The age-old question…what do I want to do when I grow up? Previous posts have focused on clinical chemist positions in an academic medical center (Mark Cervinski) and a private physician organization (Laura Parnas). I’ve been asked to represent the national reference laboratory setting.

Not surprisingly, I am also going to agree with the previous posts in this series! Our environment is somewhat unique, in that we are employed as faculty by the University but physically work (‘consult’) in a formal reference laboratory setting. Our labs also support the University hospital system, which makes us similar to the traditional hospital lab (but just down the street a bit). Therefore, we are exposed to many of the aspects discussed in the previous posts all at once: we maintain traditional academic responsibilities while directing high volume laboratories and ensuring quality patient care. Similar to many of the points brought up by both Mark and Laura, we are responsible for reviewing quality control, maintaining and reviewing operating procedures, consulting and answering client questions or concerns, teaching fellows, residents, and medical students…all while finding time to publish our research or clinical findings. So I will move beyond these common points and introduce you to some of the things that make a reference laboratory unique.

One unique aspect of the reference laboratory setting is the sheer size of our testing volumes and assay menus. There’s a lot to juggle! Of course, there are also more medical directors on staff, so you are able to focus your efforts on a specific topic or testing area. Our larger size also means we utilize larger testing platforms from many different vendors. Our large assay menus mean we use many different types of instrumentation that you wouldn’t see in a traditional laboratory. Our national presence means that many other labs look to ours for best practices and procedures, reference intervals, instrumentation issues, etc. As a medical director of a laboratory serving such a large patient population, changes that you make affect many other labs and many patients. Therefore, the repercussions of these changes need to be carefully considered and fully vetted. Large testing volumes also mean that what may start as a small problem can become a big problem very, very fast--in the blink of an eye, hundreds of test results have been generated. The implications of that are huge, thus quality is a main priority. All of this makes for a very satisfying work environment for those that love a challenge.

One of the biggest differences in a reference lab is also one of the more practical points…our specimens don’t come from patients that are laying in beds just a few floors above us, or have stopped in to our outpatient clinics for routine appointments. Most of our specimens come from all over the United States, which brings about certain challenges. Trying to identify pre-analytic variables or make changes to collection procedures to improve laboratory testing can be difficult. If you are questioning whether a specimen was collected correctly, you can’t just run upstairs and talk with the phlebotomist. Also, we often don’t receive any additional patient information, such as a diagnosis or even what other laboratory test results look like for that patient. This can make further investigations difficult. On the flip side, although I make myself available for technical concerns at any time, most of our testing is not of an “urgent” or “stat” nature, so there is no formal on-call responsibility

This type of lab setting also affords me the opportunity to be involved numerous projects and studies that might not be available in a traditional hospital laboratory. We partner with vendors to support their clinical trials and FDA submissions for new tests and instrumentation. We participate in multi-center studies and product evaluations. I’ve found it quite satisfying to know that we are helping to make new assays and technologies available by making sure they perform as they should.

As you may imagine, we are also responsible for bringing on new tests that offer clinical utility to our patients. This means we get the chance to play with the newest technologies and toys. Selecting new tests and methodologies, designing experiments to validate them thoroughly, or developing new assays from scratch are all common occurrences in this type of laboratory.

A few of the things that attracted me to this type of position included being part of a team of medical directors, having access to R&D resources, wide and varied testing menus, and exposure to multiple instrumentation platforms. I also like the duality of this type of position—maintaining academic responsibilities along with clinical duties. I’ve hit only a few of the highlights of the daily activities in a reference lab, but hopefully this gives an overview of the unique challenges that make this an exciting environment. Most clinical chemists will tell you “every day brings something different…” and that’s definitely true in the reference laboratory environment.