From speaking to a very small sampling of folks lately, it seems to me that the small, one cytotech lab could be in trouble due to the cost of the proficiency testing as it stands now. Maybe with CAP and ASCP adding their own in the future, this may change but I see a possible elimination of positions with hospital labs with fewer than 10,000 paps and/or mostly Non-GYN cases.
With this forum, I would ask if anyone has heard the rumblings yet where they work. I don't see how screening will be improved if only the large labs can afford to do it and local slides have to be sent out. I thought CLIA'88 was meant to reduce our dependence on low-quality MEGA-labs and now it may end up feeding into them!
I know some of you at these large labs will disagree and the expense can really hit home for you also.
I think pathologists will have to be creative in certain geographic areas with low population that are isolated somewhat and have several small labs scattered about. I could predict the coming of more regional cooperative labs to save on these fees. There have been those among us who have advocated these kinds of mergers for many years and now I think the time may be ripe.
Please post if you see a move in this direction in your area.