Vol. 23 • Issue 20 • Page 8

Scope of Practice

Year 2012 is looming on the horizon and everyone should be excited about what's in store for a new year. However there seems to be a sort of malaise in the profession. To hear some laboratorians speak we are a threatened species, a dying breed, headed toward extinction.

The mantra of recent years-doing more with less, cutting costs, compelled to meet burgeoning regulations coupled with a dwindling workforce-has only gotten louder. Cuts in academia and reputation as a flat career with little chance of upward mobility have done nothing to increase academic programs and attract students. In fact, programs continue to close at an alarming rate. Medicare keeps trying to reduce costs by going back to the old dry well of applying copays for laboratory testing. No thought is given to the idea that those who can least expect to pay (the elderly and those on fixed incomes) would be hit hardest. Additionally, laboratories would lose money chasing the small individual sums owed by patients.

Time to Ponder

Is there anything to be optimistic about? Is there anything to look forward to in the coming years? Indeed. There are several rays of hope if we only stop complaining long enough to ponder. In fact, the glass is more than half full.

Surveys conducted by various sources including the U.S. World and News Report and the U.S. Department of Labor have listed medical laboratory science as a growth career. The latest wage and vacancy survey conducted by American Society for Clinical Pathology (ASCP) polled 17,000 laboratorians at 625 facilities and concluded that the vacancy rate nationally for laboraorians average more than 11 percent depending on classification, discipline and geography. Some vacancies take more than a year to fill like transfusion service supervisor. This at a time when the national unemployment rate is about 10 percent.¹

The Coordinating Council on the Clinical Laboratory Workforce (CCCLW) is a coalition of more than 20 lab groups from industry and the profession that joined forces to tackle the shortage. They estimate 150,000 laboratorians will be needed to serve the nation's needs by 2014.² The fact that such a shortage exists and so many organizations are working to alleviate this issue bodes well for the profession.

More Good Signs

Another good sign is the growing popularity of initiatives like Lab Tests Online (www.labtestsonline.com) which just celebrated 10 years of delivering accurate, clear information to the public. Now worldwide in scope, it has represented the lab community well to the general public and medical professionals alike. An estimated 80 percent of Web users now search online for health information; that's nearly 60 percent of all adults in the United States. According to a recent Pew study, 16 percent of Americans report looking online to get information about interpretation of medical test results.³

In September, HHS proposed a rule that would allow patients access to their own lab results.⁴ This interesting expansion of the HIPAA laws would mandate that any lab accepting Medicare payment will provide such information, upon request, directly to patients or their personal representatives. No doubt an empowering move for patients (validation they own their healthcare information), this decision provides some challenges, but is a great boon for clinical laboratorians.

Patient-centered care is a concept that is not just trendy, it also makes good sense. A team of healthcare professionals contributing their various areas of expertise to rapid diagnosis, treatment and safe discharge of a patient has been proven time and again to be the best way to go. Patients are the beneficiaries through faster interventions, better outcomes and shorter inpatient stays. At the same time hospitals meet quality indicators and have less cost of care (or get to keep more of their payments). Organizations are approaching this patient-centric model in various ways. Of course, more point-of-care testing (POCT) is reducing turnaround time and taking advantage of a single specimen that requires minimal processing before analysis.

New protocols are being developed like "rapid rule-out" of coronary acute syndrome in chest pain patients through use of POCT and accelerated testing. Adoption of septic bundles and isolation protocols involve the use of lab tests to make rapid, time sensitive decisions. Multidisciplinary rapid response teams rushing to a distressed patient have increased mortality and reduced fatalities. Though not yet routine, it will soon become evident that a sharp clinical laboratorian needs to be part of this team.

Taking advantage of these opportunities will bring most of us full circle. Most of us entered this profession full of enthusiasm, ready to make a difference, to be equal members of a team helping patients who can't help themselves. We wanted to be valuable, respected and well compensated. To those who are disillusioned and jaded: please know you can do good and do well at the same time. We have real reason to look forward to a cup that's full and running over.

References

1. Garcia E, Bennett A, DeFranco M, et al. ASCP's 2011 Vacancy Survey of U.S. Clinical Laboratories. Lab Med 2011;42(4):200-206.
2. Coordinating Council on the Clinical Laboratory Workforce. Available at: http://ccclw.org/aboutus.aspx. Last accessed Nov. 9, 2011.
3. Pew Internet. The social life of health information. Available at: http://goo.gl/bT0a6. Last accessed Nov. 9, 2011.
4. HHS news release. Available at: http://goo.gl/7Rj9S. Last accessed Nov. 9, 2011.

Glen McDaniel is a healthcare consultant, clinical lab scientist, speaker and freelance writer. His interests include mediation, leadership, change and ethics. He can be reached at glenmcdan@aol.com.