Original articleOutsourcing: A Primer for Radiologists
Introduction
Outsourcing is a common term but one that many radiologists and radiology department personnel may not fully grasp. As medicine and the practice of radiology become increasingly business oriented, globalization is likely to play an increasing role in the organization and delivery of health care. Outsourcing is a topic we need to understand well if we are to make well-informed choices about the future of radiology, our practices, and our own careers. This article explores the nature of outsourcing and such related practices as offshoring, including their benefits and costs.
Most of our understanding of outsourcing derives not from radiology but from the discipline of economics and not the economics of health care but that of other industries. Because decisions about outsourcing often involve thousands, tens of thousands, and even hundreds of thousands of employees, most studies of outsourcing are not controlled experiments and cannot be verified in the way that a bench researcher might expect. Nevertheless, it is possible to make more or less well-informed and objective assessments of the impact of outsourcing. Our goal in this article is to review some of the best information available on the topic.
Section snippets
Defining Terms
To begin with, it is important to define some terms. The US Congress commissioned the National Academy of Public Administration to produce a report on outsourcing and related phenomena, and the academy released its report in January 2006 [1], defining the key terms as follows:
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Outsourcing occurs when a firm contracts with another unaffiliated firm, either domestic or foreign, to provide service or manufacturing activities formerly performed by its own employees.
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Offshoring occurs when a domestic
Impact of Outsourcing
Many people fear that offshoring and offshore outsourcing represent a threat to US workers and the US economy. Others support these activities, arguing that they can reduce costs, improve efficiency, enhance quality, increase revenue and incomes, augment production, lower prices, and open up businesses to new global markets, all without decreasing the number of jobs in the United States [2]. This is not a novel debate. For decades, the US manufacturing sector has been aggressively moving its
Outsourcing in Health Care
What does outsourcing mean to medicine and health care? One important difference between health care and other sectors of the economy may be a lower level of readiness on the part of consumers to sacrifice quality for lower prices. Many people might tolerate a $15,000 economy car instead of a $100,000 luxury car, but few would accept as a substitute for a $20,000 cutting-edge angioplasty procedure a $1,000 knockoff performed in a garage by a high school student using toothpicks and party
Outsourcing in Radiology
Who wants outsourcing in radiology? In some cases, outsourcing is sought by local radiologists, who wish to decrease their after-hours work commitments. In other cases, radiologists may welcome outsourcing to provide higher quality interpretive services. Other supporters of outsourcing may include health care payers, who seek to lower costs; hospitals and health care organizations, who want to increase the accessibility and timeliness of radiologic services or redress workforce shortages;
Costs of Outsourcing
As an increasing percentage of radiologic services are outsourced, radiology itself may undergo undesirable changes. One such change is the loss of patient contact and the opportunity to build patient-physician relationships. A related loss concerns continuity of care: each of a patient's ongoing radiologic studies may be interpreted by a different radiologist, none of whom sees the process evolve over time. Another loss concerns relationships between radiologists and other health
Guidelines
What principles should guide radiologists in thinking about outsourcing? Three crucial ones include eliminating the risk source, reducing the dependence between the risk source and the risk scenario, and reducing the dependence between the risk scenario and the risk impact [12]. Figure 1 outlines these 3 principles as they apply to radiology.
Consider the case of a hypothetical rural hospital. The on-site radiologist staff consists of two general radiologists who wish to outsource
The Future
In reviewing the benefits and risks of outsourcing in radiology, the ACR has made the following recommendations: any radiologist interpreting radiologic studies performed in the United States should be board certified, maintain a license to practice medicine in the state in which the images were obtained, carry appropriate malpractice coverage in the state, and have hospital privileges at the facility where the images were created [9]. Partly in response to these recommendations, corporations
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