Volume 65 - Winter 1996	Download

Multisite case study of CLT/MLT-AD program closures by Nancy C. Johnson, PhD, MT(ASCP) CLS/MT Program Director, Walter Reed Army Medical Center

One thing of which we can be positive, regarding health care in the nineties, is that change is here. Even though the Health Security Act did not pass in the 103rd Congress, the health care industry has been independently making sweeping changes in the way it does business (Beason, 1994; Tolbert, 1994). Managed health care is the wave of the future. As the health care arena is undergoing this evolutionary change, the community college, which produces the majority of entry level allied health professionals (Soto, 1994), is certain to be affected by it all.

CLT/MLT AD programs came into existence in the late 1960s to meet the changing healthcare workforce demands for increased specialization of skills. However, recent health care economics appear to have swung the pendulum in the opposite direction. Specialized skills are no longer the driving force of allied health (Nielson, 1994).

Although the number of NAACLS accredited CLT/MLT AD programs increased to 225 in 1996, there were programs that were closing. A survey of laboratorians (Guterl, 1995) indicated 31 percent of the CLT/MLT educators surveyed noted a decrease in program enrollments in the previous two to three years. Between 1992 and 1996, 19 (or eight percent of) NAACLS accredited CLT/MLT AD programs closed, although 28 programs were initiated. Many programs continued to thrive in the face of competitive pressures, but others were unable to adapt.

What led to closure of these CLT/MLT AD programs? One can speculate, but changing external environmental conditions need to be considered. Between January and July 1996, research was conducted to determine the reasons for the 19 closures. Possible factors responsible for these closures were considered. These factors included: federal regulation of clinical laboratories; technological advances in diagnostic testing leading to exportation of testing from the laboratory, and a changing manpower demand in managed care for multi skilled versus specialized health care workers. The study drew upon the techniques of exploratory research in the form of multisite case studies of the 19 programs. It included interviews of college administrators, a survey questionnaire plus a review of college documents to develop adequate descriptions and connections of the variables leading to program closure.

One college declined to be interviewed; one college maintained a CLT/MLT AD program, though it was no longer accredited; one college hired new administrators and had no historical documentation, and one college closed the program in 1992 but re instated it in 1993. Fifteen of the 19 programs participated in this research. An institutional mission change was determined to be a factor in the closure of programs but not considered unique to CLT/MLT AD programs. Two programs closed due to a change in the college's mission. Decreased enrollment and cost of maintaining a declining program were given as the external factors most influential in the closing of CLT/MLT AD programs. Job market change was most often noted as the reason for low enrollments. The Clinical Laboratory Improvement Amendment of 1988 (CLIA'88) did not emerge as a factor which respondents considered influential in the future of CLT/MLT AD programs. Some college administrators were not even aware of the legislation. This is in contrast to Guterl's (1995) survey of laboratorians where 57 percent of respondents indicated they felt CLIA '88 had hindered the profession.

From the responses, patterns emerged which indicated that managed care manpower and technological advancements in diagnostic testing appear to be factors impacting the future of CLT/MLT AD programs. These responses corroborate studies by the Bureau of Health Professions and the Pew Health Professions Commission (1995) as well as other studies from the early 1990s. A decrease in the number of clinical affiliates for student training was mentioned as an emerging concern. Some respondents indicated that downsizing in hospitals led to decreased staffing patterns and decreased training spaces. Some also mentioned that, given a choice, hospitals would provide the training spaces to baccalaureate degree CLS/MT students versus CLT/MLT AD students.

The results of this research suggest that health care reform will require community colleges to evaluate their allied health programs so that they reflect a redefinement of the duties and skills of current fields. In addition, college administrators will need to be flexible in addressing these changes.

References:

Beason, C. (1994, August). A department of veterans affairs perspective. In The Bureau of Health Professions and the Pew Health Professions Commission, The Future of Allied Health Perspectives From the Field (pp. 5 16). San Francisco, CA: UCSF Center for the Health Professions, 1995.

Guterl, G. (1995). Advance survey confirms laboratories stressed over profession in state of flux. Advance for Medical Laboratory Professionals, 7 (23), 8 9, 20 21.

Nielson, G. (1994, October). Changing educational needs for entry level graduates and for professionals in the workplace; perspective from a hospital based allied health education program. Second symposium on The Future of Allied Health Perspectives from the Field. (pp. 217 238). Conference sponsored by the Bureau of Health Professions and the Pew Health Professions Commission. San Francisco, CA: UCSF Center for the Health Professions, 1995.

Soto, C (1994, October). The education of allied health service workers: The Two Year community and technical college. Second symposium on The Future of Allied Health Perspectives from the Field. (pp. 240 255). Conference sponsored by the Bureau of Health Professions and the Pew Health Professions Commission. San Francisco, CA: UCSF Center for the Health Professions, 1995.

Tolbert, B. (1994). An integrated networks perspective. Second symposium on The Future of Allied Health Perspectives from the Field. (pp. 117 126). Conference sponsored by the Bureau of Health Professions and the Pew Health Professions Commission. San Francisco, CA: UCSF Center for the Health Professions, 1995.

Dr. Johnson is the CLS/MT Program Director at Walter Reed Army Medical Center

This article is based on the doctoral dissertation written by the author. Additional information related to this study may be obtained from the author: (202) 782 0733.

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