American accounting and medical billing firms are the latest to join the outsourcing bandwagon, transferring hundreds of thousands of jobs to India to take advantage of the low pay scales and educated workforce in the country.

While in the 2002, accounting firms sent some 25,000 tax returns to be completed by accountants in India. This year, that number is expected to quadruple.

• India and Outsourcing: Complete Coverage

"The reason lies in the numbers. Accountants in the United States typically earn $4,000 a month. In places like India, it is closer to $400, David Wyle, CEO and founder of

SurePrep," a tax-outsourcing firm based in southern California which employed more than 200 accountants in Mumbai and Ahmedabad, told CNN.

"We've estimated firms will save between $40,000 and $50,000 for every 100 returns that are outsourced," said Wyle, whose firm expects to do 35,000 returns in the coming year, up from 7,000 last year.

Xiptax in Massachusetts is another tax firm that has moved much work overseas for "a whole number of reasons," besides money, says CEO Mark Albrecht.

"Most CPAs (certified public accountants) do between 45 to 50 per cent of their work in two months out of the year. It makes for an extremely stressful time," Albrecht said, adding that "accounting firms must then 'strain' to find qualified staffers to help fill in during the crunch.

By hiring full-time staff in India, CPA firms like SurePrep and Xiptax do not have to worry about finding staff here."

Instead, firms simply send tax information to a permanent team of qualified accountants in India.

American accountants then review the returns before signing off on them. In fact, companies in a number of unexpected industries are now sending work overseas.

From scientific lab analysis to medical billing, the service-sector workforce has gone global, the CNN report said.

Increasingly, medical billing for American firms is being done by staff in India.

Alpha Thought International, a Chicago-based medical billing firm with workers in the United States, opened a billing office two years ago in New Delhi where staff do data entry work needed to process insurance and other medical billing claims.

"The reason that came about is because it's difficult to find workers in different parts of the country who want to do data entry," says Alpha Thought COO Dave Jakielo.

When staffers in the US quit, the company replaces them with India-based workers. "To work in an office over there you must have a college degree," says Jakielo. "The office workers we hire here are usually high school graduates."

Offshoring medicine is also expected to take off in a major way as cancer patients seeking treatment may soon find that when their tests are 'sent to the lab' their medical work is scrutinised by pathologists in a different country.

Since the mid-1980s, pathologists have been using robotic microscopes from offsite locations to peer at biopsy samples.

But now, pathologists are using the newest generation of technology to enhance 'telemedicine' opportunities.

Specifically, pathologists are accessing computer servers to look at digital images of lab slides, says Ronald Weinstein, director of the Arizona telemedicine project at University of Arizona College of Medicine.

The benefit isn't cost-cutting or accelerating how fast jobs are done, says Weinstein, but the power it has to bring the best and brightest medical minds together.

"Telemedicine will enable international group practices to form," he says. "You'll have a conference where three world experts can look at the slide at the same time."

To test potential uses for offshoring medicine, Weinstein's group at University of Arizona has teamed with the University of Panama School of Medicine in Panama City to work together on cancer cases.

"We're looking to have pathologists in different time zones to speed up the rate at which patients pass through clinics," he says.

"Currently we're limited by time zones, not just by access to people but to a full range of expertise."