by Nancy Maddox, MPH, writer
Earlier this year, Matt Bradke received letters of resignation from two of his five staff chemists on the same day, losing 40% of his team in one fell swoop. “They were looking for something ‘new,’ which is a common mindset these days,” said the Arkansas Public Health Laboratory’s chemical terrorism supervisor. “These were excellent scientists who were not only lost to me, but to the greater public health laboratory (PHL) system.”
Unfortunately, Bradke’s experience is not unique; 30% of state public health laboratorians responding to a 2016 APHL survey indicated an intent to leave PHL practice within five years, and an additional 26% indicated an intent to leave in five to ten years.
Part of this exodus is due to the retirement of the Baby Boom generation, the cohort born between 1946 and 1964. But many of those reporting plans to depart the PHL are in younger cohorts: among the 1,337 APHL survey respondents, 16% of Generation X (born between 1965 and 1980) and 34% of Millennials (born between 1981 and 1997) indicated plans to leave within five years. Both of Bradke’s former chemists are under age 40; one is under age 30.
This workforce churn is a problem. The SHRM Foundation, an affiliate of the Society for Human Resource Management, reports that “turnover matters for three key reasons:” cost, the impact on business performance and the impact on workforce management. Indeed, researchers estimate that an employee resignation may cost the employer anywhere from 90% to 200% of the departing worker’s annual salary, once accrued paid time off, replacement costs, new employee training costs and work disruptions/lost productivity are added up. Moreover, an employee departure may have a “contagion” effect, prompting other workers to think about leaving too.
In its 2008 report, Retaining Talent, the SHRM Foundation notes, “More and more observers agree that a talent scarcity is looming—and that this shortage will make finding and keeping the right people with the right skills increasingly challenging for organizations.”
In the public health laboratory, it is fair to say that a “talent scarcity” is already here, necessitating new thinking about workforce development.
Part of the problem is that clinical laboratory practice is a “hidden profession,” said Leah Gillis, MS, PhD, chair of APHL’s Workforce Development Committee and former director of the Florida Bureau of Public Health Laboratories (BPHL)-Miami. “People don’t think of it,” she said.
Low demand among students, in turn, led to the closure of over half the nation’s accredited clinical laboratory training programs between 1970 and 2006, constricting the pipeline for future laboratory scientists. Currently, the US graduates about 5,000 medical laboratory professionals annually, while the Bureau of Labor Statistics estimates that 12,000 new professionals are needed each year to meet consumer demand.
A second problem is the lure of better pay in academia and the private sector. From 2013 to 2016, the annual turnover rate in BPHL-Miami averaged about 20%, and the reason, said Gillis, is “the competitive marketplace for trained and experienced laboratorians in Miami—hospitals, universities and life science research facilities with laboratories.”
At the same time, while automation has eliminated some less-skilled laboratory jobs, the growing sophistication of public health laboratory analyses has generated demand for scientists with highly specialized training. For example, the advent of high-throughput, next generation sequencing created a need for laboratory bioinformaticians—a technical niche that did not previously exist.
Gillis points out that even trained professionals require ten months or more to learn the specifics of public health laboratory practice, which requires both rigor and adaptability. BPHL-Miami, for example, was one of the first in the nation to provide Ebola testing in 2014 and tested over 5,000 specimens for Zika virus in the second half of 2016. “It was always a challenge to make sure there was adequate staff to respond to new and emerging infections,” said Gillis.
“I’m very ambitious and I want to work up”
To understand how to recruit the next generation of public health laboratory scientists, one must first know what they want.
Workforce analysts at Deloitte, Monster and other firms, characterize the younger demographic—those from their 20s to early 40s—as energetic, self-confident and eager to embrace new technologies. They perceive change as an opportunity and are quick to adapt. They’re tech savvy, accustomed to multi-tasking, and comfortable questioning authority.
Importantly, researchers say, younger workers do not consider their job their life—they want flexible schedules, pay for overtime and the opportunity to use leave promptly, rather than save it up. Millennials and Gen Xers prefer to be active and engaged at work, but are loyal to their career, not their job. They expect to advance rapidly and are willing to change jobs to do so. Training is a high priority.
Scott Giatpaiboon, a scientist at the California Environmental Protection Agency (CA EPA), is the youngest full time professional in the Department of Toxic Substances Control, Environmental Chemistry Laboratory. After a brief stint at a pharmaceutical company, he was drawn to CA EPA because “government jobs are really stable.” Moreover, he said, “We get a lot of funding from our department to buy the latest technology; that was one of the pushes.” Although state government salaries don’t match the private sector, Giatpaiboon said, “Pay is a factor, but not the biggest; I would rather have a job that pays less, but you’re happy, than a job that pays more, but you’re unhappy.”
On a scale of one-to-ten, Giatpaiboon rates his job a nine: “I wouldn’t say any job is perfect, but I’m pretty happy with my position right now.”
He said, “In my first three years, I want to gain as much knowledge as possible and become competent in all our test methods.” In five years, he aspires to a supervisory role.
Giatpaiboon cites a few drawbacks to his current post. Most importantly is “the fear of not being guaranteed a promotion, even if you’re working hard.” He said, “I’m very ambitious and I want to work up.” Other nits include dealing with the state bureaucracy and, as a newbie, being tasked with records management and other administrative chores (although Giatpaiboon saw this as an early “test” of his abilities and is pleased to have gotten more significant responsibilities over time).
Overall, he says, “My supervisor is very great in helping me learn and [my colleagues] are always willing to take the time to help me learn, and that’s what I love most about my job.”
Another young professional is Stephanie Trammell, MPH, a Microbiologist II at the San Francisco Public Health Laboratory. Trammell was certified as a California public health microbiologist in 2008 and worked part time at the Contra Costa Public Health Laboratory while pursuing her master’s degree. She said, “I didn’t want to lose any opportunities to work in a lab; that’s where I enjoy being.”
After a field practicum in India spent evaluating a rapid test for Trichomonas vaginalis, she returned to the Contra Costa laboratory, but had to be retained as a contractor because of a hiring freeze. The combination of low pay, a high cost of living and, most importantly, being at a “standstill” in her career prompted her to leave. “I’m the type of person who’s pretty ambitious,” she said. “I want to see where I can best help.”
In three years, Trammell expects to be in the same job she is in today, which, she said, “is fine with me, because I have plenty to learn still at this level.” In five years—when she will have earned a DrPH degree—she hopes to be an assistant director. And in ten years, she is aiming for a position where “I can have more of a positive impact on the lab, which can be achieved by attaining a laboratory directorship.”
“My goal is to help guide the next phase of public health laboratory development and have us become less siloed,” said Trammell. “Having the opportunity to hear what these other departments are working on really helps the laboratory to see where we should go next and shows staff how important their work is.”
Asked what she would change about her job, if she could, Trammell doesn’t hesitate to respond: (1) more advancement opportunities, (2) more training opportunities and (3) more funding for cutting-edge technology and research. “It’s about helping,” she said.
“We can’t be afraid to experiment with new approaches”
Younger scientists aren’t the only ones thinking about the future of the public health laboratory. Ren Salerno, PhD, director of the Division of Laboratory Systems at the US Centers for Disease Control and Prevention (CDC), believes that “if we want to retain and develop the next generation of laboratory physicians and scientists, we need to put them into an environment where they feel supported as well as empowered.”
To this end, Salerno advocates a revamped, more inclusive approach to laboratory quality and safety management. He said, “It is less about following a checklist and more about the entirety of the operation, understanding and endorsing the rationale for quality and for safety, and understanding that quality is not just a checklist that accompanies the science, it’s actually fundamental to the science.”
Instead of delegating quality and safety—and the sometimes mundane administrative tasks that accompany them—to the “lowest level of the laboratory,” this reimagined approach elevates their importance and puts the onus on laboratory systems. “When mistakes happen—and they will—the system is responsible for that, not the individual, and the system has to work to reduce the likelihood of mistakes being made,” said Salerno.
Thus, new employees are less likely to be handed “the stuff nobody else wants to do,” less likely to be blamed when things go awry and, hopefully, more likely to stick around and immerse themselves in an enriching, laboratory-wide culture of quality.
“This issue of turnover is going to become increasingly problematic for the community, and we need to think about how to engage these younger employees in a way that keeps them interested in the PHL,” Salerno said.
At this past year’s APHL annual meeting, APHL Executive Director Scott Becker, MS, echoed this thought. He said, “We can’t be afraid to experiment with new approaches” to retain younger scientists. Among the ideas Becker proffered are:
- Encouraging Millennials and Generation X to investigate and “champion” new technologies and to help long-time staff transition to the newer platforms.
- Inviting outspoken individuals to be “community ambassadors for public health” and to write for the agency’s blog.
- Showing interest in staff. For example, at BPHL-Tampa, Director Andy Cannons, PhD, periodically spends the day working alongside individual staff members, learning what they do. His younger employees love this.
- Being generous with recognition and rewards. The DC Public Health Laboratory, under the direction of Anthony Tran, DrPH, has frequent staff events including a family day, a yearly awards program and an agency-wide summer crab feast at a riverside park.
After the simultaneous loss of two chemists, Arkansas’s Bradke helped his agency revive an internal, lateral transfer policy. He successfully hired an internal candidate for one of the positions—a process that took under three weeks—and hired an outside candidate for the other—a process that took three months. Bradke views the policy as a logical extension of cross-training and said, it promotes “public health laboratory loyalty, while still allowing for change and growth in individuals.” Even the PHL supervisor whose chemist moved to Bradke’s team had a positive view of the process, saying, “While it’s sad to lose someone, I would much rather keep our good folks in house!”
To help satisfy younger workers’ desire for upward mobility, Tran is building an official career ladder for bench-level scientists. In addition to union-negotiated pay raises, individuals will have the possibility of “jumping grades,” based on performance, and receiving an extra salary boost, averaging about $6,000/year between grades.
“We were waiting for something like this”
Training and continuing education have always been integral to PHL practice, and are even more important today, given the next generations’ interest in skills-building and advancement.
With limited funding for off-site training, innovative thinkers have come up with a range of new options. Becker suggests connecting young professionals with in-house mentors via one-on-one sessions, group programs, leadership panels or “speed mentoring” (modeled on speed dating, but with subject matter experts instead of prospective dates). The Texas Department of State Health Services Laboratory extends the concept one step further with a “job shadowing” program.
Salerno said the Division of Laboratory Systems is investigating new e-learning options, including virtual reality programs to create the illusion of working at the bench (see, for example, Labster.com) and other “gamification” techniques to make learning more fun for those who grew up with video games and other interactive media.
Perhaps the most notable recent development in PHL education is the University of South Florida’s (USF’s) DrPH program in public health and clinical laboratory science and practice, which supplies a crucial credential for aspiring public health laboratory scientists: in order to qualify as a high-complexity clinical laboratory director, federal CLIA regulations require candidates to hold an earned doctoral-level degree from an accredited institution, with an approved major. In fact, candidates cannot even sit for a CLIA-required board certification exam without an approved doctoral-level degree.
Needless to say, this is a hurdle for full time professionals, some of whom may even be serving as de facto laboratory managers under the direction of an off-site CLIA-qualified director.
The USF program’s head, Janice Zgibor, PhD, said, “One of the reasons people leave the lab is because there’s nowhere to go. We’ve created the someplace to go.”
The DrPH program launched in fall 2017 with seven students ranging in age from 34 to 52. Aside from being the only doctoral program for PHL managers in the nation, it has the distinction of being delivered largely online; students come to the Tampa campus three times over the course of two years for multi-day, in-class “intensives.”
By and large, “[students] don’t have to leave their laboratory, they don’t have to leave their jobs,” said Jill Roberts, PhD, MPH, one of the program’s instructors.
With an emphasis on PHL leadership and management, and practice-based projects that have often been implemented immediately in the field, the DrPH program is tailored to the interests and academic needs of working scientists. Trammell, who is in the program’s inaugural class, said, “Everyone who is in the program is just stoked about it. We were waiting for something like this.”
Ultimately, the future of the PHL workforce will be determined by the actions of visionary leaders today. People like Philip Amuso, PhD, a former director of the Florida BPHL-Tampa, and a champion of the USF DrPH in laboratory practice. People like Tran, who initiated internship programs at the DC PHL for high school, undergraduate and post-doc students to help fill the pipeline for future laboratory scientists. And people like Trammell and Salerno, who are thinking about how to empower PHL scientists and better articulate the value of PHL practice.
“There’s this perception that laboratories are unique, stand-alone environments and that the output of the work of the laboratory is the test result...and I don’t think that’s a good definition of value,” said Salerno. “I think we have to do a much better job of linking PHL testing to public health surveillance and public health outcomes. In my opinion, people are going to do laboratory science not just for the science or the salary; they will do it because they believe in the mission and the importance of public health.”