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Clinical Laboratories and Pathology Groups

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Clinical Laboratories and Pathology Groups

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Pathology Lab Shortages in New Zealand Are One Cause in Long Delays in Melanoma Diagnoses

Similar diagnostic delays due to clinical laboratory staff shortages are reported in other nations as well

Critical pathology shortages are causing lengthy delays for clinical laboratory test results in New Zealand, according to a report that states some patients are waiting over a month for a melanoma diagnosis. This situation puts the lives of cancer patients at risk in the island nation. 

The Melanoma Network of New Zealand (MelNet) is working to reduce the number of people who develop the disease and help melanoma patients receive a fast diagnosis and proper treatment and care.

However, plastic surgeon and MelNet Chair Gary Duncan, MBChB, FRACS, told Radio New Zealand (RNZ) that when patients return to their doctors for test results, those results often have not come back from the medical laboratory. Therefore, the physician cannot discuss any issues with the patient, which causes them to make another appointment for a later date or receive a melanoma diagnosis over the telephone, RNZ reported.

Dermatologist Louise Reiche, MBChB, FRACS, told RNZ that slow pathology services are unfair to patients. Such delays could result in the spreading of the melanoma to other parts of the body and require major surgery under anesthetic.

“Not only will they suffer an extensive surgical procedure, but it could also shorten their life,” she said.

Trishe Leong, MB.BS (hons) Medicine, FRCPA Anatomical Pathology

“We’ve got shortages across the board, and it only seems to be getting worse,” said Trishe Leong, MB.BS (hons) Medicine, FRCPA Anatomical Pathology (above), President of the Royal College of Pathologists of Australasia (RCPA). She added that “there was also a backlog of pathological examinations of placentas, which are used to detect genetic conditions and shed light on complex births,” The Sydney Morning Herald reported. Clinical laboratories in several countries worldwide are experiencing similar delays in reporting critical test results to physicians and their patients. (Photo copyright: RCPA.)

Pathology Labs Cannot Meet Demand for Testing

The Royal College of Pathologists recommends that 80% of specimen results should be returned to clinicians within five days. General practitioner Jeremy Hay, MD, of the Upper Hutt Skin Clinic told RNZ that he has never seen a melanoma report returned from the laboratory he utilizes within the suggested five-day time span. He stated that his local pathology lab simply cannot meet the demand for the vast number of samples waiting to be tested.

“I have visited the lab, and you can see even in the corridors stacks of unreported slides sitting outside the pathologist’s rooms, and there are more inside their rooms,” he said. “They need more staff and that’s quite obvious.”

Hay added that, because of the delays, he typically does not start with a small biopsy of a suspicious-looking piece of skin. Instead, he just cuts the entire area out and sends it to the lab for testing to expedite the diagnosis process.

Lab Loses Accreditation Due to Delays

Long delays caused one lab—Auckland’s Community Anatomic Pathology Service (APS)—to lose its accreditation for the lab’s skin testing department. According to RNZ, some patients had to wait up to eight weeks to learn whether they had melanoma.

An article published by medical/science specialty recruiting firm Odyssey, states that the deficiency at APS was due to several factors, including:

  • Population growth.
  • An increase in private medical practices.
  • The underestimation of the costs required to run the lab.
  • An overestimation of potential savings.
  • A shortage of qualified pathologists, specifically in the fields of anatomical, chemical, and forensic pathology.

The article also states that pathologists are now listed on Immigration New Zealand’s list of shortage skills in the country. That designation means that foreign candidates who have the skills, and who are offered jobs in the country, can immediately apply for permanent residency. 

Three Week Wait for Cancer Diagnoses in Australia

According to the World Cancer Research Fund International (WCRF), New Zealand has the second highest rate of melanoma in the world. The number one spot is held by Australia. 

Other countries are experiencing long wait times for cancer diagnoses as well. According to The Sydney Morning Herald, some individuals are waiting up to three weeks to receive a cancer diagnosis due to a shortage of pathologists.

“It could be the cancer you didn’t suspect,” said Trishe Leong, MB.BS (hons) Medicine, FRCPA Anatomical Pathology, President of the Royal College of Pathologists of Australasia. “There’s always the chance of something unexpected showing up in a biopsy, and if that is not tended to as soon as possible it can have an impact on patient care.”

This is not the first time Dark Daily has reported on clinical laboratory staff shortages around the world causing huge test result delays.

In “Irish Cancer Society Report Shows Patients May Wait Two Years or More for Genetic Cancer Test Results,” we covered research conducted at the University of College Cork (UCC) which revealed that genetic services have been “starved of investment and resources” in the Emerald Isle, leaving healthcare workers involved in cancer genetics and follow-on services “completely overstretched.”   

And in “In Canada, Shortage of Medical Laboratory Technologists and Radiology Technicians Continues to Delay Care,” we reported how varies combinations of facility, physician, and other healthcare professional shortages are generating regular headlines about patient wait times in the UK, Canada, New Zealand, and Australia, particularly for elective procedures that may be six months to a year or more.

In those countries, and around the world, healthcare experts say the solution is expanding training opportunities to solve the shortage of clinical laboratory scientists, medical laboratory and imaging technologists, doctors, nurses, and other medical professionals, and increasing funding for modernizing hospital facilities and clinics.

But in countries with government-run healthcare, that solution is problematic at best.

—JP Schlingman

Related Information:

Eight-week Wait for Skin Cancer Test Results Risking Lives – Doctors

Private Healthcare Pushing Auckland Labs to the Brink

Factors Increasing Demand for Pathology Services in Auckland NZ

‘The Cancer You Didn’t Suspect’: Medical Test Delays Could Be Endangering Patients

Irish Cancer Society Report Shows Patients May Wait Two Years or More for Genetic Cancer Test Results

Four Thousand New Zealand Medical Laboratory Scientists and Technicians Threatened to Strike over Low Pay and Poor Working Conditions

Last-minute court injunction stopped a mass walkout, but allied health workers continue to push country’s District Health Boards for improvements

In New Zealand, the unprecedented surge in PCR COVID-19 testing due to the SARS-CoV-2 Omicron variant appears to have pushed the country’s 10,000 healthcare workers—including 4,000 medical laboratory scientists and technicians—to the breaking point.

On March 3, just 24 hours before the first of two walkouts was scheduled to begin, New Zealand’s Employment Court banned the strike that would have shut down medical laboratories in the country’s mixed public-private healthcare system. Medical laboratory workers make up 40% of the nation’s 10,000 healthcare workers who planned the nationwide strike to protest low pay and poor working conditions, according to 1News.

“COVID was the perfect storm for the profile of laboratories and how undervalued they have been for far too long,” said medical laboratory scientist Terry Taylor, president of the New Zealand Institute of Medical Laboratory Science (NZIMLS).

Judge Issues Injunction Restraining the Strike

New Zealand’s Public Service Association (PSA) is the country’s largest trade union representing more than 80,000 workers across government, state-owned enterprises, local councils, health boards, and community groups.

The PSA’s 10,000 health workers (which includes 4,000 medical laboratory workers) had planned to strike on March 4-5 and March 18-19, but, according to the New Zealand Herald the Employment Court stopped the walkouts due to the rise in COVID-19-related hospitalizations.

The Herald noted, however, that PSA union members in Auckland had already postponed their walkout after county District Health Boards (DHB) expressed concern over patient safety.

“Striking has always been our last resort, and our members in Auckland continue to demonstrate their commitment to providing quality healthcare to New Zealanders by working tomorrow,” PSA Organizer Will Matthews told the Herald.

He insisted, however, that DHBs need to respond to workers’ concerns. “The depth of feeling from our members, and the support for industrial action nationwide is unprecedented,” Matthews told 1News. “We are now in a position where strike action is our only remaining option to get the DHBs and the government to listen.”

Terry Taylor
In an interview with Stuff, medical laboratory scientist Terry Taylor (above), president of the New Zealand Institute of Medical Laboratory Science, acknowledged laboratory workers’ commitment to doing the work, but he is concerned about the next big testing surge. “Goodwill only goes a certain distance in the end when people are knackered and not getting what they need. At the moment, we have the capability to do 50,000 to 60,000 [tests] per day throughout the whole country, but we couldn’t run that for more than a week. We’d be dead, we’d be overrun,” he said. Clinical laboratory leaders in this country may want to make note of Taylor’s concerns, as laboratory conditions in this country become stressed as well. (Photo copyright: Newshub.)

Clinical Laboratory Workers Claim Low Wages, Poor Conditions, Irrelevant Testing

While no new strike dates have been set, Matthews said striking workers would include contact tracers and laboratory staff as well as nearly 70 other groups of healthcare workers, many of whom “don’t even earn a living wage.” According to Peoples Dispatch, allied health workers are working under the terms of a contract that expired in 2020.

The starting salary for a DHB medical laboratory scientist after completing a four-year degree is NZ$56,773 (US$39,519), while lab assistants and technicians start out at less than NZ$50,000 (US$34,804), Stuff reported.

In an interview with 1News, Taylor maintained that diagnostic labs in New Zealand have long been understaffed, undervalued, and their workers poorly treated. The COVID-19 pandemic, he says, has exacerbated an ongoing problem. Issues such as space constraints, for example, have become even more problematic.

“We’ve got extra machinery that’s come into the labs, we don’t get any more space, all these consumables sitting all over hallways and corridors, extra staff coming in to do the stuff,” Taylor told RNZ. “So, we’ve lost all our tearooms, we’ve lost all our office space, our conditions are markedly less than they should be.”

1News points out that the country’s medical laboratory scientists and technicians are processing more than 20,000 PCR COVID-19 tests per day in addition to running 120,000 other samples and 200,000 diagnostic tests. At the end of March 2020, the average number of COVID-19 tests processed per day was 1,777.

While New Zealand has preached to its citizens the need for widespread PCR testing, Taylor argued in February 2022 that the country must change its approach to offering PCR testing only to symptomatic individuals and close contacts.

“To run our diagnostic laboratories into the ground with endless irrelevant testing is a direct reflection of poor foresight, planning, and respect for the role of this critical health workforce,” Taylor told Newshub.

Necessity of Rewarding All Medical Laboratory Personnel

Medical laboratory scientist Bryan Raill is president of Apex, a specialist union of allied, scientific and technical employees. Raill told 1News the long-term solution is for the government to address pay equity, staffing levels, and worker wellbeing in the country’s historically undervalued medical laboratories.

“Medical laboratory scientists and technicians have to be fairly rewarded for the training, skill, and expertise they bring to the health system,” Raill said. “Medical laboratory scientists need a timely, fair, and equitable process to determine their worth.”

While the stresses on New Zealand medical laboratory workers are not identical, US clinical laboratory leaders will want to monitor the lengths to which New Zealand’s laboratory workers are willing to go to force improvements in their working conditions, staffing, and pay.

As the noted above, the government-funded health system is continually strapped for funds. Consequently, the health districts often defer capital investment in hospitals and medical laboratories. That is one reason why lab staff can find themselves working in space that is inadequate for the volume of specimens which need to be tested daily.

Andrea Downing Peck

Related Information:

Why the ‘Hidden Heroes’ of Our COVID-19 Response Are Striking

COVID-19 Omicron Outbreak: Health Strike Postponed after Employment Court Grants Injunction

New Zealand Employment Court Passes Injunction to Scuttle Health Workers’ Strike

10,000 Health Workers Strike as Omicron Wave Hits

After almost Six Million Tests, an Omicron Explosion Will Heap More Stress on Exhausted Laboratory Workers

Burnt Out Laboratory Staff Working in Poor Conditions, Institute Says

COVID-19: PCR Testing Reaches ‘Crisis’ Point, Public Health and Lab Staff Plea for Symptomatic Testing Only

Pathology Laboratory Consolidation May Leave New Zealand Holiday Destinations with Limited COVID-19 Testing Capacity as Omicron Variant Arrives

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