[Problems in the management of clinical laboratories in Japan].

In Japan, laboratory automation has spread over the last two decades. Laboratory automation has saved time and labor for routine sample tests in clinical laboratories, and contributed to the downsizing of the division. This "contribution" resulted in re-arrangement of the work-force, namely, shrinkage of the blood chemistry division and expansion of the physiological tests and diagnostic imaging division. Some may call this re-arrangement as an adaptation for survival. However, I am concerned that extreme adaptation may cause irreversible shrinkage of clinical laboratories and laboratory medicine itself. In fact, outsourcing of sample tests including microbiological tests has become very popular over the last decade. Since the cost for microbiological tests is suppressed by the national health insurance policy, it is becoming difficult to keep microbiological laboratories in small-scale hospitals. The presence of a microbiological laboratory in a hospital is crucial for prompt and appropriate therapies for infectious diseases, and is essential for advanced infection control activities. The government is pushing forward fixed-term employment in national universities and hospitals, threatening long-term career planning for medical technologists. We have to keep in mind that nurturing medical personnel with special skills and extensive knowledge is mandatory to university hospitals, and laboratory medicine is crucial to the progress of modern medicine.