Who pays for the lab-clinician "Relationship" ?

Each laboratory needs to foster a relationship with the clinician who supplies specimens. The desire for a lasting relationship encourages competing laboratories to kick-back as much of their excess profits as necessary to form and retain this relationship. Supplying attractive sales reps (who routinely make over $150K, and often over $250K/yr) with company credit cards for expensive meals and fishing/golfing outings ease the relationship as do charitable donations, reimbursements for expensive computer systems, payments to office staff, in-office placement of nurses and phlebotomists, free office and medical supplies, continuing education credits, free management and recruiting services, etc. The cost of these perks is considerable and can be generated by performing unnecessary medical tests (excessive IHC stains including triple prostate stains on multiple cores, Giemsa staining of urine cytology, routine FISH Urovysion testing in addition to urine cytology, etc.)

Excess profits are needed to pay for this "Relationship" which then leads to more specimens and more perks. The clinicians have learned to wait for the best offer and play one lab off the other. In this environment, only the most aggressive will survive.