Clinical laboratories worldwide are facing labor shortages and staff burnout from myriad causes, from the increasing complexity of laboratory technology to the unyielding demands of the COVID-19 pandemic.

In few countries, however, have lab professionals taken organized action like they have in Ireland. Laboratorians watched other healthcare workers in the country receive pay increases while their own compensation did not keep up. It was no surprise to them, then, that the field faced acute problems in recruitment and retention.

In 2022, frustration among Irish medical scientists—the term in Ireland for clinical laboratory scientists or medical laboratory scientists—boiled over. Working through the union that represents them, the Medical Laboratory Scientists Association (MLSA), they served notice in March of their first strike in 60 years.

“The grievance had become so great, and efforts to address the problems were stalled for so long, that we really felt there was no other option but to withdraw our labor,” said Terry Casey, MLSA general secretary. “The decision was not one MLSA members took lightly. We had used all mechanisms to resolve this issue over a 20-year period and essentially had come to naught.”

Their ability to organize, ensure emergency coverage for patients, and achieve what they expect to be a measure of success is one of the most notable actions taken by laboratory professionals during the pandemic to stand up for a profession that’s too often taken for granted.

Pandemic Pushes Pay Parity to the Fore

MLSA’s dispute over pay parity goes back to 2002, when Irish medical scientists demanded reassignment to the same pay grade as biochemists. Before then, the government assessed medical scientists and biochemists on the same pay scale. But in 2002, the government began assessing the roles separately. In what officials said was an unintentional procedural effect during this public servant benchmarking process, biochemists were assigned to a higher pay range than medical scientists.

In 2019, medical laboratory aides underwent a similar benchmarking process. Their pay review resulted in a 13% increase in salary to reflect recent changes to their role. While well-deserved, the pay increase placed the aides’ starting salaries higher than the medical scientists to whom they report.

That same year, the government implemented new standards for the profession that raised the bar for whom hospitals could hire to work in the lab. Registration with the Irish Regulating Health and Social Care Professionals (CORU) became mandatory for medical scientists, and CORU established a code of professional conduct and ethics as well as standards of performance for the field.

While registration “gives confidence to users of medical scientist services,” said Eddie McCullagh, chief medical scientist at Cork University Hospital, “the added requirement of CORU registration limits the field’s ability to respond to staffing shortages.”

For example, McCullagh noted CORU’s requirement for registrants to train in five different laboratory areas. “In reality,” he added, “the vast majority of medical scientists will only ever work in a single discipline during their career.”

CORU registration is also hindering Irish medical scientist recruitment from the United Kingdom, medical scientists said. “CORU has essentially shut off a large pool of candidates for us,” said Elizabeth Whitney, chief medical scientist at St. Luke’s General Hospital in Carlow-Kilkenny.

The added registration and training requirements combined with low pay have made medical scientist recruitment and retention a struggle. Currently, about 20% of medical scientist positions in Ireland are unfilled.

The Union’s Demands

In January 2020, MLSA renewed its dispute about pay parity as well as its aim to resolve the staffing crisis and improve career progression opportunities for the field.

MLSA members and the executive committee outlined their grievances: Medical scientists carry out identical work to clinical biochemists in hospital laboratories but are paid on average 8% less; medical laboratory aides who report to medical scientists have a higher starting salary; medical scientists have fewer career progression opportunities, less training support, and less continuous education support than comparable colleagues; and—an average of 20% of medical scientist roles are unfilled while the role of laboratory diagnostics within health services is expanding and increasing.

The union’s executive committee sought to resolve the dispute through existing resolution channels with the Health Service Executive and Department of Health (HSE/DoH). However, 2 years later, medical scientists’ demands remained unmet.

Walking the Picket Line

On May 3, 2022, after an unsuccessful round of talks with the Irish Public Service Agreement Group, MLSA served notice of industrial action for May 18. Members of the union picketed from 8 a.m.−8 p.m., withdrawing routine laboratory services to HSE and public voluntary hospitals, private hospitals and laboratories, the Irish Blood Transfusion Service, and universities throughout Ireland.

About 14,000 procedures were canceled that day. “The impact on patient care was very significant, and that was regretted,” Casey said. “However, prior to the strike, union members ensured emergency medical laboratory coverage would be provided.”

A second day of industrial action took place on May 24. This time, MLSA members were joined by members of the Irish Blood Transfusion Service. Later that day, further industrial action was called off after MLSA accepted an invitation to attend the Labour Court with HSE/DoH for exploratory talks on the pay parity and career progression disputes.

The MLSA-Workplace Relations Commission talks will be a time-limited review of the medical scientist and biochemist roles by an independent group to determine if the roles are indeed still the same. The group’s report will go to the Labour Court and the court’s decision will be binding.

“With the assistance of both the Labour Court and Workplace Relations Commission, we should have an agreement within a 3-month timeframe,” said MLSA’s Casey in late July 2022. “We hope a recommendation will be made and that pay parity with biochemists will be restored.”

Stronger Together

MLSA represents about 2,100 medical scientists in Ireland. Despite their relatively small size, the union’s industrial action was impactful. MLSA members and the executive committee spent 2 years planning for the strike by coordinating its members, building momentum for the strike, clearly communicating its demands via local and national media outlets, and garnering support from colleagues and the public.

“We were nearly unanimous in our decision to strike,” said Whitney, “with 98% of us voting in favor of industrial action in November 2021.”

Medical scientists were also supported by their healthcare colleagues. Whitney noted that consultants, nursing staff, and clinicians showed their support by only conducting essential blood testing and by canceling all elective procedures and clinics during the May 18 and May 24 actions.

MLSA members and the executive committee also talked with local and national media outlets to deliver their message to the public. “Our members are mild-mannered and committed to their work,” said Casey. “The fact that it took a 20-year pay dispute to get them to walk out of the lab and pick up a placard really struck home for people. It really solidified public support for us.”

What’s Next for Medical Scientists in Ireland?

MLSA’s members and executive committee are hopeful that the Labour Court and Workplace Relations Commission will present an agreement before the end of the year with a recommendation to restore pay parity. “We need to achieve a sustainable work structure for the profession, and this will benefit patients and the quality and efficiency of health services they receive,” said MLSA Chairperson Kevin O’Boyle.

In addition to serving the needs and rights of its members, the MLSA industrial action increased public understanding and recognition of what it means to be a medical scientist, they said. They believe that highlighting medical scientists’ critical role in healthcare delivery and the resolution of MLSA’s grievances will attract new people to the field and improve medical scientist recruitment and retention in Ireland.

Sarah Michaud is a freelance writer who lives in London. +Email: [email protected]

Timeline of the Strike

The Medical Laboratory Scientists Association (MLSA) in Ireland represents medical scientists, the profession referred to in the U.S. as clinical laboratory scientists or medical laboratory scientists.

  • January 2020: MLSA renews its claim for pay parity and career progression and seeks to resolve the dispute with the Health Service Executive (HSE), the publicly funded Irish healthcare system.
  • November 2021: 98% of MLSA members vote in favor of taking industrial action, which includes striking.
  • March 30, 2022: MLSA serves notice of industrial action on May 18.
  • April 2022: MLSA suspends the May 18 strike after the union is invited to new dispute resolution talks.
  • May 3, 2022: After unsuccessful talks, MLSA resumes plans for the May 18 industrial action, with additional strikes planned for May 24, May 25, May 31, June 1, and June 2.
  • May 18, 2022: MLSA members strike from 8 a.m.−8 p.m.
  • May 24, 2022: MLSA and Irish Blood Transfusion Service members strike from 8 a.m.−8 p.m. MLSA accepts an invitation to attend the Labour Court with HSE for exploratory talks on the dispute and suspends plans for future industrial action.
  • May 25, 2022: Labour Court requests MLSA and HSE return to the Workplace Relations Commission to explore resolution on the employer’s side of the dispute.