I just returned from the G2 Intelligence Lab Institute conference in Washington, DC, and was struck by the dedication and persistence of laboratory executives despite seemingly insurmountable odds. Lab industry challenges grow each year, with impending PAMA reimbursement reductions now added to the mix of bundled payments, narrowing insurance networks, ACOs (accountable care organizations), and industry fragmentation. Laboratory is involved in 70 percent of patient management decisions and represents only three percent of the costs, yet it is targeted for a disproportionate amount of cost reductions by the government and other payers. It strikes me as a sort of modern existentialism.
The Merriam-Webster dictionary defines existentialism as “a chiefly 20th century philosophical movement embracing diverse doctrines but centering on analysis of individual existence in an unfathomable universe and the plight of the individual who must assume ultimate responsibility for acts of free will without any certain knowledge of what is right or wrong or good or bad.”
I see some traces of existentialism in the challenges of healthcare today. Being in middle management in healthcare definitely qualifies as unfathomable. It’s worse than being in the executive ranks, because executives at least have some measure of control over decisions, and it’s worse than being in a non-managerial staff role because they just do their jobs and let everyone else do the worrying.
Laboratory executives are stuck between a rock and a hard place:
- They have the plight of executing on mandates from above with a staff that doesn’t want anything to change.
- They do the impossible every day, year after year. No matter how impossible, they find a way of doing more with less.
- They assume responsibility for making healthcare better in an environment where no one really knows what is good or bad, right or wrong.
Another thing that is not so existential: they struggle through the unfathomable quietly, behind the scenes, and without fanfare! This behavior is particularly characteristic of laboratorians—no whining, no patting themselves on the back, no grandstanding.
Because of their quintessential “can do” persona, it’s easy to forget or ignore the contribution of laboratorians. I know you don’t get much recognition. Only those absolutely committed to helping patients would endure this conundrum. I walked in your shoes 20 years ago, but I am honestly not sure I could do it today. I see what you do as an objective outsider, and I applaud you and your efforts.