The plight of patient labs

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Plagued by a chronic shortage of phlebotomists, UR Medicine has started a new program to train the blood-draw specialists. The program expects to graduate its first class early next month and to start its second in January. 

However, the new program’s first class of four is likely to have scant immediate effect on old problems that have been exacerbated by the March 2020 COVID-19 shutdown, chronic staff shortages and high turnover of existing staff, concedes Melissa Allen, program director of the University of Rochester Medical Center’s Pathology and Laboratory Medicine department.

At the pandemic’s outset, the UR health system shut down 19 of the 42 patient-service center labs it was then operating. It has since reopened some while temporarily realigning others for purposes like COVID testing. 

As the terrain shifts, Allen’s department is evaluating its phlebotomy labs’ needs and priorities virtually on a daily basis. Allen declines to put an exact number on phlebotomists URMC is currently down by. The shortfall amounts to 25 percent of what the health system views as a full complement, she says. 

Currently, the UR health system has 30 labs in operation. The count is up by one with the recent reopening of the Lattimore Patient Service Center, one of the eight labs it temporarily closed in late September largely due to staffing issues. 

Rochester Regional Health is in similar shape. RGH has temporarily closed a dozen of its 44 labs. Staffing issues are behind the shutdowns, an RGH spokeswoman says. 

Lab shutdowns mean longer waits for patients needing blood tests. As recently as a few months ago, patients could generally expect waits of 15 to 20 minutes at most URMC labs. The eight-lab shutdown in September changed that. 

On a recent weekday, all patients at UR Medicine’s Clinton Crossings lab were met at the door where a worker took their names and cellphone numbers, instructing them to return to their vehicles and wait to be called in approximately 20 to 30 minutes. Once allowed in the service center’s waiting area, they would face a further wait after checking in.

“Would I be better off to make an appointment and come on another day?” one patient asked, noting that a notice from UR Medicine had recommended such a step.

“Not really,” the staffer replied. “I think they’re booking appointments for next week.”  

Exactly how soon or how much such bottlenecks might ease is not immediately clear, Allen says. It will depend on how quickly URMC can rebuild its phlebotomy staff complement. 

While a state-imposed mandate requiring health care workers to be vaccinated against COVID has been tagged in media reports as a major factor in health care staff shortages, Allen does not see the mandate as the main culprit behind UR’s lab-staffing woes. Nearly all of URMC’s clinical staffers, including phlebotomists, chose to bow to the mandate. 

Staff vaccine hesitancy “is a factor but not the main issue,” Allen says. 

Contributing to the chronic nature of URMC’s phlebotomy staffing ills is a stubbornly high turnover rate that runs between 10 and 30 percent. 

Burnout, a perennial problem in health care, has been exacerbated by COVID, Allen says. Issues like parents having to deal with children doing pandemic-induced distance learning have certainly helped put staffers more on edge. But other issues like low pay and a high-stress work environment predate the pandemic and will continue after it passes.

For many phlebotomists, notes Allen, child care was an issue before schools went to distance learning and remains one after most schools have reopened. Worker dissatisfaction with the pay scale also has led to departures. In the current tight labor market, phlebotomists can easily be tempted to jump to another, higher-paying job, Allen says. 

RRH and URMC, both of which have raised minimum hourly wages to $15, declined to share phlebotomists’ exact salary ranges.

URMC phlebotomists start at a wage higher than the minimum, says Allen, but not by much.

“I can tell you that they don’t make as much as Starbucks is paying,” she says, wryly referring to the chain’s recent announcement that it would boost baristas’ pay to as much as $23 an hour.

The phlebotomist shortage is only one aspect of staffing issues at health care systems here and nationwide. Other frontline health-care job categories like certified nursing assistant and nursing home and home-care aide also have been impacted. An American Hospital Association report in May warned of mounting staffing shortages that could take a toll on care. From 2019 to 2020, an AHA survey found, job vacancies for nursing personnel increased by up to 30 percent. 

Currently, in Greater Rochester, there are an estimated 945 job openings for registered nurses, according to Monroe Community College’s Workforce Clusters Database Wage and Gap Analysis. There are 144 openings for clinical laboratory technologists and technicians.

These numbers are not expected to go down any time soon. By 2026, there will be a shortage of up to 3.2 million health care workers nationwide, a Mercer study predicts. New York and California are expected to bear the brunt of the lower-wage health care staffing problem.

Lower wage health care workers
Source: Mercer U.S. Health Care Labor Market

As COVID cases continue to surge, URMC and RRH have both been working to fill gaps and overcome challenges at the point of care. Though patients experience some delays, health care systems have been trying to administer care as best they can.

At a recent Monroe County COVID briefing, Robert Mayo M.D., chief medical officer at RRH, spoke about overcapacity during the pandemic.

“Throughout the last two years, there have been a number of times where employees within Rochester Regional Health have volunteered to take extra shifts and work in other areas that need help and I’m very appreciative to the great health care workers who step up to that and that still is happening,” he said. “We still have folks that don’t regularly work in our emergency departments or on our in-patient units who step forward to help those teams out. We will continue to encourage health care workers to support one and another in this way.”

On Monday, the COVID vaccine mandate’s religious exemptions ended. While Gov. Kathy Hochul has said the state will help with health care staff shortages, the solution to a growing problem remains to be found.

Will Astor is Rochester Beacon senior writer. Managing Editor Smriti Jacob contributed to this story.

2 thoughts on “The plight of patient labs

  1. Hi Will,
    Excellent article. Also, for a brief period of a couple months in mid-2021, the vials required to collect INR/protine samples were in short supply and many of us who require monthly draws were provided with home collection kits, mostly paid for via the various health care plans except for a small monthly deducible. I found the kits to be inconsistent & not necessarily all that easy to get a good reading. I was very pleased when the local URMC lab acquired enough sample vials to begin INR blood draws and hope it remains that way going forward.

  2. “chose to bow to the mandate”
    Really? Tell us how you feel.
    How about: “chose to be vaccinated”, or if you want to editorialize: “chose to follow science and get vaccinated”.

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