Patience, Young Radiology Grasshopper…

March 2, 2020

Early career might not be the best time for a teleradiology position.

Having developed something of an online presence as a teleradiologist, I occasionally get messages asking for advice on the subject: Why did I go this route? How did/do I like it? Do I think it’s a good choice for someone in situation X?

Maybe wishing I’d had someone to advise me when I was taking the telerad plunge, or maybe just because I love feeling like I have wisdom to impart, I never waste the opportunity to reply. Indeed, I have difficulty keeping it brief.

Today, for instance, I got an inquiry from someone a year out of fellowship who was considering moving to telerad from private practice. His message clocks in at about 60 words, and my answer is a little over 600. Ending with a “feel free to ask me more” invitation because I had tried to rein myself in.

Regular readers of this column might be surprised that I advised against a typical rad in his position going into teleradiology. Since others in his boat, or even still in residency/fellowship might be considering the move also, I thought it might be worth sharing my views here.

(It has occurred to me that such early-in-career rads might not be long enough in the tooth to appreciate the “young grasshopper” reference in the title for this week’s column. Fortunately, with youth often comes greater Internet-expertise, and I, thus, have full faith in their ability to root out the source, perhaps, thence, to enjoy it.)

If you are a radiological newb, corporate telerad (a la vRad, RadPartners, etc.) is probably not yet for you. Their models are very much “eat what you kill,” meaning that you get paid purely based on how much you read. Even if you found a place that claimed not to work this way, I guarantee that you’d be hearing about your productivity if you didn’t hit sufficient numbers…and rads usually need a few years in the “real world” after training before they will hit their stride in this regard.

Might you be an exception? Sure. Maybe your training had you working like a beast, and you can already churn out RVUs with the best of them. Maybe you did a bunch of moonlighting and are effectively a few years more experienced than your residency-mates. Or, maybe your situation is such that you don’t really need/want top-dollar for your time, and you’re willing to earn less in a telerad gig than you would have in an onsite job.

Have you really thought about the hours you’d be working in the telerad world? Most of it is nights, holidays, and weekends. It’s far from impossible to live that way-plenty of folks enjoy having every other week off and are able to adjust their biological clocks to function during the daytime when they are not working. But, is that something you want for the long haul?

Quick thought-experiment: Imagine, for years to come, every time friends or family invite you to join them for something, you have a 50-percent chance that it’ll be during one of your work-weeks. Yes, you can rearrange your schedule for the longer-term stuff-a wedding next year, no problem. But, some pals just mentioned that they’re heading out for drinks this Saturday? Flip a coin: Heads, you can attend; tails, you’re working that day.

Heard about a telerad company that’s offering dayshifts and think that’ll take care of such concerns? Think again. A lot of the time they’ll still want you covering 50 percent of the weekends and holidays-which also have coverage-needs during the daytime.

One of the daytime-telerad offers I saw also expected longer shifts to justify the daytimes: 12-hour stretches. Even if that was just Monday-Friday (and it wasn’t), I’m not sure I would have been able to endure that for the long haul. Oh, and don’t forget that some of the daytime offerings are only for low-reimbursement stuff: They’re just offloading their X-rays on you, and, as a result, they’ll be paying you less than if you worked their nightshifts.

Another thing to consider, if you’re going to be relatively fresh out of training: You have your whole career ahead of you. Do you really want to start it off in a typical corporate-telerad operation, where there is no real chance you’ll ever climb any sort of hierarchy? At least in a local private practice or hospital, you’ll develop some sort of citizenship within the group. Get a good reputation, maybe eventually be tapped for some sort of leadership role. Go work for a corporate telerad for 20 years, and know what you’ll be? The same cog in their machine you were on day one.

That onsite job would also teach you an awful lot that you wouldn’t pick up from a telerad workstation: How your fellow onsite rads do things differently from where you trained. The organizational stuff behind the scenes of a practice. Interactions with the technologists, who might respect and interact with you a little more in person than if you were some faceless name at the end of an internet connection, reading for their hospital along with a hundred others. If you were years into your career and considering moving from onsite work into tele, you’d already have experienced such things. But, if you’re fresh out of training, do you really want to isolate yourself from this before you’ve even seen it?

Notice, by the way, I describe these not-for-newbie telerad gigs as being of the corporate variety. As I’ve mentioned in some columns of recent months, there is a new breed of telerad job that’s finally beginning to turn up. I’d expected this trend about a decade earlier, but better late than never: Rad groups (like mine, we’re still hiring!) which have opted to “remotely staff” with their own telerads, rather than contracting out to corporate entities.  Keeping it “under their own roof,” they maintain far more control over the situation, and can treat their remote members much more like on-site citizens than traditional tele-companies ever have.

At the very least, if you’re recently out of training and have determined that tele is the way you have to go (for instance, you live somewhere with an abysmal or nonexistent job market and cannot relocate), do yourself the favor of looking into one of these. They tend to be a far better deal for everyone involved…except the big telerad corporations, of course, which might suffer by comparison.