Familiarity breeds competence for outsourced radiologists
Do radiologists improve their performance from reading images for a few specific hospitals, or for many? That's a question that grows in importance as hospitals increasingly use the services of teleradiology companies.
"There is debate out there about whether or not we should be outsourcing this kind of work," says Jonathan Clark, assistant professor of health policy and administration at Penn State University, in an article published by the school. "Some say that one CT is the same as another, so it doesn't really matter if the CT is coming from Hospital A or Hospital B; what matters is that the person reading the image has the right training and experience. The other side of the debate says that radiological images are not commodities and that the process is more nuanced than simply exchanging bits of information over the information super highway. From this perspective a radiologist's performance will improve as he or she learns the nuances of reading images from a particular hospital."
Now, Clark and a team of researchers have determined that radiologists who work for outsourcing teleradiology companies improve their performance by reading images for fewer hospitals, rather than more. The results of their study recently were published online in the journal Organizational Science.
The researchers examined the experience and productivity of 97 radiologists who read more than 2.7 million images from 1,431 hospitals. Clark says that by estimating learning curves, the researchers determined the extent to which a reader's productivity reading an image for a particular hospital was related to that reader's experience with the hospital compared to his experience reading the same image for other hospitals. They found that prior experience with a particular hospital had a greater effect on a reader's performance than any prior experience reading the same type of images for other hospitals.
"Somebody might look at that finding and say either what we could have is outsourcing radiologists who read for only a few customers or we shouldn't have outsourcing at all," Clark says. "Because if you're going to focus on a radiologist on one or two customers, then you might as well make the argument that you should have him or her work as an employee for that customer."