Outsourcing trends worry Europe's trainees

The prospect of some or all of radiologists' reporting work being outsourced to independent businesses is causing concern among qualified radiologists and trainees alike, according to Dr. Alice Veitch in southwest England. She remains confident, however, that the rise of remote reporting is not a significant threat to public radiology services.

Multidisciplinary team meetings with clinicians are now regarded as an essential part of radiological practice, and clinicians are unlikely to be satisfied by the abandonment of such discussions, she said. Possible ambiguities in reports are more difficult to clear up if the author in question cannot be contacted. The trend toward more minimally invasive therapies also means that the role of interventional radiologists continues to expand.

"There is outsourcing in areas such as MRI and plain films now, and this is likely to increase in the future, but I think that there will always be a place for radiologists in the hospital environment," Veitch said.

The University Hospital MAS in Malmo has had to outsource some of its MRI reporting, said Dr. Sophia Zackrisson. A teleradiology firm from outside Sweden reads nonemergency images when report turnarounds for certain indications become too long. While this is helping to reduce the time patients must wait for a diagnosis, trainees may ultimately lose out.

"We have to use it so that we don't get overloaded," she said. "It is a good solution, but it can also be a problem since all the interesting cases go somewhere else."

The need for outsourcing in Malmo is being driven by a local shortage of neuroradiologists. The contracted firm has been sent mostly brain and spinal MRI cases to date. This situation may well change in the future, however, with other specialty areas becoming involved.

"We have recruited more radiologists again. But there will certainly be a long-term shortage of all types of radiologists in Sweden. So I think it will be difficult not to use outsourcing in the future," she said.

Dr. Christiane Nyhsen from Newcastle-upon-Tyne, U.K., who is president of the Radiology Trainees Forum, conducted a teleradiology and outsourcing survey of 30 European training centers in March 2006. She found that smaller radiology centers are more affected and will therefore be less attractive for trainees in the future. Some centers outsource more than one modality. Two centers where outsourcing has a significant impact on training contracted out 21% to 50% of routine MR scans and 51% to 70% of CT scans. Outsourcing of ultrasound scans and plain film reporting is limited to date, she said.

Outsourcing strategies are mostly being determined by the local hospital and mostly being paid for by the local hospital and/or the region, according to the RTF survey. Many patients know who is reporting the outsourced scans, and the reporting was mostly done in the same country. None of the centers seemed to satisfy the clinicians' demands, and trainees thought that outsourcing centers should take part in training.

Overall, Nyhsen found great variation in management courses offered to radiology trainees, and 30% report no availability of courses at all. She thinks it is important that radiologists take an interest in the political circumstances locally and nationally. She said that politicians and managers need clinical input to safeguard patients' interests and to ensure good quality training of doctors in the future.