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For Rojeet Shrestha, PhD, MLS(ASCP)SC, FAACC, FACSc, Technical Director, Patient Choice Laboratories in Indianapolis, the laboratory will always be central to medicine, and the people who work in the laboratory are “true behind-the-scenes heroes in patient care.” He recognizes that the young laboratory professionals of today are the pillars of the future of laboratory medicine—and what a bright future it is. Here, Dr. Shrestha shares what drew him to the field and the challenges the laboratory faces.  

What initially drew you to the field of laboratory medicine and inspired you to pursue it as a career?  

While most of my friends were preparing to enter medical school in the final year of high school, I have never heard about university programs in medical laboratory sciences. When I had a fever and visited a hospital, the doctor wanted me to do a blood test, and based on that he told me that I had typhoid. With a couple of doses of medicine, I quickly recovered. It didn't take me long to realize how important laboratory sciences are. At that time, there was only one university medical laboratory sciences program in the entire country (Nepal) that enrolls only four high school graduates making admission highly competitive. Fortunately, I was able to enter the Medical Laboratory Sciences program at a University in India. The more I learned about it, the more I became fascinated with the profound implication of laboratory sciences in healthcare. As a result, I graduated from the program with the top rank with a distinction grade. After a couple of months of experience as a Med Tech in a general hospital, I joined a Leprosy Hospital that shaped my entire career. Nothing is more satisfying than to serve poor, socially stigmatized patients. I realized the need for laboratory advancement in the proper diagnosis of mycobacterial diseases. My fascination with laboratory medicine deepened with my involvement in several research projects in developing rapid tests for diagnosis of leprosy and tuberculosis. It was such a great opportunity to learn highly sophisticated techniques of molecular diagnostic, in vitro lymphocyte stimulation, mycobacteriophages assays, mouse footpad cultures, and more. By that time, at the age of 22, I was fully determined to be a laboratory professional for the rest of my life.  

What impact do you hope to make through your work in this field?  

The quest for improvement for better healthcare is a never-ending process. I will continue to apply my knowledge in mass spectrometry in biomarker discovery and developing assays. In the assay development, I give equal priority to making the method technically simple, rapid, economic, and environmental-friendly in addition to analytical performance. Recently, I developed a mass spectrometric method for a urine drug test that can simultaneously identify synthetic urine, which is widely available in online markets to cheat the system. I hope to develop assays to evaluate the biomarkers of lipid oxidation for better risk stratification of cardiovascular diseases that goes beyond and above the current cholesterol testing.  

What do you see as the biggest challenges facing the laboratory in healthcare today?  

Proper test utilization and decreasing reimbursement is one of the biggest challenges that laboratories are facing. Expenditures for healthcare in the U.S. were approximately $4.1 trillion in 2020 which is an increase of 9.7% from 2019 and it accounts for 19.7% of total gross domestic product (GDP). It is estimated that about 60-70% of all clinical decisions are based on the results of laboratory testing indicating over $1.2 trillion of healthcare spending is influenced by laboratory testing. Approximately four to five billion tests are performed annually in the U.S. Unfortunately, it is estimated that at least 20% of lab orders submitted annually are inappropriate. Since 2015 I have been collaborating with Laboratory Decision System (LDS) to develop artificial intelligence and algorithms to aid providers in choosing the right test for the right diagnosis and management. The platform helps providers choose the right test, the laboratory to receive the correct orders with appropriate ICD codes, and payers to determine medical necessity based on a unique scoring system. I believe that these are some areas where laboratory professionals can bring revolutionary change to fill the quality gap in test ordering and utilization.