Dear Anti-teleradiology Colleagues:

I get it. You’ve got some issues with this relatively new business model that competes against your own, and you feel the need to push back against it. No harm, no foul; you need to make a living, and whereas you formerly only had to keep an eye on other local groups, now you can never really tell where the other bids for contracts might originate.

To the hardworking guy who’s sitting in his hospital’s reading-room, slogging through complex case after case and making himself 100 percent available to onsite-clinicians, actually getting up and going to see patients to obtain his own clinical correlation when necessary; the guy who covers a full share of on-call shifts, routinely working on nights, weekends, and holidays; the guy who truly believes that his work is better than that provided by us offsite-types, and worries that patients will be harmed if he is supplanted by telerad coverage; the guy whose first and foremost concern is quality of care and not, say, his own bottom line: To him, I offer my respect.

You, sir, are a gentleman and a scholar, and probably a better man than I for risking unfriendly interactions with your colleagues in the name of your Hippocratic Oath. However, I’ll take back the “gentleman” honorific if you try to bolster your argument by claiming that I’m somehow not a “real doctor.” I think we’ve got enough challenges in our field without slinging such mud.

To the department chair who no longer takes call, working purely 9 to 5 on weekdays (but of course not on holidays), who occasionally puts in a token half-day in the reading room but otherwise is a full-time attendee of meetings, committees, and conferences: I get it. You worry that your mini-empire may be stolen out from under you by, say, a telerad group. Or perhaps you’ve already contracted with such a group so that your department can cover less call. Still, gotta undermine these outsiders, lest they supplant you — better cast aspersions on their work.

RELATED BLOGS: Memoirs of a Teleradiologist, Round Three and Counterpoint: Where Teleradiology Falls Short

To the senior partner who maintains a death-grip on an outsized share of the profits while expecting the juniors to do disproportionate amounts of the workload in the name of “paying their dues,” taking on new coverage-contracts with local hospitals but not actually hiring sufficient numbers of new radiologists to meet the new obligations (after all, those junior guys already on the team can rise to the task if they want to prove themselves): I get it. You worry that the junior guys will eventually decide that, rather than being pawns in your increasingly-pyramidal organization where the reward for hard work is larger volumes of work in the future, they can join up with a telerad provider, where 10 percent more work always results in 10 percent more compensation. Hard to compete against that if you’re trying to maintain the structure of your Ponzi Imaging, PC.

To the elder statesmen for whom teleradiology is a newfangled gimmick, and properly treated with circumspection and skepticism until it’s been around a bit longer; who have watched radiologists’ autonomy slip away as responsibilities increase while compensations dwindle; who see the landscape changing and don’t know how to change with it but suspect that these new telerad folks are somehow profiteering from the change: As the old expression goes, “the only constant is change.”

I recommend “Who Moved My Cheese?” by Spencer Johnson. For that matter, the department chairs and senior partners should probably take a look at it, too — it’s a useful reminder that the practices which made you successful in the past might not be as effective in the future, and that one is better off by developing new approaches rather than sulking and feeling cheated.

To the residents and fellows who haven’t actually experienced the working world, but have lived in an echo-chamber of anti-telerad sentiments offered by some of the folks mentioned above (or in online forums, say on websites named after fictional female parental siblings): Keep an open mind.

Radiology, and indeed medicine as a whole, have undergone a lot of changes in the past few years, let alone decades, and will continue to do so. Probably at an increasing rate. Don’t be so eager to accept the biases of those who came before you, many of whom have axes to grind and/or fear change. Or did you listen to your parents and shun that crazy Internet-thing when it came along?