Kevin, M.D. - Medical Weblog

Radiologists I know always tell me that they don't have to worry, but I wonder sometimes. I would be a little nervous that the only thing protecting me is a law that could easily be changed if the political will is there with the proper political party in power.

Can any other posters shed some light on why this would not be the case?
 

Reading the article made me curious what law you were referring to, anonymous.

I would assume that an Indian radiologist could not be sued for malpractice like an American one could (much like cruise ship doctors) -- therefore, no liability. Patient advocates and lawyers would fight that with everything they had.

It also brings up licensing issues. Since we don't allow non-US-licensed physicians to practice in the US, I see no reason why we would essentially let foreign radiologists "practice" telemedicine in the US without proving their qualifications.

Radiologists might be in danger of having the number of positions reduced if hospitals could get away with having them sign off on teleradiology interpretations, but my guess is that US radiologists will be quite happy and well-paid for a long time yet.
 

As a family practitioner who takes care of his patients while in the hospital, I think teleradiology is a bad idea. There is no accountability. I have had misreads, corrected by the staff radiolgists when they come in in the morning but no effort made to communicate the discrepancy. Plus, by then, decisions have already been made, placing myself, ER docs and specialists, not to mention the patient, at risk. I have complained to the hospital administration only to be told this is just the way it is, I have to accept it.

No, I say. How can the best interests of the patient be served by some radiologist I don't know, in his pajamas or on a boat in the Carribean, reading the films? How does this improve quality, by adding another chef to mix the broth?

Besides, local radiologists are going to be teleradiologied right out of existence, outsourced to licensed but cheaper radiologists overseas. When, not if, that happens, the local guys are going to be contacting primary care doctors, just like me, to help make their case for them. By then, it will be too little too late.

Underpiad in upstate New York
 

The med/legal issues are not insurmountable. Just as Indian radiologists can move here and get liscensed, their is no reason why they cannot bear a US states medical liscense while working in India. The issue of liability can be worked out contracturally with the hospital and they should be able to purchase liability if the state requires it.

All can be arranged whereby they are actually legally practicing medicine in the state where the patient is located.
 

Our radiology group is based in Australia. All of them are licensed to practice medicine in Texas; they carry the same liability risk (and be sued) just like native Texan radiologists.

I suppose (in theory) a patient could sue one radiologist and have him dissapear into the Outback, but then the company would loose the contract with our 20 hospitals.

Personally, I'd had very little trouble reaching an actual doctor from the NightHawk teleradiology group and having them answer my questions. They're a lot easier than most US radiologists (especially the academic ones!) who make it as difficult as possible to interact with them.

Now if only we could outsource interventional radiologya s well...
 

Most of the radiologists that I know don't seem to be that worried about teleradiology. As a pathologist, I am somewhat concerned. Telepathology is starting to emerge. There are some slide scanning systems coming to the market (Aperio, Olympus, etc). I just saw a demonstration today. Also, I am doing some CME's on scanned slides. In a few months, one of our reference labs will be uploading scanned images of immunohistochemical stains, so we will be interpreting them via the internet. The technology is amazing and scary at the same time.
 

Thanks for the real-life teleradiology example: I'd heard it existed but didn't know about the licensing issues.

Still, I think that the average US radiologist would be scared much more about India-based doctors than Australia-based doctors. The licensing requirements and more importantly, pay scales, are not significantly different for Australian doctors versus US ones.

But it's still very difficult for an non-Western Europe/Canadian/Australian doctor to be licensed to practice medicine in the United States.

Since those doctors not from those countries would be the cheapest (assuming pay for doctors there correlate to those used in the IT industry), they'd be the real threat.

I'd heard some rumblings about telepathology as well, but don't know enough about how the field works to speculate on the danger. As always, I think the first lawsuit will draw the lines.
 

I really feel strongly about this issue, but I am honest with myself at the same time. Yes, I admit to suffering from radiology-envy. Life gets harder for every single type of physician out there EXCEPT radiologists; for them, they are not only handsomely rewarded, now they do not even have to do any call!

That admission aside, I think quality is a huge issue, and agree that the first big lawsuit will be significant: the radiologists involved, local and remote, are going to be pointing fingers at each other. That's a plaintiff lawyer's dream, doctors blaming each other. All other doctors involved in this case will be on board and will also go down with the ship.

Non-radiologists unite: speak out against teleradiology until it is too late!

Underpaid in New York
 

I guess I fee a little differently about the issue. I trained when you went down to the chest room on a daily basis daily. Now days most radiologist's act like it's a big deal if I actaully want to go over and discuss the X-ray, CT, MRI. I have repeatedly been asked "have you read the official report"? Silly me I am just the person taking care of the patient. Is it really that surprising that I want to see and discuss the study? today's younger radiologists don't even appear to be that interested in having this discussion and learning clinical details. Lately, I call if I have questions as I don't have the time or energy to deal with the smartass comments from the dark room. I have also delt with nighthawks and they appear to do a good job over all. they are also much more polite and inquisitive on the phone than our own inhouse radiologist's My question is, if I am not going down to talk to you anymore, if when I do go down to the dark room I deal with "I'm
too busy" shit, and if I get the same (or beter results with teleradiology), then why should I aid radiology when the inevitable of telerads overseas come up? I just haven't seen the purpose of inhouse radiologist's for a long time (except interventional).
 

Some Imaging centers get their exams read through teleradiology only, with no on-site Radiolgoist. If an Indian based company uses a USA based physician credentials, just from retrieving it from the Board of Medicine website (and put at the bottom of the report - Electronically signed by " DR_____ ______" what is the protection for the radiologist? Please think of this issue as it is happening with many imaging centers in USA where they fail to get all the credentials of the Radiologist and referring physician doesnt care to speak to radiologist reading the exam.