ANJAY SAINI was not prepared for the
hate mail. A radiologist at Massachusetts General Hospital, Dr.
Saini thought he had found a clever way to relieve an acute shortage
of specialists who could read X-rays and M.R.I. scans. The hospital
would beam images electronically from some scans to India, to be
worked on by radiologists there.
But the arrangement, made late last year with a company in India,
has touched off a minor furor. It turns out that even American
radiologists, with their years of training and annual salaries of
$250,000 or more, worry about their jobs moving to countries with
lower wages, in much the same way that garment knitters,
blast-furnace operators and data-entry clerks do.
Since the news got out, Dr. Saini has received a flurry of angry
e-mail messages, most of them anonymous, urging him to stop. The
American College of Radiology, the professional group for the
country's 30,000 radiologists, has set up a task force to look at
the offshore transfer of radiology services. And the online
discussion groups of AuntMinnie.com, a Web site for radiologists,
have been buzzing with debate about the prospects for competition
from "radiology sweatshops" abroad.
"This teleradiology thing is another nail in the coffin of the
job market," wrote someone on the Web site who identified himself as
a radiologist. "Who needs to pay us $350,000/yr if they can get a
cheap Indian radiologist for $25,000/yr."
Daniel Courneya, a radiologist in Hibbing, Minn., fumed on the
site that Massachusetts General, a Harvard teaching hospital known
to its admirers as "Man's Greatest Hospital," should instead be
called "Money Grubbing Hospital," another play on its initials.
On the surface, the controversy may seem a bit odd. Experts say
that the number of X-rays from the United States now being read in
India is minuscule and that regulatory restrictions are likely to
keep it from growing rapidly. Moreover, most hospital jobs, unlike
those in radiology, require close patient contact, so there is a
limit to how much offshore outsourcing can be done.
Besides, employment in American health care has been growing. In
the 12 months ended in August, the category added about 250,000 jobs
while overall nonfarm payroll jobs shrank by nearly 500,000.
Hospitals alone added about 70,000 jobs in that period.
Still, Dr. Saini's plan shows that even medical care, the most
intimate and localized of services, is grappling with the
globalization that has moved many jobs - first in manufacturing and
more recently in white-collar work - across the ocean. And in health
care, of course, there is more at stake than jobs. Dr. Courneya and
other critics worry that radiologists outside the United States may
not be trained properly, endangering patients' safety.
Dr. Saini says that the furor is much ado about nothing, that
people are reacting based on emotion, not fact. A native of India
who has lived in the United States since he was in high school, he
said that any Indian radiologist reading scans from Massachusetts
General would have to be licensed in that state and be certified by
the hospital, so patient care would not suffer.
At the moment, he said, there are no such qualified radiologists
at the outpost in India, so actual diagnoses are not being made
there. Rather, the radiologists in India are converting
two-dimensional images from scans into three-dimensional pictures
that are more understandable to surgeons; that job is usually done
by technicians in the United States.
RADIOLOGY is not the only medical service that may someday be
performed for Americans by people in other countries. Other
candidates are the analysis of tissue samples, the reading of
electrocardiograms, the monitoring of intensive care units and even
robotic surgery.
Back-office medical work has been moving offshore for several
years now, particularly to India, which has a large number of
educated English-speaking people. Though the number of affected jobs
is only a small fraction of the total, many experts say the share is
growing as hospitals face pressure to cut costs.
