…But, Do We Click?

Eric Postal, MD

Is there a strategy that works best for teleradiology compensation?

One of the facets of “Is per-click teleradiology right for me,” or “Is this telerad gig right for me?” I frequently hear pertains to the vagaries of the clicks themselves. That is, how does one know just how much one will be able to click...thus, earn?

Simplicity is a major appeal of the pay-per-click system (AKA “eat what you kill”). Thousands of rads have migrated to jobs with this model because of a sense of fairness: Work should yield reward. A salaried rad might grow intolerant of a situation where he routinely produces more than others in his group, yet never attains compensation approaching theirs. Now TeleRadCorp tells him: If you work for us and do twice as much work as the other guy, you’ll get paid twice as much, too. How can that not seem like a fairer deal?

Pay-per-click’s simplicity can also appeal to an employer. It’s one-size-fits-all for everyone in your ranks. No hassles with remembering who carved out what special deal for himself, nor haggling over nickels and dimes with a rad who thinks he’s the bee’s knees. Plus, as long as you’ve correctly figured out what percentage of an RVU you need to retain for overhead (and, God forbid, profit margin), you can safely pay out the remainder. Barring extreme circumstances, a rad will never cost you more than he’s bringing in.

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Yes, it’s a simple system that passes the “smell test” for fairness. H. L. Mencken had a thing or two to say about simple solutions to complex issues, however, and sooner or later ugly little details creep in to mess up the pretty picture.

An awful lot of prospective pay-per-click rads focus on how much a click is going to be worth to them. It might be excessive focus on this that leads many to overlook the matter of what they’ll reliably have to click on.

It does a rad no good, for instance, to lock in a deal where he’ll receive $100 for every MRI he reads…only to find out his worklist is perpetually full of $5 X-rays, nary an MR in sight. Or, yes, there’s MR…but it’s all of body-parts that the rad doesn’t personally read.

Even with a good case-mix, the rules of engagement often do not include a safety-net for the circumstance of a rad sitting at his workstation, ready and raring to go…but there’s nothing on his list at all. The practice is all caught up with its work, maybe, or there are technical issues behind the scenes that prevent cases from being uploaded.

It used to drive me nuts when vRad had routine, scheduled software-maintenance or upgrades during my working hours, leaving me dead in the water: If you are given nothing to click on, it really doesn’t matter how much your contract says a click is worth. As Foghorn Leghorn once wisely observed, “Two nuthins is nuthin!”

From the perspective of the pay-per-click employer: Hey, fair’s fair. If you have no work to do, we’re not making money either. This, nevertheless, disregards the basic value of a rad’s time. If I am required to be sitting in front of my workstation just in case you happen to give me something to do, and you fail to…well, find a way to make it up to me, or watch me find another gig.

A rad contemplating a per-click gig might ask for some proof of what hits the worklists: Give me a bunch of screen-captures of the lists during the typical hours I’ll be working. Maybe even let me login as a guest during some of those hours to watch in real-time. Let me speak with the rads currently there—rank-n-file workers, please, no exec types who might fudge the numbers to make their company look good.

Even if such investigations turn up no red flags, you might have heard “past performance is no guarantee of future results.” That’s not just boilerplate; things change. A per-click rad group with plenty of work to go around and a flawless infrastructure today might be fraught with breakdowns, growing-pains, and/or overstaffing tomorrow.

It would, thus, not be unreasonable for a rad inquiring with a pay-per-click gig to ask about what safety nets are in place for this sort of thing. Of course, the prospective employer would immediately offer assurances that this has never been an issue, it almost certainly never will, etc.

However, imagine you’re the rad. RadCorp A’s people offer you those assurances and have no follow-up for it. That is, they’ve never faced the situation, don’t expect to, and have no plan to deal with it if it ever arises. Or they promise you they’ll “look into it.” That effectively means that, half a year from now when their bereft worklists are starving you of clicks, they still won’t have a plan – and might never.

Meanwhile, RadCorp B’s people share with you that they have a strategy, or give you details about one they’re developing. Heck, you showed interest, and they want to hire you, so if you come aboard, they’ll put you on the committee that’s forming the plan. Maybe you’ll get a nice little stipend for that extra work, and/or have a chance to show them you can be more than just a film-reader in their ranks. Think you might choose B over A? I know I would.

Some sample strategies I’ve encountered and/or proposed:

  • A minimum hourly rate for rads being at their posts. Pro-rated, the clock ticking whenever a rad’s reading-list is empty. Rate well below what an average reader would earn with clicks, but a reassuring “floor.”
  • A healthier pro-rated hourly rate for such circumstances, based on the individual rad’s “rolling average” productivity for the past, say, three months of work. Would make the worst-case scenario for a rad less painful…and further reward his efforts.
  • Ditch the work shift-model entirely. There’s a group out there right now that’s offering a “log in and read when you want” approach. Right now, they claim to have far more work than they can handle…but if, one day, they didn’t, there would be nothing to stop a rad seeing an empty list from signing off and doing something else with his time, then checking back in later.

Follow Editorial Board member Eric Postal, M.D., on Twitter, @EricPostal_MD.