The changing face of laboratory medicine: a more service and less academically oriented profession?

In an effort to reduce the cost of healthcare in general and laboratory testing in particular, laboratory consolidations, outsourcing of services, and hostile takeovers of hospital laboratories by commercial companies were common occurrences in the US in the mid-1990s. These measures led to a reduction in the number of positions for clinical laboratory directors, the closing of many medical technology schools, and downsizing of postdoctoral training programs. Furthermore, the regulatory requirements, quality assessment programs, compliance issues, and general administrative responsibilities of laboratory directors have significantly increased over the past decade. As a result of these clinical service demands, the academic aspects of the profession and the time to participate in research have seemingly suffered. For instance, fewer clinical laboratory physicians and scientists are publishing in top journals such as Clinical Chemistry, where currently only approximately 35% of original reports have a first or last author associated with a laboratory medicine or pathology department. Similar disturbing changes are currently happening in other parts of the world. In this Q&A, we discuss the ramifications and long-term implications of these changes for our profession and future generations and what can possibly be done, if anything, to reverse the trend. A group of laboratory medicine leaders from the US, Germany, Italy, Australia, and the UK have independently answered relevant questions in this regard, and we present their answers below. What are the major evolutionary changes of the past 10 –20 years in the practice of laboratory medicine in your country?