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What India’s Teleradiology Market Teaches Us About the Future of Medicine

Teleradiology has the same effect on radiologists as Lord Voldemort has on Muggles. It’s the feared end point of the commoditization of imaging, with Rajeev in Bangalore outpricing Rajeev in Chicago for reading follow-up CTs for lung nodules.

But despite the fears of U.S. radiologists, their counterparts in India have more pressing things on their mind.

“U.S. radiologists think that Indian radiologists are [itching] to steal their jobs. We have plenty of work in India,” reassured Dr. Sumer Sethi, director of TeleRad Providers of New Delhi.

A tech-savvy blogger, Sethi founded TeleRad Providers in a flash of inspiration and an appreciation of market forces.

“There is unimaginable competition in private medical imaging in New Delhi,” he said.

A new radiologist wishing to set up shop in one of India’s metropolitan areas faces large upfront costs: There is little discount for a 1.5-tesla MRI scanner. This means one must have abundant spare change floating around — or ancestral wealth. And once the shop is set up, the aspiring radiology entrepreneur embarks on a long and uncertain road toward establishing reputation and market share.

Employment models in the U.S., such as partnership tracks and buying into a practice, are not generally available to Indian radiologists. The alternative to entrepreneurship is working as a salaried employee for a corporate hospital, private imaging center, or government hospital. That was not the career pathway for Sethi, whose teleradiology practice is a pure fee-for-service model.

“It’s a low-cost operation,” he explained. “We read from home.”

An elegant model

The costs of an Indian teleradiologist are certainly low. Sethi does not have to deal with intermediary agents. There are no concerns about using the wrong billing code, and there are no separate state licenses to acquire. The model is elegant in its simplicity. He gets a study, renders a report, and gets paid.

However, the low operating costs belie the actual effort that is required of Sethi to grow his practice. He negotiates with hospitals directly. Being an entrepreneur means recognizing the need for teleradiology, and persuading others of the need and its solution.

Most of Sethi’s clients are hospitals in tier 2 and tier 3 cities in India, the equivalent of Dayton, OH. The hospitals have the machines and patients but not always the radiologists.

“We mostly plug the gaps in the rota at these places,” Sethi said.

This must mean that the radiologists at these centers welcome his efforts, I surmised.

“The scrutiny of our reports is intense,” he said. “This does not mean all our reports are overread. But were we to miss something, we could lose the contract, as the local radiologists would say, ‘See, this is a report from a teleradiologist.’ I tell my team that we must be at the top of our game, always.”

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