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A new crisis in medical technology.

Two or three years ago, medical technology reached a crisis point. Health care economics were bleak. Hospitals cut back on staff, and jobs were hard to find. Manufacturers increased development of labor-saving automated "instruments". Diagnostic testing expanded to such sites as ambulatory care centers, hospital wards, and physicians' offices. Undergraduate recruitment for the laboratory field was at a standstill.

Professional organizations and educational institutions talked about the problems and tried to develop new directions. But, as is the problem with most planning efforts, decisions were slow in coming. New changes occurred before the old were dealt with.

Now we face the reverse crisis. Like nursing, lab staffing is cyclical, and we have gone from too many employees to not enough in a very short time. Health Week reported on Oct. 12, 1987, that laboratory experts across the country say we face a critical shortage of technical personnel. This shortage will worsen as more lab education programs close and test volume keeps climbing.

There is no absolute documentation of the shortage or the reasons for it. But informal surveys of laboratory managers and educators across the country indicate it is a definite trend. Numerous job openings are advertised in cities that had not experienced shortages for years. Hospital- and university-based education programs, boasting a nearly unlimited selection of students in the past, have much smaller groups to interview. They also report the quality of applicants has declined.

Everyone has a theory about why all this has happened. Basic problems such as low salaries, high stress, and lack of status and recognition are cited. These problems have always existed, but perhaps some of the shortage is due to women finding better job opportunities in other fields.

AIDS is cited as a new force deterring young people from lab careers. That would also apply to many other health professions, however, but not much has been written about shortages in these professions, except for nursing.

I believe there are other reasons why more people are leaving an fewer entering medical technology. Clinical laboratory students graduate with high expectations of what their jobs will be like. When they start working, however, they find things very different.

Very often they do not feel their skills and knowledge are being used appropriately. They grow frustrated and bored. Some find that the techniques and skills gained during the clinical phase of their education are already obsolete in their first workplace.

Because of existing political and professional conflicts, they may find they do not receive the recognition status, and respect they had been taught to believe was theirs as laboratorians.

Those who had hoped to specialize find that specialization is giving way to cross-training for generalist positions. Where specialization is still available, the boundaries between lab sections are becoming blurred due to advances in test methodology and instrumentation. In addition, rapid growth of automation, computers, and robotics is reducing the need for thinking and judgment.

Wringing hands and taking surveys will not solve the problem. All professional organizations, educational institutions, and accreditation and certification bodies must sit down and reach a consensus about the changes needed at all levels of the medical technology profession.

As the scope of clinical science grows, we tend to add courses, rather than alter, reduce, remove, or realign them. We think in terms of more learning rather than different kinds of learning. Clinical education programs are still based on formal structures rather than mastery learning. Does it make sense to keep a student in chemistry for 10 weeks if he or she achieves competency levels in seven weeks, then hold the student back for not mastering microbiologyin the allotted time?

The scope of knowledge and skills is usually limited by the procedures and instrumentation of the particular teaching hospital lab. Why not rotate students among several hospitals to expose them to different methods?

Are undergraduate course requirements still appropriate for tomorrow's laboratorians? Do they need organic chemistry, physics, and multiple courses in microbiology? Are these courses still relevant, or do they merely reflect a tradition that is difficult to end? Even medical schools are beginning to eliminate some course requirements for their applicants.

Are entry-level requirements based on what individuals will actually be doing or on academic assumptions of what they should be doing? California has virtually ignored the job supply question and instead come down hard on programs that don't meet its obsolete, arcane, and irrelevant training requirements. In this case, a state law is a hindrance rather than a help. What plans are under development to deal with fewer and fewer hospital-based clinical programs as government reimbursement for education dries up?

I have no ready answers for these questions except to say we need a revolution in medical technology to enable its practitioners to function in the 1990s. Unfortunately, today's graduates have yesterday's education.

We need strong activists who will challenge the establishment and force the changes needed to maintain quality patient services. Our focus must move from the traditional lab to the bedside.

If the quality of laboratory services is reduced because of a lack of qualified staff, patients will suffer. And other health care workers will step in to fill the gap. We can no longer afford restrictive laws or regulations, irrelevant curricula, and tradition-oriented training. Change must come now. It may already be too late.
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Title Annotation:shortage of technical personnel
Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Article Type:column
Date:Feb 1, 1988
Previous Article:Is competition lowering the cost of health care?
Next Article:Labs hit with cuts under final budget accord.

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