Failure of image off-shoring experiment reflects flawed concept

January 12, 2005

U.S. radiology has hit a conundrum: Demand for imaging interpretation services continues to increase, but the pool of radiologists emerging from residency programs remains fixed at about 3100 per year.

U.S. radiology has hit a conundrum: Demand for imaging interpretation services continues to increase, but the pool of radiologists emerging from residency programs remains fixed at about 3100 per year.

Several years ago, officials at Massachusetts General Hospital believed they had a solution: Find a clinical and technology partner in India, train their radiologists at MGH, and use international teleradiology links to meet the ever-growing demand for image interpretations.

The experiment failed, said Dr. Sanjay S. Saini, then part of the MGH staff and now radiology chair at Emory University, said in a plenary session presentation on global teleradiology. The reasons it didn't succeed suggest a less than bright future for the idea of off-shoring image interpretations.

From the start, MGH set a series of preconditions for the experiment. There would have to be a technology partner who could be linked to the MGH PACS and its hospital and radiology information systems. There would also have to be a local healthcare partner who could read for MGH but could read in a local clinical setting, as well. Finally, MGH could incur no financial risk or gain.

The process would involve MGH training Indian radiologists by subspecialty and then co-hiring them to work for MGH as part of a dynamic technology enterprise that linked Indian and U.S. clinical operations, Saini said.

Once word of the plan got out, it was improperly branded a form of job exportation and off-shoring similar to arrangements that have drawn political fire in nonmedical settings, and it thus generated a host of bad publicity in the radiology community. The publicity generally reflected an incomplete understanding of the program and how it would operate, he said.

But it wasn't the adverse publicity that killed the idea. Rather, the concept just didn't work. The idea of globally linked PACS proved too expensive to be feasible, Saini said. Furthermore, MGH couldn't find radiologists to participate.

"The experiment came to screeching halt," he said. "The technology wouldn't work and the people wouldn't come."

Even now, off-shoring of radiology reads faces some formidable obstacles. It doesn't scale well from a technology perspective, and the rest of the medical record is not available to the interpreting physician.

In one respect, however, off-shoring has succeeded. Because at least 22% of the physicians now practicing in the U.S. are international medical graduates, part of the country's medical education has in effect been off-shored, and its products have become a permanent part of our medical workforce, Saini said.