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A look back at the '80s.

A look back at the '80s

The '80s - no other decade has delivered a more resounding punch to health care services. Three major issues, evolving at different times, have produced a profound effect on our professional lives and changed the way we view our careers. * Advent of DRGs. Early in the decade, hospital reimbursement was restructured via the infamous diagnosis related groups. Doomsayers predicted the worst. The word "survival" cropped up in countless articles and seminars. For the first time, the health care profession - a term previously synonymous with job security - was discussing staff reductions and downsizing or even closing of facilities. Although prospective payment has certainly had an effect on all our lives, it fortunately didn't reach the disastrous level that many had predicted.

What did result from the limited health care dollar was a much needed institution of proper business practices in the lab profession. Many of us took courses, earned business degrees, and generally functioned in a more businesslike fashion than we had 10 years before. * Alarm in the laboratory. The AIDS epidemic claimed much of our attention toward the middle of the decade. The adoption of universal precautions altered not only the way we collect and process patient specimens but also our budgets. Labs were seen as a risky place to work as fear of the unknown grew.

AIDS, of course, is still with us. The fear, however, has subsided somewhat as employees became better informed about the associated risks and precautions involved in handling blood and body fluids. Remarkably, the appearance and spread of this insidious disease have had certain positive results. Staff members have become more safety-conscious; good laboratory safety techniques are now considered the norm in the workplace. * Team members needed. The ongoing personnel shortage is the third major issue that caused an upset in the '80s. We have seen the ranks of qualified applicants diminish rapidly over the last few years. A number of factors, including a declining birthrate and increased career options, came together in this decade and resulted in reduced enrollment in medical technology programs.

In this situation, too, I see a silver lining. First, it forced all of us to perform a long-overdue evaluation of the medical technology profession. We needed to rethink what qualifications are necessary for an individual employed in today's highly automated laboratory. Second, the shortage forced us to be a little more creative in our approach to such personnel activities as recruiting, retention, and scheduling. * What is to come. I feel that the most important concern of the '80s - the shortage of qualified personnel - may, ironically, be alleviated by what I anticipate as one of the first major issues that will confront us in the '90s: the exodus of tests from the laboratory. Over the next few years, I believe, we will see an increase of home and bedside testing, all performed by individuals untrained in technology.

Another contributing factor of which we should be aware is the growing development of indwelling censors for monitoring of routine laboratory studies. We may see the highly automated and profitable tests depart from our sphere, leaving us with the high-cost, low-volume esoteric tests, thus forcing overall laboratory costs to rise.

Undoubtedly, several new major issues will spring up as we move through the last decade of the 20th century. Just as with the "big three" issues of the '80s, we can do little, if anything, to prevent them from coming. What we must do now is to react in as expeditious and well-informed a manner as possible. Who knows - maybe at the end of this decade we will wax nostalgic about the "good old '80s."

James M. Maratea, M.A. The author is administrator of the clinical laboratories at Thomas Jefferson University Hospital, Philadelphia.
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Author:Maratea, James M.
Publication:Medical Laboratory Observer
Article Type:column
Date:Jan 1, 1990
Previous Article:How final 1990 budget affects labs.
Next Article:Personnel licensure: a raging issue that won't go away.

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