Case for the Clinical Doctorate in Laboratory Science, The

Clinical Laboratory Science, Summer 2005 by Doig, Kathy

The more dramatic difference between Figure 1 and Figure 2 is the addition of an advancement opportunity in clinical practice by the creation of a clinical doctorate in laboratory science - DLS. This individual would assume the role described above of a consultant to physicians and other care providers. The DLS would be part of an in-hospital attending physicians and physicians in training. The DLS would be an extension of the laboratory staff with the explicit role of helping to insure proper laboratory utilization. The expected benefits would be improvements in both the preanalytical and postanalytical aspects of testing. These have the potential to reduce costs by improved utilization of services. Improved diagnostic efficiency that leads to more appropriate treatments and reduced lengths of stay when useful data is generated more quickly, can be expected. In short, the DLS would be a contributor to better patient care overall. DLSs will conduct practicebased research on laboratory services utilization and impact on patient outcomes and costs to substantiate the value of a DLS in patient care.

THE CHALLENGES TO IMPLEMENTATION

There are forces that will resist such advancement for the clinical laboratory professions, producing challenges to be overcome:

* doctoral-level laboratory scientists, especially clinical chemists, already believe they should provide this service.12,13 Yet their research oriented education and limited scope of laboratory expertise fail to prepare them for the clinician role. They recognize that a generalist background is needed as a foundation for effective consultation. Examine the conference topics for their annual meetings and it is evident that they are learning via continuing education what certified CLTs and CLSs learn in their undergraduate academic programs.

* pathologists may resist this advancement as they provide this kind of consultation, but typically only at the request of the physician. The ready availability of a DLS who does not have other responsibilities for laboratory service, on the inpatient areas and in the clinics could be seen as competition for pathologists. Yet some pathologists may see this as a valuable extension of the laboratory's services. They will need to be recruited to convince their colleagues of the DSLs value.

* the patient care role must be recognized by third-party payers for reimbursement for the services.

* educational programs must be developed and will experience a period of time in which faculty will not be qualified themselves as DLSs. Rather a cadre of experts with knowledge in various areas will need to be collected to train the first true DLSs. Over time, DLSs will assume educational roles in academic programs at which time the profession will have truly matured.

* states will need to license and recognize the patient care, e.g., clinician role, of these individuals.

* funding for a demonstration project to document the value of this role in the healthcare team will need to be found. We should not wait for a curriculum to be developed and for the pioneering students to complete it. Rather a group of certified, experienced, seasoned professionals should be recruited to a fast track program that would quickly demonstrate the value of such personnel even without validation of a DLS degree. The development of the PharmD demonstration project provides a model to follow.14 This is needed to convince prospective employers that they need these individuals. They will create the demand that then will convince educational institutions to invest in developing the programs to educate DSLs (Figure 3).