The demand for laboratory professionals continues to outpace the supply. Kathy Nucifora of COLA explains the shortage and offers strategies for physician office labs facing staffing challenges.
The laboratory workforce shortage is no longer simply a recruiting challenge. It is affecting how laboratories operate, who performs testing and, ultimately, how practices maintain quality and compliance. While hospitals and health systems can draw from academic partnerships and larger talent pools, physician office laboratories face their own set of challenges, particularly when it comes to finding qualified personnel and technical consultants.
Kathy Nucifora, MPH, MLS (ASCP), COO of COLA Inc., says the pipeline is falling well short of the need. With academic programs graduating roughly 5,000 laboratory professionals annually compared with an estimated need for 10,000 to 12,000, the gap could widen without sustained action.
In the following interview with Repertoire Magazine, she discusses where the shortages are most acute, why high-complexity testing presents particular staffing challenges, and what physician offices can do to prepare for a laboratory workforce that may be smaller and more specialized in the years ahead.
How would you characterize the laboratory workforce shortage today?
Kathy Nucifora: The laboratory workforce shortage overall is critical, although vacancy rates vary across regions and laboratory departments. The shortage has been developing over many years and was accelerated during the public health emergency (PHE). Vacancy rates have decreased somewhat since the public health emergency (PHE), but have not returned to pre-PHE levels, according to the most recent American Society for Clinical Pathology (ASCP) survey. The Bureau of Labor Statistics has indicated a need for 10,000-12,000 new laboratory scientists annually, while academic programs are only graduating approximately 5,000 annually. If significant action is not taken soon, the problem is likely to get worse.
There are many contributing factors, including an aging workforce, burnout, pay disparities and a lack of awareness of the profession. In recognition of the shortage, the Medical Laboratory Personnel Shortage Relief Act was introduced in the House in September 2025 but has not progressed. This legislation, if passed, would expand the National Health Services Corp to include medical laboratory personnel, which would allow for loan repayment assistance for those who work in areas of severe shortage. The legislation also establishes federal grants for colleges and universities with laboratory science programs. The lack of a sense of urgency surrounding this legislation reflects that lack of awareness of the critical need for and critical role of laboratory scientists.
The gaps are most acute on the West Coast and the Southern Atlantic regions, according to the latest ASCP survey. Across the country, vacancy rates range from 7% to over 20%. Hiring challenges are also acute in rural areas, as we do see rural hospitals that are forced to rely on staffing agencies, which is usually a short-term and very expensive solution.
As far as laboratory departments, anatomic pathology is experiencing the highest vacancy rate, with Chemistry/Toxicology and point of care testing (POCT) not far behind.
When we talk about a shortage of laboratory professionals, which roles are hardest to recruit and retain, and why?
Nucifora: We see the most challenges in hiring and retaining high complexity testing personnel. This is because the education and experience requirements are more stringent for high complexity testing personnel than for less complicated, moderate complexity testing personnel. Laboratories performing only moderate and waived testing can often find and train high school graduates to perform the testing. This issue has been somewhat controversial but is allowed by CLIA and can be successful when training and competency requirements are met and well-documented. Some states do have more stringent personnel requirements.
How does the workforce challenge look different in physician offices and ambulatory settings compared with hospitals and large health systems?
Nucifora: Hospitals and health systems are more likely to benefit from relationships with regional academic programs, by serving as a clinical site for students. While this helps with the pipeline, hospitals and health systems typically require a larger number of high complexity personnel. So, they are certainly not exempt from the crisis.
Many, but not all physician office laboratories (POL) perform mostly moderate and waived complexity testing. And, while they may have nurses or other members of the care team trained to perform the testing, it can be difficult to keep up with compliance and documentation requirements, considering all of their other priorities. In such cases, having a qualified and dedicated Technical Consultant (TC) is key. We hear from many POLs that it is difficult to not only find a TC, but to afford them.
Are you seeing practices ask laboratory personnel or medical assistants to take on more responsibilities because they don’t have enough staff? What are the implications for training and quality?
Nucifora: Certainly. A common finding when we survey (inspect) laboratories is that staffing is insufficient for the workload, leading to noncompliances. When non-laboratory trained personnel are responsible for day-to-day laboratory testing, one implication is the lack of basic understanding of quality control and quality assessment. This sometimes causes a laboratory to miss an opportunity to address quality failures before patient results are adversely affected.
What are the biggest factors driving laboratory professionals to leave the field, and what are successful employers doing to keep them?
Nucifora: Burnout is a problem throughout most healthcare professions. Long hours, relatively low pay and a perceived lack of professional growth contribute to laboratory professionals leaving the field. Successful laboratories encourage career pathways that lead to advanced supervisory positions or becoming a specialist in a particular laboratory department. Others have implemented programs whereby an employee can start as a laboratory assistant, then move into an academic program, with tuition assistance. Programs of this type promote loyalty and a culture of recognition.
How are automation, point-of-care testing, connectivity and other technologies changing the laboratory workforce? Are they helping alleviate staffing shortages, or are they creating a need for new skills?
Nucifora: I believe both cases are true. Automation significantly increases throughput but requires laboratory staff who are specially trained to maintain the automation. An increase in available POC technologies may alleviate some staffing shortages in the laboratory but do require well-trained POC supervisors to oversee all the scattered testing.
What does the laboratory workforce pipeline look like? Are enough people entering these professions to replace those who are retiring or leaving the field?
Nucifora: Again, the pipeline is not sufficient. Academic laboratory science programs graduate approximately 5,000 laboratory professionals, while the need is for 10,000 to 12,000 annually. Graduates with degrees in chemistry and biology can qualify to hold positions in high complexity laboratories with training, and many successful laboratories have developed programs to recruit and train these graduates. This can potentially significantly add to the pipeline. But we need to do a better job of advocating for laboratory science to these graduates when they look for a career.
We also need to promote the profession to middle and high schoolers. Many have not heard of careers in laboratory science. Many laboratory professional organizations have joined forces, through the Workforce Action Alliance and the Medical and Public Health Laboratory Workforce Coalition to get out there and talk to science teachers, school counselors and students about laboratory science careers. These efforts need to be sustained over the coming years.
Looking five years ahead, what do you think the role of the laboratory professional in the physician office will look like? What should practices be doing now to prepare?
Nucifora: Unfortunately, we have seen many POLs close due to decreases in reimbursements, acquisitions by large health systems and difficulty in finding qualified laboratory staff. I think this trend will continue, at least for the foreseeable future. There are POLs that perform a large test menu of all levels of testing that are able to operate successfully. One of the keys to this success is a strong relationship with an experienced and qualified Technical Consultant. Without such a relationship, it is difficult to maintain compliance, decrease waste and provide accurate and reliable results for the patients.
In five years, I expect to see even fewer POLs. To ease the burden of finding high complexity testing personnel, POLs should consider moderate complexity options for the tests that they need to offer to their patients. If high complexity testing is needed for the practice, POLs should partner with regional academic institutions to become clinical sites for training laboratory scientists. This allows them to bond with the trainees and to hire work-ready qualified graduates.
Laboratory scientists are often underutilized. They can provide population data to detect trends and monitor progress of solutions designed to increase patient compliance and improve population health. We are all aware of the physician shortage, and while laboratory scientists of course cannot do the work of a physician, as a profession we can step up and contribute more actively to the healthcare team. This is a movement that has already begun, and will be important to POLs, where illnesses can be detected early, when treatment can be more effective.
Additionally, workplace culture is incredibly important to young professionals. If possible, laboratories should offer flexible scheduling, advancement options and a culture of support in order to attract young professionals.
Key Takeaways
- The laboratory workforce shortage remains critical, with demand for laboratory professionals outpacing the number of graduates entering the field.
- High-complexity testing is particularly difficult to staff, while rural and physician office laboratories face additional challenges finding and affording qualified personnel and technical consultants.
- Staffing shortages can affect quality and compliance, especially when non-laboratory personnel take on testing responsibilities without sufficient training in quality control and assessment.
- Physician office labs will need to adapt, including considering moderate-complexity testing, partnering with academic programs to build their talent pipeline, and creating supportive career pathways to attract and retain laboratory professionals.