Getting Results: Medical Laboratory Professionals and their Importance to Ontario’s Health Care System

Medical laboratory testing is an essential part of the health care system. Accurate and timely diagnostic results are instrumental to a physician’s decision-making process for a patient. It is difficult to imagine how the health care system could function without the quick availability of reliable testing results from the medical laboratory professionals. According to the Centers for Disease Control and Prevention (CDC), 70% of today’s medical decisions depend on laboratory test results.

The Medical Laboratory Professionals’ Association of Ontario (MLPAO) reported that Ontario itself conducts 280 million lab tests a year. Canada’s aging population is likely to cause increasing demand for medical testing over the next several decades. Among many other technical occupations in health, more Medical laboratory technologists (MLTs) and Medical laboratory assistants and related technical occupation (MLAs) will be needed to handle such larger volume of medical tests thereby ensuring a smooth functioning of the clinical laboratories.

Statistics Canada’s Job Vacancy and Wage Survey shows that currently there are high vacancy rates for MLTs, signaling a workforce shortage that is approaching crisis levels. In Toronto, where most MLT jobs in Ontario are located, the time to hire is two to three times longer than compared to previous years. On several occasions, staff shortages have also been reported for MLAs. The situation is dire in small towns, rural areas and Northern regions in Ontario.

When COVID-19 hit, 70 per cent of the province’s labs were already short-staffed. The pandemic merely put a spotlight on the importance of the medical lab professionals and amplified workforce shortages that were already an issue for the health care system. The typically non-patient-facing nature of the MLT-MLA jobs often made them forgotten whereas at the forefront of the pandemic, they were the ones who needed to produce high-volume medical laboratory results critical in numerous ways. For example, helping authorities like the Public Health Agency of Canada to track the virus and make vital public health decisions.

Experts suggest that these health care professions must become more visible and apparent to the educators. Colleges and universities must be made aware of the impending staffing crisis for these occupations. Clinical Laboratory Science should be apparent as a career choice (other than medical school) for an individual who is looking for a cross between chemistry, biology or microbiology and patient care.

Some of the key factors contributing to the supply side challenges of the MLT and MLA workforce are:

surge in the demand for medical laboratory services due to an increasing ageing population
a significant share of MLTs becoming eligible to retire in the next couple of years
limited clinical placement opportunities
limited medical science programs
advancement in technology requiring specialized knowledge and skill set that takes longer to fill the specialty roles

Using Census 2021 data, job posting numbers for the MLT & MLA occupations, key informant interviews and secondary literature; this paper:

reflects on the importance of these occupations
highlights the supply and demand side challenges of the clinical laboratory workforce
lists the key factors contributing to significant labour shortages of MLTs and MLAs
suggests possible ways to alleviate these shortages

Among other critical “Technical occupations in health” and “Assisting occupations in support of health services”, this paper focuses on two key medical laboratory occupations- Medical laboratory technologists (MLTs) and Medical laboratory assistants and related technical occupations (MLAs). Recent studies have documented that there is an excess of demand over supply for these occupations. The situation is more critical for MLTs compared to MLAs. Using information from the Employment and Social Development Canada (ESDC) & Job Bank Canada, below is a summary of the occupations by definition and employment requirements in terms of education, registrations and certifications.

MLTs conduct medical laboratory tests, experiments and analyses to assist in the diagnosis, treatment, monitoring and prevention of disease. They are employed in medical laboratories in hospitals, blood banks, community and private clinics, research facilities and post-secondary educational institutions. MLTs who are supervisors are included in this unit group.

A two- or three-year college program in medical laboratory technology and a period of supervised practical training is commonly considered as an employment requirement. To practice as a medical laboratory technologist (MLT) in Ontario, an individual must be registered with the provincial regulatory body, the College of Medical Laboratory Technologists of Ontario (CMLTO). Certification by the Canadian Society for Medical Laboratory Science (CSMLS) is usually required by employers.

MLAs perform pre-analysis and pre-testing tasks such as collecting blood and other samples, processing specimens, and preparing special chemicals for use in testing. They conduct routine medical lab tests and set up, clean and maintain medical lab equipment. They are employed in medical laboratories in hospitals, clinics, research facilities, post-secondary educational institutions and government research laboratories. College certificate program in medical laboratory science and certification by the Canadian Society for Medical Laboratory Science (CSMLS) is commonly considered as an employment requirement. Combined laboratory and X-ray technicians require completion of a combined laboratory X-ray technology program.

According to the University Health Network (UHN), MLTs make up one of the largest groups of regulated health care professionals in Canada. The MLT profession is currently regulated in eight Canadian provinces. MLTs are not regulated in British Columbia, Prince Edward Island and the Territories. Each province has its own MLT regulatory body with similar registration requirements. The certifying body for MLTs is the Canadian Society for Medical Laboratory Science (CSMLS). The College of Medical Laboratory Technologists of Ontario (CMLTO) regulates the MLT profession in the public interest. To view the standard guide used by the CMLTO, click How to Become an MLT Process Map. For internationally educated MLTs, the Michener Institute of Education at UHN offers 16 weeks long Medical Laboratory Science Bridging Program designed to help prepare for the CSMLS national licensing examination in Canada. MLAs are not regulated. But employers ask for a CSMLS certification exam.

The College of Medical Laboratory Technologists of Ontario (CMLTO) classifies new applicants into three categories:

Trained in Ontario– Applicants in this category have recently graduated from a medical laboratory technology/medical laboratory science program and passed the CSMLS certification exam. Also includes applicants who have completed an accredited education program, written the exam in a previous year but have not applied for membership with the CMLTO. Retired MLTs who wish to apply as a practicing MLT also falls in this category.
Internationally trained– Trained as a MLT outside of Canada and have had their experience assessed through the CSMLS’s Prior Learning Assessment (PLA). These professionals must pass the CSMLS certification exam before applying to the CMLTO as a new applicant.
Trained in other Canadian provinces– These applicants have completed their medical laboratory education program at a program accredited by Accreditation Canada.

To practice as a professional laboratory technician or technologist, an individual must complete a laboratory science program. Several community colleges as well as private career colleges provide programs that prepare individuals for careers in the medical industry. An Ontario College Advanced Diploma in medical science program is needed to be an MLT. The length of this program is usually 3 years. MLAs are expected to have an Ontario College Certificate for Medical laboratory technician/assistant program. The length of this program is typically 1 year. Table 1 and Table 2 lists the lab science programs offered by community colleges in Ontario and private career colleges in Toronto.

Cambrian College in Sudbury plays an essential role in serving the northern rural and remote laboratories. The Michener Institute of Education at UHN in Toronto- is the only medical laboratory science program funded by the Ministry of Health and Ministry of Long-Term Care. The rest of the educational institutions listed in Table 1 are funded by the Ministry of Colleges and Universities.

MLT graduates are eligible to write the national certification examinations conducted by the Canadian Society for Medical Laboratory Sciences (CSMLS). Certification qualifies the graduate to work across Canada or for registration with the provincial colleges, such as the College of Medical Laboratory Technologists of Ontario (CMLTO), which is a requirement to practice in Ontario.

According to a MLPAO 2021 report, the demand for all these medical laboratory education programs outstripped the number of student spots available. For example, in fall 2020, 154 students applied to Ontario Tech University, but only 46 students were registered. Also, much of the northern Ontario is under-served by education programs.

According to Census 2021, in Ontario the total number of MLTs and MLAs employed are 6,305 and 6,410 respectively. In Toronto, CMA the total number of employments for MLTs & MLAs stood at 2,725 and 3,090 respectively. This shows that based on Census 2021 statistics, 43% of Ontario’s MLT employment and 46% of Ontario’s MLA employment comes from Toronto. The Census 2021 was conducted during a global pandemic which creates some noise in the data. Only 90 MLTs in Ontario and 45 MLTs in Toronto indicated they were unemployed. These low numbers indicated a tight labour market during the time of the Census.

Figure 1 to Figure 4 reports the share of workforce and share of employment by gender for the two occupations explored in this paper- “Medical Laboratory Technologists” (MLTs) and “Medical Laboratory Assistants and Related Technical Occupations” (MLAs) in Ontario and Toronto, CMA. Census 2021 data showed that both these occupations are highly female dominated in both the province of Ontario and Toronto, CMA, although this imbalance is slightly less in Toronto when compared to the rest of the province.

In Ontario, 77% of the MLT labour force have been reported as female versus 23% male (see Figure 1). The share is similar in Toronto where 75% of the MLT labour force were female versus 26% male (see Figure 1). The MLA labour force had an even larger gender split with 85% share of MLAs females in Ontario and 82% female MLAs in Toronto (see Figure 2). These findings are reflected in Figure 3 and Figure 4 as well. A larger share of female MLT and MLA labour force means that there are more females working (employed) in these professions versus males.

Figure 5 and Figure 6 reports the level of education of MLTs and MLAs employed in Ontario and Toronto, CMA.

The majority of MLAs employed in Ontario (56%) and Toronto (42%) have completed a Postsecondary certificate or diploma. It appears that in Toronto almost half (49%) of MLA’s have a university degree (Bachelor’s degree and above). In the province of Ontario, it is way lower (34%). This strongly suggests that a significant share of the MLAs working in Toronto are either over qualified or underemployed. It could also mean that these degrees come from outside of Canada.

Using Census 2021 data, Figure 7 reports the median employment income of MLTs and MLAs in Canada in comparison to the median employment income of All Occupations. Both for MLTs ($72,000) and MLAs ($44,000) the median employment income is higher compared to all occupations ($41,200) in Canada.

It appears from Figure 8 and Figure 9 that the share of workforce by age for MLTs and MLAs versus the share of workforce by age for all occupations are similar except for the age category 45-64 years for MLTs. Both in Ontario and Toronto, CMA there is a significantly larger share of the MLT workforce falling in the age category 45-64 years. In Ontario, 47% of the MLT workforce belongs to the 45-64 years age category. In Toronto, CMA this share is 45%. On the contrary for all occupation the share of workforce in the age category 45-64 years is 39%. This suggests that compared to all occupations, the MLT profession has a larger share of workforce getting closer to the retirement age.

Figure 10 and Figure 11 was generated based on data collected and compiled from the Health Human Resource Report 2021 by the College of Medical Laboratory Technologists of Ontario (CMLTO). This analysis provides some insight into the province of Ontario’s five years status on the following: trend in the number of practicing MLTs, trend in the number new MLT registrants and the demographics of the practicing MLTs. Although this data collected from the CMLTO is of interest and gives prevailing themes, they need to be used with caution.

A breakdown of the demographics for practicing MLTs shows a significant decline in the number of MLTs in the age categories 41-50 years and 51-60 years between 2017 to 2021. This suggests that more and more MLTs are either retiring earlier than the standard retirement age or switching to a different profession. As reasoned by MLPAO, it is unlikely that these MLTs have completed 30 years of eligibility service to qualify for retirement under the Healthcare of Ontario Pension Plan (HOOPP). It is possible that these members are leaving the MLT workforce for reasons other than retirement (e.g., burnout, long-term disability or sick leave, etc.)

Also note that as shown in Table 4, in all these five years, the largest number of MLTs in Ontario fell in the age category 51-60 years. It is evident from these numbers that a significant share of the MLT workforce in Ontario will be retiring soon. Overall, in Ontario, the average age for practicing MLTs in 2021 was 45 years.

Figure 12 and Figure 13 illustrates the trend in the total number of annual job postings for MLTs in Ontario and Toronto, CMA. Between July 2013 and July 2022, there were a total of 3,022 job postings in Ontario for the role of MLTs. 58% of these total job postings came from the Toronto, CMA. In January 2021, there were 85% more job postings for MLTs in Ontario compared to January 2013. For the same points in time the number of MLT job postings in Toronto, CMA more than doubled (undergoing a 133% rise).

Infact, over the past five years the total number of MLT job postings followed a persistently positive trend both in the province and CMA. For every year analyzed in the figures below, Toronto, CMA continued to be the top location offering the greatest number of MLT jobs.

Figure 14 and Figure 15 illustrates the trend in the total number of annual job postings for MLAs in Ontario and Toronto, CMA. Between July 2013 and July 2022, there were a total of 10,402 job postings in Ontario for the role of MLAs. 44% of these total job postings came from the Toronto, CMA.

In Jan 2021 there were four times more MLA job postings in Ontario compared to Jan 2013.Both the province and the CMA saw an upward trend in the number of MLA job postings starting 2018. During this period, Toronto, CMA continued to be the top location offering the greatest number of MLA jobs.

The trend in the number of job postings for MLTs and MLAs for both the province of Ontario and CMA depicted in Figure 12- Figure 14 certainly tell us that there has been an increasing demand for MLTs and MLAs even before the pandemic hit.

Table 5 below lists the top CMAs in Ontario and Census Districts in Toronto in terms of total job postings between Jan 2013 and Jan 2021.

Over the years, while these micro sized medical labs continued to have the largest share both in Ontario and Toronto, there was a decline in their numbers over time. For example, in 2022 the share of micro-sized labs (1-4 employees) in Ontario fell to 39% from 47% in 2019. During this time, Toronto also saw a decline in its micro-sized labs from 48% in 2019 to 43% in 2022. The figures also suggest that there has been a slight increase in the number of medical labs consisting of 5-9 employees or 10-19 employees. This is an indication that over the years an increase in the demand for medical laboratory services have led to hiring more staff and expanding the facility sizes. Share of labs with 50+ employees remained stagnant for both geographies.

Although the most common employment site for medical laboratory roles is the hospital lab, opportunities can expand to include public health labs, physician offices, industrial/research labs, biotechnology labs, and crime labs.

Using findings from recent studies, empirical analysis and key informant interviews conducted by Toronto Workforce Innovation Group (TWIG), this section highlights the key factors contributing to the shortage of the clinical laboratory workforce.

Surge in the demand for medical laboratory services

The growing life expectancy is leading to an increase in the population of elderly people. With age increases the healthcare needs, the need for diagnosis through more medical testing. This also means that among many other technical occupations in health, the supply of MLTs and MLAs are becoming increasingly important to the functioning of the clinical laboratories. Conversations with the Canadian Society for Medical Laboratory Science (CSMLS) and Medical Laboratory Professionals’ Association of Ontario (MLPAO), suggested that the shortage of MLTs and MLAs have been a critical health human resource challenge facing the country for a while that has been exacerbated by the COVID-19 pandemic. MLPAO highlighted that over the past two years, demand for medical laboratory services has exponentially amplified because of the COVID-19 pandemic

Retirement

Based on Census 2021 data analysis (See Figure-8) done by the Toronto Workforce Innovation Group, 47% of the MLT workforce in Ontario falls in the age category 45-64 years. A Health Human Resource Report by the College of Medical Laboratory Technologists of Ontario (CMLTO) highlighted (see Table 4) that 37% of the MLT workforce in Ontario in the year 2021 belonged to the age category 51+ years. According to the same CMLTO report, the average age for practicing MLTs in 2021 was 45 years and the median was 45.6 years. These data suggests that a significant share of MLTs will become eligible to retire in the next couple of years. This may cause the health care system to face more strain in an already critical staffing shortage faced by the clinical laboratories. It also means that with lots of technologists retiring, they don’t have much time to train students.

Limited Clinical Placement Opportunities

Every year the number of MLTs graduating falls short of the number of MLTs retiring. There has been a general consensus among stakeholders interviewed by TWIG that schools are finding it challenging to secure spots for clinical placement. Discussions with the Michener Institute of Education at UHN highlighted how the clinical placement needs to be significantly increased particularly outside the GTA. Anderson College of Health, Business and Technology also mentioned how despite successful partnerships, clinical placements (externship) continue to be a major roadblock for the full-time MLT training programs. Clinical laboratories are not able to take on students due to their staffing shortage whereas schools have to limit the number of student intake due to lack of externship opportunities.Anderson College and MLPAO suggested to encourage investment in simulation labs to expedite clinical placement hours. They discussed direct funding to laboratories to hire preceptors exclusively for training purposes for clinical placements. As labs and hospitals are short staffed to begin with this will mean MLTs do not have to allocate their hours mentoring clinical placements. CSMLS gave similar suggestion during the interview. But they also highlighted that simulation is not quicker or cheaper. CSMLS recommended that for simulation to be successful there needs to be mandatory training of faculty in simulation and this would require school to assign more funding for faculties.

Limited Medical Lab Science Programs

The lack of commitment from clinical sites about the availability of clinical placements due to limited equipment and teaching/training resources in turn impacts the number of student spots available under the Medical Lab Science Program. During TWIG’s interview with MLPAO it has been highlighted that investment in medical laboratories must be a part of the healthcare investment conversation. Every time there is an investment in hospitals, nurses and doctors there should be an equivalent investment in labs. MLPAO pointed out that schools tend to shy away from these programs as it can be expensive to run lab science programs. They mentioned that the Ministry of Labour, Training and Skills Development has expressed that the need for these programs must bubble up from the community. Schools should actively seek funding from the government to expand these programs.

Advancement in Technology

It is also believed that advancement in technology has led to many changes in the practice of clinical laboratory science over the years. This requires specialized knowledge and skill set to perform and interpret new and evolving methods used for diagnosis and management of disease. A lack of such skill set can also signal workforce shortage as it can take longer to fill specialty roles.

MLTs and MLAs play an integral role in providing the health care system with crucial diagnostic information. This paper attempted to highlight the shortage of MLTs and MLAs and reflect on the importance of these roles. Based on secondary literature, labour force data analysis and key informant interviews, it can be confirmed that the shortage of MLTs is a bigger crisis factor compared to that of the MLAs and that the impact of this shortage is felt most strongly in Ontario’s rural and remote communities than in the cities. The objective is to improve the supply of medical laboratory professionals, build capacity, strengthen and modernize education and training pathways, promote faster learning. The system should also offer advancement through a career ladder /pathway based on interest and need.

Several driving forces behind the current crisis have been reported in this paper. These include the increased need for more critical testing due to an aging population, medical lab science program graduates falling short of the number of MLTs retiring, limited clinical placement opportunities and more. There was an overriding belief among the interviewees that the profession faces challenges with recruitment, retention, retirements, demand and expansion. Also rising vacancy rates are the reflection of difficulties in recruiting new professionals and retaining current staff.

Adding more academic seats can be a solution. But often MLT programs are in jeopardy, primarily due to the high costs associated with operating these academic programs. A pivotal element for medical laboratory academic programs is clinical placements securing placement spots appear to be a systematic problem. This would require better co-ordination between Higher Education Institutes and placement providers. There was a general agreement on considering more virtual reality or simulations to get around the on-site training bottleneck.

Employers can step in to support the recruitment drive for lab roles by strategizing better to improve placement capacity. However, enhanced placement capacity cannot be achieved by employers alone. Other stakeholders involved in the development of professionals including the higher education sector, local health care providers and national bodies along must also come together. This can lead to solutions that work for everyone. In the United Kingdom for example, through partnerships with local Universities, Northumberland, Tyne and Wear NHS Foundation Trust has increased student numbers, in particular for their mental health and learning disabilities nursing programs. To manage the increase in clinical placements and mentor support, the trust introduced a central mentor database. This feeds into a dashboard identifying mentors that are no longer active and target areas for development. The trust also created two new roles; a practice educator support nurse and practice placement support co-ordinator, who support individual learners and help embed the programs. This strategy can be applied to clinical placement of medical lab students in the country.

Internationally trained medical lab science professionals can be used to fill in the gap. Ontario has the bulk of foreign trained medical lab professionals and most of them are in the GTA. A fast and smooth transitioning of foreign trained professionals in the area can help alleviate supply challenges. The New Skills Development Fund awarded to the Medical Laboratory Professionals’ Association (MLPAO) has been an initiative taken by the government to tap the international resource. This fund targets to train 50 internationally trained MLTs, who will attend Anderson College’s Internationally Educated Medical Laboratory Technology Bridging (IEMLT) Program. This initiative by the government can be considered as the most salient approach to address the critical shortage of MLTs in Ontario. It can accelerate certification and support smooth integration of the foreign-trained MLTs.

During TWIG’s conversation with Anderson College, the college spoke about the importance of the Labour Market Impact Assessment (LMIA), tool that a Canadian employer can use to hire a foreign worker. A positive LMIA will show that there is a need for a foreign worker to fill the job as there is a shortage of local skills. This can attract international MLT/MLA talents. They could virtually attend the theoretical portion of the bridging program and complete the lab training upon arrival. Under LMIA a foreign worker needs to be committed to staying with the employer for at least two years. This initiative can better integrate foreign-trained professionals and help to address the shortage.

The national certifying body CSMLS for example also plays a critical role to facilitate the entry of MLTs and MLAs into the Canadian labour market. During COVID they modernized the certification processes to improve access for candidates. In June 2020 they piloted the Remote proctored testing (RPT) that became a mainstay for the benefit of exam candidates. All MLT regulators now permit CSMLS-certified candidates in both in-person and RPT test format; thus, offering improved access, particularly during public gathering restrictions. Exam dates were doubled between August 2020 and August 2021, to help as many graduating cohorts as possible and stabilize the number of available testing seats through the pandemic year.

College science students who are potential candidates for the profession, many fail to enter it merely because they are unaware of it. Medical Laboratory Science as a career option can be promoted to high school and university students along with a recruitment strategy. During TWIG’s conversation with MLPAO they mentioned that to make students aware of this potential career opportunity, MLPAO has presented at several schools like the Halton District School Board, Iroquois Ridge High School, HDSB Specialist High Skills Major Program (4 Schools), M.M Robinson High School, Oakville Trafalgar High School etc. Improving the visibility of the profession and showcasing it as a vital and promising health care career, can improve recruitment efforts and target to alleviate the medical lab workforce shortage.

Unlike physicians, nurses and personal support workers; laboratory workers are not always in the public eye. Yet having trained and skilled laboratory workers is critical in having a high functioning health care system. Like other healthcare occupations, public and private laboratories are facing unprecedented projected workforce shortages across a range of jobs. No single answer is sufficient to increase the number of trained workers in this field. Over the coming years, we need to not only encourage youth to enter into the field, but we also need to accelerate timelines for the licensing of newcomers. Finally, Ontario will need to continue to adopt emerging technologies in laboratory’s to help to mitigate the impending shortage of workers.

Getting Results: Medical Laboratory Professionals and their Importance to Ontario’s Health Care System

Getting Results:

Medical Laboratory Professionals and their Importance to Ontario’s Health Care System

Table of Content

Executive Summary

Overview of Medical laboratory technologists and Medical laboratory assistants

What is a Medical laboratory technologist (MLT)?

What is a Medical laboratory assistant and related technical occupation (MLA)?

How to become a MLT or MLA in Canada?

Sources of MLTs in Ontario

Educational Landscape of Medical Laboratory Science Programs in Ontario and Toronto

Labour Market Indicators for MLTs and MLAs

Analysis by Total Job Postings of MLTs and MLAs

Size of Medical and diagnostic laboratories: Canadian Business Counts

Key Factors Contributing to the Medical Laboratory Workforce Shortage

Moving Forward