Commentary 2 - Radiology in India: The next decade

Abstract

For one who has been practicing radiology for the last 42 years and seen the evolution of radiology from single x-ray machines, with dark room processing and dripping films, to digital radiography and cross-sectional imaging techniques like USG, CT, and MRI, it is not difficult to predict how radiology will develop over the next 10 years and what will be the fate of practicing radiologists and the various imaging modalities. Let us first talk about the practice of radiology in India and what could change in the next 10 years. Providers of radiology services can be divided into four broad groups. Institutions managed and funded by the central government, state governments, or municipal corporations. Private hospitals managed by big business corporations Private diagnostic imaging centers managed by a single radiologist or a group of radiologists. Small x-ray clinics managed by a single radiologist The teaching and post-graduate institutions funded directly by the central government are fairly well managed and administered as access to funds is not very difficult and therefore these institutions have been able to keep pace with the advances in imaging technology. The radiologists trained in these institutions are well exposed to the art and science of imaging and they are dependable and good in their diagnostic acumen. The teaching hospitals and medical colleges managed by the state government or municipal corporations, barring a few, are in pathetic conditions. Equipments are not regularly updated and most of them malfunction regularly, there is poor staffing, and the training given to the post-graduates is far from satisfactory. Many institutions have no full-time heads of department. These institutions suffer from lack of vision at all levels: the minister in charge, the head of the institution, and the head of the department. The second group comprises the hospitals managed by big corporates or business houses. These hospitals, at present, are the leaders in the field of imaging as far as equipment is concerned and the diagnostic facilities are fairly good. These hospitals are well managed by professionals who have to ensure their profitable functioning. However, the middle-income group tends to stay away from these hospitals as services are expensive. Many of these hospitals are recognized for training by the National Board of Examinations, but the teaching is not very good in most of these hospitals, barring a few. These hospitals compete with each other and in the process obtain the latest equipment and devices. The third group comprises the private diagnostic centers, which have been started by radiologists and sometimes funded by businessmen. In private practice, depending upon the energy, acumen, enthusiasm, and vision of the radiologists, many of these centers have the capacity to be trendsetters. Many imaging techniques and modalities that are popular today were pioneered by individual private diagnostic centers. The fourth group is of the individual or single radiologists, running small clinics with x-ray facilities and sonography units. These small private clinics serve the imaging needs of family physicians and basic preliminary imaging is done by these centers. These clinics have done yeomen service to society in the past as they are patient-friendly, doctor-friendly, and easily accessible. As far as the equipments and imaging modalities are concerned, teaching hospitals run by the state government and municipal corporations lag behind significantly. This is mainly due to the poor vision of the people at the helm of affairs. If they do not keep pace with the advances in technology, they face the risk of being derecognized by the Medical Council of India. The next decade will be the decade of privatization. The Indian economy is bullish and more and more corporates are getting involved in the health care industry. This is good for the country. Small clinics or individual radiologists cannot afford the huge investments required to run full-fledged diagnostic centers and they will have no choice but to join the big groups or be a part of a corporate organization. The small centers will not be able to survive in big metropolises unless they upgrade to digital systems and have high-end sonography units. Though the small centers will continue do well in the small and medium-sized towns, I feel that if they were to get together under one roof and acquire all the basic imaging facilities, they would of tremendous service to society and will not be held back by economic constraints. Let us now talk about individual imaging modalities and the expected changes.