Tired Doctors: Solution?: Outsourcing In House and Out of House

The issue seems simple but it really is complex as hinted at by a letter to the editor of the New York Times by a physician Martin J. Blaser, M.D. and published June 16, 2002.
Dr. Blaser wrote in response to an editorial about “Sleep-Deprived Doctors”:

Surely most patients would prefer a fully alert doctor to one who is sleep-deprived. However, consider a different question: Would you prefer a tired doctor who knows you well to one who has never seen you before? The complexity and the stakes involved in this issue are high.

Also, the values we cherish -- including being available to people in need and the ability to take responsibility -- are inculcated in training programs where doctors are taught that ''the buck stops here.'' Will Americans be better off with a group of shift workers who, not fully understanding the natural history of illness, order more tests, and pass care to the next level of specialist? Or with doctors whose schedule is determined by the demands of the clock, not the needs of the patient?

The question of “outsourcing in house” including the use of hospitalists is one medical practice that might need further evaluation. Another,as summarized at the website of Healthcare Financial Management Association today deals with outsourcing out of house, actually to another country, perhaps one where it is daytime while it's night and time to sleep in the U.S.:


Outsourcing Radiology Abroad Eases U.S. Radiologists’ Stress, Night Call

It’s just a matter of time before more specialists rely on outsourced assistance, predicts the Los Angeles Times, which examined the trend of radiologists working in Switzerland, England, France, Australia, and the Middle East making and confirming diagnoses for patients in the U.S. Hospitals are using the outsourcing to relieve stress and night hours for radiologists here; however, there is also the potential for cost savings. Although the contract radiologists abroad are American trained, board certified, and licensed from the state where the images are taken, critics of the outsourcing worry that the practice is damaging quality of care, that lines of accountability are unclear, and that hospitals will be held liable for malpractice committed abroad.

Do you think that “tired doctors” deserve a rest and how best can this be done so that the care of the patient is better served? ..Maurice.