(1)
Department of Radiology, UMDNJ-New Jersey Medical School, Newark, NJ, USA
Abstract
In early February 2004 President Bush’s chief economic advisor, N. Gregory Mankiw who was once Harvard’s youngest tenured professor, made a comment that attracted a firestorm of political invective. He told Congress that if a service could be rendered more cheaply by foreigners abroad than by Americans in the US we were better off importing it than producing it at home. According to an article on his testimony which appeared in The Economist magazine, to prove his point Mankiw used the example of radiologists in India analyzing studies of American patients’ images sent via the internet. This pronouncement elicited two types of responses [1]. Inasmuch as it was the beginning of the presidential election season, the remark was seized upon by populists in either party who rained abuse on Mr. Mankiw for such a statement. A common retort “how dare we talk about exporting jobs and in this case, the jobs are radiologists.” Yet professional economists on both sides of the aisle agreed with him, understanding that this was a typical consequence of globalization. In the aggregate it benefits many, even though it may dislocate a few in the beginning until those negatively affected relocate and redirect their employment. In fact the increased liberalization of service provision spanning national borders under the rubric of free trade continues to be a policy of the present government.
In early February 2004 President Bush’s chief economic advisor, N. Gregory Mankiw, who was once Harvard’s youngest tenured professor, made a comment that attracted a firestorm of political invective. He told Congress that if a service could be rendered more cheaply by foreigners abroad than by Americans in the US, we were better off importing it than producing it at home. According to an article on his testimony which appeared in The Economist magazine, to prove his point Mankiw used the example of radiologists in India analyzing studies of American patients’ images sent via the internet. This pronouncement elicited two types of responses [1]. Inasmuch as it was the beginning of the presidential election season, the remark was seized upon by populists in either party who rained abuse on Mr. Mankiw for such a statement. A common retort “how dare we talk about exporting jobs and in this case, the jobs are radiologists.” Yet professional economists on both sides of the aisle agreed with him, understanding that this was a typical consequence of globalization. In the aggregate it benefits many, even though it may dislocate a few in the beginning, until those negatively affected relocate and redirect their employment. In fact, the increased liberalization of service provision spanning national borders under the rubric of free trade continues to be policy government.
Well, Mankiw was right about the effects of globalization and prospects for trade in commodities and services. However, he was wrong about radiology. In 2004 there were attempts to outsource radiology examinations to physicians in other countries who were not licensed in the state for which the images originated, and had not graduated from an American or Canadian medical school, nor had they completed their residency here. Furthermore, they had not achieved American Board of Radiology diplomate status.
Why does their expertise not count whereas for engineers, for example, foreign training is not a disqualification? The reason is because physicians have been very successful in regulating themselves by setting up barriers to the internationalization of their work product. Although it is possible and even likely that radiologists elsewhere may be as adept at reading images as American radiologists and that, presently, the mechanisms for the transmission of images results in no loss of quality, nevertheless the requirements of licensure, board certification, and training in an accredited program have all effectively prevented foreign nationals without American credentials from performing teleradiology, the exception being the significant although perhaps not very well publicized reviewing of radiographs and CTs on either side of the Canadian border by radiologists who are citizens of either country [1].
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