Dayhawk Radiology and the Decline of the General Radiologist

I have posted a number of previous notes about Nighthawk Radiology and the manner in which Nighthawk Radiology plus radiology networks, originally designed for off-hours support, have paved the way for auctions of the professional services of radiologists. KevinMD recently posted an interesting note about "dayhawk" radiology and the the possible decline in the number of general radiologists (see: Nighthawks, dayhawks, and the demise of the American radiologist). Below is the note with boldface emphasis mine:

More hospitals are resorting to so-called "dayhawk" radiology services to read their x-rays. It's modeled after the "nighthawk" model, where radiologists (via Shadowfax), in some cases as far away as India, remotely read films in the middle of the night. Now, the phenomenon is happening during business hours as well, which according to radiologist Giles W. L. Boland, means that "some radiologists can no longer assume long-term job security because their core value proposition can now be outsourced." This trend was entirely foreseeable. Cash-strapped hospitals are finding it cheaper to outsource x-ray readings, and furthermore, it seems that both nighthawks and dayhawks provide better service and more timely interpretations. This adds up to a declining need for an in-house radiology staff. That's bad news for some. Radiology departments at smaller hospitals may close, and eventually general radiologist salaries will come under pressure. The answer? Like everything else in medicine, radiology sub-specialists will increasingly be in demand. Expect procedure-based, interventional radiology to grow, since what they do cannot be outsourced. Health care costs will correspondingly rise. So, like primary care, don't be surprised if the days of general radiology are numbered.

As Kevin remarks above, the evolution from "nighthawk" to "dayhawk" was entirely foreseeable. As soon as hospital executive learned that they could depend on reliable interpretation of radiology studies at night and on the weekends from Nighthawk Radiology and its imitators, few barriers remained to using the same services during the daylight hours. An added advantage for the execs of this approach has been that the cost of these services are now more exposed to competitive forces in the market. Therefore, as an added benefit, the cost advantages to outsourcing on a 7/24 basis are now becoming more apparent.

Kevin is also correct that interventional radiology services can't be outsourced and so will continue to in demand at the local hospital level. However, I think that it may be a little premature to refer to the "demise" of the general radiologist, at least as a result of the day/night-hawk radiologist business model. The U.S.-based teleradiology companies will need to find their radiology talent somewhere and I am sure that some of the personnel they hire will be general radiologists. However, a shift may be occurring in terms of the employer for many radiologists from a hospital or local radiology group to a company like Nighthawk or its newly emerging competitors. You can find the names of many of them by merely Googling the term nighthawk radiology and paying attention to the top and right-hand paid-for advertisement columns.

Frankly, this shift of employers by radiologists to teleradiology companies seems to me to be similar to the pod lab phenomenon in pathology whereby urology practices build a histology lab within their office suite and hire a pathologist part-time or full-time to provide diagnostics services. A variation on this theme is for the urology group to submit their tissue specimens to a commercial surgical pathology lab for processing and then use their own in-house pathologist to interpret the prepared glass slides that are returned by the commercial lab. In fact, I have been told that many of the surgical pathologists who are practicing in this type of environment are very satisfied with their positions.

Comments

[Full service teleradiology]

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[Daniel Schneider]

Your last paragraph attempts to put some positive spin on a sketchy practice designed to increase urologists' revenue at the expense of pathologists' and drives overutilization (in the form of excessive numbers of biopsies) at the expense of the patient, and the American healthcare system. Who are these pathologists who are "very satisfied" with that arrangement?