The Affordable Care Act, molecular diagnostics, diminishing resources, global climate change: these are a few of the disparate developments shaping the future of public health laboratories in the United States. We asked four laboratory directors – all speakers at the 2014 APHL Annual Meeting – to share their views on the top vectors of change in the public health laboratory community.
Kerry Buchs, MHA, MT(ASCP), Laboratory Operations Director, Philadelphia Public Health Laboratory
“Within the next four years, 50% of my technical staff in the laboratory will be retiring. This presents a huge challenge for us to replace these tenured staff members. Fewer students are interested in going into health and science careers so the competition is extremely tough for new graduates in our area. Fortunately we have several medical technologist training programs in the city. One of our strategies for filling vacancies is to capture these students during their clinical internship for a rotation within the public health laboratory. This exposes them to the work we do in public health and how rewarding it can be.”
Daniel Rice, MS, Director, New York State Food Laboratory; Incoming APHL President
“Diminishing resources in terms of staff and funding will continue to have a major impact on the future public health laboratories. Local and state public health laboratories have lost substantial numbers of positions and funding over the last eight years or so. This has had a remarkably negative impact on testing capability and capacity. The concept of regionalization of services is much discussed and appears to be gaining momentum. While this may bring efficiencies from larger volume testing by fewer labs, it also threatens to reduce the labs’ repertoire of testing capabilities. This could have unintended consequences. For example, testing could be delayed when a once routine capability no longer exists, and a sample needs to be shipped to another lab.
Protracted hiring freezes are causing an ever-widening gap between new scientists and seasoned staff. The median age in public health laboratories continues to rise and the number of mid-career scientists is decreasing. This situation is leading to a future, one that is not too far off, when the next wave of retirements will result in a catastrophic loss of institutional knowledge within laboratory programs. There will not be a sufficient number of appropriately trained scientists in the pipeline to fill the void of competent managers and leaders.
Technology is a fundamental driving force shaping public health laboratories. Technological advancements are occurring at such a fast pace that assessing and implementing these new technologies is a real challenge to public health laboratories. It is apparent that technology is shifting public health scientists from historical roles of bench chemist or microbiologist to more instrument- and informatics-based expertise. This is likely to change the physical layout/design of future public health laboratories and the training plan/path for future scientists significantly.
Jill Taylor, PhD, Interim Director, Wadsworth Center
“There are many drivers that will shape our future, not least among them being advanced technologies and big data. However, the thought we need to keep in the front of our minds when we are deciding how to juggle priorities while managing the next public health emergency is that, to serve and protect the public, we need to rely on the best science. Ultimately we will not have served our clients well if our decisions are based on outdated methods. While this will present many fiscal and operational challenges, it is imperative that we find creative solutions to address this need to keep abreast of our fields.
Ultimately, it is all about the people. One of the things that I have always loved about working in public health is seeing the passion, energy and commitment of the scientists and support staff who work in our labs. Nobody wants another emergency but I am sure you can relate to the observation that an emergency is a marvelous time to see everyone pulling together and making the system work. While we are now faced by a myriad of challenges, fiscal, operational and technological, I am confident that our people will continue to embrace change, move forward and find the creative solutions we need.”
John Ridderhof, DrPH, Laboratory Science Officer, CDC/OPHSS/CSELS
“One under-recognized challenge is the need for public health laboratories (PHLs) to implement informatics solutions that will provide them with the capabilities to report directly into the electronic health record (EHR) and receive HL7-based test orders (ETORs). For now, this may be OK, as many of the referring clinical laboratories are also struggling to be interoperable with EHRs and providers. This ETOR capability is the future, and we should start identifying the required solutions now, knowing this will take support from all sectors to assure PHLs continue to be effective and relevant.
There are many challenges in the way of new technology and bioinformatics capability for PHLs. In the end, it will still come down to the PHL workforce, since the biggest hurdle is not the instrumentation, but rather the education, training and competencies to use new technologies effectively. Upgrading the workforce will require a concerted effort to both recruit new talent and assure current staff are provided continuing education, mentoring and training to adopt new skills.”
