Is outsourcing medical diagnoses a good idea?

I’m sure that many of you have read the New York Times post  titled “Job Prospects are Dimming for Radiology Trainees.”

I don’t know about you, but this article made me feel more than ever that in order to choose the right specialty, you have to predict the future of the field. Don’t choose a field that’s going to be heavily affected by Medicare cuts, some say. Fields that are lucrative now may not be by the time we’re done training, others point out. The field of neurology is already lobbying heavily this year due to a projected 7% decrease in payments. But who really knows how to look into the murky crystal ball, what with Medicare cuts and expansion in primary care, not to mention physician lobbying, and come out with a clearer picture of what’s to come?

In a nutshell, the article describes how St. Barnabas Hospital in the Bronx gave its radiology residents a one-year termination notice because the hospital is replacing their radiology department with a teleradiology company. From the hospital’s perspective, this makes sense. It is cheaper, they will get readings done faster and more efficiently, and they can funnel the money they save from cutting radiology training to increase primary care residencies. But from an educational perspective, this is devastating for the future generation of radiologists.

The article highlighted the options that several of these radiology trainees are now facing. These residents already have MDs, are halfway through radiology residency training, and are now left with nowhere to go. They are offering to work for free to finish residency and have to turn to donations from family and friends to work in unpaid programs.

The article definitely gave me pause. But there are few things to think about here before we all throw in the towel. First, the radiology program at St. Barnabas Hospital is affiliated with New York College of Osteopathic Medicine, not an allopathic institution. I haven’t heard of any radiology programs at allopathic institutions being closed, and I think this distinction may have influenced the decision to choose teleradiology over residents.

Often a little clinical context goes a long way.

A second point I worry about is quality of teleradiology, which may manifest over time. When I work in the hospital, no matter whether I’m on surgery or internal medicine, we as a team will often go visit the radiologists in person to go over the imaging. This is a win-win situation – we the primary team can provide the clinical context and background for the patient’s imaging and in return, we will learn how to read the image and talk through the final diagnosis with the radiologist together. In a teleradiology setup, this important opportunity for collaboration would not exist.

I think it remains to be seen whether or not outsourcing medical diagnoses is a good idea.  If this really becomes a trend, then I might start sweating more and wonder whether other specialties will follow the same path. But for now, I don’t believe this is the future of medicine.

Joyce Ho is a medical student who blogs at Tea with MD.  She can be reached on Twitter @MedGlobalHealth.

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