PHYSICIANS/TECH: Why diagnostic radiologists won’t make $400K a year forever

One of the smartest observers of the medical scene, UCSF’s Bob Wachter had an interesting article in the NEJM on The Implications of Medical Outsourcing. Here’s the key point:

By severing the connection between the "assay" and its interpretation, digitization allows the assay to be performed by a lower-wage technician at the patient’s bedside and the more cognitively complex interpretation to be performed by a physician who no longer needs to be in the building — or the country.

Of course they’ll be lots of resistance to this — and if anything Wachter understates the extent of the war that’s about to happen (think specialty hospitals). But eventually collaboration software (as being plugged by Microsoft and Nortel) will remove the need for much direct physical connection between patient and physician, and skilled technicians and lower-paid clinicians will mediate between them.

Until of course the availability of lower-paid physical physicians re-disintermediates that trend. If you have no idea what I’m talking about, do yourself a favor and read Eric Schlosser’s fantastic article on why it’s cheaper to hire people than machines to pick strawberries.

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6 replies »

  1. > the Amish contractually agreed not
    > to file malpractice claims
    I saw that as a kicker. The hospital needs some excuse to justify the discount to those who don’t get the discount the Amish get.
    If it is really true that malpractice (insurance premuims? settlements? not quite sure here) are only 2% of total (medical services spending?) then it seems to me a promise not to sue might be worth as much as 5% to a hospital. But I bet this promise does not reduce anyone’s insurance premiums a whit, so the “savings” will never show up in anyone’s bottom line — except for the insurers’; both the Amish as a mutual insurance entity, and the malpractice carriers. But not the hospital’s or the docs’.
    I understand that a malpractice claim is distracting for (especially solo) practitioners, and there is evidently some defensive medicine (so-called) going on. It might be a personal problem, but I just can’t get all worked-up over the issue as a top public priority.

  2. I live in Hawaii, where it is not uncommon to fly to Thailand for expensive dental work not covered by insurance.
    I believe that patients could be incentivized to travel abroad for care through a kick-back mechanism. So, for example, if surgery performed in India saved insurer $10,000, patient would be given $3000 “bonus” (plus free trip to India). It’s a win-win (except for US-based docs, of course).
    Other details, such as malpractice issues, would still have to be resolved.

  3. The WSJ article was quite interesting. However, I think a significant point was glossed over: the Amish contractually agreed not to file malpractice claims. This certainlyl provides leverage to negotiate lower rates.
    As to hopping on a plane to Thailand or India for healthcare, who is the patient going to call in the middle of the night for problems? The concept does, however, highlight the fact that an imformed consumer can be a real driver of increased value in medical care. I truly believe that CDHP’s will provide impetus for patients to be more cost concious and demand accountability in medical pricing (Good series of articles in current issue of Health Affairs re: the fantasy land of hospital pricing)

  4. Sure. Today on page one of the WSJ there is story (subscription req’d) about a mutually-insured Amish community that routinely sends people to clinics in Mexico they have learned produce good outcomes. It seems when there is mutual accountability among the group members and shared values, all manner of arrangements are possible.

  5. There is no good reason why patients scheduled to undergo non-emergency surgery cannot be sent to India, Thailand, or other countries with top-quality medical facilities. In fact, the UK already does this.