Radiology will be the first because frankly its a HUGE frickin target for reimbursement cuts. I will say now Rads income will be a mere FRACTION of what it is today 10-20 years down the road. Im talking Peds will look like Bill Gates-level by comparison. Med students will run screaming from rads residencies, even though now that seems absurd. Trust me, I witnessed such cycles in other fields.
Teleradiology is really entering full maturity and is pretty supplanting hard films everywhere. Once payors realize that they can outsource the professional component, its over. Already the medicare cuts will slash the outpatient tech component (TC) for rads to crap, forcing lots of stand alone MRI units to close their doors. And good rittance. They had it too good for too long, and quite frankly they made the mistake of GREED.
Path likewise will eventually face outsourcing BUT it has 2 very unique barriers unlike Rads. For one, almost all of CP is managerial. Although the loss of clinical path professional income was a bane, it might actually end up being a BOON when outsourcing starts to tap others. Being a business minded pathologist should win out over the radiologist in the long run because you can never outsource clinical labs while still having stat capabilities for emergency folks.
Then there is the technical hurdle that glass slides cannot be cost efficiently sent electronically, the amount of visual data per slide is literally MILLIONS of times more than a radiology image. Storage of such information alone is decades away from being a reality even with terabyte sized hard drives. Then there would have to be a business model for actually do this cost effectively. Instead of just having a pathologist, you would also have to hire a certified PA to gross the specimen and select the sections to view under the scope, a technician to load the slides onto a reader, QA/QC material as well as make the slides AND hire a manager for all these additional people instead of having an on site pathologist to do it....see you could TRY to outsource path but it will never be cost efficient, path is already super cheap to operate, there is no margin of fluff. Meanwhile, Rads is fluff fest.
In the end, Pathologists got screwed in the early 80s by loss of a huge margin of their professional fee schedules, but have essentially reinvented themselves as business managers....which has no more risk of outsourcing than investment bankers, stock brokers or any number of mid to upper level management might.
