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An MT makes the move to a doctors' office lab.

An MT makes the move to a doctors' office lab

In more than two decades as a medical technologist, I had seen a trend toward bigger and bigger laboratories with more sophisticated instruments and greater specialization. Like many others, I believed "good' technologists seldom stayed in small labs because small was looked upon as inferior. Only nurses, poorly trained techs, and on-the-job trainees performed testing in doctors' offices, where we all knew the quality of lab work was at best substandard.

So I worked largely in hospitals. A few years ago, I became assistant supervisor of hematology at a 600-bed institution just when prospective payment came along. Suddenly hospital jobs were no longer secure: There were budget cuts, consolidations, and layoffs.

At the same time, many technologists stepped back and looked at their work environment. They wondered how quality could be maintained under increasingly severe financial restraints. The goal of doing one's best for the patient seemed to have faded.

I went through some soul-searching myself. My career had encompassed both large and small hospital laboratories in five states, as well as a recent one-year stint in a pathologist-owned clinic laboratory. It was pleasant to remember taking Saturday night call at an 80-bed hospital and discussing cases with doctors while they waited for a Stat CBC or a cross-match. I missed that kind of interaction.

I wanted closer contact with both doctors and patients, to see firsthand how my efforts fit into the overall picture, including what was being done for the patient. When an abnormal result came in, I wanted to know whether it was an extreme variation for that patient or just a slight change in condition. I also wanted to pursue my interests in hematology and chemistry.

One possibility was a job with a group practice. Although that might have been unthinkable in the past, physicians' offices were now being touted as a rapidly growing area of laboratory testing. I checked around and found that our central Florida community had a number of good physicians but only one non-clinic group practice with a hematologist on staff. This particular practice had five internists, including a cardiologist and a hematologic oncologist.

I dropped by one afternoon for a chat with the business manager. They had a lab and, coincidentally, a job opportunity. Their only technologist was leaving in a couple of months. During that period of time, we negotiated a salary and I considered whether I really wanted to make such a radical career move. It turned out I did.

The group's hematologic oncologist was a major selling point. His practice guaranteed I would see many of the community's most interesting hematologic cases, before the patients were admitted to a hospital and after they were discharged. My clinic experience helped minimize the shock of taking a large technological step down; on the plus side, the doctors were committed to upgrading the laboratory's chemistry capabilities.

Contrary to popular belief, office-based laboratorians are not universally underpaid. My salary is on par with what I made in my last hospital job, and I receive regular cost-of-living raises. There's also a profit-sharing bonus program, life insurance that more than doubled the coverage that I received in my hospital job, a very nice retirement plan, and free office medical care for my family.'

Of course, that's generous compared with many group practices. And all of us, from the doctors on down, work hard for our money and benefits. We have to in order to accomplish whatever must be done each day. There's no afternoon shift arriving at 3 to take over.

The idea that all doctors' office laboratories provide substandard results is another myth. Our little lab has been licensed by the state for several years, even though it's not required. (Mandatory licensing applies to labs with six or more physicians.) We also participate in CAP surveys--and do very well.

The 10 12-foot office labororatory would easily fit into the lab storeroom of any of the hospitals I worked at. Even so, it comfortably accommodates three centrifuges, a microscope, a coagulation analyzer, a mixer for the RPRs, a sodium/potassium analyzer, a batch chemistry analyzer, an eight-channel cell counter, and a therapeutic drug monitoring analyzer.

Two of the internists serve as medical directors of the laboratory. Besides myself, the lab staff consists of a technician and a phlebotomist, the latter in a position created last fall. As the only medical technologist, I am responsible for all of the testing and paperwork, with the technician acting as my assistant. The phlebotomist performs an average of 50 venipunctures each day, logs in the lab work, spins the bloods, and handles countless other chores.

I can't slough off tough slides to a crackerjack colleague or save a difficult serology for an eagle-eyed specialist who never misses a single spot of agglutination. In a situation like that, you finally face the truth about your training and experience.

Office hours run from 7:45 a.m. to 5 p.m. or later. I generally arrive shortly after 7 a.m. to take care of preventive maintenance and calibrate the instruments, and I usually go home at 4:15 p.m. The technician, who starts later, stays until the last physician leaves. The office is closed on weekends and holidays, which is one of the big advantages of working in our type of laboratory.

The five physicians keep us busy, and with a hematologic oncologist and cardiologist on staff, there's plenty of variety in the workload. The in-house test menu has doubled, and test volume has more than quadrupled in the past year. The laboratory performed 54,000 tests in the 12 months through last April. In April alone, we did 400 complete blood counts, 150 thyroids, and 200 16-parameter chemistry profiles. We also perform HDLs, lipid profiles, and a moderate amount of drug testing.

Bacteriology is sent out to the hospital next door, and esoteric chemistries go to a reference laboratory. Since we don't have back-up instruments, the hospital also does our hematology and coag testing when those analyzers go down.

Our test menu reflects the needs of a patient population that is mostly elderly. Many of the patients winter in Florida and return home each spring.

The office offers a full range of preoperative testing, including ECGs. This saves patients hours of shuffling through as many as seven departments in a large and often intimidating hospital. We keep a copy of the results on file in the lab, route another copy to the physician, and send a third to the hospital. Since we are a duly licensed group practice lab, area hospitals accept our test values.

We have been fully automated since last fall. Before that? Well, one of our instruments was a slow little cell counter nicknamed "Speedy Gonzales.' It worked well enough, even though I did have to predilute each count. After replacing several prototype boards in a single month, we retired the instrument and purchased the eight-channel counter.

The laboratory was performing manual glucoses when I arrived, up to 150 of them per month. This rankled me--I hadn't boiled sugars in 10 years.

To win the doctors over to an automated chemistry analyzer, I launched a study of the chemistry workload, talked to sales representatives, attended demonstrations, compiled price comparisons, and drafted workload justification reports. The doctors finally authorized the purchase when I showed that we could reduce send-outs and greatly increase our in-house volume within one year.

As the laboratory acquired one instrument after another within a short space of time last year, I attended all available training sessions. We did parallel testing along with our reference laboratory to make sure the instruments performed as promised.

What I consider to be advantages in my office laboratory might be viewed as drawbacks by someone in a hospital lab. I make most of the decisions and handle all of the paperwork I am also in charge of quality control, work-load studies, ordering supplies, equipment justification, preventive maintenance, developing and testing new procedures, drafting and updating the manuals, and much more--in addition to my regular bench work. A technologist who can't handle the pressure would probably be happier just following orders in a larger lab.

The most rewarding aspect of my work is the contact with patients and the doctors. Say someone comes in feeling a bit run down. I perform a CBC and report out a few giant platelets, a few hypersegmented neutrophils, and perhaps slight increase in MCV.

The reward comes when the doctor immediately responds to my findings. The patient is back at my door within five minutes with an order for a B12 and folate, and those tests reveal a B12 deficiency. In a hospital laboratory, a patient is often nothing more than a requisition, and the testing and diagnosis may take three or four days. I can't describe the sense of fulfillment from knowing that I helped a person I met feel better.

Of course, I do have my share of frustrations. For example, there's the lack of space for backup instruments, which forces us to send out tests when an analyzer goes down. Then turnaround time suffers.

Another problem is the high cost of supplies because we can't take advantage of volume discounts. In addition, many of the larger firms don't want to bother with a lab as small as ours. On the other hand, we are unhampered by contracts. We can shop around and snap up a bargain whenever we find one.

I have to make sure I don't fall behind technologically now that I'm somewhat removed from the mainstream. To stay in touch with current developments, I insist on attending at least two professional meetings or continuing education programs each year. It's one of the conditions of my employment. The doctors are very supportive on that score.

We have an excellent laboratory. It passed its most recent state inspection with flying colors and has an enviable record with CAP. Credit for this success belongs equally to the laboratory staff and to the physicians.

Working in an office laboratory isn't everyone's idea of a dream job. But for those who cherish patient contact and the chance to provide comprehensive lab work, I think it is the most rewarding job the field of medical technology has to offer.
COPYRIGHT 1986 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1986 Gale, Cengage Learning. All rights reserved.

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Title Annotation:medical technologist
Author:Ferron, Doris C.
Publication:Medical Laboratory Observer
Date:Sep 1, 1986
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