Although there has been extensive research regarding the factors that influence career choice among students in the health professions, including medicine , nursing , dentistry [12, 13], athletic trainers [14, 15], dieticians  and others [17–18], the factors that influence MLS students’ career choice have not been previously explored.
Wu et al  conducted a systematic review of both quantitative and qualitative studies of motivations for choosing a career in health care, but MLS students were not included. A primary goal of their study was to explore differences between nursing students and other health professionals, given the nursing workforce crisis and the hope of informing potential mitigating recruitment strategies. They found that intrinsic factors, like desire to help others, were consistently found across different health professionals. Similarly, the opportunity to make a difference in someone’s life has a strong influence on MLS students’ career choice. Wu et al  also noted that extrinsic factors, like job security and autonomy, were deemed important to career choice, although salary potential was not a significant influencer for medicine and nursing . Unfortunately, nursing was found to be perceived as a low-paying and low-status job among the public, negatively influencing students from choosing nursing as a career. We found that the nature of the work, including MLS being a challenging, highly skilled occupation requiring hands-on work, were rated highly among MLS students. Although not rated as highly as personal interest and nature of the work, the perception that a career as a MLS offers a stable job with opportunities for career advancement and a high income were also important factors.
Wu et al.  found that influences of family and other professionals played a role in career choice among health professionals. However, social influences were not rated highly as influencers on career choice among MLS in our study, although it was dependent upon age, with older respondents rating social influence lower than younger respondents. In particular, the majority of respondents strongly disagreed or disagreed that social media had influenced their career choice. It is possible that MLS students did not learn about the career as an option through social media, and thus online social platforms may be areas to consider as an untapped recruitment venue. This is particularly important in an era where social media is pervasive and widely used. By not utilizing social media, MLS programs run the risk of losing out on potential students due to low exposure of the laboratory profession in the public eye. In one study of 469 MLS or MLT (medical laboratory technician) programs, 20% do not have a program website, and only 40% of the programs utilized social media, with half indicating using the various platforms once a month for updates . With such a low number of MLS programs utilizing social media, it is no wonder that the results of our study indicated that social media has had little effect on their career choice.
Overall, there were few significant differences in factors that influence career choice among various demographic characteristics. Unlike Wu et al  finding significant gender differences in career choice factors among nursing students, we did not note such differences, despite our sample being skewed towards females 2:1. Of note, those respondents with military experience were less influenced by personal interest, prior healthcare exposure, the nature of the work, and job prospects than those without military experience in our study. The MLS programs in this study likely have an oversampling of military students given academic partnerships with the U.S. Armed Services. In addition students serving in the military may have fewer career options to choose from than civilians based on the military’s needs. Overall prior exposure to the healthcare system was not a strong influencer of career choice among MLS students studied, yet those students who had already worked in healthcare (i.e., serving as an emergency medical technician) were significantly more likely to rate these factors as having greater influence.
In a follow-up study Wu and colleagues  used the HCC and corresponding NCC to identify differences in the two scales among students in medicine, dentistry, pharmacy and social science. When comparing the means of the HCC subscales reported by Wu  to those among the MLS students in our study, various similarities and differences emerged, although the significance of the findings was not calculated. As with medicine (M = 22.70, SD = 2.63), dentistry (M = 21.60, SD = 2.93), pharmacy (M = 20.62, SD = 3.25) and social science (M = 20.37, SD = 3.16) students, MLS students (M = 21.861, SD = 3.073) rated the ‘personal interest’ subscale high. MLS students (M = 14.583, SD = 4.849) rated the “prior healthcare exposure’ subscale lower than medicine (M = 19.88, SD = 4.55), dentistry (M = 19.64, SD = 4.49), and pharmacy (M = 17.50, SD = 4.50) students but similarly to social science students (M = 14.78, SD = 4.74).
‘Self-efficacy’ was rated higher among MLS (M = 15.056, SD = 2.858) than medicine (M = 12.93, SD = 3.46), dentistry (M = 13.43, SD = 3.65), pharmacy (M = 13.08, SD = 2.55) and social science (M = 11.19, SD = 3.18) students. MLS (M = 20.010, SD = 3.513) rated the ‘nature of the work’ subscale highly, as did medicine (M = 19.30, SD = 3.59) and dentistry (M = 20.06, SD = 3.31) students, but higher than pharmacy (M = 17.90, SD = 3.35) and social science (M = 15.93, SD = 3.35) students.
Interestingly, ‘job prospects’ ranked higher among MLS students (26.542, SD = 3.982) than medicine (M = 23.58, SD = 5.86), dentistry (M = 25.38, SD = 4.50), pharmacy (M = 24.16, SD = 4.95) and social science (M = 20.30, SD = 5.06), which may suggest that MLS students perceive the MLS profession to offer a more stable job. Yet on the other hand, ‘social influences’ ranked slightly lower among MLS students (M = 25.667, SD = 5.455) as compared to medicine (M = 25.99, SD = 6.37), dentistry (M = 26.83, SD = 5.94), pharmacy (M = 26.17, SD = 5.67) but not social science students (M = 24.57, SD = 5.41). Of note, the participants in Wu et al.  were much younger than those in our study but distributed similarly by gender. The Wu  study was conducted in Singapore, so the majority of participants were Chinese, whereas our study was conducted in the United States and participants were primarily Caucasian. A number of factors that influence career choice among MLS students were significantly impacted by military experience, but this demographic was not reported in Wu’s  study. It is unclear how these demographic differences may have impacted the subscale comparisons.
Our study was conducted at the height of the COVID-19 pandemic, so the impact of the pandemic on MLS student career choice was also explored. Not unexpectedly, MLS students reported varying degrees to which the COVID-19 pandemic impacted them personally, as summarized in Fig. 2 and Table 5. However, for most students the pandemic did not influence their decision to pursue a career as a MLS. For some the heightened public perception of the value of all healthcare providers, including MLS, reaffirmed that they had chosen the right career path.
More work demand in healthcare, and the general public's perceptions of people in healthcare have shifted in a positive way.
Yet some respondents were discouraged by the limited availability of personal protective equipment (PPE) that plagued the initial response to the healthcare crisis.
Seeing that healthcare workers including laboratorians have not been provided proper PPE has seriously affected my desire to enter the field of MLS. The idea that I would be required by my employer to forego known and/or reasonable safety guidelines and PPE for the patients' diagnosis without respect to my or my family's health (I have an immunocompromised child) is a slap in the face. While I know and accept the risks of being a laboratory scientist, those risks are taken with the understanding that my employer and training will protect me from the worst and known threats that could lead to my death. My family is not encouraged by the treatment of healthcare workers during COVID-19 and have shared their concerns with me also.
In addition, as noted earlier, demand for MLS professionals varied in the early phases of the pandemic, where some had a reduction of hours due to the discontinuation or reduction of elective surgeries and other procedures.
The hospital in which I work had to function on a reduced workload due to the lack of elective surgeries during the pandemic. Due to the lack of hours, I've had a considerable decrease in income which has made things a bit more difficult.
The quote below best encapsulates the impact of the COVID-19 pandemic on MLS students’ career choice:
During the pandemic it has really pushed me mentally and physically. I have been sleeping less and gained weight. It has been the toughest couple of semesters in my entire academic career. Nonetheless, I haven't changed my mind and still want to pursue a career in this field. Actually with the entire pandemic going on it made me want to finish my degree even more and get to work. This is a huge deal and I am happy I will get to be a part of future testing to assist my peers in this field.