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"It's almost in crisis proportions," said E. Stephen Amis Jr.,
chairman of the board of chancellors at the American College of
Radiology and chairman of radiology at Albert Einstein College of
Medicine in the Bronx. "Demand for radiologists is growing at twice
the rate that we're turning out the radiologists who have the
ability to read them."
Radiologists who are willing to work nights are in particularly
short supply. The need for such specialists in the evening has grown
because patients coming into hospital emergency rooms are often
given scans to help diagnose their conditions. A radiologist on call
may be awakened several times a night.
One solution, made possible by electronic transmission of images,
has been so-called nighthawk services. These are companies or
individual radiologists, often working from home, who handle the
nighttime loads of several hospitals at once.
It didn't take long for some nighthawk companies to use
radiologists stationed overseas, in places where it is day during
America's night. One company, Nighthawk Radiology Services, has
stationed 15 American radiologists in a building near the Sydney
Opera House in Australia. A few radiology practices in the United
States have bought houses in Europe, and their members take turns
living there.
From nighthawk services, it was just another step to put the
night readers in countries with lower costs. Besides the two
companies in India, Infinity Radiology, based in Dallas, is using
some radiologists in South Korea.
A big obstacle to such services' growth is the requirement of
most American states that radiologists be licensed in order to
analyze scans of patients treated in those states. Moreover,
radiologists need to have credentials at each hospital where they
practice. As a result, it takes time and administrative work to set
up each new account.
THERE are other complications. Medicare does not pay for services
performed out of the country. So, in most cases, the doctors
overseas do a preliminary reading, which nonetheless is used to
guide treatment of the patient at night. The next morning, a local
staff radiologist performs the final reading and bills Medicare.
The training of overseas radiologists can vary. Both Dr.
Kalyanpur and his partner are board-certified radiologists, the
highest standard in the United States, and some customers say that
this presents no issues.
Dr. Thomas A. Manning, a staff radiologist at Centre Community
Hospital in State College, Pa., which uses Dr. Kalyanpur, said it
was better to have nighttime images read by a qualified radiologist
overseas than by a resident still in training, the practice at some
teaching hospitals. Dr. Manning said he was pleased with the
hospital's nighthawk service and did not even know where Dr.
Kalyanpur worked. "Is he actually in India?" he said. "I'm unaware
of it."
Wipro's radiologists are not licensed in any state or approved by
any hospital, Mr. Kurien said. That makes them ineligible, by
themselves, to do even preliminary readings for American hospitals.
Instead, he said, they receive scans electronically and provide
interpretations to Wipro-employed licensed radiologists in the
United States, who in turn consult with the client radiologist.
This roundabout method, he conceded, was developed after Wipro
found that it could not find licensed radiologists to directly
interpret images for American doctors. He said the business would
not grow unless he could use more radiologists trained in India.
"That is the end state because getting U.S.-trained radiologists in
huge numbers is not something we can get in India," he said.
Mr. Kurien said he pays the radiologists in India $30,000 to
$100,000 a year, depending on their training. That is more than
Indian radiologists working for Indian hospitals make, but still low
enough to allow Wipro to interpret images for about half the cost in
the United States, he said.
RADIOLOGY may be just the start of patient care performed
overseas. Next may be pathology. It is now possible to transmit
images of tissue samples for remote diagnosis. There are also
robotic microscopes that can be operated remotely, allowing a doctor
at a different site to move a slide and focus the image.
