Threat of "outsourcing" rad to other countries??

[Caerulea]

I'm a 1st year & was wondering about the future of radiology in the U.S. Because of the advancement in technology where radiologists can easily receive images remotely, is there an issue of future jobs leaving American doctors for those in India, China, etc? I know that this type of outsourcing has resulted in lost American jobs in other fields such as computers, telemarketing, etc. (OK, I know that telemarketing isn't quite the same as radiology, but I hope you get the point.)

Any opinions as to how the future of radiology may be changed because of remote technology?

Thanks.

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[RLMD]

This topic has been debated rather extensively both here and on www.auntminnie.com
Do a search, but you will get differing opinions on whether outsourcing is a serious threat to radiology in the future or not.

 

[Santiago]

I'm a 1st year & was wondering about the future of radiology in the U.S. Because of the advancement in technology where radiologists can easily receive images remotely, is there an issue of future jobs leaving American doctors for those in India, China, etc? I know that this type of outsourcing has resulted in lost American jobs in other fields such as computers, telemarketing, etc. (OK, I know that telemarketing isn't quite the same as radiology, but I hope you get the point.)

Any opinions as to how the future of radiology may be changed because of remote technology?

Thanks.

uh oh......

 

[Al Pacino]

Check the archives as this controversy has been well-thought out by many posters on this site and debated ad nauseum.

 

[Goober]

The difference is now it looks like it actually going to happen. Good ol' Dr. Saini at MGH no less is the leading the charge at plans to test out his nightawk system with Indian radiologists this September. Of course he has been denying it publically to radiologists in America, but for some reason he keeps telling Indian newspapers otherwise. Pretty sad when an American radiologist is willing to sell out his countrymen. But then again Dr. Saini is Indian so maybe he sees it as helping out his true countrymen.

"Even if we pay a radiologist $100,000 in India, it is still more cost effective," he said.

More importantly though, he stressed, if Mass General can set up an effective program with radiologists in India it will be a model to use across the United States in combating the radiologist shortage.

Saini said he believes Mass General will have something in place by the end of September to test the system.

The focus, he added, will be to ensure that the quality of work remains the same and that Mass General has the highest confidence in the offshore radiologists.

4-15-2004

http://www.indusbusinessjournal.com...octor.Sees.Through.XRay.Troubles-270844.shtml

 

[MacGyver]

Dr. Saini at MGH is greedier than everybody else. He doenst give a damn about saving money, the only thing he cares about is finding cheap Indian labor so the hospital's executive leadership can shower him with bonuses.

This guy needs to be removed from his position. He is a sell out, plain and simple.

 

[salamander]

well, when it comes to message board insights on the outsourcing topic there's been a lot more heat than light. that said, from reading posts for the last few months, and various articles it appears that dr. saini/mgh are getting only 'certified' radiologists to read x-rays (note, even in the supposedly incriminating article in the indian-based magazine, it's mentioned that physicians assistants can't read x-rays because pa's aren't certified, whereas outsourced radiologists will be certified.) the problem for american radiologists is that it apparently doesn't take that much to be certified. dr. saini's indian doctors come to the states for a two year training course, i believe, and somehow end up getting certified. what i'm confused about, personally, though, is if they really are certified, why don't they stay here and practice in the united states at much higher incomes, rather than return to india and get paid less?

anyway, if you are going to complain, don't complain about saini and greed (c'mon, he's no more greedy than the american radiologists who, knowing there's a shortage, decides to ask for ridiculously high salaries with ridiculously long vacations), rather complain about our stupidly stunted regulatory apparatus in radiology. to date, the acr (american college of radiology) has not pushed for more stringent standards for certification, and that's why saini can get away with this, legally. the acr doesn't plan to make the standards stricter because, in the short term, with the shortage of american radiologists, outsourcers are currently our friends! it means americans don't have to do overnight call as frequently, and can go on nice long vacations. outsourcing has not dampened radiologists' salaries, so for established attendings life is good.

in the long term, though, outsourcing could turn to hurt radiologists. once it becomes accepted that overnight reads are 'good enough' when read overseas, who's to stop it from becoming used more frequently during the daytime? also, by keeping standards low for certification, we may be diluting the quality of reads from overseas.

anyway, we'll see.

 

[katunoshi]

"Mens sana en corpore sano"

sorry for the OT...but reading your signature, if you're writing in latin, "en" is a mistake, it is correctly written "in":

"Mens sana in corpore sano"



/OT

 

[joshmir]

Sanjay Saini's "program" at MGH is dead, as per rads residents at MGH. I posted on scutwork the email he sent me...do a search.

If anybody want sto really be educated about outsourcing, go to aunt minnie and read forums for hours.

if you want to make a difference, join the ACR (free for students/residents?) and send email to your state representative and ask them to petition (at the next ACR meeting) for a resolution to be drafted on the outsourcing issue. Then the ACR will make a recomendation, but that's all they can do.

Right now, medicare will not reimburse for studiens where either the preliminary or final read is done overseas (one or the other).

 

[GeddyLee]

Just a quick word here about medicare policies forbidding payment on films read overseas. There was recently a bill introduced (i'm not sure of it's fate) which would have amended the rules, thus making payment on reads done outside the USA possible. The point is, look around at what is happening in medicine....medicare and insurance companies will reduce costs using whatever means necessary. Some of you (Dr. Cuts) refuse to recognize this threat. I can guarantee you that all of this will come true without recognizing the threat and banding together with you colleagues to fight it.

 

[CambieMD]

I agree with GeddkLee. Outsourcing has become a strong force in several sectors. Why would anyone think that radiology or pathology would be spared. Bean counters are motivated by cost reduction. Our friends the lawyers will take care of any legal concerns that may arise.
IR will probably just become a bigger part of what radiologists do. "Hands-on services cannot be sent overseas.

CambieMD

 

[Hudson]

Everyone needs to chill out about outsourcing. It is not going to happen and I will tell you why. Being interested in radiology I sought out to find whether outsourcing was a real threat to this field, and I personally do not think that it is. For all you guys that think that outsourcing is going to be the armageddon of radiology I challege you to do the following: Ask physicians that are not radiologist what they think about outsourcing! I have spoken to multiple urologist, IM, Gen surg, FP, and pediatricians and asked them how they felt about outsourcing. ALL have said that it should and will not happen. Almost all said "Who am I going to consult with when I have a question? I'm going to talk to some guy in India about my patient?" The fact is that most physicians highly value a GOOD in house radiologist that is AVAILABLE and KNOWLEDGEABLE. Like it or not a lot of docs depend on radiologists to help them diagnose and manage their patients. The ones I have spoken with would in no way feel comfortable using a non-american boarded radiologist's interpretation to do this. In addition, reading the film is only a part of the radiologists role in the American medical system. If you have not realized this then you are underutilizing a very valuable medical resource. We also need to think about who would do procedures? No radiology group is going to offer ANY services to a hospital once they implement outsourcing. The fact is outsourcing medicine would decrease the quality of patient care, and providing the best patient care possible should be the number one priority for all of us, including the US government.

I always hear that path will be outsourced after radiology. BS! If you have ever had the opportunity to rotate/practice at a large cancer center then you have had the wonderful opportunity to participate in conferences where the pathologists/surgeons/oncologists brainstorm together, IN PERSON, to figure out the best treatment plan for the patient. What bout intraoperative pathology? Do you think any of the surgeons you know are going to sit there in the OR while some tissue from a sentinel LN biopsy from a woman's breast gets stained, beamed to india, and read by a non-american trained pathologist. The far superior and cheaper pathologist in INDIA can then call you, long distance, and tell you whether you need to proceed to an Axillary LN dissection instead of a simple lumpectomy and F/U radiation. This is not going to happen, it also decreases the quality of patient care.

So lets say that radiology and pathology are globally outsourced, whats next? How about EEG's, 2D ECHO's, Cardiac Stress test interpretation, Holter Monitors, Sleep studies, PFT's, just to name a few. Granted there may be a more mainstream resistance to the outsourcing of these tests since most of them are read by specialists who control their own patients. My point is if you outsource the reading of one type of study it will only be a matter of time until others are outsourced as well. Once the AMA realizes this I think they will form a firm position against outsourcing. I challege the radiology and pathology doomsdayer's to ask seasoned physicians how they feel about some guy that is non-american boarded, and who they can not consult with in person, reading the films/pathology of a patient that THEY are responsible for.

 

[AlexanderJ]

Unfortunately, the clinicians will have little say as to whether outsourcing will occur. Its the beurocrats in hospitals and HMOs that will push this for $$$ savings, and they are the ones that will make outsourcing happen.

 

[JKP]

I'm relatively new and have just started reading these posts... don't know whether this has already been discussed... How about consolidation of services? For example, could a group of hospitals decide that they will send their work to a single entity within the U.S. willing to undercut and charge lower fees? Instead of hiring full-time radiologists could hospitals just hire technicians to do the legwork in-house?

 

[salamander]

Sanjay Saini's "program" at MGH is dead, as per rads residents at MGH. I posted on scutwork the email he sent me...do a search.

I'd love to see the post showing Saini's program at MGH is 'dead.' I looked on scutwork.com and didn't see anything. Maybe you can give the link.

 

[joshmir]

an earlier poster made the comment that people want an in house rasds to work with. i agree. the fear is that by outsourcing "prelim" reads, one rads will be able to fo the work of 3, with superspecialized, best and brightest guys in india doing prelimk reads *similar to how it works with attendings and residents now*. an american rads will do the final read.

then the lawyers will always have someone to sue, the doctors will always have an american rads to consult and talk to, there will just be fewer jobs for radiologists and the pay per study will drop.

for the record i am not convinced this will spread, but it is happening now on a small scale. with non-medicare pts. an earlier poster alluded to how this barrier may now change.

 

[Santiago]

I beleive this outsource threat is very real.And the worst part is that most people think that the incompetency of indian radiologist will lead to its end.Which is not the way I see it.All this "hand on rads consultation" sounds good,but as long as there is this tremendous crisis of radiologists in US and people unwilliing to do night reads this won't stop.Rads nowadays is a 24hrs /7 day job.A Rads read is better than no read at all.Go figure.

 

[Docxter]

I beleive this outsource threat is very real.And the worst part is that most people think that the incompetency of indian radiologist will lead to its end.Which is not the way I see it.All this "hand on rads consultation" sounds good,but as long as there is this tremendous crisis of radiologists in US and people unwilliing to do night reads this won't stop.Rads nowadays is a 24hrs /7 day job.A Rads read is better than no read at all.Go figure.

I forgot where I read it, but a recent survey showed that more than 90% of radiology groups in the country provide overnight service and about 15% or 16% were via teleradiology (not necessarily overseas).

 

[Santiago]

That may be true.But the other Indian fella Arjun Kalyanpur who works from Banglore reports mainly studies originating at night from a group of hospitals in the east coast.Also most of the guys who report US reads do the night reads ....say the ones based in Australia.I dunno whether its cheaper but probably so.Not as much as say getting the reads done in India but definitely cheaper then getting the reads done in US by a US radiologist at midnight.

 

[trouta]

Ive chatted with a couple of radiologists and they seem to think it isnt really a serious threat. Their biggest point is think about how many radiological tests are done here in the US... there isnt enought labor out there to be able to handle it all well and in a timely fashion. Plain and simple radiologists are always going to be needed in house just to handle the volume.

 

[charcot]

I have 4 friends in radiology residencies in the baltimore area...As it turns out 7 local hospitals have now begun outsourcing, not to India, not to Bangladesh, but rather all 7 hospitals are now covering their ER CT scanners with one hospital which has a night float in place on a q 15 rotation schedule. This system (which required major computer hardware/software installation) took effect on June 1. There is enough volume that the central hospital may add a second shift worker to read scans overnight locum Each transmitting hospital is laying off 1-2 radiologists, with a net savings on average per year of $800k. The cost of the system was $1.2 and that means they make a net profit in 2 years.
The floodgates have opened. Cocky radiologists beware, what happened to anesthesia in the late 1990's could happen to your field...

 

[radiojimi]

That much is obvious. The critical outstanding question is how?

Really, only time will give a definitive answer to that question, but in the interim there exists a world of opportunity to shape how health care dollars are spent on medical imaging.

The final answer will come from a thoughtful and collaborative effort between payors, providers, legislators, and maybe even the health care consumer. The system desperately needs forward-thinking people who are willing to take the initiative. For those considering a career in radiology, are you game?

 

[Weil-Felix]

I always hear that path will be outsourced after radiology. BS! If you have ever had the opportunity to rotate/practice at a large cancer center then you have had the wonderful opportunity to participate in conferences where the pathologists/surgeons/oncologists brainstorm together, IN PERSON, to figure out the best treatment plan for the patient. What bout intraoperative pathology? Do you think any of the surgeons you know are going to sit there in the OR while some tissue from a sentinel LN biopsy from a woman's breast gets stained, beamed to india, and read by a non-american trained pathologist. The far superior and cheaper pathologist in INDIA can then call you, long distance, and tell you whether you need to proceed to an Axillary LN dissection instead of a simple lumpectomy and F/U radiation. This is not going to happen, it also decreases the quality of patient care.

I realize that this conversation pertains mostly to radiology, but since you mentioned pathology, I thought I might say something. I'm not sure the real outsourcing threat for pathology lies in surgical pathology. I think it instead lies in CLINICAL pathology, specifically, non-urgent diagnostic laboratory tests.

I agree that it would be very difficult to send out any surgical specimen that requires a gross examination, even ones that are not intraoperative. (And I agree with you, intraop frozen sections could never realistically be outsourced.) However, HIV testing, liver enzymes, not to mention the countless array of tests that might otherwise be sent to large US reference labs like ARUP are fair game for being sent overseas for much cheaper.

If outsourcing of laboratory tests becomes the rule rather than the exception, the hardest hit would be these large clinical reference labs (which are generally run by clinical pathologists), followed by hospitals with robust clinical pathology labs (which could potentially be reduced to "stat" labs in the future).

Here's an interesting article, from (I believe) an Indian news source:

The next outsourcing wave - lab tests

Rumi Dutta in Mumbai | April 19, 2004 07:48 IST


For hospitals in the United Kingdom and the United States it's cheaper to outsource laboratory and diagnostic tests to India. This is the case in West Asia as well. India is on the cusp of another outsourcing wave: high-end laboratory and diagnostic testing.

"Generally these are highly specialised tests like molecular diagnostics and hormones-related tests. Indian laboratories are 70-80 per cent less costly than the US ones," says A Lal, chairman of Dr Lal Path Labs.

Adds Sushil Shah, chairman of Metropolis Health Services, a referral centre for a wide range of medical specialities that caters to over 1,100 laboratories, hospitals and research institutes in India: "Outsourcing of laboratory testing and diagnostic services is set to become big business in India."

Some high-end tests that could be outsourced to India are cancer, HIV, tumour and hepatitis marker tests. Indian labs offer a comprehensive test menu -- over 1,500 tests under one roof.

With that range on offer, it's no surprise that the big laboratory companies here are either in talks with or already are partnering hospital chains overseas in connection with lab tests. Dr Lal Path, a key laboratory company, is close to finalising outsourcing tie-ups for high-end laboratory testing with hospitals in West Asia.

Metropolis Health Services has already tied up with Gulf Medical College Hospital, Ajman, in the UAE. "We are currently in talks with a consortium of hospitals in the US and in the UK and are close to finalising the deal. We expect our turnover to exceed Rs 100 crore (Rs 1,000 million) by next year from the present Rs 35 crore (Rs 350 million)," says Shah.

Metropolis expects $30 million per annum [about Rs 130 crore (Rs 1,300 million)] in orders from each international tie-up or at least 100 samples for testing from each partner every day.

The industry's other big boys are Ranbaxy SRL, Ezy Health, Gribbles, N M Diagnostics and Nicholas Piramal Pathology labs.

According to a study on the Indian healthcare industry by SKP Crossborder Consulting, the Rs 4,000 crore (Rs 40 billion) diagnostics and pathology laboratory testing business is growing at a compounded annual growth rate of 20 per cent.

While the industry has around 20,000 laboratories, only a few prominent ones have any international accreditation that instills confidence about their quality among foreign hospital chains.

To be sure, Indian laboratory companies think that local US and European labs could kick up a rumpus about outsourcing work to India and argue that the quality of work here is below par. But Indian labs may have an ace or two up their sleeves.

For example, they could underline the quality control standards here. To import blood samples for testing purposes, laboratory testing companies have to acquire a licence from the Drug Controller General of India, in addition to approval from the Director General of Foreign Trade. Lab companies have already approached them for approvals.

Still, a huge backlash against outsourcing lab work in the West is unlikely.

Says the chief scientific officer of a research-based Indian pharmaceutical company: "Research and other medical activities may not face as severe a backlash. These are highly complex and expertise-driven jobs where the quality of work is the most essential element."

Foreign call

Indian laboratories are 70-80% less costly than the US ones.
Indian labs offer a comprehensive test menu -- over 1,500 tests under one roof.