Offshoring and Radiology

• Discussion

References

Autor, David, Frank Levy, and Richard J. Murnane. 2003. "The Skill Content of Recent Technical Change: An Empirical Investigation." Quarterly Journal of Economics 118 (November): 1279-1334.

Freidson, Eliot. 1970. Professional Dominance: The Social Structure of Medical Care. New York: Atherton.

Goelman, Ari. 2005. "What's Space Got to Do with It?" Ph.D. dissertation, Department of Urban Studies and Planning, Massachusetts Institute of Technology.

Grumbach, Kevin. 2002. "Fighting Hand to Hand over Physician Workforce Policy; The Invisible Hand of the Market Meets the Heavy Hand of Government Planning." Health Affairs 21 (5): 13-27.

Kane, Carol, and Horst Loeblich. 2003. "Physician Income: The Decade in Review." In Physician Socioeconomic Statistics, edited by John Wassenaar and Sara Thran, pp. 5-11. Chicago: American Medical Association.

Levy, Frank, and Richard J. Murnane. 2004. The New Division of Labor. Princeton University Press and the Russell Sage Foundation.

Mullan, Fitzhugh. 2002. "Some Thoughts on the White-Follows-Green Law." Health Affairs 21 (1): 158-59.

———. 2003. "The Future of Medical Education: A Call for Action." Health Affairs 22 (4): 88-90.

Miller, Mark E. 2005. "MedPAC Recommendations on Imaging Services." Statement prepared for the Ways and Means Committee, U.S. House of Representatives, March 17 (http://www.medpac.gov/publications/congressional_testimony/031705_TestimonyImaging-Hou.pdf).

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Footnotes

1. Scott Thurm, "Lesson in India: Not Every Job Translates Overseas," Wall Street Journal, March 3, 2004.

2. Radiology has several subspecialties. Diagnostic radiologists read images and typically do not deal directly with patients. Interventional radiologists both read images and perform procedures on patients—for example, the image-guided insertion of a stent—and so their work is not at issue here.

3. See also Autor, Levy, and Murnane (2003). A second characteristic required for computerization is that the information being processed can be digitized. For simplicity, we do not discuss that characteristic here.

4. The machine tool instructions come from the computer-assisted design software used to design the aircraft. See Levy and Murnane (2004, chap. 3) for further discussion.

5. The Kurt Rossmann Laboratory at the University of Chicago Medical School is one such center. Note that the radiologist must both recognize an abnormal pattern (which is what the software does) and identify the abnormality, a potentially harder job.

6. One developer of such software is R2 Technologies in Santa Clara, California; see www.r2tech.com.

7. But a U.S. residency does not require having attended a U.S. medical school, a point we return to below.

8. RSNA News, October 2004 (www.rsna.org/publications/rsnanews/oct04/salary-1.html).

9. The H1B visa is the primary USA work visa (permit) for foreign professionals who want to live and work in the United States. It is typically valid for up to six years.

10. Interviews conducted in 2005 by Kyoung-Hee Yu, a Ph.D. candidate in MIT's Sloan School of Management.

11. www.nighthawkrad.net.

12. This restriction was adopted a number of years ago to guard against, for example, people going to Mexico or Canada for treatment.

13. For example, a principal website for radiologists, www.AuntMinnie.com, holds an annual poll to choose "The Minnies," the leading people and most significant developments and events in the field. In 2004, competition from foreign doctors was neither the first- nor second-ranked "biggest threat to radiology." (It had been ranked second in the semifinal voting.) The Minnie for biggest threat went to "increased use of medical imaging by physicians in other specialties (turf battles)," discussed later in this section. See www.auntminnie.com.

14. As reported in Tracie L. Thompson, "Cardiology Leader Slams ACR Imaging Initiatives" (www.auntminnie.com [March 10, 2005]). See also Tracie Thompson, "U.S. Congress Hears Debate over Federal Imaging Standards" (www.auntminnie.com [March 17, 2005]).

15. Charles Stein, "Partners Program Aims to Rein in Skyrocketing Costs of Diagnostic Imaging," Boston Globe, June 27, 2003.

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