How Automation Can Ease Clinical Lab Staffing Shortages

Last year I toured a clinical laboratory at a hospital just outside of Boston. As I visited areas for pathology, histology, and microbiology, one overarching concern was made clear by the laboratory director: staffing.

Or better put, a lack of staffing. The director told me the issue that worried him the most on any given day was whether he would have enough bench technicians to handle the volume of more than 6,000 tests coming through the lab daily.

It’s a scenario familiar to diagnostic labs across the US and Canada. No single answer will solve the lab staffing shortage, but technology must play a part over the next decade. A potential bright spot for labs is automation. The hope is that automated instruments can more consistently step in to handle routine tasks typically done by medical laboratory scientists so that those people can instead focus on skilled duties.

Why there’s a staffing shortage in clinical labs

When I first started covering the lab industry in 1998, the concerns I heard from lab directors centered on bloodborne pathogen risks, personal protective equipment, and ergonomics. There wasn’t a lot of discussion about staffing levels.

But a lot has changed in the quarter century since then. Yes, the COVID-19 pandemic nudged a portion of lab workers into leaving their jobs due to burnout, but the staffing crunch had been bubbling up before 2020.

Medical laboratory scientist (MLS) and medical laboratory technician (MLT) programs at colleges and universities have been decreasing for decades, according to the American Society for Clinical Laboratory Science (ASCLS)¹. In the lab version of the chicken-or-egg debate, it’s not clear whether less interested students led to the decline in educational programs, or the lack of programs deterred would-be bench techs. Either way, the decline is startling.

“From 1970, the number of accredited programs declined from nearly 1,000 to less than 450 in 2006,” states the ASCLS. “Since 2008, the number of programs has rebounded modestly from 427 to 479 in 2015.”

This problem combined with another sizable hurdle: Many anatomic pathologists who ran labs approached retirement age in the 2010s. Once the pandemic hit, a sizeable gap in leadership and frontline lab staff formed.

Implementing automation doesn’t have to be an “all or nothing” approach in the lab.

Through 2032, the U.S. Bureau of Labor Statistics (BLS) predicts that 24,000 lab tech jobs will be open each year. Employment for this role is expected to rise by five percent during this period.² “Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire,” BLS stated in an online update from April 2024.

Clinical tasks where automation can step in

Through a clinical lab’s service lines, automation is ripe to take over manual, time-consuming tasks. Automation can also speed up the time to diagnosis. Consider the following activities:

Sample preparation, such as selecting the correct tube for an analyzer or pipetting serum, can easily be handled with robotic instruments. This leaves bench techs with more time for skill-related tasks, such as investigating why an unexpected tube got delivered by a courier or determining why a patient ID in the laboratory information system does not match up to the sample.
Increased turnaround time is a frequently lauded benefit of automation in labs. Because automated systems can scale more easily than humans, it is possible for many more samples to run through an analyzer at quicker speeds, thus improving the time to diagnosis.
Next-generation sequencing (NGS) of human genomes requires a variety of steps that are repetitive and thus ideal for automation. A study published in 2019 in Genetics in Medicine offered painstaking details on the costs and time associated with NGS—sometimes totaling hours of a lab worker’s effort per cancer or rare disease case.³ Automated instruments can decrease this time commitment in areas such as NGS library preparation.

In short-staffed labs, all three of the above areas can run into delays if automation is not present. For example, if a genetics lab is down one or two lab scientists, it’s easy to see how NGS progress becomes stifled.

Key point for any lab: Focus on workflows first

A senior director at a large in vitro diagnostics manufacturer once told me that installing automation in a lab is a broader consideration than simply trying to reduce time on tests or fill in for understaffed areas.

Instead, she noted that automation evaluations must start with workflows and processes in a lab. If a process doesn’t operate efficiently, automation is not going to solve the problem simply because machines take over. On the other hand, process improvements—even without automation—may streamline tasks and reduce pressure on a short-staffed lab.

There is no army of new medical laboratory scientists coming to the rescue for short-staffed clinical laboratories.

An important point: Implementing automation doesn’t have to be an “all or nothing” approach in the lab. Although “big bang” automation rollouts do occur at clinical labs, most times automation begins by stepping in for one process—perhaps agar plate handling in microbiology. This moderate approach allows lab leaders to:

Observe the advantages of the automated instrument,
Adjust things as needed,
Get buy-in from bench staff, and
Consider expansion to other areas.

Even hesitant labs must now consider automation

There is no army of new medical laboratory scientists coming to the rescue for short-staffed clinical laboratories. Instead, lab leaders in these organizations must pursue a combination of cost-savings, workflow efficiencies, and helpful technology.

Lab automation—particularly of mundane, repetitive, and manual tasks—has been lauded for years. The costs of these systems acted as a detriment to some labs who stayed away from automation.

But given the endemic nature of fewer lab workers in the industry, even medical laboratories that once shied away from automation must now evaluate it. Doing so could allow staff to earmark more hours for skilled duties and diagnostic activities, which are key to the financial success of clinical labs.

References

1. https://ascls.org/workforce/

2. https://www.bls.gov/ooh/healthcare/clinical-laboratory-technologists-and-technicians.htm#tab-6

3. https://www.nature.com/articles/s41436-019-0618-7

4. https://www.clinicallab.com/trust-in-clinical-lab-automation-takes-a-new-turn-27765