Nearly all doctors call lab testing essential, but shortages and patient pressures are putting the system to the test.
Physicians across the United States certainly recognize the indispensable role of clinical laboratory testing in patient care, but growing workforce shortages, financial pressures, and rising patient demands are straining the system, according to a new survey conducted by YouGov on behalf of Siemens Healthineers.
The survey was released on July 29, during the Association for Diagnostics & Laboratory Medicine (ADLM) conference in Chicago.
The Dark Dailyrecently covered how findings at ADLM showed digital pathology trends are being slowly adopted in the US but how there’s a larger movement to connect patient care more directly.
The survey of 408 physicians, along with a parallel poll of 1,000 patients, reveals both how deeply doctors depend on laboratory professionals and how external pressures are reshaping testing decisions.
“Ninety-nine percent of physicians agree clinical lab testing is an integral part of the healthcare system,” the report states. Nearly all respondents said lab results are vital in informing treatment choices, with 98% noting they had modified a diagnosis or care plan based on test outcomes. As one physician put it, lab tests “help determine my actions” by providing crucial clarity in uncertain cases.
Doctors also reported that laboratory insights streamline the use of other healthcare resources. “Together, we help the health system and avoid unnecessary patient interventions,” one physician said, noting how test results often reduce the need for additional imaging or biopsies. In fact, 100% of surveyed physicians agreed that lab data helps them use other healthcare tools more effectively.
The Growing Strain on Labs
Despite reliance on labs, the collaboration doctors depend on is increasingly at risk. Clinical laboratory professionals manage more than 80,000 different tests across US facilities and generate roughly 14 billion results annually. Yet the workforce supporting this output is shrinking.
“When labs are short-staffed, it has a downstream effect on patient care,” 96% of doctors agreed. Another 94% expressed concern about healthcare staffing shortages more broadly. The problem is particularly acute in laboratories, where the number of training programs has dropped below 250 nationwide, leaving only about one lab scientist per 1,000 Americans.
Financial pressures are compounding the workforce issue. Though lab services account for only 4% of hospital costs, they are frequently targeted for cost-cutting. Consolidation and outsourcing have moved testing away from local facilities and toward centralized “dark labs,” largely operated by automation. While these high-tech labs maintain throughput, physicians caution that automation cannot replace collaboration. “In the age of automation, the human collaboration physicians depend on still counts,” the report warns.
Patient Demands Reshape Testing
Physicians are also feeling pressure from patients, many of whom arrive armed with information—or misinformation—from the internet. This rising “patient agency,” defined as the ability to influence healthcare decisions, is reshaping physician-patient interactions.
“Patient requests have forced me to weigh patient satisfaction against clinical judgment,” one physician admitted. Survey data shows 84% of patients expect their doctors to order requested tests, while 76% of physicians acknowledged ordering labs simply to satisfy those requests.
Zobair Younossi, MD, MPH, chairman, The Global NASH/MASH Council, said, “As a hepatologist dedicated to enhancing liver disease care, I believe that advances in laboratory testing are enabling us to ‘move the needle’ from liver biopsy toward blood-based biomarkers, allowing for earlier intervention through less invasive methods. For this shift to be successful, collaboration between clinicians and laboratory professionals is essential.” (Photo credit: MASH Alliance)
At the same time, 90% of patients said they trusted their doctor’s recommendation if the physician advised against unnecessary tests. Still, the survey underscores tension: while exploratory testing may placate patients, it can also create unnecessary costs and confusion. “Laboratory testing may be somewhat mitigating, though it can add unnecessary volume and expense for already overburdened clinical laboratories,” the report cautions.
The Hidden Role of Cost and Bureaucracy
Physicians also report external bureaucratic and financial pressures influencing test orders. About 32% said they had faced directives to reduce testing, while only 37% had visibility into the cost of lab tests they ordered. That number dropped further when asked about insurance coverage.
“Inadequate healthcare coverage may prevent patients from getting the appropriate level of laboratory testing,” the report notes. Among doctors who do know test costs, 60% admitted delaying orders due to expense concerns. From the patient side, 29% of respondents reported unpaid medical bills, with more than half saying their debt included lab testing fees.
Physicians are caught between avoiding unnecessary spending and protecting themselves from malpractice risk. Nearly 70% cited fear of being sued for misdiagnosis as a top concern, and 92% said they consider whether lab testing might reduce that risk. As one doctor put it, “Errors that negatively impact a patient’s care weigh heavy on my conscience and affect my mental health.”
A Call for Stronger Collaboration
Despite these pressures, doctors remain clear on their priorities. “Ninety-five percent agree that ordering tests to validate a patient’s care plan is their priority over conserving resources,” the report found. To achieve that, physicians want stronger ties with clinical lab professionals.
More than half—55%—said they heavily rely on lab experts to confirm which tests are most relevant, while 96% said they welcomed feedback from laboratory colleagues to improve ordering practices. “Physicians say clinical laboratory professionals are essential partners in delivering high-quality patient care, but a shrinking laboratory workforce may threaten the collaboration doctors rely on for clinical clarity,” the report concludes.
The Future of the Lab
Looking ahead, the report raises the question of whether the rise of automation-heavy dark labs will be a temporary solution or a permanent shift. For many doctors, the fear is losing the human expertise that helps interpret increasingly complex test menus.
“What physicians want are clinical partners and greater access to skilled professionals whose clinical insights help inform their patient care decisions,” the report states.
Without reinvestment in labs and workforce development, patients may face longer wait times, higher costs, and reduced trust in the system.
Ultimately, both doctors and patients recognize the centrality of the lab. The challenge now, as the survey shows, is ensuring those professionals are supported. “Recognizing laboratory professionals as collaborative clinical partners, and resourcing clinical labs as essential infrastructure rather than cost centers, is vital to safeguarding the important clinical support physicians rely on,” Siemens Healthineers concluded.
Noted Author lauds the quiet professionals working in the world’s laboratories
Seldom do laboratory professionals get the recognition they deserve each day for their role in protecting the public health from spread of disease. Now, with the specter of an influenza pandemic hanging over the world, CNN Contributor Bob Greene suggests it is time to pay homage to what he describes as our unsung “heroes in lab coats.”
Writing yesterday in a commentary on the CNN Web site, Greene observed “Right now, as the eventual path of the swine flu emergency remains uncertain, the world is beginning to turn its pleading eyes in the direction of men and women whose names and faces we don’t even know. The wider world seldom gives them a thought until suddenly we realize that we need them.”
Powerful, fast-moving trends are propelling pathology and radiology toward personalized medicine
February 11, 2009
It is no exaggeration to characterize the advances in molecular technologies as a huge “molecular asteroid” on a target path to smash Planet Pathology and Planet Radiology. That is the collective wisdom shared by experts speaking here in Philadelphia yesterday and today at the second annual Molecular Summit on In Vivo and In Vitro Integration.
This important conference, produced by The Dark Report, is the only global event which brings together innovators in the fields of molecular imaging, molecular diagnostics, and health informatics to share their progress on establishing integrated diagnostic and therapeutic services for clinicians and patients. Yesterday’s podium fireworks offered attendees impressive insights on the current level of molecular transformation underway in molecular imaging and molecular diagnostics-along with a impressive consensus on the future for these diagnostic areas.
For example, keynote speaker George Poste, DVM, Ph.D., Chief Scientist and Director of The Biodesign Institute of Arizona State University, laid out a compelling argument that personalized medicine is an unstoppable trend. Poste, a leading international expert on biomarkers, declared that multi-modality diagnostics will play an essential role in how healthcare evolves toward a pro-active healthcare system organized to serve the needs of personalized medicine.
Of particular interest to pathologists and laboratory professionals, Poste characterized the field of diagnostics as rapidly organizing around multiplex, automated, miniaturized assays, amid plenty of chaos as new science and technologies upset long-standing practices in laboratory medicine. He illustrated this chaos by noting that “there are approximately 157,000 biomarkers in the literature with some claim of validity. These biomarkers were developed mainly in academic settings and are supported mostly by anecdotal evidence.”
Throughout the day, experts at the Molecular Summit podium stressed several common themes about how molecular imaging and molecular diagnostics is transforming. These are valuable insights for the many pathologists and radiologists who work in community hospital settings and don’t often have the opportunity to participate in conferences such the Molecular Summit on In Vivo and In Vitro Integration:
* Personalized medicine is already happening. It is not an idea, but is now an active trend in the American healthcare system.
* There will be swift progress to move away from single-analyte assays (such as potassium and chloride) and single biomarker tests (such as HER2/Neu) in favor of multi-analyte assays. Microarrays with their tens of thousands of data points are just one example of how diagnostics is incorporating huge amounts of measurement points.
* Multi-modality disease assessment will become the norm. Molecular imaging, molecular diagnostics, and other relevant clinical data sets will be pulled together and assessed. Diagnosticians will then provide an integrated answer to the clinicians. This integrated answer will address diagnosis, therapeutic options, and patient monitoring.
* In anatomic pathology, technology will make it possible to extract quantitative data from specimens. The technology will reduce human variability in assessment of the specimen and will provide richer information for diagnosis, to guide therapeutic decisions, and patient monitoring.
Dark Daily will provide more insights from this Molecular Summit, which continues through the end of today. As noted above, there is strong consensus among the speakers that a transformation of diagnostic services is underway. Such a consensus among numerous experts in molecular imaging, molecular diagnostics, and health informatics is, by itself, confirmation that a major trend is unfolding.
Armed with this understanding, it explains why the metaphor of a huge molecular asteroid striking Planet Pathology and Planet Pathology is apt. Look for additional intelligence about the presentations and insights emerging from this year’s Molecular Summit!
Your Dark Daily Editor,
Robert L. Michel
Related Information:
2009 Molecular Summit on In Vivo and In Vitro Integration
Findings of a recent study on laboratory test ordering confirm what is widely-known by laboratory professionals across the globe. In the United Kingdom, many junior doctors do not understand common hospital laboratory tests and are putting patients at risk as a result. This was the primary observation of UK biochemists in a recently-published study.
Dr. Trevor Grey from the Northern General Hospital in Sheffield, England surveyed 80 junior doctors, asking them how they felt about the clinical biochemistry tests they were expected to order on a daily basis. His findings were published as “Learning Needs in Clinical Biochemistry for Doctors in Foundation Years” in the January 2008 issue of The Annals of Clinical Biochemistry. The article reported that one in five (18%) of more than 80 junior doctors surveyed were happy to order a test they could not fully interpret. The article, along with an editorial piece by Dr. Danielle Freedman of the Association of Clinical Biochemistry, blamed both poor teaching and a reduction the amount of pathology and laboratory medicine taught at medical schools.
When asked about 12 common lab tests, junior doctors questioned during this survey said they were not entirely confident about interpreting the results for 10 of them. For three common types of lab tests, more than one-third of the junior doctors surveyed said they were not confident about interpreting the results. 18% of the junior doctors said they were happy to order a test which they did not fully understand how to interpret. Seven out of 10 junior doctors said they would find more teaching in biochemistry to be useful.
In Freedman’s editorial, she said the results revealed “a national problem” in the UK. She knew of situations where patients were discharged from a hospital, only to suffer a major heart attack because a key laboratory test had either not been ordered or the results had not triggered an appropriate clinical response. The UK’s General Medical Council is currently preparing to review its guidance on the content of medical education.
Across the laboratory medicine profession, there is recognition that time devoted to pathology and clinical lab testing in medical school is often not adequate to teach new physicians to be: 1) both competent and confident in ordering the right tests at the appropriate time; then 2) responding to the lab test results with the correct, recommended actions. Efforts to constantly improve patient safety will eventually evaluate and assess how young physicians are using laboratory tests. It will take a few more years for that to happen.
However, when real-time data is gathered that links errors in patient care to inappropriate ordering of lab tests and improper response to test results by young physicians-who were not properly trained during their medical education-only then is it likely that healthcare systems in the UK and other countries will take active steps to remedy this long-recognized deficiency.
