I’m sure that many of you have read the NYTimes blogpost last week 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.
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.
wonderful article. my aunt is a radiologist. she started when it was a growing field. the great thing about it is that when she decided to start a family, they let her work nights from home. she still went in but had more flexibility. she got paid less but she got to spend time with her children and family. being just minutes away also meant that she can go in if need be. it was a win-win situation. going offshore sounds like it is going to affect the quality. but it also seems like cost cutting is inevitable. healthcare costs have been growing faster than the economy as a whole (GDP) for a long time. now, that growth is slowing (from NYT Slower Growth of Health Costs Eases Budget Deficit). it is more sustainable.
perhaps, one day, robotic surgeons with much more dexterity and degrees of freedom than hands or super imaging/diagnosis machines run on supercomputers can figure everything out instantaneously. but any patient (including a potential patient like myself) would take that sincere, kind-hearted doc any day (your previous article).
thanks for sharing!
The way I see it, as imaging technologies evolve, you don’t need to be a radiologist to diagnose anything…..
Thanks for your comment Allen! I hear you (or rather, your aunt) for reasons why women especially may choose to go into radiology. That same perk of being able to work remotely may now actually be what hurts the field as outsourcing presents a cheaper and more efficient alternative. I see the same trend going on in other fields across medicine as well. This month during surgery I’ve been seeing mostly nurse anesthetists as opposed to anesthesiologists. If both are able to do 80 of the job equally, why hire the one that’s 3x more expensive for routine cases? I suspect that as the healthcare system changes we will only see more similar expansions in what non MDs can do legally.
that may be true for obvious diagnoses, but after spending some time in a reading room you can see how valuable a good radiologist can be in piecing together several findings to fit with the clinical picture.