Is radiology in danger of being outsourced?

[athelas314]

Of all medical specialties, it seems that radiology is the most vulnerable to outsourcing; since one is basically interpreting images, that interpretation can be done pretty much anywhere. It seems possible that scans can be sent over the web to overseas radiology centers, which would presumably be considerably less expensive. Is there a good chance that American radiologists will be under greater foreign competition of this sort in the near future? Thanks.

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[BeatrixKiddo]

That sounds like a good idea to me.

 

[thesauce]

Of all medical specialties, it seems that radiology is the most vulnerable to outsourcing; since one is basically interpreting images, that interpretation can be done pretty much anywhere. It seems possible that scans can be sent over the web to overseas radiology centers, which would presumably be considerably less expensive. Is there a good chance that American radiologists will be under greater foreign competition of this sort in the near future? Thanks.

I've thought about this a lot. I don't think it'll happen because whoever is interpreting the images will have to have American licensure. And that's no gonna change.

 

[Docxter]

Of all medical specialties, it seems that radiology is the most vulnerable to outsourcing; since one is basically interpreting images, that interpretation can be done pretty much anywhere. It seems possible that scans can be sent over the web to overseas radiology centers, which would presumably be considerably less expensive. Is there a good chance that American radiologists will be under greater foreign competition of this sort in the near future? Thanks.

First of all, you may be posting in the wrong forum. Radiology has it's own forum. Also, you're a few years too late in making the observation you made. This whole outsourcing issue has been beaten to death over the last couple of years. Do a search on the topic on SDN or auntminnie.com. Bottom line, people are not worried that foreign outsourcing will be a major threat.

 

[stephew]

moved to the radiology forum.

 

[cdql]

Lawyers love suing doctors. If business is outsourced to cheaper labor, lawyers will have a hard time a) getting close enough to sue them and then b) cashing in on any significant winnings. Which is why we might see lawyers and doctors work together (you know, when youknowwhere freezes over) before radiology has to worry about significant outsourcing.

 

[MacGyver]

Right now outsourcing is not a major problem but if healthcare costs go unabated and the govt takes over, then it will take hold.

The govt has the power at the stroke of a pen to erase all the regulations that currently hamper outsourcing. If we ever have a full govt takeover, they will exercise this authority in the name of cost controls.

 

[hans19]

Right now outsourcing is not a major problem but if healthcare costs go unabated and the govt takes over, then it will take hold.

The govt has the power at the stroke of a pen to erase all the regulations that currently hamper outsourcing. If we ever have a full govt takeover, they will exercise this authority in the name of cost controls.

Riiiiight..... 🙄

If the government takes over health care, it will screw its domestic radiologists over by contracting for outsourced reads from India.

The government will also buy discount AIDS drugs from India and Africa. and other drugs (developed by predominantly American pharmaceutical companies) from Canada.

You are on to something Mac!

 

[MacGyver]

Riiiiight..... 🙄

If the government takes over health care, it will screw its domestic radiologists over by contracting for outsourced reads from India.

The government will also buy discount AIDS drugs from India and Africa. and other drugs (developed by predominantly American pharmaceutical companies) from Canada.

You are on to something Mac!

I dont know why are you being sarcastic. Name me one country that has a govt health system that pays radiologists more than 250k per year. You cant find one. When govt takes over, all of these rads docs pulling in 500k per year can kiss that goodbye.

Dont like it? They'll open the floodgates to FMGs who would gladly work for 100k per year. Even a lowball figure of 100k is more than docs make in most countries.

Specialists like radiology earn 4 times more per year than primary care. The first thing socialized medicine in Europe and CAnada did was to cut that figure down drastically. Now you wont find specialists making more than twice what a primary care doc gets.

In the end, a pure government run system could be better for docs than the alternative, which is a patch work private/public mix which keeps insurers in play. The best thing for healthcare would be to remove the third party middle men and take away their 20% cut of the healthcare budget.

 

[Neuronix]

Now? No.

Five years from now? Yes.

What technology or policy does not exist now that will exist in five years to make this happen?

Ten years from now? The majority will be done by computers and by foreign radiologists abroad.

Same questions for ten years from now. Also, just because machines can read EKGs or spit out DDx for IMs, does that mean you immediately rely on the EKG interpretation or diagnosis spit out by the machine? I don't think any automated system will ever reach a level where it will not have to be verified by a person. This is not just for technical reasons, but for legal reasons as well.

Meanwhile we haven't opened the floodgates for any other medical shortage. I can't imagine they would for rads. Even if they slashed Rads reimbursements (maybe, though we keep coming up with new, highly reimbursed technologies), Rads pay is so high now you could cut it in half and still make more than a general practicioner. With the relatively good lifestyle (oh no, I said good pay and lifestyle! AHHHH!), we're never going to be seriously hurting for med school applicants.

I don't see all the gloom and doom that some people see. I've been thinking about Rads now for years, and every year the forecast is more gloom and doom (OH NO TELERADS IS REAL THIS TIME!) (BUDGET SLASHES WILL KILL OUR SALARIES!), but in reality it doesn't seem like anything has happened yet? If anything it seems like things are pretty stable over the past 5+ years? I don't see anything that makes it looks any worse now than it did then.

 

[zoidberg925]

How is the fee for a scan broken down (i.e. how much goes for aquiring the image, and how much goes towards the radiologist reading the film) - I really don't know? If a radiologist here only makes $20 for reading a chest X-ray (which is what I hear), I don't see how much of a cost-saving benefit there would necessarily be to having it read overseas. It seems if you really want to outsource to defer the majority of cost in radiology, you would have to send the actual PATIENT overseas to have their scan done cheaper...It just makes more sense that if our country institutes universal healthcare, that the first thing to be affected would be the procurement and distribution of expensive advanced imaging equipment...anyone want to take a guess what the waiting list is like for an non-emergency brain MRI in Canada?

 

[MacGyver]

What technology or policy does not exist now that will exist in five years to make this happen?

Not technology, its policy. The ABR sets up a bunch of BS that you have to wade thru to read/interpret films in the US. However, dont think for a moment that the ABR could be rendered totally irrelevant with some congressional legislation. Wont happen right now, but probably will down the line, since a govt takeover of healthcare at some point is virtually inevitable.

Meanwhile we haven't opened the floodgates for any other medical shortage.

For primary care we certainly have. FMGs have virtually a 100% chance at landing a primary care slot somewhere. Primary care docs have zero leverage to negotiate for increased salaries because FMGs are readily available and states have expanded midlevel autonomy tremendously the last 20 years or so.

Normally you would expect the shortage of american grads going into primary care to translate into increased salaries due to a labor shortage. But of course the govt has broken this "rule" of marketplace economics by supplying a huge labor force ready to substitute in place of american grads (FMGs and midlevels).

Rads pay is so high now you could cut it in half and still make more than a general practicioner.

If your goal is to make simply more than a GP then yes rads will always trump GPs, even with a socialized medical model. The difference is in the amount of excess income over GPs. In europe and canada, specialists like rad docs are lucky to make twice the income of a GP. Here in the US its common for rad docs to make 4 TIMES the income of a GP. That excess wont stand over hte long term. The govt wont allow it.

we're never going to be seriously hurting for med school applicants.

Even if med school applicants plummeted, like I said the govt has a trump card that makes med school applicant trends irrelevant. See my primary care example. There is a huge shortfall of american grads going into primary care, but that has NOT translated into increased bargaining power for income.

Suppose for a moment that med school applicants plummetted to 30% of their current value, enough for med school seats to go unfilled. That will NOT translate into increased salaries for docs, because the govt will just open the FMG floodgates. FMGs wishing to practice in the US GREATLY OUTNUMBER american med school grads. They will gladly come to the US for meager salaries of 70k. Thats a huge amount of leverage for the govt to use against us.

I don't see all the gloom and doom that some people see. I've been thinking about Rads now for years, and every year the forecast is more gloom and doom (OH NO TELERADS IS REAL THIS TIME!) (BUDGET SLASHES WILL KILL OUR SALARIES!), but in reality it doesn't seem like anything has happened yet? If anything it seems like things are pretty stable over the past 5+ years? I don't see anything that makes it looks any worse now than it did then.

5 years is too short of a timeframe to judge. The writing is on the wall though. Every day more politicans screaming for universal health coverage and a govt takeover. Maybe not in the immediate future, but its virtually guaranteed over hte long term. There is no end to the increases in healthcare costs. More and more of the general public is bitching about it. I'll be absolutely shocked if we dont have a govt takeover within the next 15-20 years.

 

[Neuronix]

I'll be absolutely shocked if we dont have a govt takeover within the next 15-20 years.

Your post makes interesting points. You're absolutely right about GPs, and that is a somewhat scary thought.

The only other thing I don't understand is why it's automatically assumed physician salaries will be hurt by a government managed health care system. At this point, medicare sets the reimbursements for everything and private insurers reimburse at more or less the same rates. At the hospital I'm at, something like 45% of the patients are paid for by medicare, which is roughly the same as all private insurers combined. My point is that as it is the government pretty much has taken over. Private insurers are no better, and if anything their cost cutting measures seem even worse at times.

If the government wants to cut Radiologist salaries, it can and will, and all the private insurers will follow. I don't see why it would have any more power to hurt us in the future than it does now, because it already holds all the cards. I just can't imagine a congress that would allow foreign trained and foreign located docs to interperet imaging studies. Certainly I don't think they give a damn about our salaries, but I think they do care about patient safety and legal culpability to some extent.

 

[Max_Berry]

Correction:

GPs make twice what specialists (including radiologists) make in Europe. No kidding.

 

[MacGyver]

Correction:

GPs make twice what specialists (including radiologists) make in Europe. No kidding.

Link please

 

[Max_Berry]

Don't have a link, but I did attend medschool in Sweden and am working in Denmark. GP's are in demand and make about double the salary of the University fellows. Some academics even to moonlight to try to close the gap.

 

[f_w]

Not technology, its policy. The ABR sets up a bunch of BS that you have to wade thru to read/interpret films in the US. However, dont think for a moment that the ABR could be rendered totally irrelevant with some congressional legislation.

- the practice of medicine is regulated by the states.
- ABR certification is not required by the feds to bill imaging interpretations to medicare, congress therefore has no way to make ABR certification more or less relevant (only exception: mammography)

(For your info: There are three mechanisms that limit as to who can bill for the interpretation of imaging services:
- credentialing by hospitals
- standards of malpractice insurers
- credentialing by commercial health insurers and HMOs
Neither of these mechanisms is subject to federal regulation requiring ABR or any other certification. These bodies have decided that they require a certain level of demonstrated competency and no law written on capitol hill can change that)

Wont happen right now, but probably will down the line, since a govt takeover of healthcare at some point is virtually inevitable.

You keep saying how it is inevitable, you are a bit fuzzy about the details. (e.g. which of the major parties will make it their agenda: the party of industry or the party of trial lawyers ?)

Primary care docs have zero leverage to negotiate for increased salaries because FMGs are readily available and states have expanded midlevel autonomy tremendously the last 20 years or so.

You might want to phrase that as 'FMGs and DOs' are readily available.

(Primary care incomes are mainly set through the mechanism of the AMAs RUC committee. The goverment through the SGR mechanism just tells the AMA how big the pie will be next year, it is up to the physicians to duke it out among themselves on how it is divied up. If you believe that reimbursements are the product of any kind of bidding or market process, you are looking at the wrong country)

Every day more politicans screaming for universal health coverage and a govt takeover. Maybe not in the immediate future, but its virtually guaranteed over hte long term. There is no end to the increases in healthcare costs. More and more of the general public is bitching about it. I'll be absolutely shocked if we dont have a govt takeover within the next 15-20 years.

The sky is falling !

 

[f_w]

How is the fee for a scan broken down (i.e. how much goes for aquiring the image, and how much goes towards the radiologist reading the film) - I really don't know?

Depends on the modality. For the high-end stuff about 80% of the fee is the technical component. That is the part that pays for depreciation on the scanner, the maintenance contract, consumables, tube-time technical staff salaries etc.

Just as one example, here are the medicare RVUs for a MRI orbit/face w/wo contrast in Michigan (outside of Detroit)

work 2.15
practice expense 25.66
malpractice 0.94
total 28.75

In real $ this translates into:
a global payment of:
$1031.18
out of which the interpretation comes out to be
$110.82

(in the entire pie of medical imaging cost, radiologist salaries are a minor contribution. In addition to the fact that the majority of expenses are technical fees billed by the hospitals and imaging centers, a good share of imaging studies is billed as in-office imaging by non-radiologists like OB-gyns and cardiologists)

 

[hans19]

I dont know why are you being sarcastic. Name me one country that has a govt health system that pays radiologists more than 250k per year. You cant find one. When govt takes over, all of these rads docs pulling in 500k per year can kiss that goodbye.

Dont like it? They'll open the floodgates to FMGs who would gladly work for 100k per year. Even a lowball figure of 100k is more than docs make in most countries.

Specialists like radiology earn 4 times more per year than primary care. The first thing socialized medicine in Europe and Canada did was to cut that figure down drastically. Now you wont find specialists making more than twice what a primary care doc gets.

In the end, a pure government run system could be better for docs than the alternative, which is a patch work private/public mix which keeps insurers in play. The best thing for healthcare would be to remove the third party middle men and take away their 20% cut of the healthcare budget.

Radiologists in the developed world, with the notable exceptions of Spain and Germany, do quite well. Suffice it to say they can do exceptionally well in Canada and the Netherlands. (>$250k US accounting for the currency conversion)

Why would the government outsource radiology to India when it has already invested so much tax payer money to subsidize the training of is domestic work force? That defies logic. There may be a reimbursement cut for radiology services, but outsourcing? Absurd. Secondly to whom would international radiologists be accountable? Dick Cheney?

If the government is really after the cheapest solution, whatsoever, why doesn't the US govt just buy generic AIDs drugs from India and China, where they are available much cheaper?

I've seen your previous threads. If you could do it over again, you'd have gone to nursing school so you could be an NP?

There's the glass half-empty people, half-full people...

and then there's Mac who thinks the glass is smashed and we are rolling around in the shards.

 

[javandane]

You might want to phrase that as 'FMGs and DOs' are readily available.

a small point, but i'm wondering what you mean by this?

last time i checked, DOs are US-trained fully-licensed physicians who command salaries equal to those of US-trained MDs in the same specialty. i don't think you'll find any DOs who are willing to accept a drastically-reduced income just so that they have a primary care gig in america.

 

[f_w]

last time i checked, DOs are US-trained fully-licensed physicians who command salaries equal to those of US-trained MDs in the same specialty. i don't think you'll find any DOs who are willing to accept a drastically-reduced income just so that they have a primary care gig in america.

Oh no, you can't mention the letters D+O together without someone getting his blood pressure up.

McGyvers contention is that the incomes of US physicians in general and PCPs in particular is on the plunge because there are these hordes of lowly midlevels and FMGs that compete with them for jobs. The part he doesn't seem to get is the fact that the federal goverment has pretty much set the number of residency positions at a maximum with the 1997 Omnibus deficit reduction act. US allopathic medschools don't put out enough graduates to fill those positions so the balance fills with either DOs (who don't want to do DO residencies) or US citizen IMGs or non-citizen IMGs. The total number of annual residency graduates (which would have an influence on the physician labor market if there was one) is fixed.

Yes, of course DOs are real doctors, never wanted to doubt that. But when it comes to filling the 5k or so of extra residency positions available in the US every year, they 'do' compete with FMGs (and as far as I know, the majority of DOs go into primary care specialties, whether based on interest or competitiveness I don't know).

 

[Quite_Simply]

I for one certainly wouldn't have my radiographs read by some sweat shop worker in India making 10 bucks an hour. Would you? We have very high standards in the US and outsourcing to questionable individuals isn't gonna happen. Why in the hell do you think the US is flooded with FMGs, its because socialized or "socialism" or "communism" medicine doesn't work!! The need of incentive is built into our human core, otherwise going to the doctor would be like going to the DMV.

 

[sara3426]

Once on a plane i sat next to a young guy who worked for nighthawk as a tech (flying around and setting up systems, IN THIS COUNTRY), and he told me that as a rule it's illegal to get images read primarily by FMGs. The primary read needs to be by a certified US physician. Not saying that people in India can't do prelim reads, but in the end the image must be stamped by a US physician in order to be acceptable at a US hospital. Furthermore, in almost all cases, that US physician needs to have hospital priviliges at the hospital for which he's reading. And this was a nighthawk guy telling me these things. Most of his stories revolved around US physicians living abroad (lots in Australia) and doing image-reading. I'm not sure if kicking an image abroad to a US-trained physician really counts as outsourcing, nor am I sure it would have any discernable affect on the salaries of radiologists.

 

[f_w]

Not saying that people in India can't do prelim reads,

A prelim read is the practice of medicine and requires a medical license in the state that the service is provided.

but in the end the image must be stamped by a US physician in order to be acceptable at a US hospital.

If a report is provided by an unlicensed provider and just countersigned by a US licensed physician (without that physician actually providing the interpretation or direct supervision of the unlicensed provider) it remains illegal. There is at least one indian teleradiology company that operates under this system, the last time I mentioned the location of that company on an internet bulletin board I was threatened with a lawsuit.

Furthermore, in almost all cases, that US physician needs to have hospital priviliges at the hospital for which he's reading.

The bigger companies are JCAHO accredited healthcare providers. Their physicians can be credentialed by reciprocity at most JCAHO accredited hospitals.

Most of his stories revolved around US physicians living abroad (lots in Australia) and doing image-reading.

'Nighthawk radiology' (the company) provides prelim reads from their facility in Sidney. Any final reads (on medicare patients) have to be provided from US soil.

I'm not sure if kicking an image abroad to a US-trained physician really counts as outsourcing, nor am I sure it would have any discernable affect on the salaries of radiologists.

If outsourcing is any service you purchase from another service provider, then yes, it is outsourcing. If the providers located overseas are US credentialed and licensed physicians it is hardly the same wage-dumping type of outsourcing Lou Dobbs is ranting about.

 

[da3dl3us]

I for one certainly wouldn't have my radiographs read by some sweat shop worker in India making 10 bucks an hour.

That, is an extremely ignorant, borderline bigoted remark. Many physicians in India are as qualified if not more than us over here.

 

[athelas314]

Besides which, you (speaking of the average American) may not have a choice, as some HMOs gun for the bottom line.

 

[dr kevin40]

reading this thread, good discussion and some interesting points. honestly I it's hard to predict the future for any medical specialty, but radiology is in its growth phase and thus not in as much danger as some other specialties.

 

[medtrial82]

x

 

[f_w]

2. Board certified Radiologists are moving to other countries (including India). Where they hire 50 local radiologists. Images are seen and written up then the board certified person signs the document to meet US regulations. Lower the cost substantially and still meet the regulations.

If the US credentialed person just signs off on the study without providing the actual professional service, it is and will remain illegal to do so. (There are 2-3 sweat shop teleradiology providers out there, the last time I mentioned the geographic location of one of them I was threatened with a lawsuit.)