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Radiology too "extreme" for outsourcing: study

by Brendon Nafziger, DOTmed News Associate Editor | December 06, 2010
At this year's Radiological Society of North America conference in Chicago, some experts predicted an outsourced future for radiology: exams taken in America or the rest of the developed world would be read by highly trained radiologists in India for a fraction of the cost of a domestic doctor.

But those radiologists worried about losing their jobs to readers in Bangalore should have no fear, according to a new study.

In an article appearing in a forthcoming edition of the British Journal of Industrial Relations, a pair of economists suggest radiology is too "extreme" for normal offshoring, and that the rise of the Indian teleradiologist is mostly media speculation.
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"Truth wins out in the end and the story of U.S.-radiology-to-India will soon lose its luster," wrote Frank Levy, an economics professor at Massachusetts Institute of Technology, and Kyoung Hee-Yu, with the Australian School of Business.

The researchers say despite the lower cost of using Indian radiologists, there are simply too few qualified doctors there. Radiology also depends on tacit knowledge acquired over years of experience, and is thus hard to reduce to the simple rules needed for outsourcing to go smoothly, they said.

"Computerization of low-end diagnostic radiology ultimately poses a bigger threat to the profession than offshoring," the authors argue.

At first glance, they say, outsourcing makes sense: smaller U.S. hospitals need outside radiologists to do night reads, and Indian radiologists are relatively cheap. A radiologist there makes about $35,000 per year, less than one-tenth of a U.S. radiologist's median annual income of $402,000, according to figures pulled from salary.com.

But the problem, the authors say, is that radiology has too many "judgment calls," so it's not as easily squeezed into rule-based programs that govern other outsourced jobs, like call-center work.

As an example, they compare it with tax processing. It's easy to offshore call-center work for basic tax processing because the U.S. tax code follows step-by-step rules, rules which can also be codified into software, like TurboTax.

But radiologists work with case-based reasoning, the economists say. That is, they solve current problems by constructing analogies with past ones, which they then use as a starting point to work out their answers. This requires extensive training; for U.S. radiologists, generally, this means, after medical school, a five-year residency and often one- or two-year post-residency fellowships.

And unlike U.S. radiologists, who get frequent constant exposure to a range of modalities, Indian radiologists' training is also more specialized, and often limited to one modality, the authors said.