The American Society for Microbiology Benchmarking …€¦ · The American Society for...

T h e A m e r i c a n S o c i e t y f o r M i c r o b i o l o g y B e n c h m a r k i n g S t u d y

Clinical MicrobiologyLaboratory Workloads, Productivity Rates andStaffing Vacancies

Survey ofClinical MicrobiologyLaboratory Workloads, Productivity Rates andStaffing Vacancies

ABOUT THE AMERICAN SOCIETY FOR MICROBIOLOGY

The American Society for Microbiology (ASM) is the

largest, single life science society, composed of over

42,000 scientists, teachers, physicians, and health

professionals. The ASM’s mission is to promote research

and research training in the microbiological sciences and

to assist communication between scientists, policymakers,

and the public to improve health, economic well being,

and the environment.

ASM Benchmarking Advisory Committee

Vickie Baselski, Ph.D., University of Tennessee at Memphis

Kay Buchanan, Ph.D., St. Joseph Medical Center

Roberta Carey, Ph.D., Centers for Disease Control and Prevention

Jill Clarridge, Ph.D., VA Medical Center/University of Washington

Alice Weissfeld, Ph.D., Chair, PSAB Committee on Professional Affairs

Microbiology Specialists, Inc.

The ASM Survey of Clinical Microbiology Workloads was conducted by the Laboratory Assurance

Program of the Graduate School of Public Health at San Diego State University, California

Contributing Editor:

William Check, Ph.D., Medical and Scientific Communications

October 2005

Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study

ii




EXECUTIVE SUMMARY 1

I. INTRODUCTION 2

II. METHODS 3

A. Selection of Laboratories for Survey 3

B. Characterization of Laboratories 3

C. Survey Administration and Data Analysis 3

D. Definitions 4

III. RESULTS 5

A. Response Rate 5

B. Descriptive Characteristics ofResponding Laboratories 5

1. Settings of responding laboratories 5

2. Fraction of responding laboratories performingwork in each specialty area 6

3. Degree of automation inresponding laboratories 11

C. Workloads and Productivity Rates ofResponding Laboratories 11

1. Total workloads and productivityrates of clinical microbiology laboratories

in various settings 11

2. Productivity among laboratoriesperforming labor intensive activities 14

3. Productivity in mycology andmycobacteriology laboratories 17

iii

TABLE OF CONTENTS

D. Staffing and Vacancies inClinical Microbiology Laboratories 17

1. Staffing in responding laboratories 17

2. Vacancy rates and time to fill vacancies 17

E. Aging of the Microbiology Laboratory Workforce 18

IV. DISCUSSION AND CONCLUSIONS 20

APPENDIX A: Survey Instrument 22

APPENDIX B: Productivity Tables 30

APPENDIX C: Selected Open-EndedComments From Surveys 35


iv

TABLE OF CONTENTS (Continued)

Individuals who are responsible for staffing and directing

clinical microbiology laboratories are continually faced

with making estimates of how many workers are neces-

sary to do a given amount of work, or how much work can

reasonably be done by a given number of workers. To

address this question, a detailed survey was done among

a representative selection of microbiology laboratories in

the United States.

The 612 laboratories responding were distributed among

a representative sampling of settings, from community

for-profit and not-for-profit hospitals to commercial/refer-

ence laboratories to central/network laboratories to univer-

sity/teaching hospitals and Veterans Administration (VA)

hospitals. As well, a wide spectrum was represented with

regard to volume, extent of molecular testing and other

labor intensive activities. Since the sample was designed to

reflect the actual distribution of number of microbiology

specialty areas done (bacteriology, mycology, parasitology,

mycobacteriology, diagnostic immunology, and virology), it

included many smaller laboratories as well as large univer-

sity and reference laboratories.

The amount of work done was highly variable across

laboratories. Productivity rates were calculated by the num-

ber of Current Procedure Terminology (CPT) codes passed

or total tests (defined by each individual laboratory) done

per fulltime equivalent (FTE) annually for each type of lab-

oratory and each level of activity. Median productivity was

6,107 CPT codes or 7,410 total tests per FTE per year.

Surprisingly, productivity was higher in laboratories that

performed testing in more specialty areas and those that car-

ried out the identified labor-intensive activities.

Vacancy rates in responding microbiology laboratories

were elicited. Budgeted openings were reported by 39% of

laboratories, with 57% of openings being for persons with

Medical Technologist (MT) or Clinical Laboratory Scientist

(CLS) qualifications and 14% for Medical Laboratory

Technician (MLT) personnel. Respondents reported that

half of vacancies required more than three months to fill.

Consistent with other sources, this survey showed that

the microbiology laboratory workforce is aging. Overall,

67% of microbiology workers in the responding laboratories

are more than 40 years of age and 34% are over 50 years.

This survey provides the first reliable figures that micro-

biology laboratories can use for benchmarking their labora-

tories’ productivity. It also substantiates an impending

personnel crisis in microbiology laboratories. An appendix

to this document provides tables that each laboratory can

use to find where it stands in relation to laboratories of a

similar type doing comparable levels of work.

1

EXECUTIVE SUMMARY

Like other segments of the American health care system,

clinical microbiology laboratories feel the pressure of budg-

etary limitations. Administrators require laboratories to do

more work with less staff, a trend that will no doubt continue

and remain an important consideration in planning. As clin-

ical microbiology laboratories function in an ever-leaner

mode, directors, managers and supervisors face the issue of

less-than-optimal staffing. What are reasonable workload

expectations for laboratories of different sizes in different

settings performing varied menus of tests? What is a justifi-

able level of staffing for a given workload? Individuals in

charge of staffing and quality assurance for laboratories

may sense that administration is demanding cuts that impair

the ability of the laboratory to function effectively, or that

staffing is suboptimal due to retirement of experienced

workers, but lack objective data to support their intuition.

Laboratory productivity data do exist. However, the

most-often cited numbers apply to chemistry laboratories,

which are much different in test complexity and degree of

automation from clinical microbiology laboratories.

Productivity data are also available for some types of labo-

ratories through ongoing American Society for Clinical

Pathology (ASCP) surveys, but, while some microbiology

laboratory workers are included in these surveys, ASCP

data do not contain information that is specific to the clinical

microbiology laboratory.

In 2003, the American Society for Microbiology (ASM),

on behalf of the Public and Scientific Affairs Board’s

(PSAB) Committee on Professional Affairs, contracted with

the Laboratory Assurance Program of the Graduate School

of Public Health at San Diego State University (SDSU) to

conduct a benchmarking study to remedy this lack of pertinent

information. In this benchmarking study, SDSU surveyed a

representative cross-section of clinical microbiology laborato-

ries to obtain data on workloads, workforce characteristics,

level of technical skill required for various procedures,

types of laboratory procedures performed and staff charac-

teristics and vacancy rates.

Central to this project was the gathering of information

that would make it possible to calculate output per worker

for the several kinds of testing that a clinical microbiology

laboratory carries out. The resulting microbiology-specific

productivity figures make it possible for clinical microbiology

laboratories of many types to compare their output efficiency

with staffing levels in institutions of the same size and with

similar extents of service.


2

I. INTRODUCTION

A. SELECTION OF LABORATORIES FOR SURVEY

Selection of laboratories to receive the survey went through

many steps to ensure that the data collected represented the

spectrum of U.S. clinical microbiology laboratories in terms

of geographic distribution; size of laboratory, as measured

by annual test volume and staff; type of laboratory setting;

and scope of services, as measured by number of specialty

services provided. Responding laboratories also represented

a wide range in number and type of labor-intensive servic-

es. Obtaining data from laboratories with many different

profiles provided a range of productivity figures that clini-

cal microbiology laboratories of varying sizes and service

levels can use to benchmark their performance.

From a comprehensive list of 180,000 Clinical

Laboratory Improvement Act (CLIA) registered laborato-

ries, 23,526 were selected that had accreditation for doing

one or more of six microbiological specialty areas: bacteri-

ology, virology, mycology, mycobacteriology (acid fast

bacilli, AFB), parasitology and diagnostic immunology in

support of infectious disease testing. Selecting only hospital

or independent laboratories gave 7,257 potential recipients.

Laboratories were removed that were foreign or in U.S. ter-

ritories, that did not do bacteriology or that had received a

recent SDSU survey on hepatitis testing. Laboratories in the

highest and lowest decile for volume were also excluded,

leaving an even 2,000 organizations.

B. CHARACTERIZATION OF LABORATORIES

Laboratories were characterized by how many of six spe-

cialty areas they were qualified to perform—bacteriology,

mycology, mycobacteriology, virology, parasitology and

diagnostic immunology for infectious disease. The vast

majority of laboratories were qualified for two to four spe-

cialty areas, with two areas being the most-frequent number

of specialties.

C. SURVEY ADMINISTRATIONAND DATA ANALYSIS

After extensive consultation between SDSU and ASM’s

PSAB Committee on Professional Affairs, a 34-question,

6-page survey instrument was adopted that was tailored to

focus on technical personnel, resources and productivity

(Appendix A). This survey was sent by mail to the 2,000

selected laboratories. In two further waves, non-respond-

ing laboratories received repeat mailings of the survey

instrument at one-month intervals. Responding laborato-

ries were given a confidential tracking number for pur-

poses of data analysis. Data from completed surveys were

keyed into Access databases, then exported into a statisti-

cal analysis package, SPSS version 11.5.2, for cleaning

and analysis.

3

II. METHODS

D. DEFINITIONS The following definitions are used in this report:

■ Microbiology Laboratory: laboratory doing bacteriology,

mycology, mycobacteriology, parasitology, or virology

■ Diagnostic Immunology: infectious disease and syphilis

serology

■ Fulltime Equivalent (FTE): 2,080 paid hours/year (the

amount of time an individual working 8 hours per day, 5

days per week, 52 weeks per year can be paid for; only

the time spent in microbiology or diagnostic immunolo-

gy is considered in this category)

■ Total FTEs: all part time and full time personnel includ-

ing clerical and managerial support who are paid

■ Technical FTE: laboratory worker who performs diag-

nostic work (not included in this category are man-

agers, directors, clerical support who perform other

services for the laboratory and were counted in the

Total FTE category)

■ Current Procedure Terminology (CPT-4): billable tests

performed; CPT as defined by the American Medical

Association in Version 4


4

5

A. Response Rate Of the 2,000 laboratories to whom

surveys were mailed, 675 (33.8%)

returned filled-out surveys. Of these,

612 surveys were complete and were

used as the basis for further calcula-

tions, for a response rate of approxi-

mately one-third. One limitation to the

responses was surely the length and

complexity of the survey instrument.

In particular, information on the num-

ber of CPT codes passed per year may

not have been readily accessible at the

laboratory level. More than two-thirds

of responding laboratories indicated

that they did not count CPT codes. It

seems more likely that these labora-

tories chose not to seek CPT code

data from their billing office or

administration.

III. RESULTS

Non-profit57%

Communityfor-profit

11%

Central/Network

16%

University/ Teaching

5%

Commercial/Reference

6%

VA2%

Other3%

B. Descriptive Characteristics of Responding Laboratories

1. Settings of responding laboratories

Of the 612 laboratories who returned completed surveys, a majority, 57%, are

based in community non-profit hospitals (Figure 1). Community for-profit hospi-

tals constitute 11% of the sample, while central/network laboratories make up

16%. Smaller proportions consist of university/teaching hospital laboratories, 5%;

commercial/reference laboratories, 6%; and Veterans Administration (VA) hospi-

tals, 2%.

Results from the surveys fall into several sections: response rate; characteristics of responding laborato-

ries, including tests performed; work rates, measured by CPT codes or tests per FTE per year; staffing

and vacancy rates in microbiology laboratories; and the aging status of the clinical microbiology labora-

tory workforce.

Figure 1: Settings of responding laboratories

Almost all laboratories, 95%, reported

performing at least one type of test

within the specialty area of bacteriology

(Figure 2). Participation in the other

specialty areas decreased progres-

sively: diagnostic immunology or

serology for infectious disease, 64%;

mycology and parasitology, each 46%;

virology, 32%; mycobacteriology, 31%.

Laboratories were also asked whether

they use molecular methods for any

tests in any specialty; 17% replied that

they do perform such tests.

A diagnostic immunology labora-

tory for infectious disease testing is

incorporated into the microbiology

laboratory for 28.7% of respondents,

35.9% have a separate diagnostic

immunology laboratory and 35.4% do

not have a diagnostic immunology lab-

oratory that tests for infectious disease.

Laboratories are broadly distributed

as to the number of specialty areas that

they perform, with 21% doing only

one specialty area, 15% doing three,

13% doing six areas and 7% perform-

ing all seven areas (counting molecu-

lar testing as a seventh specialty area).

Distribution of number of specialty

areas performed within non-profit,

for-profit, central/network and com-

mercial/reference laboratories fairly

closely tracks the overall distribution.

Within university/teaching hospital

laboratories, however, there is a major

difference: all university respondents

report performing tests in three or

more specialty areas, and 80.3% do

testing in six or seven areas.

Looking at which types of labora-

tories do each type of testing, it is

apparent that almost all laboratories,

90-100%, in all categories are doing

bacteriology (Figure 3). For mycolo-

gy, AFB and parasitology, participa-

tion rates are well below 50% for all

laboratory types except for universi-

ty/teaching hospital laboratories and

VA laboratories, which have perform-

ance rates of 90% or higher for these

disciplines. Rates are generally

around 30% for virology, with univer-

sity/teaching hospital laboratories

again being the exception, with a per-

formance rate of over 80% (Figure 4).

Participation rates are higher for diag-

nostic immunology for infectious

disease, with 70-85% of all laboratories

(except for those in for-profit hospi-

tals) doing this type of testing.

University hospital laboratories have

by far the highest performance rate for

molecular testing, at almost 90%.

Laboratories in VA hospitals are above

50%, while all other types of laborato-

ries are much lower.


6

0

20

40

60

80

100

Molec IDAFBVirolParasitMycolDiag Imm

Bact

% of labs working in the specialty area

95

64

46 46

32 31

17

2. Fraction of responding laboratories performing work in each specialty area

Figure 2: Percentage of responding laboratories participating in specialty areas

I I I . R E S U LT S

7

0

20

40

60

80

100

Other (n=19)

VA (n=12)

Commercial or Ref Lab (n=37)

University Teaching & Medical Hosp (n=30)

Central Laboratory Network (n=99)

For-Profit Hospital (n=64)

Not-for-Profit Hospital (n=344)

parasitologymycobacteriologymycologybacteriology

Specialty Area

% o

f La

b T

ype

0

20

40

60

80

100

Other (n=19)

VA (n=12)

Commercial or Ref Lab (n=37)

University Teaching & Medical Hosp (n=30)

Central Laboratory Network (n=99)

For-Profit Hospital (n=64)

Not-for-Profit Hospital (n=344)

molecular testing for IDdiag. immun. for IDvirology

Specialty Area

% o

f La

b T

ype

Figure 3: Percentage of each laboratory type that performs at least one test in bacteriology, mycology, mycobacteriology and parasitology

Figure 4: Percentage of each laboratory type that performs at least one test in virology, diagnostic immunology for infectious disease, and molecular infectious disease testing

In mycobacteriology, only 9% of

laboratories that provide this service

do molecular testing on the primary

sputum specimen, while 88% perform

AFB cultures (Figure 5). Identification

is done by conventional methods in

17% of laboratories; 25% do identifi-

cation by molecular methods.

However, laboratories that use molec-

ular methods for identification process

a much larger volume of mycobacter-

ial specimens: the median number of

specimens on which conventional

methods are used for identification is

35, while the median number for

molecular AFB identification is 87.

Thus, roughly 2.5 times as many tests

are now done by molecular methods

as by conventional methods, indicating

that molecular tests have completely

changed how AFB identification is

done. Only 13% of laboratories perform

AFB susceptibility testing in-house.

Mycology cultures are done by

89% of laboratories that provide this

service (Figure 6). Identification is

done by conventional methods in 56%

of laboratories, while molecular meth-

ods are used in only about 5% of lab-

oratories. Contrary to the situation

with AFB identification, only about

25% of fungal identification is done

by molecular tests. Serology is done

by 16% of laboratories.


8

0

20

40

60

80

100

AFBsusceptibility

tests performedin-house

AFBidentificationsby molecular

methods

AFBidentifications

by conventionalmethods

AFBcultures

molecular TBtests performed

on primaryspecimens

Specific mycobacteriology procedure

% o

f la

bo

rato

ries

wit

h m

yco

bac

teri

olo

gy

that

per

form

sp

ecif

ic m

yco

bac

teri

olo

gy

pro

ced

ure

Figure 5: Percentage of laboratories that perform specific procedures in mycobacteriology

0

20

40

60

80

100

mycologicalserology

mycologicalsusceptibility

tests performedin-house

identificationsby molecular

methods

identificationsby conventional

methods

mycologycultures

Specific mycology procedure

% o

f la

bo

rato

ries

wit

h m

yco

log

y th

at p

erfo

rm

spec

ific

myc

olo

gy

pro

ced

ure

Figure 6: Percentage of laboratories that perform specific procedures in mycology

Among virology laboratories, 33%

are doing chlamydial and viral cul-

tures and 79% are doing viral antigen

screens, such as for rotavirus, respira-

tory syncytial virus and influenza A

and B viruses (Figure 7). Antigen

screening is clearly a mainstay of

virology laboratories. Viral serology

testing is done in 56% of virology lab-

oratories. Antigen and antibody tests

for hepatitis A, B and C viruses and

HIV are done in 32% of laboratories.

A minority of laboratories are doing

qualitative and quantitative molecular

tests for infectious viral agents, 13%

and 11%, respectively.

Among laboratories that do para-

sitology, 77% still do a major workup

for ova and parasites (O&P) (Figure 8).

Antigen screens for individual organ-

isms are done by 47% of laboratories.


9

Figure 7: Percentage of laboratories that perform specific procedures in virology

Figure 8: Percentage of laboratories that perform specific procedures in parasitology

0

20

40

60

80

100

quantitativemoleculartests for

infectiousviral agents

qualitativemoleculartests for

infectiousviral agents

antigen andantibodytests for

hepatitis A,B, C and HIV

viralserology

tests

viralantigenscreens

Chlamydiaand viralcultures

Specific virology procedure

% o

f la

bs

wit

h v

iro

log

y th

at p

erfo

rm

spec

ific

vir

olo

gy

pro

ced

ure

0

20

40

60

80

100

antigen screensO&P examinations

Specific parasitology procedure

% o

f la

bo

rato

ries

wit

h p

aras

ito

log

y th

at p

erfo

rm

spec

ific

par

asit

olo

gy

pro

ced

ure

The above percentages were calcu-

lated using the number of laboratories

who said they worked in a particular

area as the denominator. Using the

entire 612-laboratory sample as the

denominator, 19% of laboratories do

screens without full O&P exams; 10%

do antibody tests for hepatitis virus

and human immunodeficiency virus

(HIV); and 17% do at least one molec-

ular test for infectious agents (Figure

9). Looking in detail at who performs

molecular tests, it is no surprise that

they are done by 89% of laboratories

in university/teaching hospitals and

56% of VA laboratories; about 30% of

commercial/reference laboratories;

and only 10% or so of community

hospital laboratories do molecular

testing (Figure 10). Overall 20% of

laboratories do molecular tests, show-

ing that this technology is becoming

more kit oriented and is an area to

watch over the next few years.


10

Figure 9: Summary percentage data on laboratory testing

Figure 10: Percentage of sites performing moleculartests for infectious agents

0

20

40

60

80

100

Molecular testsfor infectious

agents(n=612)

Hepatitis,HIV antibody

tests(n=612)

Screeningwithout fullO&P exams

(n=612)

Testing Procedure

Per

cen

t

0

20

40

60

80

100

Total(n=514)

Other(n=17)

VA(n=9)

Commericalor

ReferenceLaboratory

(n=24)

UniversityTeaching

and MedicalHospital(n=27)

CentralLaboratory

Network(n=90)

For-ProfitHospital(n=58)

Non-for-ProfitHospital(n=289)

Laboratory Type

Per

cen

t

3. Degree of Automation inResponding Laboratories

Data on automation show that, despite many types of auto-

mated blood culture instruments being available, only 64%

of clinical microbiology laboratories say that they have such

an instrument (Figure 11). This could reflect the preference

of hospital administrators to purchase more expensive chem-

istry analyzers because of a perception of greater impact on

cost-savings. A higher proportion of laboratories, 83%,

report having an automated instrument for primary suscepti-

bility testing, leaving a rather small market, 14%, using

manual testing methods such as E tests and Kirby-Bauer disk

diffusion for its primary susceptibility test method.

C. WORKLOADS AND PRODUCTIVITY RATES OF RESPONDING LABORATORIES

Figures for workloads and productivity rates are at the heart

of this survey. In this section, productivity figures are pre-

sented by type of laboratory setting from three perspectives:

for all microbiology and diagnostic immunology work done

in all reporting laboratories; for all testing done by labora-

tories doing more complex, labor-intensive activities (e.g.,

full anaerobic work-up in chamber; molecular testing; train-

ing students, residents, fellows, etc); and for two specialty

areas, mycology and mycobacteriology.

1. Total workloads and productivityrates of clinical microbiology laboratories in various settings

Workload data for use in determination of productivity were

captured using two parameters: number of CPT-4 codes

passed and number of tests performed. For each measure, both

the mean (the arithmetic average) and the median (the value

above and below which 50% of values lie) are given. Looking

at how many CPT codes a single technologist passes per year

in microbiology and diagnostic immunology, it is obvious

that means and medians are fairly close and are around the


11

Figure 11: Automation in microbiologylaboratories

Automated BC64%

Manual BC36%


12

0.0

2000.0

4000.0

6000.0

8000.0

10000.0

12000.0

14000.0

16000.0

18000.0

Median

Mean

Total(n=127)

Other(n=10)

UniversityTeaching


CentralLaboratory

Network(n=19)


Not-for-ProfitHospital(n=70)

Laboratory Type

CP

T c

od

es /

tota

l FT

E /

year

0.0

1000.0

2000.0

3000.0

4000.0

5000.0

6000.0

7000.0

8000.0

9000.0

10000.0

25th Percentile

Median

75th Percentile

Total(n=127)

Other(n=10)

UniversityTeaching


CentralLaboratory

Network(n=19)



Laboratory Type

CP

T c

od

es /

tota

l FT

E a

nn

ual

ly

Figure 12: CPT codes passed per FTE per year by laboratory type by mean and median

Figure 13: CPT codes passed per FTE per year by laboratory type by median and 25th and 75th percentiles

6,000 level for most types of laboratories (Figure 12).

University/teaching hospital laboratories are a notable

exception, with a mean of over 8,000, which is considerably

higher than the corresponding median. In all cases the stan-

dard deviation is quite large, and in some cases the standard

error of the mean is as large as the mean itself. Standard

deviations are most likely quite large in this dataset because

the survey included both small and large laboratories: the

reported range of total CPT-4 codes passed annually by

responding laboratories was one to 252,000 (median, 16,444).

For this reason, this report will focus on the median when

reviewing these numbers. For all laboratories reporting

information on CPT codes, the median number of codes

passed annually per FTE was 6,107.

Another informative way of looking at these data is by

percentile (Figure 13). For most settings, the 25th and 75th

percentiles are quite divergent. Again, the exception is

university/teaching hospital laboratories. Since university/

teaching laboratories make up only about 10% of all labo-

ratories who reported CPT data, total figures reflect the

other laboratory types and show a wide spread between 25th

and 75th percentiles, which are 288 and 8,500 CPT codes

passed annually per FTE, respectively.

A second way of measuring workload, as opposed to

FTE codes passed, is by total number of tests performed

(Figure 14). A total of 412 laboratories provided usable

information on this measure. The median total number of

tests performed annually is 25,000, with a range of 75 to

one million. Looking at productivity rates, the median num-

ber of tests performed annually per FTE is 7,410, with a

75th percentile value of 20,700. Clearly, workload and pro-

ductivity values based on numbers of tests done are much

higher than values based on FTE codes passed. This implies

that not all laboratories define “test” in the same way. While

some laboratories may define “test” as a procedure produc-

ing a reportable patient result, other laboratories may be

counting as a “test” even the smallest component proce-

dures which may cumulatively but not individually generate

a reportable patient result. In retrospect, a better definition

of “test” is needed to effectively evaluate these data.


13

0

10000

20000

30000

40000

50000

60000

70000

80000

25th Percentile

Median

75th Percentile

Total(n=412)

Other(n=10)

VA(n=10)

Commericalor

ReferenceLaboratory

(n=27)

UniversityTeaching


CentralLaboratoryNetwork(n=53)



Laboratory Type

Test

s / t

ota

l FT

E a

nn

ual

ly

Figure 14: Total tests per FTE per year by laboratory type by median and 25th and 75th percentiles

2. Productivity among laboratories performing labor intensive activities

To make these productivity figures more useful, the study

looked more closely at laboratories that perform labor

intensive activities. Laboratories were asked to define

labor-intensive activities. Six tasks emerged:

■ Cystic fibrosis (CF) respiratory cultures

■ Full anaerobic cultures

■ Full virology cell culture for

cytopathic effect

■ Homebrew molecular tests

■ Having to input data into more than one computer

system

■ Training infectious disease (ID) fellows, residents,

and/or students

All of these functions are clearly labor-intensive and

may place additional personnel requirements on a laboratory.

For example, CF respiratory cultures take several days to

complete because multiple organisms are often recovered

which require further work-up, and automated instruments

cannot be reliably used for their identification or suscepti-

bility testing. Performing a conventional or shell vial virol-

ogy cell culture involves much more time and effort than

using a rapid antigen detection kit. Additionally, homebrew

or analyte specific reagent-based molecular tests require

more labor than kit-based products due to a need to internally

optimize and validate initially. Anyone who is required to use

more than one computer system may have to perform dupli-

cate entry into computers. This situation may result from

either the consolidation of laboratories or when the laboratory

information system (LIS) does not connect to the hospital

information system, or an automated blood culture or iden-

tification and susceptibility instrument does not feed directly

into the LIS. Finally, training activities at any level, includ-

ing the training of new employees, take considerable time.

Many laboratories in the survey are doing at least one of

these labor-intensive activities, with training being most

frequent and homebrew molecular tests being least frequent

(Table 1). Most notably, almost one-third of responding lab-

oratories are entering data into more than one computer sys-

tem and more than one-third are doing training. Not all types

of laboratories do equivalent numbers of the six specified

labor-intensive activities (Figure 15). University/teaching

hospital laboratories and VA hospital laboratories in this

survey all do at least one of these six labor-intensive activ-

ities, while 76% and 50%, respectively, do three or more of

them. On the other hand, more than 40% of laboratories in

community non-profit and for-profit hospitals perform none

of the six specified labor-intensive activities. Similarly,

more than 40% of central/network laboratories and 70% of

commercial/reference laboratories do not perform any of

the six specified labor-intensive activities.

Table 1: Percentage of laboratories thatperform each of the six identifiedlabor-intensive activities

Labor-Intensive Activities Performed by Labs

CF respiratory cultures 16.0%

Full anaerobic culture 19.0%

Full virology cell culture 8.6%

Homebrew molecular tests 3.0%

More than one computer system 31.0%

Train ID fellows, residents, students 39.0%

Looking at productivity in laboratories that perform one

or more of the six identified labor-intensive activities, the

median number of CPT codes passed per FTE annually is

7,225 (Figure 16). In these laboratories, productivity rises

from 5,753 CPT codes passed per FTE per year for those

that do one such activity, to 7,031 for those that do two

labor-intensive activities, to 7,884 among laboratories that

do three or more labor-intensive activities. Somewhat para-

doxically, productivity in laboratories that undertake any of

these six identified labor-intensive activities is substantially

higher than among laboratories that do none of them, which

have a median number of CPT codes passed per FTE per

year of 1,000.


14


15

0%

20%

40%

60%

80%

100%

3 or more

2

1

0

Total(n=595)

Other(n=17)

VA(n=12)

Commericalor

ReferenceLaboratory

(n=36)

UniversityTeaching


CentralLaboratoryNetwork(n=97)



147

97

54

43

252

147

101

95

26

19

10

8

43

19

22

13

26

5

4

1

10

4

1

2

02

5

22

01

5

6

Laboratory Type

Lab

or-

inte

nsi

ve p

roce

du

res

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

Median

Mean

Total(n=95)

Other(n=5)

UniversityTeaching


CentralLaboratory

Network(n=15)



Laboratory Type

CP

T c

od

es /

tota

l FT

E /

year

Figure 15: Distribution of the six identified labor-intensive activities by laboratory type

Figure 16: CPT codes passed per FTE per year in laboratories that perform labor-intensive procedures, by laboratory type


16

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Median

Mean

Total(n=165)

Other(n=15)

UniversityTeaching


CentralLaboratory

Network(n=27)



Laboratory Type

Myc

olo

gy

cult

ure

s / m

yco

log

y FT

E

0

500

1000

1500

2000

2500

3000

3500

4000

Median

Mean

Total(n=104)

Other(n=10)

UniversityTeaching


CentralLaboratory

Network(n=15)

For-ProfitHospital

(n=8)


Laboratory Type

AFB

cu

ltu

res

/ myc

ob

acte

rio

log

y FT

EFigure 17: Number of mycology tests performed per FTE by laboratory type

Figure 18: Number of AFB cultures performed per FTE per year by laboratory type

3. Productivity in mycology andmycobacteriology laboratories

In addition to calculating figures for overall productivity for

all tests in microbiology and diagnostic immunology, the

study calculated work rates for mycology and mycobacteri-

ology tasks separately. In both cases these figures are much

lower than for overall productivity.

Among the 165 laboratories that reported both the num-

ber of mycology tests per year and the number of FTE’s

devoted to mycology, the median number of mycology tests

per FTE per year was 1,000 (Figure 17). A familiar pattern

is seen here: laboratories in university/teaching hospitals

had the highest productivity rates, with a median of just

over 3,000 tests per FTE per year. Central laboratories had

the next highest rate, with a median around 1,550.

For AFB cultures, productivity was slightly higher, with

a median of 1,116 tests per FTE per year (Figure 18).

Central/network laboratories and university/teaching hospi-

tal laboratories produced higher figures, with a median over

1,500. These types of laboratories also do more tests, con-

sistent with the notion that laboratories that do more tests

have a better productivity quotient. In this respect, it seems

that consolidation with resulting higher volumes may be

advantageous.

D. STAFFING AND VACANCIESIN CLINICAL MICROBIOLOGYLABORATORIES

1. Staffing in RespondingLaboratories

As part of this survey, the study attempted to get a profile of

who is working in microbiology laboratories. Thirty-eight

percent of responding laboratories have a laboratory director,

30% have a laboratory manager and 54% have a supervisor.

Ninety percent of laboratories said that they employ workers

with either a Medical Technologist (MT) or a Clinical

Laboratory Scientist (CLS) degree or both as part of their

workforce, while 41% have Medical Laboratory

Technicians (MLTs). Laboratory aides are employed in a

rather small proportion of these laboratories, 11%, while

even fewer, 8%, have clerical personnel. Fully 71% of lab-

oratories reported that they have no coverage in microbiol-

ogy during some part of the week. Unfortunately, whether

this is the weekend or third shift was not defined.

2. Vacancies Rates and Time to Fill Vacancies

Looking at vacancies, 39% of responding laboratories have

budgeted openings, while 61% do not (Figure 19). Loss of


17

Figure 19: Laboratories with currentvacancies

No budgetedopenings

61%

Havebudgetedopenings

39%

positions due to budget cutbacks and mergers has no doubt

eliminated some positions that would otherwise be listed as

vacancies. Calculating the number of vacancies as a ratio of

the laboratories reporting vacancies (345 laboratories

reporting 502 vacancies), yields 1.44 FTEs per laboratory.

This ratio did not vary much by laboratory type, ranging

from just under 1.2 for VA laboratories to about 1.5 in for-

profit hospital laboratories. By far the greatest number of

vacancies, 57%, is for individuals with an MT or CLS qual-

ification, the individuals who are required to exercise inde-

pendent judgment in the performance of their work (Figure

20). Only 14% of vacancies are for MLTs. Across the four

major geographic regions of the U.S., the percentage of lab-

oratories with a budgeted FTE vacancy did not differ much

for either MT/CLS workers or for MLTs.

When it comes to filling vacancies, only 20% are filled

in less than one month (Figure 21). Adding in the 29% that

are filled between one and three months, almost half of all

vacancies are filled within three months. A further 23% of

vacancies are filled in four to six months and 13% take

more than one year to fill, which puts pressure on those in

the laboratory to carry an additional workload or to delay or

neglect duties that should otherwise be done during this

period.

An important consideration is whether laboratories have

to turn to workers from countries outside of the United

States to fill these vacancies. The survey found that 91% of

laboratories are meeting their staffing needs without resort-

ing to hiring resident aliens (Figure 22). Only 9% of labo-

ratories employ non-U.S. citizens, with an average of 1.4

workers per laboratory who fall into this category.

E. AGING OF THE MICROBIOLOGY LABORATORY WORKFORCE

Consistent with prior estimates of total laboratory work-

force, the workforce of the clinical microbiology labora-

tories responding to this survey is skewed toward older


18

MT/CLS57%

Other29%

MLT14%

1-3 mo29%

>1 yr13% <1 mo

20%

7-12 mo15%

4-6 mo23%

No ResAliens91%

ResAliens

9%

Figure 20: Currently vacant laboratorypositions or those filled inpast 12 months

Figure 21: Time to fill vacancies

Figure 22: How laboratories are meetingstaffing needs

individuals (Figure 23). Only 10% of

the workforce is less than 30 years and

just over 20% is 30-39 years of age,

while the largest group, 35%, is

between 40 and 49 years. Overall,

67% of microbiology workers in this

survey are more than 40 years of age

and 34% are over 50 years.

To compare the microbiology lab-

oratory workforce to the female U.S.

workforce in general, the data in

Figure 23 are repeated in Figure 24

with a superimposed line showing the

percent of U.S. females working at

various ages. Participation of U.S.

females in the workforce is very high,

between 75 and 80%, up to age 50

years. So the weight of the overall

female workforce is toward the left,

younger, end of the age distribution,

opposite to the pattern among the

microbiology laboratory workforce

(Figure 24).


19

Figure 23: Microbiology workforce by age category, 2003

Figure 24: Microbiology workforce by age category,2003, compared to age-specific U.S. femalelabor force participation estimates, 2000

0

5

10

15

20

25

30

35

40

60 plus55-5950-5440-4930-39LT 30

Personnel Age Category

Per

cen

t

0

10

20

30

40

50

60

70

80

90

U.S. Female labor forceParticipation rate, 2000

Micro Workforce(n=3876)

60 plus55-5950-5440-4930-39LT 30Personnel Age Category

Per

cen

t

What is most important about this survey is that for the first

time it provides a set of productivity numbers that can be

used by clinical microbiology and diagnostic immunology

laboratories of various types to benchmark their perform-

ance, both for microbiology and diagnostic immunology

overall and for specific subdisciplines such as mycology

and mycobacteriology. Clinical microbiology is very differ-

ent from other laboratory disciplines, which are more auto-

mated, so numbers that accurately reflect the methods and

technologies used in this work area, including the invest-

ment of “independent judgement” by MT and CLS level

personnel, are needed. Criteria from other clinical laborato-

ries cannot fairly be used to evaluate productivity of micro-

biology by administrators.

For overall performance, the median number of CPT

codes passed per FTE annually in clinical microbiology lab-

oratories was 6,107. Inverting this ratio, one arrives at an

estimate of just over twenty minutes of paid technical time

per test. Based on the numbers and types of processes that

are involved in the ultimate generation of a reportable

microbiology result, this represents a very plausible amount

of time input.

It is clear from this productivity median that figures of

10,000 CPT codes per FTE annually that are cited by con-

sultants represent an overestimation for many microbiology

laboratories. Such figures may be readily achievable in

chemistry laboratories with automated analyzers, but

should not be used to benchmark productivity in microbiol-

ogy laboratories, with their more manual, high-complexity

test procedures requiring exercise of individual independent

judgement. This is especially true for specialty areas like

AFB, parasitology, virology and mycology that are even

less automated and require even greater human attention,

with attendant lower productivity.

At the same time it is important to recognize that half of

all reporting laboratories had productivity values above

6,107, with some, particularly university/teaching hospital

laboratories, exceeding 10,000. Comparisons also showed

that laboratories that performed one or more of the six iden-

tified labor-intensive activities had higher productivity.

Further, those laboratories that do three or more of these

specified labor-intensive activities have the highest median

productivity. It is reasonable to infer that such laboratories

are more versatile and their staff may be more efficient and

have a higher level of expertise. This conclusion is support-

ed by the observation that, in general, laboratories that per-

form more specialty areas have higher productivity as well.

For a microbiology laboratory to be competitive, it will

not be enough to aim for the median productivity. It will be

necessary to strive for much higher numbers allowing for

lower overall labor costs per test. These data suggest that

higher productivity numbers are achievable by full-time,

highly active and versatile laboratories that are fully staffed

by experienced technologists, which can produce work

faster and presumably with better overall accuracy than

lower volume laboratories staffed by generalists. This con-

clusion is supported by a productivity survey that PSAB’s

Committee on Professional Affairs sent by e-mail to 118

clinical microbiology laboratories in 1999. In that survey,

the median productivity was 8,900 annual CPT codes per

FTE, about one-third higher than in this survey. Unlike the

present survey, participating laboratories in the 1999 survey


20

IV. DISCUSSION AND CONCLUSIONS

did not represent the entire size range of clinical microbiol-

ogy laboratories, but were weighted toward larger universi-

ty hospital laboratories managed or directed by individuals

with specific expertise in microbiology. Larger university

hospital laboratories responded in a higher proportion in the

1999 survey at a rate of 47%, as opposed to 5% who

responded to the present survey. Whereas the 1999 survey

was sent electronically to all subscribers of ASM’s Division

C and ClinMicroNet listserves, the present survey was sent

via US mail to selected laboratories using random sampling

methodology. Random sampling, an accepted sampling

technique used in survey research, is an efficient and effec-

tive method to study a population. By using random sam-

pling, the likelihood of bias is reduced.

It is important to be aware that in this survey only 127

laboratories provided information on CPT codes, so the pro-

ductivity figures derived from these responses represent a

minority of the laboratories surveyed. Perhaps the persons

who filled out the survey from many laboratories did not

have quick access to the data and did not take the time to go

to laboratory administrators to get it. Alternatively, it is pos-

sible that laboratories do not collect data on CPT-4 codes,

though this is less likely since CPT codes are critical for

billing purposes. However, a sufficient number of laborato-

ries of all types did report CPT-4 data to allow productivity

benchmarking data to be calculated for all laboratory types.

With regard to laboratories that reported number of tests

performed, rather than CPT codes, it seems clear that the

term “test” was interpreted rather broadly. Theoretically,

there should be more CPT codes per person than tests. For

instance, for a sputum culture, one could count four or more

CPT codes: performing a Gram stain, performing and pre-

liminarily assessing the culture, and identification and sus-

ceptibility testing of each significant isolate. In the survey,

however, much higher numbers of tests were reported than

CPT codes. Median number of tests per FTE per year was

7,410, higher than the 6,107 CPT codes per FTE per year;

and the 75th percentile for tests was almost 21,000, as

opposed to 8,500 for CPT codes. The only way to explain

this discrepancy is if some laboratories counted every dis-

tinct procedure performed, including such minor proce-

dures as catalase and oxidase tests which would generally

be a component of the CPT code for the primary culture in

the case given. The definition of “test” needs to be better

specified in order for these data to be fully evaluable.

Vacancy rates in this survey can be compared to those in

a small ad hoc survey conducted among microbiology lab-

oratories in June, 2000. In that earlier survey, 70% of vacant

positions were for MT-level workers, as opposed to 57% in

the current survey. Conversely, persons without an MT,

CLS or MLT certification made up 29% of vacancies in the

current survey, more than double the 14% rate in 2000. It is

possible that work is being shifted away from the more

highly qualified workers who by definition must be capable

of exercising independent judgement; or perhaps the work

is being sorted into functions that may be performed by the

lower qualified personnel leaving the more complex tasks

in the clinical microbiology laboratory for MT/CLS person-

nel. While the former could have deleterious effects on

quality of work, the latter may be a means of increasing effi-

ciency in larger laboratories. It is also possible that MT and

MLT positions are being filled and that laboratories are now

looking for laboratory helpers, people who come in at a

lower wage to do such things as setting up tests rather than

performing tasks requiring independent judgment. One

caveat is that it is impossible to know from these data how

many laboratories had budgeted openings eliminated

through workforce reduction.

Once again this survey provides evidence of the aging

microbiology workforce, especially the high fraction over

age 50. This continues to be a worrisome trend. Distribution

of workers in the ASCP survey is very similar to that seen

for the microbiology numbers, so this is not just an anom-

aly in microbiology. This finding should be considered a

wake-up call for individuals working in laboratories and

particularly for individuals who will be seeking qualified

professionals to staff laboratories in the near future. Women

of all ages are in the workforce, they are just not being

drawn to microbiology. Other professions with higher

salaries are siphoning off this young incoming workforce

who are needed to offset the loss of current workers.

I V. D I S C U S S I O N A N D C O N C L U S I O N S

21

SURVEY OF MICROBIOLOGY LABORATORY WORKLOADS1. Which of the following best describes your diagnostic immunology laboratory which handles testing for infectious

diseases?

� Incorporated within the microbiology laboratory

� Separate from your microbiology laboratory

� We do not have a diagnostic immunology laboratory that tests for infectious diseases.

2. Which of the following terms best describes your microbiology/diagnostic immunology laboratory or laboratory

location?

� Community (City or County) non-profit hospital

� Community for-profit hospital

� Laboratory for a hospital and/or clinic (i.e. centralized laboratory) network

� University/Medical school/Teaching hospital

� Commercial laboratory

� Single location � Multiple locations

� Veterans Administration (VA) hospital

� Federal government (military)

� Reference laboratory (Obtains specimens from other laboratories)

� Other diagnostic laboratory, please specify:

3. Our laboratory performs at least one type of test in the following laboratory specialty areas:

Yes No Yes No

Bacteriology � � Diagnostic Immunology for Infectious Disease/Serology � �

Mycology � � Molecular infectious disease testing � �

Mycobacteriology � �

Parasitology � �

Virology � �


22

APPENDIX A: SURVEY INSTRUMENT

4. Our microbiology and diagnostic immunology laboratory is staffed by the following personnel categories and the

number of each:

� Laboratory director #

� Administrator/Manager #

� Supervisor #

� Medical technologist/Clinical laboratory scientist #

� Microbiologist #

� Medical laboratory technician #

� Clinical laboratory assistant #

� Laboratory aide #

� Clerical #

� Other (please specify) #

5. What are the “total FTEs” in your microbiology laboratory budget? (Please refer to definitions)

Total FTEs (If immunology laboratory has a separate budget, answer Q8 also.)

6. What is the number of “total FTEs” staffing each of the following specialty areas in your laboratory?

Total FTEs We do no testing in this area

Bacteriology �

Mycology �

Mycobacteriology �

Parasitology �

Virology �

7. What are the total “technical FTEs” in your microbiology laboratory? (Please refer to definitions)

“Technical” FTEs

8. What are the “total FTEs” in your diagnostic immunology laboratory budget if separate from microbiology?

(Please refer to definitions)

Total FTEs � NA

9. What are the total “technical FTEs” in your diagnostic immunology laboratory if separate from microbiology?

(Please refer to definitions)

“Technical” FTEs � NA

10. What is your total estimated annual patient test volume in:

Microbiology Lab Diagnostic Immunology Lab

A P P E N D I X A

23

11. What percentage of your total specimens are accessioned or cultured in the microbiology laboratory?

(Please give one value, not a range of percents)

%

12. Is there a time during the week that no microbiology personnel are on-duty but your laboratory microbiology is

covered by another means for after-hours or “STAT” procedures?

� Yes, If Yes, please answer a and b. � No, GO TO Q13.

a. Are microbiology after-hours or STAT tests performed in a core laboratory?

� Yes � No

b. Are microbiology after-hours or STAT tests performed by other department personnel within your laboratory?

� Yes � No

13. What is the total number of CPT codes passed for your microbiology and diagnostic immunology laboratory by per-

sonnel included in the “total FTE” category for the most recent 12 months or most recent fiscal or annual year for

which summary statistics are available?

If you don’t count CPT codes, check NA and GO TO Q16.

Total number of CPT codes � NA

14. Are separate CPT codes passed for organism identification tests?

� Yes � No

If Yes, what are the total number of CPT codes passed for organism identification?

Total CPT codes

15. Are separate CPT codes passed for antimicrobial susceptibility tests?

� Yes � No

If Yes, what are the total number of CPT codes passed for susceptibility tests?

Total CPT codes

16. What is the total number of tests performed in the most recent 12 months as counted manually or by your laboratory

computer system?

Total tests


24

The following questions pertain to the various specialty areas within the microbiology laboratory.

If your laboratory does not do testing in the specialty area, please indicate that and proceed to

the next specialty area.

BACTERIOLOGY

17. Is bacteriology performed in your laboratory by personnel in the “total FTE” category?

� Yes, Please Answer a,b,c,d,e,f. � No, If No, GO TO Q18.

a. What is the total number of CPT codes passed in bacteriology for 12 months?

CPT codes � NA

b. What is the number of susceptibility tests done in 12 months?

Tests

c. What is your primary method for susceptibility testing?

� Manual (i.e., Kirby-Bauer, E-test) � Automated (i.e., Vitek, MicroScan) � NA

d. Please fill in the number of tests performed for 12 months for the following culture types or tests.

Type Culture Number per 12 months

Aerobic wound/tissue/fluid � NA

Anaerobic wound/tissue/fluid � NA

Combination Aerobic and anaerobic wound/tissue/fluid � NA

Blood � NA

Cerebral spinal fluid � NA

Genital sites (includes prenatal Group B strep) � NA

Respiratory (includes Group A strep screen) � NA

Stool � NA

Urines � NA

e. Please fill in the number of tests performed for 12 months for the following procedures.

Nonculture Test Number per 12 months

Bacterial antigen serology (non-syphilis) � NA

Chlamydia nonamplified technique � NA

Chlamydia amplified technique � NA

Clostridium difficile test nonamplified technique � NA

Clostridium difficile test amplified technique � NA

Molecular test to identify bacteria (Pertussis, Legionella, etc.) � NA

Neisseria gonorrhea nonamplified technique � NA

Neisseria gonorrhea amplified technique � NA

f. Does your laboratory have an automated blood culture system?

� Yes � No

A P P E N D I X A

25

VIROLOGY

18. Is virology performed in your laboratory by personnel in the “total FTE” category?

� Yes, If Yes, Please complete the table below. � No, If No, GO TO Q19.

Please write in the TOTAL NUMBER for 12 months or check � NA (not applicable) where appropriate:

Qualitative

Antigen and Molecular Tests

CPT Chlamydia Viral Viral Serology Antibody Tests for Infectious Quantitative

Codes and Antigen Tests for hepatitis Viral Agents Molecular Tests

passed in Viral Screens (includes A, B, C and (HBV, HCV, for Infectious

virology Cultures (IFA, EIA) syphilis) HIV HIV, EBV) Viral Agents

No. No. No. No. No. No. No.

� NA � NA � NA � NA � NA � NA � NA

MYCOLOGY

19. Is mycology performed in your laboratory by personnel in the “total FTE” category?



Mycological Mycological Mycological

CPT Codes identifications by identifications by susceptibility tests

passed in Mycology conventional molecular performed Mycological

mycology cultures methods methods in-house Serology

No. No. No. No. No. No.

� NA � NA � NA � NA � NA � NA

20. Are separate CPT codes passed for mycological identification?

� Yes � No � NA

MYCOBACTERIOLOGY

21. Is mycobacteriology performed in your laboratory by personnel in the “total FTE” category?



26


AFB AFB

Molecular TB identifications identifications AFB

CPT codes tests performed done by done by susceptibility

passed in on primary conventional molecular tests performed

mycobacteriology specimens AFB cultures methods methods in-house

No. No. No. No. No. No.

� NA � NA � NA � NA � NA � NA

22. Are separate CPT codes passed for mycobacterial identification?


23. Does your laboratory use an automated instrument as part of your primary AFB culture system?


PARASITOLOGY

24. Are parasitology exams performed in your laboratory by personnel in the “total FTE” category?



CPT codes passed in O & P

parasitology examinations Antigen screens

No. No. No.

� NA � NA � NA

25. Does your laboratory perform full ova and parasite (O & P) examinations including a permanent stain on most

specimens?


26. Does your laboratory routinely screen parasitology specimens for:

All pathogens? � Yes � No � NA

Only specific pathogens? � Yes � No � NA

Require a specific request for a complete O & P exam? � Yes � No � NA

A P P E N D I X A

27

LABOR INTENSIVE TESTS AND ACTIVITIES

27. Following is a list of labor-intensive test procedures that your laboratory may perform.

Please indicate (a) if the test or procedure is performed and (b) the number per month.

(b)

Number of

(a) procedures per

Labor-Intensive Activity Performed? month

Respiratory samples from cystic fibrosis patients � Yes � No

Full anaerobic work-up (in chamber) � Yes � No

Full virology cell culture including exam for cytopathic

effect, hemadsorption, etc. � Yes � No

Home brew molecular, molecular typing

(e.g., isolates, HIV, HCV) � Yes � No

28. Following is a list of labor-intensive activities your laboratory may perform.

Please indicate (a) if the activity is performed and

(b) the number of hours per month performed by microbiology personnel.

(b)

Number of hours

(a) per month for

Labor-Intensive Activity Performed? activities

More than one computer system requiring multiple data or

test result entry, checking, etc. � Yes � No

Training students, residents, fellows, etc. � Yes � No

29. What are the number of “total FTEs” approved in your microbiology budget?

Total FTEs

30. What are the total number of “total FTEs” approved in your diagnostic immunology laboratory budget

(if separate from the microbiology budget)?

Total FTEs


28

The following questions are to determine laboratory vacancy rates across the country.

31. What are the number of FTEs openings in your laboratory by position?

Medical technologist/Clinical laboratory scientist FTE � NA

Medical laboratory technician FTE � NA

Other, please specify position:

FTE � NA

� We currently have no budgeted openings in our laboratory FTE � NA

32. Indicate, on average, how long the budgeted FTE positions have been vacant. If you do not currently have openings,

please indicate how long it took to fill positions during 2002.

BUDGETED FTE POSITIONS

Position: Position: Position:

Vacancy: < 1 month � Vacancy: < 1 month � Vacancy: < 1 month �

1-3 months � 1-3 months � 1-3 months �



> 1 year � > 1 year � > 1 year �

33. Among your current full- or part-time microbiology/medical technologist/clinical laboratory scientist employees

in microbiology and diagnostic immunology,

(a) indicate the approximate number in each of the following age categories:

29 years or younger 30-39 years 40-49 years

50-54 years 55-59 years 60 years or older

(b) How many of this staff are resident aliens (i.e., working on temporary visas)?

Staff Members

34. Do you have any comments on laboratory vacancy or retirement issues?

� No � Yes, please specify:

35. Thank you for your help with this research. Please return this questionnaire in the self-addressed, stamped enve-

lope enclosed. If the envelope is misplaced, please mail or FAX the questionnaire to:

Laboratory Assurance Program TELEPHONE: (619) 594-5006

6505 Alvarado Road, Suite 209 FAX: (619) 594-8816

San Diego, CA 92120

May we contact you for response clarification? � Yes � No

Name: Telephone Number:

Best Time to Call:

A P P E N D I X A

29

In the following four tables, productivity is given by

number of CPT codes or number of tests per FTE annually

by laboratory type. In the first two tables, laboratories are

stratified by the number of labor-intensive activities; in

the next two, by number of specialty areas performed. All

tables include several percentiles and the median for each

laboratory type. For a laboratory to see where it stands

against these benchmarks, it should determine how many

of the six labor-intensive activities or seven specialty

areas it performs, then find the appropriate column of the

table by laboratory type. For example, in Table 3, if you

are a not-for-profit hospital laboratory that performs testing

in six specialty areas, you should be passing more than

8,659 CPT codes/FTE/year to be above the 75th percentile.

It is then possible to determine where that laboratory

stands along the range of productivity percentiles.


30

APPENDIX B: PRODUCTIVITY TABLES

TABLE 1: BENCHMARKING: TOTAL TESTS / TOTAL FTEs ANNUALLYHow does your laboratory compare? Identify your laboratory type then count the number of labor intensive activities you perform by checking the applicable boxes:

� Respiratory samples from cystic fibrosis patients � Home brew molecular, molecular typing (e.g. HIV)� Full anaerobic work-up (in chamber) � Training of residents, students, fellows, etc.� Full virology cell culture including exam for � More than one computer system requiring multiple data

cytopathic effect, hemadsorption, etc. or test result entry, checking, etc.

A P P E N D I X B

31

TOTAL TESTS / TOTAL FTE ANNUALLY BY THE COUNT OF LABOR INTENSIVE ACTIVITIESPERFORMED IN EACH TYPE OF LABORATORY

COUNT OF LABOR-INTENSIVE ACTIVITIES

0 1 2 3 Group Total

Percentile 05 210 983 395 2579 400Percentile 25 1960 4896 4332 6133 3600

Not-for-Profit Median 5120 8639 7682 8517 7619Hospital Percentile 75 16444 19667 18733 17879 16611

Percentile 95 153636 208649 123576 344860 199860Valid N N=103 N=77 N=37 N=31 N=248Percentile 05 706 2941 5779 8444 2531Percentile 25 4000 5382 6000 8729 5649

For-Profit Median 7200 7881 10612 11438 8737Hospital Percentile 75 31429 15875 10855 12394 12394


Central Median 5271 11667 6155 9927 8240Laboratory Percentile 75 50000 50000 10888 13897 24505Network Percentile 95 0 0 0 0 305895

Valid N N=19 N=15 N=10 N=9 N=53Percentile 05 0 5288 5133 199 785

University Percentile 25 0 5288 5552 5291 5333Teaching & Median 0 5705 6516 7059 6377Medical Percentile 75 0 0 7904 23110 8335Hospital Percentile 95 0 0 0 0 63025

Valid N N=0 N=2 N=5 N=17 N=24Percentile 05 319 381 2255 667 405Percentile 25 2000 644 2410 1364 1500

Other Median 20603 3250 6871 3053 5600Percentile 75 92500 51044 11500 6661 30365Percentile 95 438200 0 0 0 342333Valid N N=23 N=9 N=7 N=8 N=47


Total Median 6075 8509 7414 7702 7467Percentile 75 27633 19086 11625 13214 16174Percentile 95 201839 208342 102286 229813 197694Valid N N=156 N=117 N=66 N=71 N=410

TABLE 2: BENCHMARKING: TOTAL CPT CODES PASSED / TOTAL FTEs ANNUALLYHow does your laboratory compare? Identify your laboratory type then count the number of labor intensive activities you perform by checking the applicable boxes:

� Respiratory samples from cystic fibrosis patients � Home brew molecular, molecular typing (e.g. HIV)� Full anaerobic work-up (in chamber) � Training of residents, students, fellows, etc.� Full virology cell culture including exam for � More than one computer system requiring multiple data

cytopathic effect, hemadsorption, etc. or test result entry, checking, etc.


32*Laboratory Type collapsed due to small sample size

TOTAL CPT CODES PASSED / TOTAL FTE ANNUALLY BY THE COUNT OF LABOR INTENSIVE ACTIVITIESPERFORMED IN EACH TYPE OF LABORATORY*

COUNT OF LABOR-INTENSIVE ACTIVITIES

0 1 2 3 or more Group Total

Percentile 05 .6 4 32 7 4Percentile 25 261 725 6000 10 369

Not-for-Profit Median 1960 6823 7750 7333 6390Hospital Percentile 75 7121 8745 10053 11210 8835


For-Profit Median 4517 5167 7108 8824 5889Hospital Percentile 75 0 10500 10145 0 9453


Central Median 895 5333 6019 9807 6958Laboratory Percentile 75 2503 0 7150 13925 8500Network Percentile 95 0 0 0 0 0

Valid N N=4 N=3 N=6 N=6 N=19Percentile 05 0 6122 5133 2546 2564

University Percentile 25 0 6122 5133 5351 5301Teaching & Median 0 6122 6607 7037 6429Medical Percentile 75 0 6122 0 8162 8078Hospital Percentile 95 0 6122 0 0 0

Valid N N=0 N=1 N=2 N=10 N=13Percentile 05 3 1 9 10746 1Percentile 25 5 1 9 10746 6

Other Median 10 10 9 10746 10Percentile 75 4394 0 9 10746 2661Percentile 95 0 0 9 10746 0Valid N N=5 N=3 N=1 N=1 N=10


Total Median 1000 5753 7031 7884 6107Percentile 75 6784 8495 8604 10746 8535Percentile 95 12178 12450 13102 21503 14679Valid N N=31 N=36 N=24 N=35 N=126

TABLE 3: BENCHMARKING: CPT CODES PASSED / TOTAL FTEs ANNUALLYHow does your laboratory compare?1) Identify your laboratory type 2) Check the number of specialty areas in which your laboratory performs at least one type of test:� Bacteriology � Parasitology � Diagnostic Immunology for Infectious Disease/ Serology� Mycology � Virology � Molecular infectious disease testing� Mycobacteriology

3) Compare your laboratory productivity by locating the count of your specialty areas on the table below.

A P P E N D I X B

33* Laboratory Type collapsed due to small sample size

TOTAL CPT CODES PASSED / TOTAL FTE ANNUALLY BY THE COUNT OF LABORATORY SPECIALTY AREASIN EACH TYPE OF LABORATORY*

NUMBER OF SPECIALTY AREAS IN LABORATORY1 2 3 4 5 6 7 Group Total

Percentile 05 .4 3 6 7 5 8 13 4Percentile 25 6 29 31 393 4570 6313 7750 369

Not-for-Profit Median 1480 5246 5913 7727 7619 7556 9867 6390Hospital Percentile 75 2993 7620 8000 11688 10280 8659 11250 8835

Percentile 95 0 0 0 0 0 0 0 15213Valid N N=10 N=14 N=11 N=7 N=10 N=11 N=7 N=70Percentile 05 2 4000 31 8437 25 5779 8 2Percentile 25 2 4000 31 8437 25 5779 8 30

For-Profit Median 2 4000 5167 13406 3013 7405 4416 5889Hospital Percentile 75 2 4000 0 0 0 0 0 9453


Central Median 1776 6 5333 0 3519 10718 7302 6958Laboratory Percentile 75 0 0 0 0 0 0 12233 8500Network Percentile 95 0 0 0 0 0 0 0 0

Valid N N=3 N=3 N=3 N=0 N=3 N=3 N=4 N=19Percentile 05 0 0 2546 0 5133 6122 5000 2546

University Percentile 25 0 0 2546 0 5133 6199 5234 5301Teaching & Median 0 0 2546 0 5589 7252 7884 6429Medical Percentile 75 0 0 2546 0 0 29019 8251 8078Hospital Percentile 95 0 0 2546 0 0 0 0 0

Valid N N=0 N=0 N=1 N=0 N=3 N=4 N=5 N=13Percentile 05 7 1 0 10 714 9 0 1Percentile 25 7 1 0 10 714 9 0 6

Other Median 10 3 0 10 4607 9 0 10Percentile 75 0 0 0 10 0 9 0 2661Percentile 95 0 0 0 10 0 9 0 0Valid N N=3 N=3 N=0 N=1 N=2 N=1 N=0 N=10

Percentile 05 .4 1 6 7 5 8 8 4Percentile 25 7 5 265 393 1416 6218 6586 329

Total Median 288 2808 5250 8437 6202 7556 7982 6107Percentile 75 2213 6900 8224 13406 8500 9516 10202 8535Percentile 95 0 10648 0 0 17663 33808 0 14679Valid N N=17 N=21 N=18 N=11 N=20 N=21 N=18 N=126

TABLE 4: BENCHMARKING: TOTAL TESTS / TOTAL FTEs ANNUALLYHow does your laboratory compare?1) Identify your laboratory type 2) Check the number of specialty areas in which your laboratory performs at least one type of test:� Bacteriology � Parasitology � Diagnostic Immunology for Infectious Disease/ Serology� Mycology � Virology � Molecular infectious disease testing� Mycobacteriology

3) Compare your laboratory productivity by locating the count of your specialty areas on the table below.


34

TOTAL TESTS / TOTAL FTEs ANNUALLY BY THE COUNT OF LABORATORY SPECIALTY AREAS IN EACH TYPE OF LABORATORY

NUMBER OF SPECIALTY AREAS IN LABORATORY1 2 3 4 5 6 7 Group Total

Percentile 05 219 234 730 4254 1201 2136 4592 400Percentile 25 2115 1550 3800 8324 4621 6145 6966 3600

Not-for-Profit Median 4320 4600 8333 12182 6886 8000 9993 7500Hospital Percentile 75 13333 19011 66250 93500 15136 13944 11858 16097


For-Profit Median 6750 13903 8957 10922 7881 5779 8824 8737Hospital Percentile 75 10128 41993 11714 14602 37223 5779 0 12394


Central Median 1750 4649 9870 4916 23998 9120 12770 8240Laboratory Percentile 75 7341 56495 118734 7869 84375 12494 45135 24505Network Percentile 95 0 0 0 0 0 0 0 305895

Valid N N=6 N=10 N=12 N=4 N=9 N=8 N=4 N=53Percentile 05 0 0 2546 5113 5133 2857 199 785

University Percentile 25 0 0 2546 5113 5247 5705 5811 5333Teaching & Median 0 0 2546 5113 5780 7328 7348 6377Medical Percentile 75 0 0 2546 5113 6170 22938 27159 8335Hospital Percentile 95 0 0 2546 5113 0 0 0 63025

Valid N N=0 N=0 N=1 N=1 N=4 N=9 N=9 N=24Percentile 05 288 381 1500 1342 714 1401 667 405Percentile 25 443 2688 19125 4536 1033 2255 667 1500

Other Median 2000 4500 64175 14479 2414 3692 4440 5600Percentile 75 66667 35160 128065 81107 56551 9740 0 30365Percentile 95 0 0 0 0 0 0 0 342333Valid N N=7 N=14 N=6 N=6 N=5 N=7 N=2 N=47

Percentile 05 218 358 1448 3068 1105 2231 503 487Percentile 25 1880 2306 4047 5917 4772 5939 7056 3714

Total Median 4445 4713 8704 9333 7112 7811 8651 7387Percentile 75 13114 25000 61042 30365 18939 11896 12383 15806Percentile 95 205000 290933 211335 253333 150170 120234 84407 197513Valid N N=74 N=87 N=60 N=35 N=65 N=58 N=32 N=411

Question 34 on the survey offered respondents an opportu-

nity to make open-ended comments about laboratory vacancy

and retirement issues. Many people used this opportunity to

express their opinions on these issues. Comments generally

fell into seven themes. These themes are summarized

below, with representative quotes from the survey.

1. Having a MT/MLT training program in their institution

helps to fill vacancies: If you train them, you’ll get them

as employees.

“Am thankful for MLT program in which we par-

ticipate as clinical site. I have hired from it 6 out

of 7 years we have participated.”

2. Staffing issues are more acute in rural areas. (Lower

salaries and location not attractive. Smaller pool of

workers to draw upon.)

“Rural America is really beginning to suffer from

medical technologist shortages; the pay just isn’t

there to compete for the people who are available.”

3. Using BS and MS degreed persons to fill laboratory

positions. No MLTs/MTs available who have the specific

technical and clinical training. (It takes longer to train

those not coming from a program designed to teach

laboratory medicine.)

“Although we may have filled positions, often there

were no traditional MTs available and we hired BS

or MS people and trained them with varying results

—some made the jump and stayed, others did not.”

4. Vacancy openings do not take into account persons out

on long term disability/medical leave/FMLA. (Lab looks

adequately staffed but that is smoke and mirrors.)

“Although we were fully staffed during survey

period, we had many people out on long-term

FMLA or weeks of surgery and recovery. This

doesn’t show up in the tally.”

5. Lack of younger people entering the field. (Who will fill

the lab positions when the masses start their retirement?)

“Half of our staff will retire in the next 10 years

and too few technologists are being trained to

replace them. We need to find highly trained tech-

nologists with skills in molecular methods.”

“The age of laboratory professionals is rapidly

approaching retirement. Current vacancy is due to

“workforce management”—to keep expenses

down, the laboratory has been asked to keep one

open position for every 25 FTEs.”

“Hard to find younger technologists willing to

work weekend and take call. Don’t know what we

will do when the old guard retires.”

“I am very concerned about the lack of younger

people pursuing our career. Recruitment is becom-

ing more and more difficult and the majority of

people in the field will be retiring soon.”

35

APPENDIX C: SELECTED OPEN-ENDEDCOMMENTS FROM SURVEYS

6. Salaries are not competitive, the job is stressful.

(Compensation does not match the responsibilities of the

job. No young person is going to do this.)

“Vacancies are directly proportional to the com-

pensation of our staff (and the field in general). It

is a thankless job with substandard pay dispropor-

tionate to the work performed.”

“Low salaries make the profession unattractive to

young people. There is little emphasis (funding) to

train PhD laboratory directors. The profession is

dying, the need for the profession is not.”

7. Labs are resorting to importing personnel from outside

the U.S. (Communication now becomes more of an

issue, and training must cover every detail. Take nothing

for granted.)

“We had an ad for an MT listed nationally for

three months without one call. Finally we had to

get a technologist from the Philippines; that has

worked really well.”


36

Office of Public and Scientific Affairs1752 N Street, NWWashington, DC 20036

phone: 202-942-9209fax: 202-942-9335email: [email protected]://www.asm.org/policy

The American Society for Microbiology Benchmarking …€¦ · The American Society for...

Documents

Transcript of The American Society for Microbiology Benchmarking …€¦ · The American Society for...