Thread: Outsourcing radiology

Thought some of you might be interested in this article......




http://www.iht.com/articles/2006/04/19/ ... source.php


Political clout matters in the age of outsourcing
By David Leonhardt The New York Times

WEDNESDAY, APRIL 19, 2006


NEW YORK A few years ago, stories about a scary new kind of outsourcing began making the rounds. Apparently, hospitals were starting to send their radiology work to India, where doctors who make far less than American radiologists were reading X-rays, MRIs and CT scans.

It quickly became an iconic example of how globalization was moving up the food chain, threatening not just factory and call center workers but the so- called knowledge workers who were supposed to be immune. If radiologists and their $350,000 average salaries weren't safe from the jobs exodus, who was?

On ABC, George Will said the outsourcing of radiology could make health care affordable again, to which Senator Charles Schumer, Democrat of New York, retorted that thousands of American radiologists would lose their jobs. On NPR, an economist said the pay of radiologists was already suffering. At the White House, an adviser to President George W. Bush suggested that fewer medical students would enter the field in the future.

"We're losing radiologists," Representative Sherrod Brown, Democrat of Ohio, said on CNN while Lou Dobbs listened approvingly. "We're losing all kinds of white-collar jobs, all kinds of jobs in addition to manufacturing jobs, which we're losing by the droves in my state."

But up in Boston, Frank Levy, an economist at the Massachusetts Institute of Technology, realized that he still had not heard or read much about actual Indian radiologists. Like the once- elusive Snuffleupagus of Sesame Street, they were much discussed but rarely seen. So Levy began looking for them. He teamed up with two other MIT researchers, Ari Goelman and Kyoung Hee Yu, and they dug into the global radiology business.

In the end, they were able to find exactly one company in India that was reading images from American patients. It employs three radiologists. There may be other such radiologists scattered around India, but Levy says, "I think 20 is an overestimate."

Some exodus.

Urban myths exist by feeding off real fears, and this myth caught on because Americans don't know quite what to think about globalization. There is no doubt that trade makes countries richer, but it also creates victims. And since the United States is doing almost nothing right now to ease the burden of those victims, it is easy to get scared.

Radiologists seem like just the sort of workers who should be scared. Computer networks can now send an electronic image to India faster than a messenger can take it from one hospital floor to another. Often, those images are taken during emergencies at night, when radiologists here are sleeping and radiologists in India are not.

There also happens to be a shortage of radiologists in the United States. Sophisticated new MRI and CT machines can detect tiny tumors that once would have gone unnoticed, and doctors are ordering a lot more scans as a result.

Economically, radiology has a lot in common with industries that are outsourcing jobs. It has high labor costs, it's growing rapidly, and it's portable.

Politically, though, radiology could not be more different. Unlike software engineers, textile workers or credit- card customer service employees, doctors have enough political power to erect trade barriers, and they have built some very effective ones.

To practice medicine in this country, doctors are generally required to have done their training here. Otherwise, it is extremely difficult to get certified by a board of other doctors or be licensed by a state government. The three radiologists Levy found in Bangalore did their residencies at Baylor, Yale and the University of Massachusetts before returning home to India.

For now, the practical effect on radiology is small.

But that is going to change. Eventually, a lot of Indian radiologists will be able to do the preliminary diagnoses that are a big part of radiology. Something similar will happen in accounting, architecture, education, engineering and the law, as Levy and his colleagues suggest in the upcoming Milken Institute Review.

These fields tend to be regulated already, giving them noble excuses - like certification, client privacy and legal accountability - to put up trade barriers. But the real reason will usually be a simple desire to protect jobs and salaries.

When factory workers have asked for that kind of protection, the country has told them no. So why does the answer change when the request comes from a wealthier, more influential group of workers?

NEW YORK A few years ago, stories about a scary new kind of outsourcing began making the rounds. Apparently, hospitals were starting to send their radiology work to India, where doctors who make far less than American radiologists were reading X-rays, MRIs and CT scans.

It quickly became an iconic example of how globalization was moving up the food chain, threatening not just factory and call center workers but the so- called knowledge workers who were supposed to be immune. If radiologists and their $350,000 average salaries weren't safe from the jobs exodus, who was?

On ABC, George Will said the outsourcing of radiology could make health care affordable again, to which Senator Charles Schumer, Democrat of New York, retorted that thousands of American radiologists would lose their jobs. On NPR, an economist said the pay of radiologists was already suffering. At the White House, an adviser to President George W. Bush suggested that fewer medical students would enter the field in the future.

"We're losing radiologists," Representative Sherrod Brown, Democrat of Ohio, said on CNN while Lou Dobbs listened approvingly. "We're losing all kinds of white-collar jobs, all kinds of jobs in addition to manufacturing jobs, which we're losing by the droves in my state."

But up in Boston, Frank Levy, an economist at the Massachusetts Institute of Technology, realized that he still had not heard or read much about actual Indian radiologists. Like the once- elusive Snuffleupagus of Sesame Street, they were much discussed but rarely seen. So Levy began looking for them. He teamed up with two other MIT researchers, Ari Goelman and Kyoung Hee Yu, and they dug into the global radiology business.

In the end, they were able to find exactly one company in India that was reading images from American patients. It employs three radiologists. There may be other such radiologists scattered around India, but Levy says, "I think 20 is an overestimate."

Some exodus.

Urban myths exist by feeding off real fears, and this myth caught on because Americans don't know quite what to think about globalization. There is no doubt that trade makes countries richer, but it also creates victims. And since the United States is doing almost nothing right now to ease the burden of those victims, it is easy to get scared.

Radiologists seem like just the sort of workers who should be scared. Computer networks can now send an electronic image to India faster than a messenger can take it from one hospital floor to another. Often, those images are taken during emergencies at night, when radiologists here are sleeping and radiologists in India are not.

There also happens to be a shortage of radiologists in the United States. Sophisticated new MRI and CT machines can detect tiny tumors that once would have gone unnoticed, and doctors are ordering a lot more scans as a result.

Economically, radiology has a lot in common with industries that are outsourcing jobs. It has high labor costs, it's growing rapidly, and it's portable.

Politically, though, radiology could not be more different. Unlike software engineers, textile workers or credit- card customer service employees, doctors have enough political power to erect trade barriers, and they have built some very effective ones.

To practice medicine in this country, doctors are generally required to have done their training here. Otherwise, it is extremely difficult to get certified by a board of other doctors or be licensed by a state government. The three radiologists Levy found in Bangalore did their residencies at Baylor, Yale and the University of Massachusetts before returning home to India.

For now, the practical effect on radiology is small.

But that is going to change. Eventually, a lot of Indian radiologists will be able to do the preliminary diagnoses that are a big part of radiology. Something similar will happen in accounting, architecture, education, engineering and the law, as Levy and his colleagues suggest in the upcoming Milken Institute Review.

These fields tend to be regulated already, giving them noble excuses - like certification, client privacy and legal accountability - to put up trade barriers. But the real reason will usually be a simple desire to protect jobs and salaries.

When factory workers have asked for that kind of protection, the country has told them no. So why does the answer change when the request comes from a wealthier, more influential group of workers?

yep its true. I have worked in the radiology department at our local hospital for 5 years. a couple of years ago we started sending ct scans that were done in the late night hours to australia to be read by their doctors. our doctors will look at them too the next day to make sure their interpretation was correct.

With radiology what they are doing is outsourcing second opinions which used to be done across town. The radiologists in the same town might not see each other. The Australians are on duty at a different time of day and so can be a time saver and reciprocate. India also has a time of day benefit but it is mostly cost.

It is also interesting that Schumer should be protecting radiology when he is for amnesty and guestworkers.

but what does this mean if the test are misread? will these foreign contractors be immune to liability?

Agh Mamie...remember they are wanting to put a stop or a cap on malpractice suits because they say that's why our medical expenses are so high. They're already putting things in place to cover their behinds.

Read an article in INC magazine about 8 months ago concerning a startup company that will fly people to China for reduced rate surgeries.