Current status of US programs for training clinical laboratory scientists and anticipated impact of healthcare reform

We surveyed directors of medical technology (MT) and postdoctoral clinical chemistry (CC) training programs and of clinical pathology (CP) and combined anatomic/clinical pathology (AP/CP) residency programs regarding the number, quality, training emphasis, and job-placement experience of trainees for 1985-95 as well as the directors' opinions on the impact of "healthcare reform." Responses were received from directors of 94 of 249 (38%) MT programs, 14 of 15 (93%) CC programs, and 63 of 138 (46%) pathology residency programs. In all four categories the numbers of trainees have increased steadily over the last 5 to 7 years but are expected to remain stable or decrease slightly. Directors of MT and CC programs expect increasing difficulty placing their graduates; directors of AP/CP and CP residency programs do not. Although > 60% of MT graduates have entered private hospitals, this is anticipated to decrease, with a concomitant increase in university hospital placements. Of the AP/CP residents, > 60% and < 5% accepted service- and research-oriented positions, respectively. In contrast, 83% of CP residents entered university hospitals, with half of these taking research-oriented positions. Among CC graduates, 41% joined university hospitals and 10-15% accepted positions in each of either private hospitals or industry or reference laboratories. The emphasis of training varies, with clinical service and pathophysiology the major focus in AP/CP programs. CP and CC programs take two distinct approaches--some accentuating management, and others emphasizing research. Finally, MT program directors appear the most optimistic regarding the opportunities that healthcare reform may present.