory sites receiving clinical placement students is decreasing. This is increasing the burden on the remaining clinical sites to uphold the high standard of quality training required by medical laboratory students to achieve competency (MLA and MLT). Academic programs require a clinical placement site and reserved spot prior to admitting a student, creating a system bottleneck.
  • a. A major theme through the environmental scan of academic programs, national discussions at the Educator and Employer Forums (2016 and 2017) and recent graduate survey (see CSMLS website for report) revealed a consistent message of burden by major stakeholder groups.
• 5) Academic programs and clinical sites are willing to investigate and create new education and clinical placement models to accommodate clinical needs.
  • a. Verification from educators and employer representatives across Canada on this topic was obtained at the Forums (2016 and 2017) as well as through the Simulation Knowledge Exchange – Research Network.
  • b. During the 2015/2016 academic year, approximately half of Canadian MLT accredited programs utilized less than 1, 225 student hours for clinical placement training, offering half of MLT programs a chance to evaluate clinical hour reductions against a norm while challenging the remaining programs to look for further optimization. Considerations for balancing program prerequisites and didactic hours against clinical placement hours are vital in the evaluation process.
• 6) Support for academic programs and clinical sites to create the necessary change requires infrastructure and resources from staff and administration. This is difficult given the current financial recession within many education and health sectors.
  • a. Verification from educators and employer representatives across Canada on this topic was obtained at the Forums (2016 and 2017) as well as through the Simulation Knowledge Exchange – Research Network.

These clinical laboratory employers are willing to discuss with academic programs how they can take on students for clinical placement training. Join us now and sign a letter of commitment!