Commentary
Public Health Reports
Strengthening Laboratory Partnerships,
Enhancing Recruitment, and Improving
Retention Through Training and Outreach
Activities: The Minnesota Experience
Anna K. Strain, PhD1; and Maureen M. Sullivan, MPH1
Keywords
laboratory, workforce, public health, training
Medical laboratory professionals are integral to health care
systems in the United States, performing testing to guide
clinical care.1 The need for skilled medical laboratorians has
been rising steadily, with increased access to health care and
demand for laboratory testing services and increased need for
testing and monitoring of chronic diseases.2,3 The shortage of
medical laboratorians is well known; calls to action to
address the shortage began in the 1980s.4,5 This shortage
affects clinical laboratories and public health laboratories
(PHLs), because both draw from the same applicant pool.
In clinical laboratories, medical laboratorians focus on diag-
nostic testing to guide patient care. At PHLs, medical labor-
atorians may perform diagnostic testing for less common
diseases (eg, tuberculosis or measles). However, the primary
focus in PHLs is surveillance and characterization of dis-
eases that affect a population (eg, outbreak detection, anti-
biotic resistance testing, genotyping). PHLs are also affected
by the laboratory workforce shortage, although they may
face different challenges than clinical laboratories.6
Staffing Challenges Facing the Public Health
Laboratory Workforce
The 2018 American Society for Clinical Pathology
(ASCP) Vacancy Survey reported an average vacancy rate
of 8.6% in US medical laboratories, 7 up from 7.2%
reported in the 2016-2017 ASCP Vacancy Survey.8 This
vacancy rate is paired with a projected 13% increase in
the need for medical laboratorians between 2016 and 2026
(a total of 42 700 vacancies).9 Other factors contributing
to the projected gap include an aging workforce, low
awareness of laboratory science careers, and difficulty
retaining qualified staff.10
One challenge to the recruitment and retention of medical
laboratorians is a shortage of qualified applicants. Although
the number of certified medical laboratorians increased by
42.0% from 2000 to 2016 (4802 to 6818), the number of new
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medical laboratorians entering the workforce is not keeping
up with future demand.11,12 Exacerbating this nationwide
supply-and-demand problem is a decrease in the number of
available training programs.13,14 According to the 2017
National Accrediting Agency for Clinical Laboratory Sci-
ence annual survey, there are about 500 accredited medical
laboratory programs in the United States, down from more
than 1000 programs in 1970.12 Likewise, the number of clin-
ical laboratory rotations offered for training students in a
laboratory facility has decreased.15 To combat this shortage,
programs have reduced the duration of the 4 required rota-
tions from 22 weeks to 12 weeks, which affects the readiness
of students to enter the workforce properly trained.16,17
Another challenge for the PHL workforce is an increased
demand for health care services. Clinical laboratories have
seen an increase in the demand for testing services as the
incidence of chronic conditions rises.15,18,19 With more per-
sons using health care because of population changes and
increased accessibility, the demand for laboratory services
has increased, in both clinical care and PHL testing.6,20
Because they draw from the same candidate pool, the heigh-
tened demand in the clinical laboratory sector affects the
number of applicants in the PHL sector. Volume of testing
performed at PHLs has also increased, with the need to mon-
itor for antibiotic-resistant microbes, testing for less common
illnesses (eg, measles, babesia), and advancements in tech-
nology allowing detection of a broader panel of chemical
compounds and genetic disorders. For example, the number
of test results reported from the Minnesota Department of
Health (MDH)-PHL Infectious Disease Laboratory (IDL)
1
Minnesota Department of Health, St. Paul, MN, USA
Corresponding Author:
Anna K. Strain, PhD, Minnesota Department of Health, 601 North Robert
St, St Paul, MN 55165, USA.
Email: anna.strain@state.mn.us
12S
increased by 35.7% from 2015 to 2017, from 45 281 to
61 429 tests (unpublished data, MDH-PHL).
Further affecting the applicant pool is low awareness of
clinical laboratory science.21 Career awareness for science,
technology, engineering, and mathematics is on the rise, and
numerous programs target adolescents in middle school and
high school.22 However, most awareness for health care–
related careers centers on well-known professions, such as
physicians, nurses, and pharmacists. Clinical laboratory
work is the “unseen” profession.21
Finally, laboratories face challenges in retaining qualified
medical laboratorians. According to the 2018 ASCP
Vacancy Survey, about 15% of laboratorians are expected
to leave the workforce by 2023.7 A 2016 Association of
Public Health Laboratories (APHL) survey estimated that
30% of state public health laboratorians would leave the
workforce by 2021.23 Among non–retirement-age laborator-
ians, the most frequently cited issues related to staff retention
were limited career mobility and noncompetitive salaries.23
In addition, new millennials entering the workforce do not
expect to stay long at any one job.24 The 2016 APHL survey
found that employees aged <35 who were satisfied with their
work environment or valued the salary, benefits package, or
flexible work schedule found at their PHL were less likely to
report an intent to leave PHL practice within 5 years than
employees who were dissatisfied with these factors.23 This
intent to stay in a job indicates that job satisfaction also
affects vacancy rates, because retention and recruitment
initiatives are negatively affected by staff members who are
dissatisfied with their work.
How MDH-PHL Is Addressing
This Shortage
In Minnesota, the total number of PHL staff members was
constant from 2013 to 2017, whereas the number of tests
reported increased by 35.7% in the IDL section alone. The
vacancy rate for MDH-PHL in 2016 was 21%, based on the
number of open positions and total number of positions.
MDH-PHL uses numerous strategies to counteract the short-
fall in qualified staff members. Training and outreach activ-
ities target all education levels and include school projects,
classroom-level training, hands-on laboratory training, and
internships. These activities are designed to raise awareness
about laboratory careers in public health while allowing
internal staff members to refine their skills and take a lead-
ership role in developing curriculum. These efforts may help
retain current employees by improving job satisfaction
through staff development.
From 2016 through 2018, MDH-PHL hosted 7 high
school students. Students worked on small projects
throughout the laboratory and met with epidemiologists and
laboratory staff members to discuss career opportunities.
MDH-PHL also participates in Scrubs Camp.25 The project,
sponsored by Health Force Minnesota and Minnesota State
Colleges and Universities, introduces middle school and
Public Health Reports 134(Supplement 2)
high school students to various health science careers. Stu-
dents interact directly with health care professionals and
industry partners, including clinical laboratorians and pub-
lic health laboratorians. Because these students have not
entered the workforce, it is too soon to tell whether these
efforts will increase recruitment to the PHL. However,
these efforts raise awareness of the PHL as a place to work
at and allow students to learn about the educational require-
ments and technical skills needed before they begin their
college education.
To give college students an in-depth look at a career in
PHL science, MDH-PHL routinely hosts student interns, stu-
dent workers, and fellows. Internships and fellowships provide
opportunities to work with a laboratory mentor on a project,
and student worker positions involve students in routine
laboratory functions. Agency-wide, 104 of 1550 (6.7%) MDH
employees began as student workers (MDH, unpublished
data). In the PHL, 5 of 155 (3.2%) current employees began
working at MDH as students, including the current IDL
section manager, who started as an undergraduate student
worker and completed a doctor of philosophy degree
before returning to MDH (MDH-PHL, unpublished data).
The success of these student work opportunities is mea-
sured by the number of students who return for full-time
employment at MDH as positions become available, either
in the laboratory or elsewhere in the agency. Many student
interns are pursuing careers in epidemiology and use the
opportunity to better understand the role of the laboratory
in public health.
MDH-PHL has offered clinical laboratory rotations for
undergraduate students pursuing degrees in medical labora-
tory science since 2009. Students are at MDH-PHL for 3
weeks, working with staff members in all areas of the labora-
tory. They focus on learning hands-on laboratory skills in
microbiology and virology, as well as learning molecular
surveillance techniques and emergency preparedness activi-
ties. They meet with epidemiology partners to understand
how laboratory testing helps identify outbreaks and affects
surveillance activities. Two current IDL staff members com-
pleted their medical laboratory science microbiology rota-
tions at MDH-PHL. Many of the students who had clinical
rotations now work in clinical laboratories throughout Min-
nesota. Their experience at MDH-PHL provides them with a
better understanding of the importance of their work and its
relationship to public health.
MDH-PHL has also hosted fellows with master’s degrees,
doctor of philosophy degrees, or doctor of medicine degrees.
Fellowships are supported by APHL, the Centers for Disease
Control and Prevention, the Department of Energy, and part-
nerships with medical facilities in Minnesota. Depending on
program length, fellows work on projects, participate in rou-
tine laboratory functions, and meet with epidemiology sub-
ject matter experts. Four of 65 (6.1%) current full-time
employees in the IDL were fellows at MDH-PHL. The
current PHL director was a training fellow in the IDL.
Strain and Sullivan
In addition to educational opportunities, from July 1,
2016, through June 30, 2017, MDH-PHL developed and
hosted 8 national and local trainings for 509 clinical and
public health laboratorians from Minnesota and across the
country. Topics included biosafety, bioinformatics, antibio-
tic resistance, and hands-on laboratory training to recognize
potential bioterrorism agents and refer them to MDH-PHL
for identification. These activities benefited the trainees by
raising career awareness and providing training required for
ASCP certification. By hosting such trainings, MDH-PHL
supports its recruitment and retention efforts. Historically,
4 staff members have been hired at MDH-PHL after attend-
ing training outreach activities. Current PHL staff members
also benefit from the opportunity to mentor and train new
laboratorians. For many staff members, opportunities to con-
tinue their education and training through mentoring activi-
ties may contribute to their job satisfaction.23
Staff retention is important for combating the workforce
shortage. Although limited in salary and career mobility
compared with clinical laboratories, MDH-PHL has found
other ways to increase job satisfaction and retain staff mem-
bers. Laboratorians may create an individualized develop-
ment plan, allowing staff members to maximize job duties
that play to their strengths, prioritize learning objectives, and
identify leadership opportunities. Staff members are encour-
aged to help plan and develop the projects they work on,
rather than merely providing laboratory data. A 2018 MDH
employee survey indicated that the areas that most affect job
satisfaction are “stretch” assignments that challenge their
abilities, such as mentoring assignments, short-term projects,
and career development opportunities. Of 122 PHL respon-
dents, 73 (60%) indicated that these areas most heavily
affected employee job satisfaction.
Current nonsupervisory staff members are encouraged to
consider participating in the MDH Everyday Leaders Pro-
gram (ELP). This 10-month program is coordinated by the
MDH Human Resources Management division to provide
leadership training to staff members agency-wide. Classes
include conflict resolution, team building, collaboration,
coaching, and career development planning, and participants
complete a group project that addresses an agency-wide ini-
tiative. From its inception in 2009 through 2017, 170 MDH
staff members participated in the training, including 27
(15.9%) from the PHL. Of the 27 PHL employees who par-
ticipated in ELP, 20 (74.1%) were promoted at least one
classification level since participation and 4 moved into
supervisory positions (MDH, unpublished data). In compar-
ison, 73 of 149 (49.0%) MDH-PHL non-ELP participants
were promoted during this timeframe (MDH, unpublished
data). Although program participation positively affects
career mobility, the program’s success comes with several
caveats. First, because of the employee information tracking
mechanism, data are not available for employees who left
MDH but did not participate in ELP, making it difficult to
compare historical retention rates between the 2 groups (ELP
participants and nonparticipants). Second, it is possible that
13S
persons who participated in ELP would have had similar
career mobility without participating in the program. Finally,
career advancement in the laboratory is limited, as evidenced
by 2 ELP participants who left MDH-PHL to pursue career
advancement opportunities elsewhere in the public health
sector.
In the process of implementing recruitment and training
approaches at MDH-PHL, we identified several lessons
learned and areas for improvement. One area in need of
improvement is that MDH-PHL currently waits for groups
to approach it for education and training. MDH-PHL plans to
seek younger students more actively, to provide educational
experiences that expose middle school and early high school
students to the field of public health.
The initiatives described take time to coordinate and
implement. Hosting students, whether summer projects,
internships, clinical rotations, or training activities, requires
an investment of time from staff members to teach new skills
and to guide projects. The return on investment may not be
immediate, and some tasks may need to be redirected while
the trainee is learning. However, a benefit is that trainees can
be hired, as MDH-PHL has done with several training parti-
cipants. Funding for new positions is not always available to
hire a promising trainee, but establishing trainees’ interest in
the PHL and maintaining contact with past trainees provide
opportunities for future hiring.
MDH-PHL has taken advantage of the ELP to grow the
next generation of laboratory leaders, consistently sending 2
or more staff members each year to participate. It requires an
investment of time away from technical work, with the ben-
efit of enhancing nontechnical leadership skills. A limitation
to this program is that staff members still reach the top of
their job classification with few options for career advance-
ment. Initiatives to address this limitation are underway (eg,
expanding job classification series).
MDH-PHL is not alone in experiencing recruitment and
retention issues. The fall 2018 edition of APHL’s Lab Mat-
ters newsletter describes approaches that other PHLs have
used to address these challenges.26 The Texas state PHL
implemented a job shadowing program that allows staff
members to observe a trained and experienced employee
on a given task (Grace Kubin, personal communication; see
also Monahan et al27 for an example). This program provides
an opportunity for staff members to learn about different
areas of the laboratory and connects staff members in a way
that may not otherwise occur. In Tampa, Florida, senior PHL
staff members shadow a bench laboratorian for a day to see
how the work is changing and how improvements can be
made.26 Another example is a program implemented at the
Washington, DC, PHL that recognized the value of frequent
“rewards” for staff members with events such as a family
day, yearly awards program, and an agency-wide crab
feast.26 To increase career awareness among younger stu-
dents, the State Hygienic Laboratory at the University of
Iowa offers a robust mentorship program for junior and
senior high school students.28 Other ideas for engaging staff
14S
members include encouraging younger generations of labor-
atorians to investigate new technologies or help enhance a
laboratory’s social media presence.26
With laboratory workforce shortages predicted to con-
tinue through at least 2026, recruitment and retention of
qualified staff members is important. To address this short-
age, MDH-PHL couples recruitment and retention activities
with training and outreach activities held throughout the
year. Training activities strengthen partnerships with clinical
laboratory partners and allow trainees to gain competence in
all areas and at multiple levels in the laboratory. Outreach to
undergraduate- and graduate-level trainees aids in recruit-
ment and retention efforts by introducing new trainees to
public health and providing staff leadership and training
opportunities. By nurturing collaboration with laboratory
partners and providing current staff members with continu-
ing development opportunities, Minnesota is able to stay
ahead of workforce recruitment issues and retain current staff
members. These practices, which have helped MDH-PHL
overcome workforce challenges, can be used by others to
overcome challenges in their own laboratories.
Acknowledgments
The authors acknowledge MDH-PHL staff members who help to
further recruitment and retention goals by participating in trainings
and outreach, and Sara Vetter, PhD, for her critical review of this
article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, author-
ship, and/or publication of this article.
ORCID iD
Maureen M. Sullivan, MPH https://orcid.org/0000-0003-0043-
7061
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