More hospitals are resorting to so-called “dayhawk” radiology services to read their x-rays.
It’s modeled after the “nighthawk” model, where radiologists (via Shadowfax), in some cases as far away as India, remotely read films in the middle of the night.
Now, the phenomenon is happening during business hours as well, which according to radiologist Giles W. L. Boland, means that “some radiologists can no longer assume long-term job security because their core value proposition can now be outsourced.”
This trend was entirely foreseeable. Cash-strapped hospitals are finding it cheaper to outsource x-ray readings, and furthermore, it seems that both nighthawks and dayhawks provide better service and more timely interpretations. This adds up to a declining need for an in-house radiology staff.
That’s bad news for some. Radiology departments at smaller hospitals may close, and eventually general radiologist salaries will come under pressure.
The answer? Like everything else in medicine, radiology sub-specialists will increasingly be in demand. Expect procedure-based, interventional radiology to grow, since what they do cannot be outsourced. Health care costs will correspondingly rise.
So, like primary care, don’t be surprised if the days of general radiology are numbered.
Related posts:
- Teleradiology
- Letters to the jury: Look at what your ridiculous award has caused
- How many radiologists cheat or take short-cuts in their interpretations?
- Will integrated systems become a reality in American health care?
- "Do not piss off a radiologist"
- Are there too many hospitals?
- "Radiologists are sabotaging the practice of medicine"
{ 9 comments }
Over on SDN in the radiology forums, there is mention of IR now becoming its own 5 year specialty.
Sadly, I am rather ambivalent about the whole issue. I trained and started practice in a time of daily radiology rounds. There would be a review with the radiologists over given scans. Yes I know it would probably slow them and us down a bit. However, I suspect they would get a much better clinical picture of the patient and we would better understand what they where seeing on the scan. I honestly thought it was a win win for all of us and the patients. As the radiologists who I worked with have retired, I have noticed the younger replacements frankly are irritated if not ouright hostile to me showing up in their domain. Often I get snide comments of “have you read the report” or “I’m busy” (as if I am not, my day starts and usually ends before/after yours respectively). It frankly is not a collegial relationship. I have dealt with nighthawks and frankly don’t see a drop off in quality AND over the phone deal with radiologists who appear to be genuinally interested in the clinical picture. 10 years ago I would have argued long and hard to keep the inhouse non IR radiologists. Now, I don’t even know who half of them are anymore. What does that say?
I knew about this in med school when I was considering Radiology. It deterred me enough to never reconsider a residency. I think it would be absolutely stupid, as I use in-house radiologists all of the time for quick prelim reads. We call over from various hospitals that are connected, when our staff are out, to have the in-house O/N people read scans/ xrays, etc. I can’t imagine trying to do that with Nighthawk, which did a lot of the films in the hospital where I was a med student. The reads didn’t seem any faster, better, or (and frankly most importantly to me) I wasn’t able to talk to them (that could have changed). It’s paramount to insanity to think that outsourcing medical professionals will lead to the same care.
The obvious question is that of liability. If the nighthawk, or dayhawk, gets a read wrong, can he be sued for malpractice? The lawyers will probably demand that they fall under the US legal domain, and will probably get it (political lobbies being what they are). This will likely drive price of such services up, in response to the increase in perceived risk.
Thus onsite radiologists become cost-effective again, and nighthawks go the way of the dodo. Beautiful, isn’t it?
I too am old enough to remember when we actually talked to the radiologist about every case. All the docs knew who the radiologists were and respected them.
Today I might walk past a radiologist and have no idea who he is.
The first time I got told “I’m too busy to read your stat film, the report will be back in an hour” was the last time I went to radiology for anything. My collegues had similar experiences so we use a radiology group in Belgium now. They have an 800 number that we can call and get a a doc on the phone within minutes – it’s almost like real medicine. We even get films read instead of getting told “clinical correlation required” on every read.
No one has a monopoly any more – it’s all service based. The good radiologists will always have jobs; the ones who can’t communicate well will have a harder time.
A recent scan by an in house and skilled neuro radiologist read a cerebellar mass as an old infarct. Turns out three months later it grew and now appeared to be a metastasis from a lung cancer. This second reading wasn’t a slam dunk either. It took a lot of deduction and differentials from an internist (me), a radiation oncologist and another skilled neuro radiologist.
Outsourcing THAT would have made the process 10 times worse.
Kevin, I don’t see how this is going to raise cost. This is the free market at work. The lowest bidder that provides quality service gets the business. Radiology has enjoyed their run, but like the other posters have said they have lost their clinical concern. They are no longer physicians but technicians and therefore service goes to the lowest bidder.
In a global economy, outsourcing of physician services to foreign countries is inevitable. Medical tourism is a growth industry for surgical procedures and will parallel what is occurring in radiology.
it is not about being cheap,it is more about being readily accessable to the healthcare providers but if the radiologists can not cope with the sheer volumes of scans and keep basing the priority based on the revenue and billables that each scan might recover there are no viable alternatives to the present situation.
Comments on this entry are closed.