jmou123 said:
Apparently the only negative about IR is the fact that they do not see their own patients. I think that typically they get referrals for patients that other surgeons/docs do not want to touch. This is not to say that IR will die, but from what I understand this is the main reason that IR guys can't hold on to their procedures. As other specialties decide that they can do what the IR guy does, they adopt the procedure and quit referring to the IR guy. From what I have read, this means that IR guys will basically have to start running their business like Gen surgeons (ie manage their own patients).
IR tends to lose turf when its own success means that a very high percentage of another specialty becomes amenable to interventional therapy. Examples include angioplasty/stenting, EVAR, aneurysm coiling and so-on. It does not mean that radioloigsts wil not do these procedures, but it does mean that the other specialty is under strong pressure to adopt these procedures to survive. In addition, there are not enough IR specialists to provide these services if they become the commonplace standard. You will see that less commonly performed interventions (chemo embo, UFE) are under less pressure. This has turned out not to be as big a deal as people thought because: 1 its a bigger marked than people realized. The IR guys are getting a lot of business regardless. 2. For every procedure lost, many more are developed and performed.
The net effect of this is that IR salaries have increased faster than DR in the recent past. This seems incongrous with the bleak picture people are portraying no?
jmou123 said:
As far as the outsourcing goes....I have thought alot about this, and have many questions.
It seems to me that there are definite possibilities for outsourcing. From what I understand, in order for a person in India to receive images for outsourcing, he/she must have completed a US residency. In addition to this they must be certified in the state from which they are receiving the images.
No. The only requirement in most states is that the person whose name appears on the report has a state medical license. Now, many insurers will not reimburse for a radiology "code" unless the provider is a radiologist, but this is not legally mandated.
Indeed, in order to perform brain surgery, all you need is ... a state license. (But again, hospitals may not give you priveledges). I stress that board cerfification is totally voluntary and not protected by any statute (but important with hospital credentialling, insurance reimbursement, etc etc).
jmou123 said:
Apparently the hard part is the residency as many radiologists are certified in many states. What scares me about this? There are more radiology residency spots than any other field. So what? Well I havent read any books on globalization, but from what I understand as technology increases and economies mesh, we will be overpowered by the expanding work force that lives overseas and works for less money. Is it possible that the expanding population may result in a larger number of FMGs going into rads? Then, after residency will they return home to set up an outsourcing group? If so, the number of available radiologists will be larger in the future. My point is, the current number of overseas radiologist may seem benign, but will that change with the high demand for imaging studies?
Radiologists trained in the US are not an issue. The number of spots is tightly restricted with respect to manpower needs (many journal articles in the yellow and grey journals on this). Moreover, you think that North American trained radiologists will go to 3rd world counries (even if that is home) to work for cheap when they are suddenly highly marketable, can easily get a visa and stay?!?! Think again, these people will be payed extra to live abroad and cover call.
No, the issue being raised has to do with NON-board certified, NON-n. american trained radiologists providing services for lower price. One model would be to get them state medical licences (not BC); the other is to have them read reports under a BC radiologist's name. The latter to me is essentially fraud (the person need not even be an MD, perhaps). The former relies on their being a pool of skilled foreign radiologists ready to work for cheap, which as I have pointed out is not actually even the case. In addition, it would require all hospitals to change their credentialling to accept non BC radiologists (why would they apply this exemption only for radiologists?!?)
In summary, the many reasons that outsourcing is not as big a threat as people apparently fear is:
1.) Hospitals need to credential the individuals providing the interpretation -- they are accessing confidential info. This costs $$$. If they only accept US licenced BC radiologists, this will provide no cost savings. If they accept non BC foreigeners, they would be in the position of suspending their own credentialing policy for only one class of physician -- not a solid position.
2.) Even if this happens, the actual number of foreign radiologists is not high enough to make a very significant impact, in my opinion. In addition, they will be of varying quality and people will demand standardization. If that standardization is BCertification, once these people are boarded, they will demand full salaries like everyone else.
3.) You need people in house. There is a lot of other stuff to do to keep a radioloigy department running smoothly. People think everything happens automatically (protocols for studies, QC, accreditation, equipment selection, talking to clinicians, going to multi-disciplinary rounds etc.) And I haven't even mentioned IR
4.) Empirical: Despite the voiciferous prognostications, most of it from people like droliver who are not even involved in the radiology industry, the actual outcome in the past 5 years has been outsourcing of call to nighthawk groups composed of BC radiologists who are providing prelims, so the in-house group is well rested and ready to attack the films in the am.
