Memoirs of a Teleradiologist, Round Four

April 5, 2012

In the teleradiology field, I’m partial to working with larger, more established groups, but are there advantages of the smaller startup enterprises?

Looking through my last few columns, you might (correctly) have gotten the impression that, in the teleradiology field, I’m partial to working with larger, more established groups as opposed to smaller, perhaps startup enterprises. For the sake of keystroke-economy, I’ve taken to referring to a hypothetical big telerad company as BT, and a little one as LT. I’ve mentioned a few ways in which I think BT enjoys huge advantages over LT.

So, does LT offer a prospective teleradiologist any advantages over BT?

In theory, LT could offer its radiologists a better compensation scheme than BT. Imagine the compensation for reading, say, a head CT as a pie. Both BT and LT are going to be taking slices out of that pie before you get it. Those slices are going to feed their administrative costs, plus whatever profit margin they expect to reap as a result of having set up this whole enterprise. (You didn’t think they were just doing this for the fun of it, did you?)

Being the big telerad company, BT has a bigger administration than LT. It should come as no surprise that they might take a bigger slice of the pie as a result. BT also needs to feed the small army of support staff who are doing all of the non-doctor work while you focus on reading cases, so they’re indirectly consuming pie, too. Theoretically, as LT is leaving more of this support-staff work for you to do yourself, you should be getting more of the pie for yourself.

For whatever reason, however, my admittedly brief look around the telerad field didn’t seem to bear this out. The smaller guys, if anything, seemed to pay less per case than the big boys. I could theorize that BTs are enjoying an economy of scale, that LTs are less efficient (or more greedy, keeping the extra for their command staff and/or investors -but truth be told, I haven’t got a specific reason. All I can say is that this theoretical advantage of LT over BT did not materialize when I scoped it out myself.

Another potential advantage of LT is that any given radiologist joining the team has much more of a voice than one joining BT. On Day One of your job at LT, you might represent a fifth of the workforce. Even with no seniority at all, your ideas and concerns are much more easily heard than, say, those of radiologist No. 194 at BT, which just hired No. 237. (That said, some large companies have been known to be far more attentive to their employees than smaller enterprises - if you know anybody working for Google, ask them what I’m talking about.)

For me, the biggest reason to seriously consider LT over BT would be the notion of getting in on the “ground floor.” That is, you’re either one of the founding members of the group, or you’re joining not long after they’ve gotten going, and part of your deal is that you are going to share in the success of the place, above and beyond whatever you get paid for the image interpretation work you personally do.

Your initial group of four eventually grows to 20? Congratulations, you’ll probably get some kind of title and first pick of when you want to work. You might even get a small percentage of the profits generated by those who joined after you. Perhaps your group is wildly successful and attracts the attention of BT, which approaches with a juicy offer to assimilate your LT into its empire? Congratulations, as a founding member you might be in line for a share of the multimillion-dollar buyout. Or maybe your group is so wildly successful that you can eventually take the thing public, selling stock and becoming a new BT in your own right. Just make sure you’ve spelled out such things when writing up your original contracts; you don’t need to watch movies like The Social Network to know what might happen to your supposed partnership otherwise.