outsourcing of radiology

[sixteenstones]

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does anyone have any input on how outsourcing (the process of sending films to be read in other countries for less money) will effect the practice of radiology in the US. Do you think reimbursements for US rads will decrease? Do you think the number of rads will decrease?

Thanks.

Sixteenstones

 

[oldandtired]

Remember that radiology is the practice of medicine. Unless one has met the state requirements for licensure, it would be illegal to practice medicine. Unless this rule changes, outsourcing is a non-issue.

Most of the world is experiencing radiologist shortages anyways. The training and technology in most countries is sub-par. Who will the lawyers go after? The lawyers are the ones who will prevent this from happening. They are the ones who prevent most specialists from doing their own readings.

 

[MacGyver]

oldtired is semi-correct.

Radiologists should be worried... if the big state govt fatcats keep seeing rads shortages year after year, eventually they will take action and change laws or put pressure on the ABR to allow foreign docs to get board-certified.

 

[oldandtired]

If the feds allow foreign docs to become certified in radiololgy, this will open the gates for other fields. There are shortages in many fields of medicine (orthopedics, cards, urology especially in rural areas). I do not see why a radiology shortage is any more bothersome than a shortage of urologists for example.

The feds will then allow Indian dermatologists, urologists, cardiologists to enter the US with little to no adiditonal training. This may eventually ease the shortage of docs in these areas.

I strongly believe that outsourcing should not be of concern to anyone. The day outsourcing of MRIs, CTs etc. is done is the day we have docs straight from Bombay opening clinics in America.

 

[sixteenstones]

actually what is happening is the health care organizations are contracting with foreign physicians and sending the films electronically to be read. What costs $300,000 in salary in the US is being done for $70,000 overseas. Of course, they can not do the procedures over seas, but actually some surgeries are now being outsourced as well. (ie. fly to india, get a weeks vacation, get a bypass surgery, all for much, much less than in the US). I know you don't know me, but please trust me, keep an eye on this issue folks.

Sixteenstones

 

[oldandtired]

An unscrupulous american radiologist could send films to India to have read and transcribed and then blindly co-sign the reports. This is the only avenue I can think of. It is is ilegal to have films read in India with final reports issued.

 

[txrad]

Originally posted by sixteenstones
(ie. fly to india, get a weeks vacation, get a bypass surgery, all for much, much less than in the US). Sixteenstones

1. For people with health insurance, such a scenario is unlikely, because why would one do that if most of the bills would be covered by insurance.

2. Even if one does not have insurance, with the current system, it may be cheaper to receive care in the US. (Even UNDOCUMENTED aliens can receive free medical care here, why can't any one else?)

3. Why would one want to go to, say India, for healthcare, while the rich people from the rest of the world are coming to this country to receive medical care? You may argue that quality there is as good as here, but then do you think most people will believe it?

 

[RADRULES]

I read this on auntminnie.com forum:

"This is a VERY SERIOUS issue that no one seems to take serious. A friend of mine who is a board certified US rad was recruited by the ****er at MGH, Saini and Co. to got over the India. You sign 6 or 12 months contracts with them, where you work 8 hour shifts over there overreading all the reads put out by a small group of Indian radiology you supervise. They put you up really nice, in a fancy bungolow, provide a car, driver, maid.... pay for your airfare, pay you probably $12-15,000 per month starting, of course your cost of living is one-tenth here so you can put a TON away. You are paid in Indian money and will not pay US taxes, and of course the "tax" scheme over there is flexible. Basically, a sweat shop for radiology, but if you were a US trained rad with some connection to India you would not think about doing this half the year? Maybe take a cushy academic gig for the other half.... it would not be a bad life. Think about it."

This sounds like a serious threat to me, something needs to be done.

 

[tofurious]

I just ran across the NY Times article discussing this and posted it in allopathic. You folks might be interested in reading it too

http://forums.studentdoctor.net/showthread.php?s=&threadid=102992

 

[Energon]

tofu, that article is very informative.
As far as txrad: there are a lot more people heading for India from other parts of the world primarily eurasia, mid east and yes N America who used to come here in order to seek treatment. I read an INDIA TODAY article which showed the breakdown in costs and trust me, we just cant compete. Also the services provided there are phenomenal. On my recent trip to Mumbai (Bombay) I visited around 11 high end medical facilities which provide everything from bypass-cath- plastic surgery- organ transplant- to every other complex medical procedure under the sun. It also seems that their clinicians are highly qualified which means interpreting CT/MRI/X-rays is really not a big deal. I even had great dental work done in a state of the art office for a fraction of the cost.
The scariest thing is that there are a lot more hospital/ hospital systems like Apollo which are believed to be more superior to the ones i saw.
The way I look at it: With the rise of tele everything, jobs are going to find their way over there just because the profit margins are so good for the high quality product.
It really cracks me up when our "analysts" keep calling them a 3rd world nation. India has a gargantuan highly educated middle-class population who consider an MS "inferior". Further more they keep on graduating highly trained and skilled doctors, engineers and scientists year after year.
If we are to hold our own, we have to give up the ridiculous notion of 500k salaries with a great lifestyle requirements (no call, no nights) and of course, this goes for me as much as it does for anyone else.
Hope our government establishes a really good relationship with the indian government and take trade to a new level. This in turn will increase the local standard of living hence cutting down on the currency play which is what screws us in the first place.

 

[Goober]

I still don't see why people would go to India for a surgical procedure.

If you have insurance than paying should not be an issue. Insurance companies pretty much limit where you can have the procedure done and I doubt they would reimburse you for airfare, hotel and meals if you fly to India. I doubt that any Insurance company would pay for a procedure done in India.

If you are rich enough to pay in cash, why would you go to India? Money is not an issue and you go to the big name local institutions.

If you are poor, you aren't going to be able to afford to go to India. So what kind of patient in the US would fly over to India for an operation? Right now people can have surgeries done cheaper right across the border in Canada, but you don't see huge numbers of Americans flocking over to Canada for treatment.

 

[txrad]

Hi

All we need is just one case of mishap for these cases read in India. The lawyers will sue the supervising US radiologist and the hospital. This greedy US doctor will take the stand and will have to admit that s/he read X times (anywhere from 3 to 15 times) more studies than an average rad. Then, the reason will be revealed there there goes the big verdict.

The next thing you know, malpractice insures will ask if you supervise any foreign rads and will not insure you. End of story.

Go JDs!!!!!

 

[AlexanderJ]

this is kind of interesting. The medical community in general, and radiology in particular, has been wanting tort reform for years. Last year Bush proposed a $250,000 cap on certain malpractice claims. It did not pass Congress but it is sure to be an issue this year in the election. If we finally get our tort reform after the election, and malpractice claims are capped, this could open the floodgates for outsourcing since the "big settlement" cases won't occur anymore. Kinda ironic that radiologists might actually wish to oppose tort reform in this day and age with the threat of outsourcing, while the rest of the AMA will continue to strongly lobby for it.

 

[Docxter]

Originally posted by AlexanderJ
Kinda ironic that radiologists might actually wish to oppose tort reform in this day and age with the threat of outsourcing, while the rest of the AMA will continue to strongly lobby for it.

What!!!!!!!!!! Who said radiologists would be against tort reform? This the most ridiculous thing I've heard. Radiologists are sued quite often, much more than many other specialists, esp. in mammography. In some states, any woman who develops breast cancer and has had a mammogram in the past automatically sues. And also remember, if a nonradiologists misses an obvious finding on physical exam, they can always deny that it was present at the time of exam. If a radiologists misses something, the evidence is right there. No wonder ER docs and vascular surgeons don't take (any or a lot of) pictures when doing US or angio.

 

[AlexanderJ]

Dude Chill...
All I am saying is that if medicolegal reasons are what is preventing widespread outsourcing and radiology reads by clinicians, then if we put caps on malpractice claims, that medicolegal barrier will partially be removed. Think about it, if a clinician or outsourcer gets sued he knows there won't be a huge settlement. Moreover, if lawyers can't make the big bucks on a big settlement they will be less inclined to take these cases. Consequently, clinicians reading films and outsourcing may become more popular if tort reform happens