Physician office laboratory education and training in primary care residency programs.

OBJECTIVE: To assess the status of office laboratory residency education and training in family practice, internal medicine, obstetrics and gynecology, and pediatric residency programs. DESIGN: A single mailed survey to 1299 residency programs from December 1992 to February 1993. PARTICIPANTS: Primary care residency directors from 507 (39%) of 1299 programs. INTERVENTIONS: A 27-item survey of residency-based office laboratory practices, education, training, and resources. MAIN OUTCOME MEASURES: Differences between specialties in provision and quantity of office laboratory education and training, presence of a residency-based office laboratory, laboratory classification under the Clinical Laboratory Improvement Amendments, and available laboratory tests. RESULTS: Of those responding, office laboratories were present in 89% of family practice, 19% of internal medicine, 29% of obstetrics and gynecology, and 24% of pediatrics residency programs. Laboratory training was available at 60% of family practice, 16% of internal medicine, 15% of obstetrics and gynecology, and 30% of pediatrics programs. The median number of hours of formal skills training was 10 hours for family practice residency programs but less than 2 hours for the other specialties. Only 25% of the programs reported educational assistance from pathologists. Merely 4% of the programs had postassessment examinations and 2% awarded certificates of achievement. A majority of family practice programs performed waivered tests and physician-performed microscopy tests, but moderately complex tests were performed in less than 50% of family practice programs. CONCLUSIONS: Family practice residency programs provide more office laboratory training for residents than other specialties. There is a need for improved residency training in the basics of office laboratory practice.

Office lab equipment. Aids in selection and cost analysis.

Factors determining the setup of your office laboratory include your anticipated benefits, such as rapid turnaround time, ease of operation, accuracy, convenience to patients, and profit; the type and volume of tests done in your office; percentage of reimbursement received from third-party payers; office space currently available for a lab; additional training required for office personnel; and instrument selection. As a aid in determining cost analysis of necessary equipment, the author provides work sheets for evaluation of various brands of instruments, calculation of your break-even point following purchase of equipment, and revenue analysis.

The office laboratory. A boon to your practice? Or a burden?

Many primary care physicians are finding it convenient and productive to set up their own office laboratories. Such on-site labs answer many needs, but there are also potential drawbacks. All the pros and cons involved in such a venture are described: Increased efficiency in patient care may be counterbalanced by the irritation generated by reimbursement control and governmental regulation. For those who wish to proceed with this project, the author offers sound step-by-step advice.