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As technology improves, "it would be possible for a small
hospital in the United States to digitize an image, put in on their
server and have a pathologist anywhere in the world, such as in
India, provide a diagnosis," said Ronald S. Weinstein, professor and
head of pathology at the University of Arizona College of Medicine
in Tucson and director of the Arizona Telemedicine Program. He said
he had heard of a pathologist in Poland who was planning an
international pathology service.
Other services can also be performed remotely. Some hospitals are
starting to monitor intensive care units in part from remote sites,
with readings from electronic monitoring devices and video cameras
sent electronically. That is not yet done across borders, but could
be.
Someday, said Dr. Weinstein, who is also president of the
American Telemedicine Association, a professional society, there may
be virtual universities that can train doctors in foreign countries
to meet American requirements. "The concept of boundary-limited
medical education and licensure will fade in time," he said.
Still, what goes one way could also flow the other. Dr. Weinstein
said telemedicine might provide a net gain to the United States
because of the expertise here to provide diagnoses for patients in
other countries.
"I think the opportunities for U.S. health care internationally
probably are very large," Dr. Weinstein said. The University of
Arizona plans to market its pathology services around the world, he
said.
Leading American medical centers already market themselves abroad
to recruit foreign patients to travel for operations. Some hospitals
are setting up outposts overseas.
The University of Pittsburgh Medical Center essentially manages a
transplant hospital in Italy, performing some pathology from
Pittsburgh. The Armed Forces Institute of Pathology in Washington,
part of the Walter Reed Army Medical Center, provides second
opinions on about 60,000 cases a year, for Americans and foreigners.
Most of the time, slides and tissue samples are sent in by mail, but
about 300 to 500 a year are analyzed by using telepathology.
Eventually, there may be a division of labor, with high-end
services performed in the United States and more routine services
done in countries with lower wages. And radiologists may even come
to appreciate having offshore help.
"People want to protect their turf," Dr. Saini of Massachusetts
General said. "But it's very interesting that that turf battle stops
at 5 p.m. on Friday. How many people say they want to do this thing
on Saturday and Sunday?"
Indeed, not every posting on the radiology Web site has
criticized Dr. Saini. Some favored using foreign radiologists. "If
we don't hire them, we'll be working longer hours for the same pay,"
one person wrote. "So everyone please shut up about this."
