Most of us will have had experience with getting blood drawn or tissue sampled for diagnosis. We’re told that these samples are then sent to the “lab for testing” and eventually, we receive results. For most people, including some doctors, the “lab” is a black box.

“We’re there before you’re born, up to your last breath. Techs are involved in anything from prenatal screening, diabetes, to cancer. We don’t just collect your blood,” said Christine Nielsen, CEO of CSMLS, whose membership included 13,706 technologists, cytologists and lab assistants across Canada.

Physicians have a lot to learn, and many won’t need to know the details of lab management as generalists. “We have lectures on what happens behind the scenes, but it’s touched on briefly. I’m sure there is work generating results that we don’t get exposed to at all,” said Michael Minkley, a medical student at UBC.

Lab staff at LIfelabs in Toronto. Photograph by Monica Rubi.

April 26th marks the start of National Medical Laboratory Week, and is an opportunity to recognize the talented workforce across Canadian laboratories.

Why is laboratory funding important, and who are the people behind the results?

Laboratory professionals — technologists, cytologists, pathologist assistants (PAs) — work behind the scenes to help guide patient care. They sort, prepare and sometimes analyze samples from virtually every part of the body. They participate in research activities, and work as assistants during autopsies. Some work as educators providing teaching to resident physicians like myself.

As a pathology resident, I would not be able to do my job without the hard work of many other laboratory staff. Pathologists rely on a number of professionals in the process of writing diagnostic reports, which then get sent to GPs and specialty physicians. The information from these reports informs diagnosis, prognosis and patient care.

An aging population, advances in medicine and larger caseloads have put immense pressure on labs, without proportionate increases in funding. When hospitals hire a new surgeon, administrators don’t always think to hire more laboratory staff to handle the increased workload associated with more surgeries. At many Canadian hospitals, PAs have stepped up to do some of the work previously done by pathologists, to allow pathologists to deal with complex cases.

"It’s time that governments start to see inadequate funding for labs and for training laboratory personnel as inadequate funding for patient care."

“When I was a resident, one pathologist helped prepare and dissect specimens before pathology review each day; now we are only consulted for challenging cases,” said Dr. Nancy Chan, PA program director, Western University, which has one of only two accredited Canadian PA programs. “PAs can’t easily be replaced if someone calls in sick. Standards show patients with malignancies should have pathology reports ready within 14 days postoperatively,“ Dr. Chan said.

It’s not uncommon for labs to receive calls from clinicians asking for immediate results. Understandably, doctors are patient advocates, and patients want to get started on time-sensitive treatments.

Danielle Lee (left), pathologist assistant and Assistant Clinical Professor, PA Program, University of Alberta with Dr. Pauline Alakija (right), surgical and forensic pathologist, Edmonton, AB. Photograph courtesy of Dr. Pauline Alakija

Some of these calls are related to a lack of understanding of what actually happens in the lab. Specimens often undergo a series of tests required for accurate diagnosis — a process that involves many people and can take multiple days. Other times, delays happen due to case backlogs, which are often related to understaffing.

Lab professionals work hard to communicate critical results. “When we get a COVID-19 positive result, we know it’s our responsibility to communicate this. The faster we do this, the better we can prevent the spread of the virus,” said Safire Dhanji, medical lab technologist at LifeLabs, Toronto.

While COVID-19 helped bring light to shortages of laboratory staff in Canada, we mustn't forget the important work the lab will continue to do once the dust settles. PAs and technologists are front-line workers comparable to nurses in the world of diagnostic medicine. Without them, our health-care system could not run.

“As Canadians live longer, testing increases. It costs $100,000 to train a single technologist. The deficit between retirees and graduates is 400 to 500 per year. Major cuts often hit the lab first — we lose staff, faculty, and teaching programs close. In the last 15 years, we’ve only seen three new programs and only small enrolment increases. Nobody pays you for teaching, and sometimes nobody even thanks you,” Nielsen said.

Two lab technologists at work. Photograph courtesy of Christine Nielsen, CEO of CSMLS.

“I hope that after COVID19, the awareness brought forward about the lab will make our important role better understood” says Monica Rubi, a medical technologist working in Toronto.

It’s time that governments start to see inadequate funding for labs and for training laboratory personnel as inadequate funding for patient care.

“Technologists and PAs are highly trained and underrated by hospital administration and physicians. I’ve always had fantastic staff prepare specimens — they are much better than me. The relationship is essential,” said Dr. Pauline Alakija, surgical and forensic pathologist in Alberta.

To everyone working in the lab: We see you, and we thank you.

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As a retired MLT I understand the crucial work performed in medical labs and the often stressful conditions that go along with it. Because we are not as visible as nurses salaries have not kept pace when once they were comparable. I hope the public will acquire a greater understanding of our role and a deeper appreciation.