Commercial (for-profit) laboratories
Large commercial enterprises, regional and national in scope, are harvesting as much of the nation's supply of small biopsy samples as they can muster. Their sales forces are out and about, persuading physicians and their administrators to send their specimens to these laboratories. The desired specimen types are all small, and include biopsies from the prostate, gastrointestinal tract, skin, and so on. Some teaching hospitals are doing so-called outreach, and some are probably doing better at this than others. However, I imagine that few are interested in or even capable of competing with the mega-giants. Just as ambulatory care is being driven from hospitals, so are the small (uncomplicated, income-generating) biopsies being sucked from the teaching institutions, leaving academia with the bulky, Time-consuming, and more complex material. As small biopsies become less available in the teaching centers, the question will arise as to how the skill in interpreting these specimens will be transmitted to future trainees. Will private laboratories fulfill this role? If so, will they (can they?) be configured to meet the requirements of accreditation? I do not know the answers to these questions.