10 H-1B/L-1 Offshoring Articles
10 H-1B/L-1 Offshoring Articles
Date: Monday, November 17, 2003 3:13 PM
JOB DESTRUCTION NEWSLETTER
www.ZaZona.com
Article 1:
http://www.amconmag.com/11_3_03/buchanan.html
Wall Street Journal vs. America
Unlike the patriarch Sen. Prescott Bush, George H. W. and his son are
free traders who simply cannot see the industrial ruin before them from
a decade of NAFTA, GATT, MFN for Beijing, and U.S. subordination to the
Yankee-baiting Eurocrats of the WTO.
Article 2:
http://www.washingtonpost.com/wp-dyn/articles/A13983-2003Nov7.html
'Buy American' Provision Weakened - House Cuts Terms Opposed by
Pentagon
The House passed a weakened version of a "buy American" program
yesterday, eliminating terms opposed by the Defense Department and U.S.
allies that would have expanded restrictions on foreign purchases by
the Pentagon.
Article 3:
http://www.bayarea.com/mld/mercurynews/7220550.htm
Hard data on lost tech jobs no easy task
How many U.S. tech jobs have moved overseas? It's anything but clear.
Article 4:
http://jobcenter.dallasnews.com/sharedcontent/careers/workingnews/110203ccCareersTechmain.1553fc53.html
Experts debating future of IT careers
Some expect shortages in field, but others say outsourcing will
permanently cut jobs in U.S.Many educators, employers and labor experts
insist that technology is so pervasive and fast-growing that a shortage
of technical workers is inevitable over the next several years. Hold
your horses, Richard Ellis tells them. "The industry has been hollering
about a shortage of high-tech people for half a century, and that's not
an exaggeration,"
Article 5:
http://in.news.yahoo.com/031015/43/28heu.html
CSC to open facility in Hyderabad
Computer Services Corporation (CSC), a leading global IT services
company, Wednesday announced the setting up of a facility in this
southern city.
Article 6:
http://www.zdnetindia.com/news/national/stories/92779.html
BPO likely to affect Indo-US relations, says expert
An expert on Indo-US relations has warned that continued outsourcing of
jobs from the US to India could become a major political element in
President George W Bush's election and if the American economy does not
pick up substantially, could lead to the construction of firewalls and
unemployment guarantees against outsourcing by the US.
Article 7:
http://sify.com/news/fullstory.php?id=13307985
Indian campaign in US on outsourcing
Will the Indian campaign in US on outsourcing succeed?
Washington: A coalition of Indian government officials, business groups
and influential Indian Americans has quietly launched an extensive
lobbying campaign here to counter allegations that the country was
taking an unfair number of high-end US jobs, a media report said.
Article 8:
http://news.bbc.co.uk/1/hi/business/3263027.stm
Boss backs India call-centre move
The chief executive of National Rail Enquiries has said Indian call
centre workers are more educated and do a better job than those in
Britain. Giving evidence to MPs on the transport select committee,
Chris Scoggins said the service could be improved and made more
accurate if outsourced to India.
Article 9:
http://online.wsj.com/article_email/0,,SB106868494945455700-H9jeoNnlaV2n5yqaH6HbKmJm4,00.html
India Aims to Calm U.S. Outsourcing Fears
Lobbying Effort Counters Complaints About Competition for High-Tech
Jobs
China may be Americans' favorite scapegoat for many of the U.S.
economy's ills, but India is working to fend off a growing reputation
for snatching jobs.
Article 10:
http://www.nytimes.com/2003/11/16/business/yourmoney/16hosp.html
Who's Reading Your X-Ray?
ANJAY SAINI was not prepared for the hate mail. A radiologist at
Massachusetts General Hospital, Dr. Saini thought he had found a clever
way to relieve an acute shortage of specialists who could read X-rays
and M.R.I. scans. The hospital would beam images electronically from
some scans to India, to be worked on by radiologists there. But the
arrangement, made late last year with a company in India, has touched
off a minor furor. It turns out that even American radiologists, with
their years of training and annual salaries of $250,000 or more, worry
about their jobs moving to countries with lower wages, in much the same
way that garment knitters, blast-furnace operators and data-entry
clerks do.
http://www.amconmag.com/11_3_03/buchanan.html
November 3, 2003 issue
Copyright ) 2003 The American Conservative
Wall Street Journal vs. America
by Pat Buchanan
Commentators have lately begun to point up parallels between the
presidency of George W. Bush and that of his father. Both enjoyed
extraordinary approval in their third years after triumphs over Saddam
Hussein. Both began to slide due to a sickly economy. Both won office
on Reaganite rhetoric. But both then left themselves open to a populist
revolt by embracing the counterfeit conservatism of the Wall Street
Journal.
In 1992, Ross Perot tore off a third of the Reagan coalition, leaving
George H. W. with the smallest share of the presidential popular vote
in 80 years. Were the son to face a third-party challenge from the
Right, he too would be going home after one term.
The mega-issues on which the Bushes abandoned conservatism for the Hong
Kong values of the Wall Street Journal are free-trade globalism,
open-borders immigration, and Wilsonian interventionism.
Unlike the patriarch Sen. Prescott Bush, George H. W. and his son are
free traders who simply cannot see the industrial ruin before them from
a decade of NAFTA, GATT, MFN for Beijing, and U.S. subordination to the
Yankee-baiting Eurocrats of the WTO.
But the returns from 10 years of free trade are in. America is running
huge trade deficits with Canada, Mexico, Japan, China, and the EU.
Manufacturing jobs have been disappearing at the rate of 83,000 a month
every month Bush has been in office. Under George W., one in every six
manufacturing jobs has vanished.
Is there no amount of bleeding of jobs that will jolt Mr. Bush into
grasping that the Journals free-trade fanaticism is denuding his
country of its industrial base and could kill his presidency, as it did
his fathers?
The second issue is immigration. For years, the Journal has pushed to
amend the U.S. Constitution to read, "There shall be open borders." The
Journal wants to tie the hands of the President and Congress to
guarantee that the Third World invasion of America is unstoppable. Yet,
mass immigration is bankrupting California, as millions of poor
immigrants have poured in and millions of middle-class Californians
have fled to Nevada, Arizona, Colorado, and Idaho.
Ten million illegal aliens now live here. Their crime rates and
social-service demands are higher and tax payments far lower than those
of our native-born. As California is fast becoming a Third World state,
America is becoming a Third World country. Why is President Bush
welcoming this radical transformation of America into a giant replica
of the UN General Assembly? What was so wrong with the country we grew
up in?
Can the Bushites not see the consequences of blindly following Journal
ideology? The Clintonites could. They evaded the law to get millions of
Latinos naturalized and registered. In 1996, it paid off. First-time
Hispanic voters went 91 percent against Dole-Kemp.
The third issue on which Bush II has embraced Journal neoconservatism
is foreign policy. For a decade after Desert Storm, containment had
worked with Saddam. Iraq had not invaded a neighbor nor launched a
single terror attack against Americans.
Yet, no sooner had the World Trade Center towers fallen than the
Journal was shrieking for strikes on "terrorist camps in Syria, Sudan,
Libya, and Algeria, and perhaps even in parts of Egypt." This was
warmongering. None of these countries had anything to do with 9/11.
After the overthrow of the Taliban, the Journal began beating the drums
for the war it always wanted and the cause it never abandoned: "On to
Baghdad!" Impose a "MacArthur Regency"! Now we have Baghdad and the
Bremer Regency. And if Mr. Bush cannot extricate us from this new war
of suicide bombings and sniper shootings we warned him would follow a
U.S. invasion, he may not be re-elected.
What President Bush and many conservatives do not realize is that the
Wall Street Journal is to true conservatism what Eisner is to Disney, a
cow bird that flew in to sit on the nest another bird built.
Journal editor emeritus Robert Bartley once told author Peter Brimelow,
"I think the nation-state is finished." In June, Bartley flew to Italy
for the 10th Santa Colomba Conference hosted by Journal guru Robert
Mundell. Topic: "Does the Global Economy Need a Global Currency?"
"World money, with a world central bank, seems a next logical step,"
chirps Bartley, who dreams of a New World Order currency replacing the
U.S. dollar. Yet, as Margaret Thatcher told this writer, a nation that
gives up its currency gives up its sovereignty and independence.
Time to say it: Loyalty to the New World Order is treason to the
Republic. But why is Bush blindly following the counsel of faux
conservatives leading him down a path that ends in the abolition of
America? Why, Mr. President?
November 3, 2003 issue
Copyright ) 2003 The American Conservative
http://www.washingtonpost.com/wp-dyn/articles/A13983-2003Nov7.html
'Buy American' Provision Weakened
House Cuts Terms Opposed by Pentagon
By Renae Merle
Washington Post Staff Writer
Saturday, November 8, 2003; Page E01
The House passed a weakened version of a "buy American" program
yesterday, eliminating terms opposed by the Defense Department and U.S.
allies that would have expanded restrictions on foreign purchases by
the Pentagon.
Under the original proposal, all critical components in a weapon would
have had to be American made and a system overall had to be 65 percent
American. Those two requirements were eliminated from the provisions
approved yesterday in a $401 billion military spending bill.
Instead, the 2004 defense authorization bill calls for the Pentagon to
produce a study assessing how much the United States depends on foreign
suppliers and to provide incentives to contractors to encourage use of
domestic machine tools. The Senate is expected to vote on the bill next
week.
Rep. Duncan Hunter (R-Calif.) championed the original provisions out of
concern that the United States had become too dependent on foreign
companies for its defense needs, raising worries about their
reliability in times of conflict. But the Pentagon and large defense
contractors complained that international projects such as the Joint
Strike Fighter would be endangered by rigid "buy American" rules.
European allies criticized the provisions as protectionist, prompting
U.S. defense contractors to worry about facing retaliation when they
pursued contracts overseas.
"It is a good first step in helping us understand that there are
certain critical weapons systems and components for which we cannot
rely on potentially unreliable foreign sources," said a spokesman for
Hunter, who is chairman of the House Armed Services Committee.
For years, the United States has required that 50 percent of a weapons
system be American made, a provision that remains on the books.
Despite the watering down of the latest "buy American" proposals, some
European allies were not satisfied because the issue is still under
review.
"We are extremely disappointed but will continue to work closely with
the U.S. to ensure that increased defense cooperation works effectively
in practice," a British Embassy spokesman said. It is Britain's
industrial policy "to welcome American industry and technology as we
seek to achieve greater interoperability with United States armed
forces."
Under the approved provisions, the Pentagon would have to create a
Defense Industrial Base Capabilities Fund to ensure that the domestic
industrial base can manufacture all critical military components. The
Pentagon also would determine whether any countries have refused to
deliver military supplies because they objected to U.S.
counterterrorism or military operations and, if so, would stop buying
from them.
The provisions would create an incentive program to encourage defense
contractors to buy from domestic machine tool makers, which have
struggled in recent years. That is a scaling back from the original
proposal, which would have required defense contractors to use only
domestic machine tools, the large pieces of equipment that cut and bend
metal into vehicles and airplanes.
The titanium industry applauded the House legislation because it would
rebuff Pentagon efforts to make it easier for defense contractors to
use foreign specialty metals, including titanium, in weapons. The
specialty-metals clause "not only protects jobs in the U.S., but
ensures that certain critical materials needed for our national
security are always available from U.S. sources," said Timothy G.
Rupert, chief executive of titanium maker RTI International Metals Inc.
) 2003 The Washington Post Company
http://www.bayarea.com/mld/mercurynews/7220550.htm
Posted on Sun, Nov. 09, 2003
Hard data on lost tech jobs no easy task
How many U.S. tech jobs have moved overseas?
It's anything but clear.
For one thing, job shifts are rarely one-for-one: Companies sometimes
hire several employees in India or China when they lay off one in the
United States, or they shuffle workers as part of a broader corporate
restructuring. Also, when counting, there's no single definition of
what constitutes a ``tech job.''
Congress has ordered a General Accounting Office study of offshoring
and the Information Technology Association of America, a trade group,
has commissioned a Nobel-winning economist to determine how many jobs
have been affected. Both reports are due out next year.
Most experts agree that the movement of jobs offshore will only pick up
steam. But forecasts from two leading technology consulting firms --
Forrester Research and Gartner -- vary greatly. Gartner says
information-technology companies will move one in 10 jobs offshore by
the end of 2004. Forrester, which has the most widely accepted
forecast, projects more broadly, saying that 3.3 million
tech-and-service jobs will leave the country by 2015. Forrester
predicts that 472,632 of those 3.3 million lost jobs will be computer
positions, or nearly 10 percent of all current U.S. computer jobs.
Just last week, researchers at the University of California-Berkeley
published a report that criticized existing offshoring forecasts as
obsolete and too conservative. The report said a total of 14 million
U.S. service jobs, including tech positions, are threatened by
offshoring.
http://jobcenter.dallasnews.com/sharedcontent/careers/workingnews/110203ccCareersTechmain.1553fc53.html
Experts debating future of IT careers
Some expect shortages in field, but others say outsourcing will
permanently cut jobs in U.S.
By VICTOR GODINEZ / The Dallas Morning News
Many educators, employers and labor experts insist that technology is
so pervasive and fast-growing that a shortage of technical workers is
inevitable over the next several years.
Hold your horses, Richard Ellis tells them.
"The industry has been hollering about a shortage of high-tech people
for half a century, and that's not an exaggeration," said Mr. Ellis,
who worked on an engineering workforce commission in the 1950s and is
now head of Ellis Research Services in Pennsylvania.
Mr. Ellis and others contend that demand for information technology
workers has been permanently reduced, because more companies are
sending entry- and midlevel tech jobs overseas.
MILTON HINNANT/DMN
Southern Methodist University's Dr. Geoffrey Orsak says he has no doubt
that new tech jobs will be created: "Somebody has got to design,
market, distribute and maintain that technology."
The U.S. Bureau of Labor Statistics projects that IT will be the
fastest-growing job field between 2000 and 2010, but he said those
d fatter profits that U.S. companies can plow back into
more-innovative businesses.
Washington-based law firm Akin, Gump, Strauss, Hauer & Feld will
collect $600,000 annually to advise India and work the halls of
Congress, according to Justice Department records. Former House Speaker
Tom Foley and other former diplomats and lawmakers at the firm will run
the campaign. The Indian Embassy also has an annual $240,000 retainer
with well-known international adviser Edward von Kloberg, who
represents several Eastern European countries but is best known for
representing Iraq's Saddam Hussein and Romanian dictator Nicolae
Ceausescu.
India's National Association of Software and Service Companies, known
as Nasscom, a New Delhi trade group representing 850 international
companies, also is shouldering part of the load: It hired Hill &
Knowlton, an influential public-relations and lobbying firm. According
to Senate lobbying records, Nasscom paid the company $100,000 for the
first six months of this year.
"India really feels a need to get their story out. They're frustrated"
by being bashed for their success in developing an educated work force
that can compete world-wide, said Michael Clark, executive director of
the U.S. India Business Council.
For all that high-powered lobbying muscle, the new campaign won't be
buying any newspaper or television ads to educate the American public.
U.S. business organizations, whose members do a lot of business in
India, have advised the Indian Embassy to keep a low profile to avoid
drawing even more public anger. Indeed, officials at India's embassy in
Washington didn't return calls or answer e-mails seeking comment about
the new lobbying campaign. Akin Gump also declined to comment. Mr. von
Kloberg said that he has been retained by the embassy to do "press
relations" and that the current Indian campaign "is enormously active."
So far, the India alliance, working with Hill & Knowlton and a few
local Indian-American lawmakers, has succeeded in temporarily blocking
passage of outsourcing bills in New Jersey and Maryland.
Battle plans are being drawn for what are expected to be far-tougher
fights next year in those states, as well as in Michigan, North
Carolina and others considering legislation that would outlaw the use
of overseas workers to do state contract work.
The alliance is having less luck so far in Congress. Labor and
white-collar activists recently persuaded lawmakers not to renew a
measure that had tripled the number of H-1B work visas issued to
foreign professionals to 195,000 annually from the original 65,000.
India gets a majority of those visas issued for high-tech jobs.
Members of the Indian coalition complain they didn't get the support
they needed from U.S. companies that benefit from the expanded visa
programs.
"The U.S. industry has been a little slow in getting involved," said
Kiran Karnik, president of Nasscom. "We are concerned. We'll continue
to work through companies and associations in the U.S." So far, Nasscom
officials are doing most of the face-to-face work on Capitol Hill.
Since the beginning of the year, Mr. Karnik said, on U.S. trips, he and
his colleagues have met with more than 50 members of Congress and
government officials.
Longer range, the Indian coalition is laying the groundwork through the
World Trade Organization to create a new guest professional-services
visa that will have no fixed expiration, he added.
To bolster India's lobbying muscle, coalition members say they are
urging Indian-Americans -- many of whom are well-paid technical workers
and professionals -- to get more involved politically. Of the nearly
two million Indian-Americans, 20% are millionaires, according to a
Merrill Lynch & Co. study. They currently have few active
political-action committees or Washington advocacy groups, but
individuals are generous contributors to election campaigns, according
to some political and cultural leaders in the community.
The community's generosity is one reason membership in the House's
India Caucus has swelled to 175 members, a 40% increase from last year.
But an aide to Caucus Co-Chairman Joe Wilson, a South Carolina
Republican, said Indian-Americans generally don't press caucus members
to vote a certain way on issues.
Narayan Keshavan, a former Hill staff director of the India Caucus who
favors outsourcing to India, said that is going to have to change. Mr.
Keshavan says he has advised Indian-American community leaders that
they need to develop political clout to help shape relations between
the U.S. and India: "We've built plenty of Hindu temples in the U.S.
Now is the time to build a political temple in Washington."
Write to Michael Schroeder at mike.schroeder@wsj.com
Updated November 13, 2003
http://www.nytimes.com/2003/11/16/business/yourmoney/16hosp.html
Who's Reading Your X-Ray?
November 16, 2003
Who's Reading Your X-Ray?
By ANDREW POLLACK
ANJAY SAINI was not prepared for the hate mail. A radiologist at
Massachusetts General Hospital, Dr. Saini thought he had found a clever
way to relieve an acute shortage of specialists who could read X-rays
and M.R.I. scans. The hospital would beam images electronically from
some scans to India, to be worked on by radiologists there.
But the arrangement, made late last year with a company in India, has
touched off a minor furor. It turns out that even American
radiologists, with their years of training and annual salaries of
$250,000 or more, worry about their jobs moving to countries with lower
wages, in much the same way that garment knitters, blast-furnace
operators and data-entry clerks do.
Since the news got out, Dr. Saini has received a flurry of angry e-mail
messages, most of them anonymous, urging him to stop. The American
College of Radiology, the professional group for the country's 30,000
radiologists, has set up a task force to look at the offshore transfer
of radiology services. And the online discussion groups of
AuntMinnie.com, a Web site for radiologists, have been buzzing with
debate about the prospects for competition from "radiology sweatshops"
abroad.
"This teleradiology thing is another nail in the coffin of the job
market," wrote someone on the Web site who identified himself as a
radiologist. "Who needs to pay us $350,000/yr if they can get a cheap
Indian radiologist for $25,000/yr."
Daniel Courneya, a radiologist in Hibbing, Minn., fumed on the site
that Massachusetts General, a Harvard teaching hospital known to its
admirers as "Man's Greatest Hospital," should instead be called "Money
Grubbing Hospital," another play on its initials.
On the surface, the controversy may seem a bit odd. Experts say that
the number of X-rays from the United States now being read in India is
minuscule and that regulatory restrictions are likely to keep it from
growing rapidly. Moreover, most hospital jobs, unlike those in
radiology, require close patient contact, so there is a limit to how
much offshore outsourcing can be done.
Besides, employment in American health care has been growing. In the 12
months ended in August, the category added about 250,000 jobs while
overall nonfarm payroll jobs shrank by nearly 500,000. Hospitals alone
added about 70,000 jobs in that period.
Still, Dr. Saini's plan shows that even medical care, the most intimate
and localized of services, is grappling with the globalization that has
moved many jobs - first in manufacturing and more recently in
white-collar work - across the ocean. And in health care, of course,
there is more at stake than jobs. Dr. Courneya and other critics worry
that radiologists outside the United States may not be trained
properly, endangering patients' safety.
Dr. Saini says that the furor is much ado about nothing, that people
are reacting based on emotion, not fact. A native of India who has
lived in the United States since he was in high school, he said that
any Indian radiologist reading scans from Massachusetts General would
have to be licensed in that state and be certified by the hospital, so
patient care would not suffer.
At the moment, he said, there are no such qualified radiologists at the
outpost in India, so actual diagnoses are not being made there. Rather,
the radiologists in India are converting two-dimensional images from
scans into three-dimensional pictures that are more understandable to
surgeons; that job is usually done by technicians in the United States.
RADIOLOGY is not the only medical service that may someday be performed
for Americans by people in other countries. Other candidates are the
analysis of tissue samples, the reading of electrocardiograms, the
monitoring of intensive care units and even robotic surgery.
Back-office medical work has been moving offshore for several years
now, particularly to India, which has a large number of educated
English-speaking people. Though the number of affected jobs is only a
small fraction of the total, many experts say the share is growing as
hospitals face pressure to cut costs.
For example, when doctors at Children's Hospital of Wisconsin in
Milwaukee dictate information about a patient's condition, their words
are sometimes whisked electronically to India, where trained medical
transcriptionists type them and send them back, to be incorporated into
the patient's medical record.
Then there is Botsford General Hospital in Farmington Hills, Mich.,
which uses a company with operations in India to help collect unpaid
bills. "They came in with a rate that is less than half of what a
U.S.-based collection agency would charge me," said Luke Meert,
corporate director for accounts receivable at Botsford Health Care
Continuum, the parent company.
Coding - the assignment of numbers for medical procedures to bills - is
also heading offshore. The American Academy of Professional Coders now
has chapters in India. Some insurance-claims processing is moving, too:
Aetna Inc., the health insurance giant, has 400 people in that country.
Bob Burleigh, the president of Alpha Thought Global, a medical billing
company in Chicago that has operations in India, said he had witnessed
an incident in which a worker in Chennai, India, handling the billing
for an American medical practice, needed to check on the status of an
insurance claim. When he called the American insurance company's "800"
number, the phone was answered by someone else in Chennai.
Companies have sprung up to offer services like billing and
transcription in India. For example, Ajuba International Inc., based in
Novi, Mich., does the billing follow-up for Botsford Hospital. And
Manor Care Inc., an operator of nursing homes, owns the majority of
Heartland Information Services of Toledo, Ohio, which does the
transcription in India for the Children's Hospital of Wisconsin.
The movement of back-office jobs offshore has raised some concerns
about privacy, in that foreign workers could not be easily prosecuted
under American laws governing confidentiality of American records.
But the outsourcing of radiology overseas raises more issues. Unlike
back-office functions, radiology is performed by doctors and is
directly related to patient care. A mistake could conceivably cost a
patient his or her life.
Massachusetts General is not the only place where controversy has
arisen. Yale-New Haven Hospital ended a program in which a doctor was
reading X-rays in India.
The doctor, Arjun Kalyanpur, had been on the staff at the hospital and
on the faculty of Yale but decided to move back to his native India for
family reasons. "It was not that I was taking a job away from anybody,"
he said. "I was taking my own job with me." After a trial run, he and
some Yale colleagues even published a paper showing that
interpretations from India were as accurate as those done in New Haven.
But Yale stopped the program, apparently because of internal
complaints. "I think Yale was not ready for it yet," Dr. Kalyanpur
said.
A spokeswoman for Yale said that communications with the doctor in
India were too costly and that the hospital had no need for such a
program because an attending radiologist was always on call.
So far, Teleradiology Solutions, which is Dr. Kalyanpur's company, and
Wipro Ltd., the one working with Massachusetts General, appear to be
the main providers of radiology services in India for American
hospitals.
Dr. Kalyanpur and a partner read about 100 scans a day in their office
in Bangalore, a high-tech center in India. He said the scans come from
more than 30 hospitals in the United States, including several
community hospitals in Pennsylvania.
Wipro is one of India's largest companies, with nearly $1 billion in
annual sales, mainly from handling computer programming jobs for
American and other foreign companies. To the company, the outsourcing
of health care jobs is a new opportunity.
Wipro now has about 12 radiologists in India and counts four American
hospitals or radiology practices as clients, said T. K. Kurien, its
chief executive for health sciences. He said he could not name the
clients because of the sensitivity surrounding the issue. Even
Massachusetts General has now prohibited Wipro from discussing its
relationship with that hospital.
Marketing is difficult, he said, because the idea of patient X-rays
being analyzed in a third-world country does not sound so appealing to
Americans. "Wouldn't you be scared to death if it was being done in
India?" he said. "That's the real issue for us." When the company takes
on a client, he said, "we know the person at the other end is going to
get a lot of flak."
Yet both Wipro and Teleradiology Solutions are simply responding to a
widely acknowledged shortage of radiologists in the United States.
"It's almost in crisis proportions," said E. Stephen Amis Jr., chairman
of the board of chancellors at the American College of Radiology and
chairman of radiology at Albert Einstein College of Medicine in the
Bronx. "Demand for radiologists is growing at twice the rate that we're
turning out the radiologists who have the ability to read them."
Radiologists who are willing to work nights are in particularly short
supply. The need for such specialists in the evening has grown because
patients coming into hospital emergency rooms are often given scans to
help diagnose their conditions. A radiologist on call may be awakened
several times a night.
One solution, made possible by electronic transmission of images, has
been so-called nighthawk services. These are companies or individual
radiologists, often working from home, who handle the nighttime loads
of several hospitals at once.
It didn't take long for some nighthawk companies to use radiologists
stationed overseas, in places where it is day during America's night.
One company, Nighthawk Radiology Services, has stationed 15 American
radiologists in a building near the Sydney Opera House in Australia. A
few radiology practices in the United States have bought houses in
Europe, and their members take turns living there.
From nighthawk services, it was just another step to put the night
readers in countries with lower costs. Besides the two companies in
India, Infinity Radiology, based in Dallas, is using some radiologists
in South Korea.
A big obstacle to such services' growth is the requirement of most
American states that radiologists be licensed in order to analyze scans
of patients treated in those states. Moreover, radiologists need to
have credentials at each hospital where they practice. As a result, it
takes time and administrative work to set up each new account.
THERE are other complications. Medicare does not pay for services
performed out of the country. So, in most cases, the doctors overseas
do a preliminary reading, which nonetheless is used to guide treatment
of the patient at night. The next morning, a local staff radiologist
performs the final reading and bills Medicare.
The training of overseas radiologists can vary. Both Dr. Kalyanpur and
his partner are board-certified radiologists, the highest standard in
the United States, and some customers say that this presents no issues.
Dr. Thomas A. Manning, a staff radiologist at Centre Community Hospital
in State College, Pa., which uses Dr. Kalyanpur, said it was better to
have nighttime images read by a qualified radiologist overseas than by
a resident still in training, the practice at some teaching hospitals.
Dr. Manning said he was pleased with the hospital's nighthawk service
and did not even know where Dr. Kalyanpur worked. "Is he actually in
India?" he said. "I'm unaware of it."
Wipro's radiologists are not licensed in any state or approved by any
hospital, Mr. Kurien said. That makes them ineligible, by themselves,
to do even preliminary readings for American hospitals. Instead, he
said, they receive scans electronically and provide interpretations to
Wipro-employed licensed radiologists in the United States, who in turn
consult with the client radiologist.
This roundabout method, he conceded, was developed after Wipro found
that it could not find licensed radiologists to directly interpret
images for American doctors. He said the business would not grow unless
he could use more radiologists trained in India. "That is the end state
because getting U.S.-trained radiologists in huge numbers is not
something we can get in India," he said.
Mr. Kurien said he pays the radiologists in India $30,000 to $100,000 a
year, depending on their training. That is more than Indian
radiologists working for Indian hospitals make, but still low enough to
allow Wipro to interpret images for about half the cost in the United
States, he said.
RADIOLOGY may be just the start of patient care performed overseas.
Next may be pathology. It is now possible to transmit images of tissue
samples for remote diagnosis. There are also robotic microscopes that
can be operated remotely, allowing a doctor at a different site to move
a slide and focus the image.
As technology improves, "it would be possible for a small hospital in
the United States to digitize an image, put in on their server and have
a pathologist anywhere in the world, such as in India, provide a
diagnosis," said Ronald S. Weinstein, professor and head of pathology
at the University of Arizona College of Medicine in Tucson and director
of the Arizona Telemedicine Program. He said he had heard of a
pathologist in Poland who was planning an international pathology
service.
Other services can also be performed remotely. Some hospitals are
starting to monitor intensive care units in part from remote sites,
with readings from electronic monitoring devices and video cameras sent
electronically. That is not yet done across borders, but could be.
Someday, said Dr. Weinstein, who is also president of the American
Telemedicine Association, a professional society, there may be virtual
universities that can train doctors in foreign countries to meet
American requirements. "The concept of boundary-limited medical
education and licensure will fade in time," he said.
Still, what goes one way could also flow the other. Dr. Weinstein said
telemedicine might provide a net gain to the United States because of
the expertise here to provide diagnoses for patients in other
countries.
"I think the opportunities for U.S. health care internationally
probably are very large," Dr. Weinstein said. The University of Arizona
plans to market its pathology services around the world, he said.
Leading American medical centers already market themselves abroad to
recruit foreign patients to travel for operations. Some hospitals are
setting up outposts overseas.
The University of Pittsburgh Medical Center essentially manages a
transplant hospital in Italy, performing some pathology from
Pittsburgh. The Armed Forces Institute of Pathology in Washington, part
of the Walter Reed Army Medical Center, provides second opinions on
about 60,000 cases a year, for Americans and foreigners. Most of the
time, slides and tissue samples are sent in by mail, but about 300 to
500 a year are analyzed by using telepathology.
Eventually, there may be a division of labor, with high-end services
performed in the United States and more routine services done in
countries with lower wages. And radiologists may even come to
appreciate having offshore help.
"People want to protect their turf," Dr. Saini of Massachusetts General
said. "But it's very interesting that that turf battle stops at 5 p.m.
on Friday. How many people say they want to do this thing on Saturday
and Sunday?"
Indeed, not every posting on the radiology Web site has criticized Dr.
Saini. Some favored using foreign radiologists. "If we don't hire them,
we'll be working longer hours for the same pay," one person wrote. "So
everyone please shut up about this."
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