Evolving concepts of the role of pathology and their respective dilemmas.

Remarkable changes are affecting the discipline of pathology. Variety and volume of testing, new instrumentation, personnel matters, economics, and government are effecting these changes. Laboratory costs and charges have been confused and in hospitals, laboratories are changing from revenue centers to cost centers. Twelve principles upon which physician payment emphasize productivity, quality, efficiency, and variety. Seven competency characteristics of a clinical laboratory director stress administration, strategic planning, laboratory test use, communication, education, and research and development. Relationships with physicians' office laboratories, the likelihood of overproduction of laboratory personnel, fundamental problems of competition, and the rationing of human life pose additional dilemmas.