X-Ray Lemons into Radiological Lemonade

April 24, 2015

Reading X-rays is turning this radiologist back into a dayhawk.

I’ve got to hand it to the dysfunctional workplaces I endured before moving to teleradiology. However unintentionally, they finally did me a favor.

Being the new guy in a practice (or simply remaining inferiorly situated on a group’s totem pole after a tenure of years), one might expect a certain amount of being dumped upon by those more senior. This can take many forms, including being the go-to guy for scutwork, STAT cases, and generally #1 in line for anything which might interrupt one’s workflow. When one actually has the chance to read studies, they have a way of being unwanted leftovers…whether from outright cherrypicking or slightly less-blatant claiming of turf (such as a senior partner declaring himself the only one capable of reading high-RVU studies like MRI).

The upshot, for me, was that I often found myself pulled in multiple directions. I rarely had more than a few minutes, if even that, between one distraction and the next. The more time and attention a study took to read, the likelier it would be that I’d get pulled away from it, returning later to attempt recovering whatever train of thought had been derailed.

I therefore developed a proficiency, even a liking, for cranking through what I thought of as “bite-sized” cases, commonly X-rays. Not only could I squeeze them in between other tasks, but they were in plentiful supply since nobody else seemed to want to read them. It became a known certainty: Put me in an office with a massive backlog of plain-film studies, and things would be cleaned up posthaste. Notwithstanding my fellowship in body imaging, I began to think of myself as something of an X-ray specialist.

One of the adjustments I made when moving to teleradiology a few years ago was a much lower proportion of X-rays on my worklists. Telerad, historically, had been CT-heavy, for several reasons not worth going into. Which was good news for most rads doing the work, since X-ray, unsurprisingly, paid poorly as compared with other modalities.

Times changed as the teleradiology field continued to grow, and X-rays increasingly populated telerad worklists. It posed a problem (or challenge, depending on your perspective)…how to deal with the trend? Typical rates and overhead meant that the modality was a money-loser, yet to compete for contracts a telerad entity now pretty much had to agree to take on facilities’ XR in order to get at the more desirable CT, MR, etc.

There are, of course, multiple ways to deal with the issue, perhaps the simplest of which being to just let the x-ray tide flow into the general telerad worklist. In the fullness of time, everyone should receive comparable shares of XR and its downward effect upon margins.

Or, recognizing that some rads find X-ray less objectionable than others (and occasionally, in cases like mine, more desirable), a telerad operation might let them self-select to shoulder more of the burden. Some sweetening of the pot might be helpful to get enough willing participants, whether a stipend to offset the lower pay-rate for XR or some other inducement.[[{"type":"media","view_mode":"media_crop","fid":"34546","attributes":{"alt":"sun","class":"media-image media-image-right","id":"media_crop_5012037865072","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3682","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 197px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Studio Barcelona/Shutterstock.com","typeof":"foaf:Image"}}]]

vRad (with whom I work, lest a reader be unaware), noting that a big chunk of the XR workload is nonemergent, put forth the offer that anyone rising to this challenge could do so during daytime hours, rather than the nocturnal shifts typical of telerad. Meanwhile, rads sticking with nights, many unhappy with their recent increase in XR volume, have the unwelcome modality diminish as it gets consumed by their daytime counterparts.

Offered the combination of no longer working nights and playing to strengths I developed during my 5-6 years of post-fellowship work, I had to think for all of about a nanosecond before throwing my hat into the ring. I’m currently doing my last week of night-coverage, but will surely detail my life as a dayhawk in columns to come.