The World is Flat

The World is Flat,
by Thomas Friedman.

I recently finished reading The World Is Flat by Thomas Friedman. This fascinating book is an “account of the great changes taking place in our time, as lightning-swift advances in technology and communications put people all over the globe in touch as never before.” I recommend it highly.

Is the world of medical physics flat? That I can write this blog about the 4th edition of the textbook Intermediate Physics for Medicine and Biology and have it read immediately, anywhere, by anyone in the world is amazing, and suggests how our world is flattening.

One example that Friedman presents is the outsourcing of reading x-rays and MRIs to India and other countries. On pages 15–16, Friedman quotes an email from Bill Brody, president of Johns Hopkins University:

Dear Tom, I am speaking at a Hopkins continuing education medical meeting for radiologists (I used to be a radiologist)... I have just learned that in many small and some medium-sized hospitals in the US, radiologists are outsourcing reading of CAT scans to doctors in India and Australia!!! Most of this evidently occurs at night (and maybe weekends) when the radiologists do not have sufficient staffing to provide in-hospital coverage... Since CAT (AND MRI) images are already in digital format and available on a network with standardized protocol, it is no problem to view the images anywhere in the world... Best, Bill

A 2006 New York Times article by David Leonhardt, “Political Clout in the Age of Outsourcing,” states that

For now, the practical effect on radiology is small. At its highest levels, the United States health care system may be the best the world has ever known. India doesn’t even have many radiologists today, let alone a large number who measure up to American standards. But that’s going to change. Eventually, Indian doctors will be able to do the preliminary diagnoses that are a big part of radiology.

In his editorial “American Radiology and Outsourcing,” published in the journal Radiology (Volume 242, Pages 654–657, 2007), William Reinus writes

...to one degree or another, health care experiences the same market forces as do other industries. Whether in manufacturing, accounting, law, research science, or medicine, ultimately efficient markets will carry business activity to the lowest-cost and highest-quality supplier. At the current time, radiology is particularly vulnerable to outsourcing because of recent technologic developments. Other specialties, such as pathology, may soon follow suit. As the level of education rises in other countries, it is likely that medical tourism will also grow. If nothing else, American medicine should expect some major changes in its way of doing business in the coming years.

Outsourcing can be good or bad, depending on your perspective. Take a look at the website of the company Outsource2India to get the Indian view on outsourcing.

What is the bottom line? Outsourcing in radiology is a complex issue that I cannot resolve here. Generally I favor free trade, so I don’t view these developments with fear. One thing I can say with reasonable certainty is that, like it or not, the world of medical physics is becoming flatter.