The American Society for Microbiology Benchmarking …€¦ · The American Society for...
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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.
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
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
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Clinical MicrobiologyLaboratory Workloads, Productivity Rates andStaffing Vacancies
Survey ofClinical MicrobiologyLaboratory Workloads, Productivity Rates andStaffing Vacancies
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
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
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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
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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.
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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.
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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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.
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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
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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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.
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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0
20
40
60
80
100
Molec IDAFBVirolParasitMycolDiag Imm
Bact
% of labs working in the specialty area
95
64
46 46
32 31
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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.
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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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.
I I I . R E S U LT S
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.
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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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
I I I . R E S U LT S
11
Figure 11: Automation in microbiologylaboratories
Automated BC64%
Manual BC36%
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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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
and MedicalHospital(n=13)
CentralLaboratory
Network(n=19)
For-ProfitHospital(n=14)
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
and MedicalHospital(n=13)
CentralLaboratory
Network(n=19)
For-ProfitHospital(n=14)
Not-for-ProfitHospital(n=70)
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.
I I I . R E S U LT S
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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
and MedicalHospital(n=24)
CentralLaboratoryNetwork(n=53)
For-ProfitHospital(n=38)
Not-for-ProfitHospital(n=250)
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.
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
14
I I I . R E S U LT S
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
and MedicalHospital(n=29)
CentralLaboratoryNetwork(n=97)
For-ProfitHospital(n=63)
Not-for-ProfitHospital(n=341)
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
and MedicalHospital(n=13)
CentralLaboratory
Network(n=15)
For-ProfitHospital(n=12)
Not-for-ProfitHospital(n=50)
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
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
16
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Median
Mean
Total(n=165)
Other(n=15)
UniversityTeaching
and MedicalHospital(n=24)
CentralLaboratory
Network(n=27)
For-ProfitHospital(n=13)
Not-for-ProfitHospital(n=86)
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
and MedicalHospital(n=19)
CentralLaboratory
Network(n=15)
For-ProfitHospital
(n=8)
Not-for-ProfitHospital(n=52)
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
I I I . R E S U LT S
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
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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).
I I I . R E S U LT S
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
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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 � �
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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?
� Yes, If Yes, Please complete the table below. � No, If No, GO TO Q21.
Please write in the TOTAL NUMBER for 12 months or check � NA (not applicable) where appropriate:
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?
� Yes, If Yes, Please complete the table below. � No, If No, GO TO Q24.
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
26
Please write in the TOTAL NUMBER for 12 months or check � NA (not applicable) where appropriate:
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?
� Yes � No � NA
23. Does your laboratory use an automated instrument as part of your primary AFB culture system?
� Yes � No � NA
PARASITOLOGY
24. Are parasitology exams performed in your laboratory by personnel in the “total FTE” category?
� Yes, If Yes, Please complete the table below. � No, If No, GO TO Q27.
Please write in the TOTAL NUMBER for 12 months or check � NA (not applicable) where appropriate:
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?
� Yes � No � NA
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
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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 �
4-6 months � 4-6 months � 4-6 months �
7-12 months � 7-12 months � 7-12 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.
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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
Percentile 95 0 0 0 0 119468Valid N N=11 N=14 N=7 N=6 N=38Percentile 05 60 4684 750 3022 477Percentile 25 2500 7225 4650 4932 4199
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
Percentile 05 242 833 1228 1381 485Percentile 25 2010 4896 5060 5000 3741
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.
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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
Percentile 95 16088 11813 0 0 15213Valid N N=20 N=24 N=11 N=15 N=70Percentile 05 2 25 31 8 2Percentile 25 2 2013 1468 8 30
For-Profit Median 4517 5167 7108 8824 5889Hospital Percentile 75 0 10500 10145 0 9453
Percentile 95 0 0 0 0 0Valid N N=2 N=5 N=4 N=3 N=14Percentile 05 6 7 3 7314 3Percentile 25 8 7 2640 7369 1776
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
Percentile 05 1 4 4 8 4Percentile 25 7 27 3909 5589 329
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
Percentile 95 2 4000 0 0 0 0 0 0Valid N N=1 N=1 N=3 N=3 N=2 N=2 N=2 N=14Percentile 05 13 3 5080 0 7 7387 6958 3Percentile 25 13 3 5080 0 7 7387 7041 1776
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.
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
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
Percentile 95 204000 249633 230542 326894 158731 208242 0 199844Valid N N=55 N=53 N=33 N=20 N=41 N=33 N=14 N=249Percentile 05 706 2627 4000 5714 4000 5779 8444 2531Percentile 25 3927 3885 5239 6395 5500 5779 8444 5649
For-Profit Median 6750 13903 8957 10922 7881 5779 8824 8737Hospital Percentile 75 10128 41993 11714 14602 37223 5779 0 12394
Percentile 95 0 0 0 0 0 5779 0 119468Valid N N=6 N=10 N=8 N=4 N=6 N=1 N=3 N=38Percentile 05 60 424 2500 3500 4684 6364 9927 477Percentile 25 390 2847 3830 3833 6238 7141 10362 4199
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.”
Survey of Clinical Microbiology Laboratory Workloads, Productivity Rates and Staffing Vacancies • The American Society for Microbiology Benchmarking Study
36
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