IMs and RTs

September 21, 2020

The two philosophies of Itinerant Mercenaries and Remote Teammate teleradiologists.

Anybody who’s read more than a column or two of mine probably knows that the majority of my post-training career has been via teleradiology. Between first-hand experience and communication with other telerads, I’ve mused that I’m more of a sub-specialist in tele than I am in body imaging. Notwithstanding my fancy, I have a framed certificate to attest to the latter.

I, thus, flatter myself that I have some wisdom about matters teleradiological to share—and am even more flattered when others recognize this and seek me out for it. It’s becoming a rare week in which I don’t receive at least one “private message” online on the matter.

Recently, in discussion with one of the directors of my radgroup, I shared my perception that the teleradiologist population has two major subsets, in terms of attitudes and approaches to their careers. I called them Itinerant Mercenaries (IMs) and Remote Teammates (RTs). Of course, there’s a spectrum of individual variability, but I’m painting with broad brush-strokes here:

An IM is looking for the most immediately beneficial set of circumstances for his work as a radiologist. Who's paying the most per RVU, offering the best hours for the IM’s preferences, providing the best tools to get the job done, and imposing the fewest hassles.

Extenuating circumstances aside, an IM will stay with you as long has he feels like you’re giving him the best deal. The flip-side of that: It doesn’t really matter how long he’s been with you and how mutually beneficial it’s been. If some other radgroup offers him a better deal, he’ll probably move on. (Hence the “itinerant” part of IM.)

Thus far, I’d say the majority of the teleradiologist population has been IMs. Some of this has been the result of self-selection: This is only a job to them, a means of earning the best living possible. Why not earn as much as you ethically can with the best quality of life? Some IMs will tell you that they just got tired of working in groups where those who worked hardest/best didn’t get proportionally rewarded for it.

The model offered by most telerad companies, to date, seems the answer to an IM’s prayer: A pure exchange of productivity for compensation, no strings attached. The IM’s responsibility ends at the moment he turns off his workstation at the end of a shift. He gets a competitive payoff for his work now, rather than something less in exchange for vague/implied promises like, “Stick with us long enough and prove yourself—maybe someday we’ll make you more than a virtual film-reader.”

RTs maintain a more traditional attitude when it comes to a career as a physician: You join a group (assuming you can’t start your own), demonstrate your value as a member of the team, and earn a position equal to those who were there before you. You’re sharing the risks in growing and maintaining the practice, so it only makes sense that you should share in its decisions…and, yes, its rewards. It’s not just business, though—there’s also professional pride in being a part of something like that, as well as an intellectual satisfaction.

Why on earth would an RT even go into teleradiology, when the telerad model is so favorable to an IM’s way of thinking? There are a number of reasons. Commonly, the RT lives somewhere that doesn’t have any realistic paths to partnership or other positions above a permanently bottom-tier image interpreter, and/or the local jobs are overall crummy. Telerad gives the RT a chance to make a better living, maybe while watching the job market to see if things change.

People, too, change in the fullness of time. Sometimes RTs morph into IMs and vice versa. Or, with aging and soul-searching, someone who thought himself an IM or RT realizes that he’s always been of the other camp in his heart of hearts.

Circumstances can make this happen more readily. In previous columns I’ve shared my observation that smaller, more localized groups are beginning to leverage teleradiology for themselves, remotely hiring rads to be virtual members of the team rather than sacrificing a chunk of money and control to use the telerads of some outside entity. When a group hires a remote telerad, it’s a lot more able (and likely!) to treat that doc as a true citizen of the practice, rather than just another cog in a machine.

I pause to add: Some radgroup-leaders, corporate and otherwise, might say things like, “But of course! We highly value all of our physicians as members of our radiological team,” and, then, go ahead and treat some of them like expendable pawns on a chessboard. You’re probably better off not even trying to make such pretenses because they don’t fool anyone.

As smaller groups account for more of the teleradiology workload, I think the telerad population’s majority is going to shift from IM to RT. Partially because a bunch of now-IMs were really frustrated RTs who adapted to their environment, but will soon have better options. Also, because a lot of rads who want to be a member of a team will see that they can do so remotely, rather than exclusively on-site and might, thus, join the telerad population as RTs, whereas they would previously not even have considered tele for themselves.

I don’t think IMs are going to fade away, just as I don’t expect the thus-far typical corporate teleradiology companies which appeal to them will all fold. Some IMs don’t want to be RTs, nor expected to behave as such. Supply/demand dictates that they will be able to find what they seek. Even if all of the corporate telerads magically vanish, some smart radgroups will attract IMs by offering them terms similar to what the corporations previously did.

Similarly, radgroups that have already begun remotely hiring (or contracting with) their own teleradiologists would be smart to think about how they might appeal to RTs…and to do so in a way that will compare favorably with whatever plans competing groups might one day hatch.