Sean2tall

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Hi all. First I just wanted to say thanks for the helpful info I have read before making my first post here. Anyway, as a student just starting medical school this year, radiology is a field I would definitely like to look further into (likely interventional). Having read all of the predictions about the future of outsourcing and reimbursements changing and so on, I am wondering whether many of you that are getting into the field believe that there will be a serious lack of future for radiologists. There have been huge battles around the forums about this, but very rarely is that original question addressed. It seems a lot of you believe that there will always be a job for you with at least an average doctor's salary. It may be more workload intensive than today, and the pay may not be as extravagant, but it will remain an interesting field with exciting technology, independence, and many things to do. Do any of you disagree? That is, do some of you think that people like me should reconsider the field as it may not even exist? Anyhow, sorry that was a long winded question, but I am just interested in thinking about what I will do in the future and apart from these few concerns, radiology sounds like a really great match.

Sean
 

Sean2tall

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Haha thanks for the reply. I am beginning to think that I don't give a crap about those -"the sky is falling"- people.

Anybody else agree or not?

Thanks,
Sean
 
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amnesia

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I have read a number of sources about what you are asking... Many people have ambivalence toward outsourcing, but I think there will always ben jobs in the U.S...

You should check out auntminnie.com :)
 

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Originally posted by amnesia
You should check out auntminnie.com :)

That website is scary. I made a point not to look at it until after I match. People write all kinds of untrue statements just to piss off others.
 

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I am worried about this, and mostly since I will barely match at a third-tier program this year, that when the S&*% hits the fan soon about the problems with rads' future, people will flee the rads match next year...and if I would have waited a year, I would have been able to go where I really wanted to go. A similar thing happened in anesthesia some years ago.

The problem is there are too many disparate, well-thought out opinions from very intelligent people on this.

Also, there is a lot of emotional bias; people have the ability to convince themselves of only the positive outlook. When you go on residency interviews, everyone will tell you they are "happy"; when some, especially at third tier programs, are obviously not...which they later tell you on your second look. Nobody will tell you they regret their choice, because they have CONVINCED themselves that's the way it is...it's their psychological survival mechanism...the positive spin is everywhere and is SO frustrating when you want to be open-minded.

Current attendings have relatively less to lose than students about to start a radiology residency...rads residents, again, have to convince themselves (and thusly, other people) that everything will be fine, and they haven't made a mistake.

Even though I have spent hours reading everyone's point of view, I am still scared. At the end of this posting, I will share what I've heard can be done about this...and I welcome anyone corrections, because I want to be proven wrong.

Also, most importantly, I haven't heard a PEEP out of *any MGH rads resident* on any discussion boards...if you're out there, can you please share your thoughts? If anybody knows one, can they please inquire?

We have nothing to fear form foriegn docs doing PRELIM reads, which is being done now...in addition to being done by er docs and rads residnts here...it just won't make a huge dent. But Harvard's design to outsource FINAL reads is what is scary.

What scares me is that MGH (Harvard's hospital) brings the thunder...if they put their will into it, I don't think they will be swept under the rug. The outcry form the radiology community is as loud as it will *ever* be (the people who care about this pretty much already know about it), and they are proceeding full steam ahead. The people with real power to wield are not threatened by this because it won't hit for a number of years, and they can probably benefit too (50 yr old rads docs who have already made their money and sit on medical boards will be happy with not having to take call, they already are partners, maybe they can get a piece of the action somehow, etc). I don't think the public's general outcry over "outsourcing" will cover this when they find out radiologists will still make close to six figures, and they (the public) will save so much money. The idea of Indian docs reading X-rays is much more palatable if they are "Harvard trained and supervised". It is very important to understand exactly what they are doing...

The state of MA only requires one to have 2 years of graduate medical education to get a MA license. But who's going to sponsor a 2 year residency/fellowship for any reason? you won't be able to get hospital priveleges with just that, whe you haven't has a US intern year, passed all 3 parts of the USMLE, be board certified, etc.

EXCEPT Harvard.

The following is taken form articles quoting MGH's radiology professor Sanjay Saini...to confirm, visit Aunt Minnie.

MGH wants to bring over the most promising indian radiologists for their fellowship and then send them back...(they will have no choice but to go back...they will only have a MA license, not a VISA or citizenship, etc) Don't think the indian docs aren't smart enough, look around at the smart indian docs you already know...plus these will be the best of the best, will receive Harvard training, will super-specialize, will get regularly updated training, over the web and in Boston once in a while, and spend less more time on fewer films....their income will be doubled back in India while still remaining one-tenth of the standard US rads salary.

They will do FINAL reads for MGH (and maybe other MA hospitals) because they will be licensed to do so and will get hospital priveleges from MGH. They will NOT be able to do any reads for Medicare patients, which is a federal program and will not reimbursed for any reads done on foriegn soil...that will be the lawmaker's symbolic gesture to the public ("No outsourcing of Federal contracts" but I doubt they will micromanage a small program by Harvard...or meddle in the workings of MA's medical boards). So after proving the program, and using Harvard's name, MGH will market this service to other hospitals, and cherry-pick all the films that will be reimbursed by third party payors.

Harvard puts clout behind this novel idea. They will obviously grant hosptial priveleges to their own graduates. Right now they are employing indian rads to do 3-d reconsructions. One of India's largest companies, Wipro, is on board. Sanjay Saini has admitted publicly that he is trying to circumvent current regulations. I think Harvard probably has pull on the MA medical board.

How many people will this effect? I don't know. PLEASE point out how I am wrong. PLEASE investigate the thoughts of current MGH rads residents.

I am sorry for not posting the links to the articles I sources...if you search in the resident's forum in aunt minnie you can find them.

So what can be done? Go to the ACR's website, and find out who your state's representatives are...email them (or better yet, get someone from your school's rads club to take a letter around to get signed by students and rads residents, then mail it). Tell the rep that the ACR needs to put this issue of outsourcing (not just prelim reads, specifically what MGH is doing) before committee at the next meeting and come up with a position statement. That may be the only thing that can influence the MA medical board, which the ACR has no power over.

word is born.
 

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Many are worried about this, especially those who will barely match at a third-tier program this year, because when the S&*% hits the fan soon (with next year's residency applicant crop) about the problems with rads' future, people will flee the rads match next year...and if I would have waited a year, many would have been able to go where they really wanted to go. A similar thing happened in anesthesia some years ago.

The problem is there are too many disparate, well-thought out opinions from very intelligent people on this.

Also, there is a lot of emotional bias; people have the ability to convince themselves of only the positive outlook. When you go on residency interviews, everyone will tell you they are "happy"; when some, especially at third tier programs, are obviously not...which they later tell you on your second look. Nobody will tell you they regret their choice, because they have CONVINCED themselves that's the way it is...it's their psychological survival mechanism...the positive spin is everywhere and is SO frustrating when you want to be open-minded.

Current attendings have relatively less to lose than students about to start a radiology residency...rads residents, again, have to convince themselves (and thusly, other people) that everything will be fine, and they haven't made a mistake.

Even though I have spent hours reading everyone's point of view, I am still scared. At the end of this posting, I will share what I've heard can be done about this...and I welcome anyone corrections, because I want to be proven wrong.

Also, most importantly, I haven't heard a PEEP out of *any MGH rads resident* on any discussion boards...if you're out there, can you please share your thoughts? If anybody knows one, can they please inquire?

We have nothing to fear form foriegn docs doing PRELIM reads, which is being done now...in addition to being done by er docs and rads residnts here...it just won't make a huge dent. But Harvard's design to outsource FINAL reads is what is scary.

What scares me is that MGH (Harvard's hospital) brings the thunder...if they put their will into it, I don't think they will be swept under the rug. The outcry form the radiology community is as loud as it will *ever* be (the people who care about this pretty much already know about it), and they are proceeding full steam ahead. The people with real power to wield are not threatened by this because it won't hit for a number of years, and they can probably benefit too (50 yr old rads docs who have already made their money and sit on medical boards will be happy with not having to take call, they already are partners, maybe they can get a piece of the action somehow, etc). I don't think the public's general outcry over "outsourcing" will cover this when they find out radiologists will still make close to six figures, and they (the public) will save so much money. The idea of Indian docs reading X-rays is much more palatable if they are "Harvard trained and supervised". It is very important to understand exactly what they are doing...

The state of MA only requires one to have 2 years of graduate medical education to get a MA license. But who's going to sponsor a 2 year residency/fellowship for any reason? you won't be able to get hospital priveleges with just that, whe you haven't has a US intern year, passed all 3 parts of the USMLE, be board certified, etc.

EXCEPT Harvard.

The following is taken form articles quoting MGH's radiology professor Sanjay Saini...to confirm, visit Aunt Minnie.

MGH wants to bring over the most promising indian radiologists for their fellowship and then send them back...(they will have no choice but to go back...they will only have a MA license, not a VISA or citizenship, etc) Don't think the indian docs aren't smart enough, look around at the smart indian docs you already know...plus these will be the best of the best, will receive Harvard training, will super-specialize, will get regularly updated training, over the web and in Boston once in a while, and spend less more time on fewer films....their income will be doubled back in India while still remaining one-tenth of the standard US rads salary.

They will do FINAL reads for MGH (and maybe other MA hospitals) because they will be licensed to do so and will get hospital priveleges from MGH. They will NOT be able to do any reads for Medicare patients, which is a federal program and will not reimbursed for any reads done on foriegn soil...that will be the lawmaker's symbolic gesture to the public ("No outsourcing of Federal contracts" but I doubt they will micromanage a small program by Harvard...or meddle in the workings of MA's medical boards). So after proving the program, and using Harvard's name, MGH will market this service to other hospitals, and cherry-pick all the films that will be reimbursed by third party payors.

Harvard puts clout behind this novel idea. They will obviously grant hosptial priveleges to their own graduates. Right now they are employing indian rads to do 3-d reconsructions. One of India's largest companies, Wipro, is on board. Sanjay Saini has admitted publicly that he is trying to circumvent current regulations. I think Harvard probably has pull on the MA medical board.

How many people will this effect? I don't know. PLEASE point out how I am wrong. PLEASE investigate the thoughts of current MGH rads residents.

I am sorry for not posting the links to the articles I sources...if you search in the resident's forum in aunt minnie you can find them.

So what can be done? Go to the ACR's website, and find out who your state's representatives are...email them (or better yet, get someone from your school's rads club to take a letter around to get signed by students and rads residents, then mail it). Tell the rep that the ACR needs to put this issue of outsourcing (not just prelim reads, specifically what MGH is doing) before committee at the next meeting and come up with a position statement. That may be the only thing that can influence the MA medical board, which the ACR has no power over.

word is born.
 

amnesia

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joshmir,

This is very scary...

outsourcing is not just going to hurt radiology, but also many computer industries. It is very scary that at the expense of other workers...

Programming used to be a great job, but now it is turning out to be a rather mundane one...

I truly hope you are wrong, but I have seen many people post of what you are saying at auntminnie.com...
Dunno I just hope radiology is fine in 10 years+ because that is when I will be in med school, etc.
 

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The sky is falling!!!!!!!!!!!!!!!!!!!!!!

Seriously, get a grip people. The entire practice of American radiology is not moving to India.

Radiology is the practice of medicine. If radiology is outsourced, then all other apects of medicine can also be.... pathology, dermpath, etc.... tele-medicine from India.

The reason we have medical school, residency, board exams, licenses, etc is to prevent any damn person from practicing medicine on American patients. Unless a LOT of laws change, the practice of medicine is not at any risk (which includes radiology).

However, the only issue I see is the loophole where these Indian rad would provide prelim reports for an unscupulous rad who would sign off a large number of studies. It is hard to fight this except from a HIPAA slant, because it would be like computer-aided diagnosis except with people. Of course, the American rad would be putting himself and his reputation at major risk... not to mention the ethical issues. I would think the AMA, ABR, hospitals etc would catch onto it.

Of course, no one can predict the future, but I do not see outsourcing as a major threat. I would like to nip it in the bud regardless.
 

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quoting radrules:

"The reason we have medical school, residency, board exams, licenses, etc is to prevent any damn person from practicing medicine on American patients. Unless a LOT of laws change, the practice of medicine is not at any risk (which includes radiology). "

i hear you, man, and i respect your posts- so i value the fact that this particular scenario doesn't bother you.

Could you comment less generally, and more specifically, on the loophole about needing only 2 years of GME in MA to be licensed there? I'd be intersted to know why it doesn't scare you...just the idea that with their small numbers, they won't be able to handle too much volume?

I bet 3rd party payors will drop their reimbursements to medicare levels real fast...which will improve access to care for medicare benificiaries...

And my dream of living in Hawaii and telerading for the east coast may not happen, because groups won't need partners to take call. Oh well.

+pity+
 

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Finally a voice of reason on this forum.

Joshmir has hit on an important point. The reason this outsourcing is happening is because of GREEDY american radiologists. They are, after all, the ones pushing this.

They are looking to make money and cash out. They dont give a **** about the future of hte profession.
 

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While the possibility of an outsourcing crisis is still debatable, the underlying issue is already present and real. All areas of medicine are coming under fire as we look to curb the skyrocketing costs of health care. Lower-level practitioners are gaining more power and rights by the day and nothing is being done to keep malpractice premiums at a reasonable level. The responsibility of resolving these issues falls on us - current students, residents, and young attendings. I find it disturbing that so many people on here nonchalantly dismiss the possibility of radiology outsourcing, CRNA practice rights, NP practice rights, etc. All of these things are happening very quickly and very dramatically at a pace like no other in the history of medicine. We as physicians have to help ourselves here. The days of relying on lawyers, politicians, public opinion, etc. are gone.

One of our state representatives that came to our school last semester to address the malpractice crisis brought up a very important point. He said that doctors are not used to getting involved with the legal and political aspects of medicine. In the past they had full autonomy, so it wasn't necessary. But now our rights are being taken away. He said the reason trial lawyers are winning the fight against doctors right now is because they are used to donating money and being actively involved in politics. They know what it takes to get their policies passed in the legislature. Doctors are not used to donating to political campaigns, lobbying, etc. But if we are to survive, we better get used to it a hurry. He even advised us as medical students to give what we can because when a politician has to decide on a critical issue, he's going to side with the people that gave him the money to keep him in office.

The days of "I'm too busy, why should I have to donate money to political campaigns, I'm just trying to help people" are over.

Please don't be one of the physicians on this board that sits back and says "that's ridiculous, that'll never happen to us." Because before you know it - it'll be happening to you.

I'm not thrilled about getting involved in politics at all- I hate politics. But the survival of my profession and way of life depends on it.

The sky may not be falling yet, but it's starting to crumble.
 
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Originally posted by DireWolf


I'm not thrilled about getting involved in politics at all- I hate politics. But the survival of my profession and way of life depends on it.


So Kerry or Bush?
Bush = outsourcing of Jobs
Kerry (If he chooses Edwards to run with him) = Trial Lawyer
 

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Originally posted by Dr. Cuts
With all the hubbub surrounding "the future of Radiology" and outsourcing to India and what not... I have yet to see/hear of one person who chose to train in some other field b/c of this "perceived threat." Joshmir if you do you'll be the first. Truth is, most of the people I see that buy into this paranoia and sense the "impending demise" of Radiology are disgruntled/envious residents in other fields. It probably somehow makes them feel better about foolishily not having chosen Rads themselves.

Just my 2 cents...

What you dont understand is that it ONLY takes 1 state to bend its rules, and then the cats out of the bag. If you practice rads in California, you'd better damn sure be worried about whats going on in all the other states, cause it doesnt take long for a trend to spread.

Lets look at NPs for example. For a period of approximately 20 years, their duties were essentially teh same as RNs. They were RNs who were slightly better trained. They could not prescribe meds, they could not diagnose illness, they could not run lab tests, they could not do procedures.

The threshold event occurred in Washington state. Once Washington State changed their scope of practice for nursing to allow those things which were previously forbidden, in the span of less than 5 years 35 states followed suit.

If you are still watching and waiting for the first state to change the regulations, but not doing anything to pre-emptively attack it, then you have waited too long. All it takes is 1 state, and then other states quickly follow suit. All the NPs had to do was say "hey, look at washington state, they allow us to do these things." That was all hte lawmakers needed to hear.
 

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Good news...

from auntminnie.com
*********************


OK - Here's the truth: I am a current resident at MGH and have discussed this with Dr. Saini at length -- There are currently NO PLANS to train pseudo-radiologists from elsewhere to become final signers. There was a pilot program to have MGH attendings or fellows go to India to provide telerad for the hospital, no different than is being done elsewhere. The plan you mentioned was considered and dropped, partly due to opposition from within the department. The company that is doing the Telerad (WIPRO) is a separate entity and may be trying to market the idea, but it won't be through MGH, period. Right now the only work being done outside the US is 3D lab processing overnight.

That's the final word on this -- please let the issue rest. I can promise you that MGH is not an evil institution, and there are many individuals (myself included) who are opposed to any plan to outsource radiology, put patients in danger, create loopholes for malpractice issues, etc.

If you are going to post, please back it up with facts, not other posts on random bulletin boards. This type of disinformation doesn't help anyone


:clap:
 

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Originally posted by pez
So Kerry or Bush?
Bush = outsourcing of Jobs
Kerry (If he chooses Edwards to run with him) = Trial Lawyer

I am not thrilled about this choice either. Neither choice is perfect for physicians. The Republicans support tort reform but refuse to touch insurance companies. The Democrats do not support tort reform but do want to regulate medical malpractice insurance companies. I believe the only real solution to the malpractice crisis is a combination of tort reform and insurance regulation.

I'm still not sure who would be better at protecting our practice rights from outsourcing and midlevel practitioners.
 

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I am not thrilled about this choice either. Neither choice is perfect for physicians. The Republicans support tort reform but refuse to touch insurance companies. The Democrats do not support tort reform but do want to regulate medical malpractice insurance companies. I believe the only real solution to the malpractice crisis is a combination of tort reform and insurance regulation.

I'm still not sure who would be better at protecting our practice rights from outsourcing and midlevel practitioners.


Outsourcing is a long term threat. Universal health care, on the other hand, is an immediate threat that the democrats will try to push thru within the next few years.

I dont like the repubs much either due to outsourcing, but they are the lesser of 2 evils.

Universal health care will be an absolutely disaster for doctors. Expevct to see incomes plummet across the board. Rads will probably fall to 150k tops, and FP and IM will drop to 60-70k.
 

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Originally posted by MacGyver
Universal health care will be an absolutely disaster for doctors. Expevct to see incomes plummet across the board. Rads will probably fall to 150k tops, and FP and IM will drop to 60-70k.

In that event, FP and IM would almost certainly begin to die as specialties, being that no one could afford to get a medical eduation or would want to spend 7-8 years doing it. In which case there would be an enormous shortage of healthcare and compensation would increase again. Unless of course the government pays for medical education and/or makes it shorter, in which case I would still do what I'm doing. But what would happen to the docs who paid 100,000-200,000 for their medical school years and then have their salaries cut to half that?

Sean
 

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Originally posted by Dr. Cuts
O.k. -- worst case scenario... universal health care is implemented and outsourcing becomes a reality. What will happen to us? Will the U.S. have no more need for ABR certified Radiologists? Will we be unemployed? Will we have to go back and train in another specialty to practice? I don't think so. What might happen is yes, we might take a big pay cut. So instead of getting paid 200-400K we'll get 100-150K. But, I think our lifestyles/work hours will stay the same or may even get better. For me anyway this is not such a bad deal.

Yes I oppose outsourcing, and when I advance in my training I will do whatever I can to prevent it from happening. But I also know how to roll with the punches, and I'm not worried about the future. Even if the aforementioned scenario was a reality today, I would still choose Rads far and above all other fields in medicine.


Word.
 

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Radiology in 10 years:

Almost all studies outsourced to India, China and the Phillipines. Remaining studies read by clinical subspecialists in their offices.

Radiology residencies close. Flouro and IR done either by remote control from outside countries or supertrained technologists.

Radiologists who were in practice either retrain or quit medicine.

Reimbursements cut by 98%.
 

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Originally posted by MacGyver


Universal health care will be an absolutely disaster for doctors. Expevct to see incomes plummet across the board. Rads will probably fall to 150k tops, and FP and IM will drop to 60-70k. [/B]

this would be the end of medicine as we know it. I don't think it will happen. doctor salaries don't drive the cost of healthcare - technology does. Universal care would merely stymie technological advancement to current levels.
Judd
 

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Originally posted by juddson
this would be the end of medicine as we know it. I don't think it will happen. doctor salaries don't drive the cost of healthcare - technology does. Universal care would merely stymie technological advancement to current levels.
Judd

I have been thinking that myself! I'm glad to hear somebody who agrees!
 

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There may be a few specialists (i.e. surgeons) who survive in a universal, socialized medicine environment, but the real losers are the primary care docs.

PAs and NPs will step up to fill the hole. After MDs leave primary care, the govt will just authorize PAs and NPs to do whatever they want to with no MD supervision. It will be easy for the govt to circumvent the actions of doctors in primary care.

For specialists, especially surgeons though, things are different. Robotic surgery is too crude and expensive to implement surgical outsourcing, so I think surgeons would still be OK. They'd see salaries drop, but it wouldnt totally devastate them like it would for the FP and IM docs.
 
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