Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Indian radiologists have more to worry about than teleradiology

Dr. Saurabh Jha
Physician
June 29, 2015
99 Shares
Share
Tweet
Share

shutterstock_145545640

Teleradiology has the same effect on radiologists as Lord Voldemort has on Muggles. It’s the feared end point of the commoditization of imaging, with Rajeev in Bangalore outpricing Rajeev in Chicago for reading follow-up CTs for lung nodules.

But despite the fears of U.S. radiologists, their counterparts in India have more pressing things on their mind.

“U.S. radiologists think that Indian radiologists are [itching] to steal their jobs. We have plenty of work in India,” reassured Dr. Sumer Sethi, director of TeleRad Providers of New Delhi.

A tech-savvy blogger, Sethi founded TeleRad Providers in a flash of inspiration and an appreciation of market forces.

“There is unimaginable competition in private medical imaging in New Delhi,” he said.

A new radiologist wishing to set up shop in one of India’s metropolitan areas faces large upfront costs: There is little discount for a 1.5-tesla MRI scanner. This means one must have abundant spare change floating around — or ancestral wealth. And once the shop is set up, the aspiring radiology entrepreneur embarks on a long and uncertain road toward establishing reputation and market share.

Employment models in the U.S., such as partnership tracks and buying into a practice, are not generally available to Indian radiologists. The alternative to entrepreneurship is working as a salaried employee for a corporate hospital, private imaging center, or government hospital. That was not the career pathway for Sethi, whose teleradiology practice is a pure fee-for-service model.

“It’s a low-cost operation,” he explained. “We read from home.”

An elegant model

The costs of an Indian teleradiologist are certainly low. Sethi does not have to deal with intermediary agents. There are no concerns about using the wrong billing code, and there are no separate state licenses to acquire. The model is elegant in its simplicity. He gets a study, renders a report, and gets paid.

However, the low operating costs belie the actual effort that is required of Sethi to grow his practice. He negotiates with hospitals directly. Being an entrepreneur means recognizing the need for teleradiology, and persuading others of the need and its solution.

Most of Sethi’s clients are hospitals in tier 2 and tier 3 cities in India, the equivalent of Dayton, OH. The hospitals have the machines and patients but not always the radiologists.

“We mostly plug the gaps in the rota at these places,” Sethi said.

This must mean that the radiologists at these centers welcome his efforts, I surmised.

“The scrutiny of our reports is intense,” he said. “This does not mean all our reports are overread. But were we to miss something, we could lose the contract, as the local radiologists would say, ‘See, this is a report from a teleradiologist.’ I tell my team that we must be at the top of our game, always.”

However, Sethi’s group, which includes subspecialized radiologists, is appreciated by many in the private medical imaging industry. One group is investing in a 64-detector-row CT scanner for coronary imaging, only on the reassurance that Sethi’s radiologists will read the cardiac studies when their radiologists are not available.

Sethi does not live in a regulation-free nirvana. The most onerous regulation is the Indian Evidence Act. Doctors who treat patients who have sustained deliberate bodily injuries are obliged to testify if the case reaches the courts. This is time-consuming, and doctors hate the legislation. It dissuades many from taking on needy patients whose injuries may be part of a “criminal case.” This is a particular problem for teleradiologists.

“The first problem is that we have to be physically present in the district court,” Sethi explained.

Sethi’s team reads studies from far-flung rural India. To get there, you need planes, trains, and automobiles, in that order. What’s more, cases in Indian courts can linger for a long time.

“The bigger problem is that judges don’t understand radiology,” he said. “I was once asked to testify in a case where a patient sustained craniofacial fractures from bodily harm. The judge asked me to identify the plaintiff. How could I tell? I saw his CT, not his face. Even with 3D reconstructions it was unclear.”

Sethi now insists on a waiver that excuses his radiologists from having to testify. This is just as well; his group reads 500 cases a day — 50 per radiologist. The volume may not sound like a lot, but there are no plain films, only CT, and MR. And nearly all are positive for pathology.

“In India, we don’t generally get ‘rule-out’ studies,” Sethi said. “The scene is different. Patients are sick. I have yet to read a normal study from Lakhimpur.”

Lakhimpur in Assam is India’s Outer Mongolia. You’re more likely to encounter a German tourist than a physician. National Highway 52 runs through it, and it has a higher-than-average rate of road traffic accidents. The Indian government’s National Health Mission decided that areas of interior India, such as Lakhimpur, needed hospitals. Hospitals needed CT scanners to deal with, among other things, polytrauma. Surgeons, even in remote India, don’t wish to perform a laparotomy or thoracotomy unless it’s necessary. Can there be a greater testament to the value of imaging?

Needless to say, a CT scan is pretty useless unless someone interprets the images. So Sethi’s group frequently reads studies from remote places such as Lakhimpur, Kokrajhar, and Nagaon in Assam.

“We get paid for it,” Sethi hastens to clarify, in case one eulogizes him undeservedly. “Charity doesn’t help people in areas of need. Charity is short-lived. You need a long-term solution. This means a business model that is win-win. I get to read from New Delhi, since I don’t wish to relocate to Lakhimpur or a city so remote. We are paid as if we are reading for someone in Delhi. They’d have to pay a radiologist a lot to move to Lakhimpur. But I also get the satisfaction that I am helping people in my own country. This is much more satisfying than reading CTs from the U.S.”

Sethi’s fee for service philanthropy (this is not intended to be facetious) extends to Africa. The model is slightly different, but the principles are the same. There are CT scans and patients but no radiologists. Sethi’s team reads the studies and gets paid per study.

The images are not received in real-time: They are streamed from the CT scanner to a server, then to the cloud, and then to the PACS. What about measures to protect patient health information?

“Sir, in Lakhimpur, patients value their lives more than their privacy,” Sethi rejoined.

Ouch! I felt like a bumbling college student with the insight of Marie Antoinette.

“But our cloud is firewalled,” he added.

Sethi has also utilized teleradiology for another purpose: education. He has a large teaching file, encompassing the esoteric and the common, and he is revered by radiology residents in India.

Teleradiology has many faces. In the U.S., it helped radiologists sleep at night (and now we are losing sleep because of it). In Britain, it is clearing the waiting list and increasing productivity. In India, it provides semi decent health care for poor people in far-off places.

Sethi’s team is making a difference and is not any poorer for it. This is a testament to his efforts and to the value of medical imaging for sick patients.

Saurabh Jha is a radiologist and can be reached on Twitter @RogueRad. This article originally appeared in AuntMinnie.com.

Image credit: Shutterstock.com

Prev

Use physician rating sites to establish an online reputation

June 29, 2015 Kevin 1
…
Next

Should radiologists disclose results to patients? The answer isn't what you think.

June 29, 2015 Kevin 13
…

Tagged as: Radiology

Post navigation

< Previous Post
Use physician rating sites to establish an online reputation
Next Post >
Should radiologists disclose results to patients? The answer isn't what you think.

More by Dr. Saurabh Jha

  • Masks are an effigy of American technocratic incompetence

    Dr. Saurabh Jha
  • False negative: COVID-19 testing’s catch-22

    Dr. Saurabh Jha
  • Why the Lancet’s editorial on Kashmir is unhelpful

    Dr. Saurabh Jha

More in Physician

  • A tense family drama unfolds as a young daughter pursues unconventional career path

    Osmund Agbo, MD
  • Decoding the brain’s decision-making: insights for medical professions and strategies for success

    Harvey Castro, MD, MBA
  • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

    Jay K. Joshi, MD
  • Discover your true north: Navigating life’s confusions and embracing your path to success

    Tyler Jorgensen, MD
  • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

    Anonymous
  • From journalism to medicine: Unveiling the untold stories of patients’ medical conditions

    Veronica Bonales, MD
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician
    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Nails or Sliding Hip Screws to Repair Trochanteric Fractures?
  • Skipping Radiotherapy 'Seems Safe' for PMBCL Patients in Remission
  • More Anxious Kids Medicated; Apple's Mental Health Moves; OTC Video Game for ADHD
  • ADHD Meds Linked to Lower Suicide Risk in Borderline Personality Disorder
  • Promising Gene Therapy for Overactive Bladder

Meeting Coverage

  • Skipping Radiotherapy 'Seems Safe' for PMBCL Patients in Remission
  • Promising Gene Therapy for Overactive Bladder
  • Shotgun Sequencing of Small Intestine Reveals Species Tied to GI Symptom Severity
  • FGFR Inhibitor Stakes Claim to Post-Anti-PD-1 Role in Advanced Bladder Cancer
  • Multimorbidity Patterns and Healthcare Utilization in Vets With Schizophrenia
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician
    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Indian radiologists have more to worry about than teleradiology
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...