Commercial pathology lab expands to four-state area

When a doctor or nurse draws blood or takes a tissue sample at a hospital or clinic in mid-Missouri, the samples and specimens are likely to end up being tested at Boyce & Bynum Pathology Laboratories, a 42-year-old Columbia-based business owned by 10 physicians.

“We are the doctors behind the doctors,” said Dr. Robert Cheek, associate medical director and a co-owner of Boyce & Bynum. “We are behind the scenes for most surgeries or diagnoses.”

Boyce & Bynum, or BBPL, now employs 400 people and operates in four states. It is the largest independent medical laboratory facility in Missouri and one of only a handful in the entire country.

At a time when health management organizations and mega medical corporations are merging and swallowing up small to mid-size practices throughout the country, the leadership at Boyce & Bynum is determined to remain independent.

“Think of our lab as a physician practice,” says Dr. Michael Curry, medical director and co-owner. “Our philosophy is that we are a medical laboratory practice and not just another reference lab. Aside from Boone Hospital and the university, we are the largest physician practice in the area, and we are privately held.”

Boyce & Bynum is a pioneer in the field of independent laboratory development and was first established in 1965 by John Boyce and William Bynum, who recognized the need for a lab that could serve small hospitals like those in mid-Missouri. Although Boyce and Bynum are now both deceased, their legacy continues.

“Bynum had a vision,” Curry says. “He started as a solo pathologist, and it’s grown from there.” Currently, Boyce & Bynum has 23 patient service centers and 21 physicians working in 19 different hospitals and clinics throughout Missouri, Oklahoma, Kansas and Arkansas.

The main reference lab facility is located at 200 Portland, just off of Keene Street, an area that has grown into a corridor for medical facilities. After outgrowing several smaller locations, Boyce & Bynum purchased the vacant Charter Hillside Psychiatric Hospital in 2002. The two-story, 57,000-square-foot facility sits on nine acres, and it required only moderate renovation to accommodate the laboratory requirements of Boyce & Bynum.

Approximately 250 employees work at the central location, which performs lab work 24 hours a day, seven days a week. “Sixty to 70 percent of the clinical work here is done overnight,” says Bill Thornton, clinical lab director for Boyce & Bynum.

Patient specimens or samples are collected at area hospitals, at clinics or at any of the 23 patient service centers in Columbia, Ashland, Centralia, Fulton, Jefferson City, Moberly, West Plains, Kansas City and St. Louis—as well as Arkansas, Oklahoma and Kansas.

To keep the supply chain going, Boyce & Bynum employs its own couriers and contracts with private courier services to deliver specimens or samples from the patient service centers throughout the state. “We use air carriers for our lab work coming in from nearby states,” Curry says.

Consequently, a steady stream of couriers delivers blue insulated packages of specimens or samples to the main Boyce & Bynum facility. The deliveries are labeled, entered into the data entry system, triaged by lab workers, then directed to the appropriate lab for testing. “We try to have a 24-hour turnaround time,” Thornton says. Some of the highly specialized machines that perform routine testing can accommodate up to 2,400 tests per hour, according to Thornton. Blood tests make up the majority of lab work.

Test results are then faxed, phoned or electronically transmitted to those requesting the tests. Depending on the type of test and the results, specimens and samples may be kept for several days or weeks, but most are discarded once the test results are complete. Special bio-hazard refuse removal is used to destroy or eliminate post-test materials.

Remaining on the cutting edge of technology and research is fundamental to the success of Boyce & Bynum. For example, a new method for testing Pap smears, called the “liquid based” method, allows for higher quality testing, and the DNA extracted from the cell nuclei can be utilized to test for genetic mutations, like cystic fibrosis, human papilloma viruses, or clotting factor mutations. “We were the first in this area to offer the liquid-based testing and associated genetic analyses,” says Cheek.

Each Pap smear first receives a computerized screen for abnormal cells, and then cytotechnologists rescreen each patient’s slide. For quality-control purposes, approximately 25 percent of the slides are then examined a third time. In addition, any suspicious cell findings outside the acceptable test parameters are referred to the pathologists for a fourth examination before results are reported. “Industry standards require only a 10 percent re-screen rate, but we exceed that minimum requirement,” says Curry.

According to Mitzi Marshall, executive assistant, advances in information technology are also important to the lab. “Although we still use paper and fax machines, now patients and physicians can interface via computers,” Marshall says. In addition, highly efficient and reliable computer bar-coding is used to identify and track each sample or specimen as it travels through the lab testing processes.

The physicians at Boyce & Bynum divide their time among administrative duties and pathology. Some of the physicians also hold teaching or research positions at the University of Missouri or perform duties at area hospitals. “Most pathologists don’t perform patient procedures, except for bone marrow biopsies and fine needle aspiration biopsies,” Curry says.

However, the pathologists at Boyce & Bynum cover the spectrum of specialty areas, allowing them to be a full-service laboratory.

Curry says one of the challenges of the lab industry is finding adequately trained lab personnel. “We have many long-time employees. In fact, our general manager has been here 38 years. But our medical technologists’ average age is approaching 50.” Curry says. To avoid a future crisis in recruiting employees, Boyce & Bynum is committed to its educational mission. “We’ve developed a collaborative training model for clinical laboratory scientists and our partners are the University of Missouri and the University of Nebraska Medical Center (UNMC),” Curry said.

Though historically they’ve been referred to as med techs, the new term for the highly trained specialists is “clinical laboratory scientist” (CLS). The CLS certification typically requires a four-year degree, including a one-year laboratory internship.

Boyce & Bynum is currently working with three students, who will graduate with CLS degrees in a few weeks. The next class of six to eight students begins in May. “The University of Missouri School of Health Professions provides recruiting assistance and UNMC provides the didactic curriculum,” Thornton said. Boyce & Bynum provides classroom space and the opportunity for clinical lab experience for the students. The company also offers its students Wi-Fi, video-streaming, Power Point and Real Time technology.

One of the reasons for the current shortage of lab workers with the CLS certification, Thornton says, is that the University of Missouri stopped offering a degree in medical technology after 1985. According to the American Society for Clinical Pathology, entry-level CLS positions can earn annual salaries between $35,800 and $45,700, with CLS supervisors earning up to $66,500.

Marshall says popular television shows based on scientists who perform lab work, like CSI or Bones have piqued recent interest in the field of lab science; however, raising awareness of the career opportunities at Boyce & Bynum remains an ongoing endeavor.

As the week of April 22-28 marks National Medical Laboratory Professionals Week, representatives from Boyce & Bynum will visit career centers to spread the word regarding careers in medical laboratory science. Other lab-based careers that don’t require a medical degree include: pathologist assistant, histotechnologist, cytotechnologist, phlebotomist, clinical chemist, microbiologist, lab manager and lab educator.

Curry emphasized that the physicians and technical professional staff share a common mission as well as common goals and core values: “We are excited about future growth of the lab and its services, competitive with state-of-the-art technology and always place the needs of the patient and their families as first priority. We work with the communities in which we serve to provide the essential laboratory infrastructure to provide optimal community healthcare.”

According to Curry, one of Boyce & Bynum’s priority goals in response to the changing health-care environment and rising insurance premiums is a desire to directly contract with small and larger businesses that either are now or may want to become self-insured. Another goal is to accommodate individuals, employees and employers who have or want to establish health savings accounts as part of their medical insurance plans. Curry adds, “Individual patients and business owners have the right to choose their lab service provider, and BBPL wants to be their preferred provider.”