Service in Medicine, Has it become a quaint anachronism from a bygone era?

Bob Wachter has posted some great points regarding the "service" of radiology.

The last paragraphs are priceless:

In my NEJM article on dis-location, I described the growing teleradiology trend, driven by the fact that the same technology that allows me to read my films without going to the radiology department also allows a radiologist in Banglaore to read a film as easily as a radiologist in Bangor. The Indian radiologist earns one-tenth of what the U.S. radiologist earns. If my experience in visiting Radiology World tends to be of the positive, collegial sort, I’ll fight like hell to keep the radiologists in the hospital. If it feels like I’m distracting them from their “real work,” then (assuming comparable technical competency) there’s no reason for me to care whether they are in the building.

Or the country.

I feel the same way about so many aspects of modern medicine. If primary care physicians want better reimbursement, they need to "add value" to their interactions with patients. Otherwise, why not have a nurse practitioner or physician assistant grab their business at a discount (e.g. at CVS Pharmacies)? If emergency medicine docs want more respect from their colleagues and to not render themselves useless, then they have to do much more than act as glorified triage nurses. In the same way, if radiologists want to avoid having their jobs outsourced, let them raise their standards of service.

The list of examples could go on and on. Read Arnold Kling's recent article in tcsdaily to see one reason why quality has declined so frequently. Hint: imagine what happens to a service when the recipient pays for it rather than someone else like a third party payer.