How much does an MT program cost the hospital.
Administrators hemmed in by rising costs and prospective payment may wonder whether their hospitalsl can still afford student training in the lab. The main concern is the drag on productivity as technologists turn away from testing to instructing; there are other expenses as well.
But exactly how much does an MT program cost the hospital? And what does the program give the hospital in return? These two questions are answered in a cost-benefit analysis, which may be crucial for the survival of many medical technology programs.
When the questions arose at our hospital a few years ago, it became my job, as assistant education coordinator at that time, to make such an analysis. I was assisted by education coordinator Jane McGlauflin throughout the project.
Our 12-month clinical rotation is the final year for 3 + 1 medical technology baccalaureate candidates. The training facilities are the CAP-accredited clinical laboratories of our 400-bed hospital in eastern Maine.
During the period under review, the 1981-82 clinical year, the faculty consisted of the laboratory's medical director, education coordinator, assistant education coordinator, interested technologists and supervisors who lectured in their areas of expertise, and technologists who gave clinical instruction in the lab. Eight students were in our class.
We wanted to compare our education expenses with revenues produced by tuition, student contributions to the laboratory workload, and related benefits. Here is how we proceeded.
On the expense side of the ledger (Figure 1) were staff technologists' wages during the time spent on lectures and clinical instruction; faculty salaries (education coordinator and assistant); costs of reagents for simulated testing; and a miscellany including reference books, graduation pins, diplomas, and financial support for student travel to a state technologists' meeting in the fall.
Indirect costs did not apply. Students must pay for their own health and professional liability insurance. We have no special facilities that would incur extra expenses for lights, heat, and rent. And with rare exceptions, our students are on the payroll as part-time employees--so they are entitled to cafeteria and pharmacy discounts, use of the hospital employee health office, and free attendance at hospital in-service sessions.
In developing direct teaching costs, I wanted to let each section know how much of its staff budget was devoted to educating the students. Thus, if a technologist in special chemistry gave coagulation lectures, that instructional cost was charged to the chemistry department.
The challenge lay in determining how much time was spent on clinical training. We don't have a teaching lab with a faculty devoting its time only to students. When our technologists teach, they almost always have concurrent service responsibilities to the hospital. We needed a way to separate these intertwined duties.
I decided to determine "nonproductive teaching time" by section. This was defined as the time a technologist spends teaching to the exclusion of other service responsibilities to the hospital. Since our most experienced technologists provided the bulk of the instruction, the top wage for technologists was used in calculating salary expense.
Students receive 1-1/2 hours of lecture each morning. A technologist lecturing to students is obviously not available to perform any of the workload, so this is pure nonproductive teaching time. I added up the number of lectures given by technologists from each laboratory section, tacked on one hour of preparation time for each lecture, and multiplied the total by the wage figure.
As I have indicated, clinical instruction time was harder to get at. A clinical instruction in each laboratory section is charged with orienting the student, making sure a technologist is assigned to teach, keeping quizzes and evaluations up to date, and reporting grades and evaluations to me. I now asked the clinical instructors to log daily nonproductive teaching time.
It was confusing at times. For example, in the first week of a student's rotation through microbiology, a technologist is taken completely off the work schedule to teach basic microorganisms and identification techniques. This can add up to 40 hours of nonproductive teaching time, but more often the technologist instructs and performs patient testing simultaneously.
In such instances, I told the clinical instructors to calculate the reduction in normal workload production during teaching periods. This would yield the nonproductive teaching time.
What about students taught in pairs? We were careful to divide that time by two in calculating teaching hours per student.
Also included in our summary was the time necessary to prepare laboratory practicals and quizzes, complete evaluation forms, and hold student conferences.
The process seemed to work well. When I asked a few technologists to independently compute their lab teaching time for a certain day or week of a rotation, the figures were similar. The fact that our clinical curriculum is carefully scheduled made it easier for us to isolate teaching time.
Nonproductive teaching time per student for each section was multiplied by the number of students (eight) and then by the technologist wage rate to arrive at the total salary cost for teaching in each lab section for the program year. We regularly update the entire cost-benetit analysis, and supervisors or the lab manager frequently inquire about the amount of time spent teaching in the lab.
Note in Figure 1 that microbiology calls for a longer rotation and more hours of instruction than any other section. There's more time devoted to microbiology because it isn't as automated as chemistry and special chemistry. Part of the teaching time also reflects a tendency toward perfectionism in a section that deals with "arts" like interpreting Gram stains and colony counts.
Among the other categories of expense, reagent costs merit explanation. They are low because we don't need to stock a separate lab for students. Since students essentially learn on the job, they carry out few procedures that are not part of the workload. We cannot afford to practice a great deal with expensive reagents.
Expenses for the medical technology program came to $39.200 in 1981-82. Now let's turn to the other side of the ledger.
Benefits to the hospital were computed in terms of revenue produced (Figure II), including productive work by students; savings derived from hiring our graduates instead of recruiting and orienting new personnel from outside the medical technology program; and tuition.
In addition to keeping their teaching time logs, clinical instructors also logged the hours of productive work per student. This was defined as work contributing to the lab workload.
Direct student contributions to patient care are an area of controversy. Since the goal of our program is to graduate medical technologists competent to function at the entry level, we feel it is essential to involve students in the patient workload. This real-life involvement is instrumental in producing independent practitioners who are capable of decision making on the job, high quality technical performance, and adjustment to the stress of our profession.
Our program is accredited by the AMA's Committee on Allied Health Education and Accreditation, and we adhere to the standard that a student not substitute for or assume the responsibilities of regular staff members. But we also follow the recommendation of the National Accrediting Agency for Clinical Laboratory Sciences that students be permitted to perform certain procedures under careful supervision, after they demonstrate proficiency. As NAACLS notes, this allows students "to develop speed, confidence, and ability to organize work efficiently under pressure."
Special chemistry and hematology had the highest number of hours of productive work per student, for two different reasons. In special chemistry, radioimunoassay kits and other reagents are so expensive that a student soon must start on the regular workload under supervision. The technologist is free to handle a certain amount of extra workload while supervising the student.
In hematology, students are given plenty of time to become proficient at pefforming differentials, a skill we want them to feel comfortable with. Consequently, they report out quite a volume of work after reaching proficiency; again, under supervision. All this supervisory time was figured into the teaching expense, by the way.
The wage used for determining revenues from student productive work was the currents starting salary for medical technologists. A student who reaches the point of reporting results has usually attained entry-level skills.
We were a little surprised by the large contribution to workload that our students make--more than $25,000 worth, in total. This is tangible proof of a return on our investment. It demonstrates decisively that students represent more than a drain on resources.
Revenues accruing to the hospital from hiring our own graduates and from student tuition are also itemized in Figure II. At the time of the study, we were hiring an average of three graduating students per year. I asked the hospital's personnel director to quantitate the expense of hiring someone other than a program graduate to fill a technologist position. He estimated that the cost of advertising the job and hiring and orienting a nonprogram graduate was $500. That's how much we saved each time we tapped one of our former students for a position.
The revenue total for the program was $34,200. Subtracting that from expenses of $39,200 revealed that the medical technology program cost the hospital $5,000 in 1981-82. That's not the entire story, however. Other identifiable benefits help offset this expense and contribute to the quality of health care:
* A pool of part-time phlebotomists and laboratory aides. Most of our students work part time in our laboratory in phlebotomy or as aides, processing and logging specimens, inoculating plates in microbiology, and so on. They are a valuable resource on weekends, evenings, and early mornings, although we restrict their number of hours so that work won't interfere with their studies.
Without the student pool, we would probably have to hire more part-time help. The students serve as high-caliber workers in these areas and are already familiar with our system and techniques.
* A source of well trained medical technologists. Fifty-four per cent of our technologists are graduates of our program. By hiring our own after a year of observing their interest and aptitude, we can better match the right graduates with the right jobs. And these new employees immediately start at good productivity levels, since they were trained in our system.
* A service to the community, region, and state. Our program supplies medical technologists to small regional hospitals in the more rural areas of Maine. Our graduates can be found all over the map, from the chief technologist in Fort Kent at the Canadian border all the way south 335 miles to a chemistry technologist in the state's largest hospital in Portland. Most students come to us from the nearby branch of the state university system. Through our program, the hospital supports that educational institution.
If these benefits are not enough to offset the costs, consider what I believe to be the greatest advantage of the medical technology program. Ours is a teaching laboratory, and that translates into a higher standard of performance.
Because our technologists are involved in teaching, there is constant questioning and upgrading of skills. You can't teach what you don't know. Students help keep technologists on their toes. Patients are the beneficiaries.
As for the cost-benefit analysis, it enables the laboratory to spot areas that may be ripe for cutting. For example, we stopped teaching some manual chemistry methods no longer used in our lab.
When the analysis is updated from year to year, the lab can monitor financial trends and keep teaching activities within bounds that are acceptable to the administration--which is just where our MT program is.
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|Title Annotation:||medical technology|
|Author:||Wiebe, Martha Fogler|
|Publication:||Medical Laboratory Observer|
|Date:||Mar 1, 1984|
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