Assessing the survival of an MT school - medical technology

Medical Laboratory Observer, Jan, 1989 by Beth R. Cepil

With an eye on their budgets, laboratory administrators have become increasingly sensitive to the issue of balancing clinical services with educational activities, particularly in institutions that sponsor formal hospitalbased medical technology programs. Every year MT program directors must explain how their activities can be maintained in an environment of cost-contained laboratory services.

Between 1983 and 1988, a total of 173 accredited medical technology programs closed, according to the American Medical Association's Committee on Allied Health Education and Accreditation. In the last academic year alone, CAHEA reported 44 closings, leaving 465 MT programs across the nation. An additional 46 programs became inactive (no enrollments) or were about to close.

Program directors blamed the closings on a combination of factors: prospective payment and other Federal health care policies, budget restrictions, a dearth of suitable applicants, and lack of opportunities for graduates in their local areas. Now, however, the national shortage of competent medical technologists is causing programs to carefully consider the option of remaining open.

Our medical technology program, like many others, has been subject to a number of pressures. In the spring of 1986, management of our newly consolidated laboratory organization questioned the need for our hospital to sponsor a medical technology program, the program's cost, and the laboratory's commitment to the MT program.

The laboratories of 350-bed Allentown Hospital and 450-bed Lehigh Valley Hospital Center had merged into HealthEast Laboratories, an unincorporated division of the hospitals. These were the first departments in the two institutions to combine. (The full merger of the hospitals was completed Jan. 1, 1988; they still exist as two sites, however.)

Our students rotated through laboratory sections in both hospitals, which are four miles apart. The Allentown campus provided training in blood banking, endocrinology, immunology, toxicology , and Stat laboratory services. Lehigh Valley Hospital has its own blood bank, along with automated chemistry, hematology, coagulation, and microbiology sections.

A laboratory education task force-consisting of the MT program director, the laboratory director, three technical supervisors, and three staff technologists-gathered data for laboratory management so it could make a well-informed decision about the future of the medical technology program.

Many laboratories have managed to save their programs by demonstrating the value of their school and services through cost analysis. Our task force ordered a three-phase needs assessmenta cost-benefit study, information about lab staff commitment to the MT education program, and a report on laboratory staffing trends in the area.

The first phase, a complex analysis of costs and benefits, used laboratory education data available from a recent hospitalwide educational inventory. The hospital finance department and a time management engineering firm, which coincidentally was completing studies for various departments in our institution, provided additional information and expertise.

The analysis was based on expenses incurred during the August 1985-July 1986 academic year (see Figure 1). Direct costs of $99,274 included the amount of salary and benefits represented in teaching time, lecture preparation time, the program director's management time, and clinical super vision of students, along with outlays for materials and travel to educational meetings.

Costs in the category of clinical supervision are difficult to estimate because instructors engage in revenue-producing activities during their contact with students, students also engage in such activities after initial training, and the workload and nature of the work varies dramatically between laboratory sections.

We got at these costs by estimating the decrease in productivity due to teaching. The time management firm estimated that an instructor's productivity will drop by 40 to 60 per cent at the beginning of a student clinical rotation. As the student becomes functional and less supervision is required, the average decrease in productivity will be 20 to 25 per cent. Note that this is an average figure for all sections.

A 25 per cent decrease in productivity translates into one hour and 15 minutes of service required to perform one hour of service work. The labor dollars attached to the additional 15 minutes reflect the cost of clinical education.

Indirect costs were estimated at 45 per cent of the program's net direct cost (direct costs minus $6,400 in revenue from eight students' tuition payments), or $41,793. This included allocations for depreciation, general administration, housekeeping, general building operation, and so on.

Among the intangible benefits to be factored in was the money saved by not having to recruit and train new graduates from an outside MT school. We estimated a $540 cost for advertising a technologist's job, interviewing candidates, and orienting the new hire (recruitment costs and salaries run much higher today because of the laboratory staffing shortage). In addition, there was the $2,717 cost of the new technologist's time, at $11.32 per hour, during the six weeks of orientation in our laboratory. That brought the total cost to $3,257 for developing a productive new employee from an outside school.