Value-added laboratory medicine in an era of managed care.

Clinical laboratory consultants (M.D.s and Ph.D.s) must add value and medical relevance to the healthcare system to earn and maintain their roles in an era of managed care. Service opportunities include new and expanded roles in system-wide (a) managing of point-of-care testing, (b) informatics and information systems, (c) clinical consultation, (d) resource management, (e) management of utilization, (f) improving healthcare quality assurance, and (g) technology assessment and implementation. Hypothesis-driven research focused on the linkage between the laboratory and outcome analysis, clinical practice guidelines, total quality improvement, technology assessment, and healthcare policy provides major opportunities to complete for expanding research support. Changes in clinical laboratory consultant training are necessary to provide the knowledge, skills, and experience required to provide value-added and medically relevant services. Clinical laboratory consultants with Ph.D. degrees should initially be trained broadly in all areas of the laboratory, with emphasis on system-wide issues, and then trained as specialized scientists.