Talking Teleradiology: Trends, Tallies, and True Tales

BLOG POST ABSTRACT

Teleradiology: the career choice for radiologists who want a life outside of work. 

That’s (mostly) a joke and yes, the subject of this post is teleradiology.  If you’re a regular here, by now, you probably know I must begin this topic with a thorough splash of scholarly context.  Teleradiology as a practice subtype emerged in relatively recent years and continues to evolve today—but the perceptions, applications, and general nature of teleradiology have shifted rather dramatically since its inception.  

Controversy! Murky data! A tell-all account from a real-life teleradiologist convert! Reader, read on:

History and current state of teleradiology

Historically, there has been a concern that remote interpretation by external teleradiology providers would lead to commoditization, reduced reimbursement, displacement of radiology groups from their hospital contracts, increased encroachment by non-radiology specialties, and reduced quality [1].  Despite these concerns, teleradiology is widespread throughout modern radiology practice, helping practices to achieve geographic, after-hours, and multispecialty coverage; reduce turnaround times; and expand underserved access.  

Shifting trends in teleradiology 

Teleradiology is defined as the interpretation of imaging examinations at a different facility from where the examination was performed [1]. Due to differences in this definition over time (particularly as to whether both internal and external teleradiology are included in the definition), published data on the penetration of teleradiology in the radiology market are difficult to compare.  

A 2003 survey showed that 15% of radiology practices reported using external teleradiology, and 67% reported using teleradiology overall whether internal or external [2].  A more recent survey showed that among radiologists in a non-teleradiologist primary work setting, 85.6% reported performing teleradiology (84.4% internally and 45.7% externally; 44.5% – 79.6% to cover evening, overnight, and weekend hours) [1].  

The most commonly reported challenge with teleradiology was accessing the patient’s EHR.  Other challenges related to quality assurance of offsite examinations, lack of proximity to the technologist, and accessing prior imaging examinations in the PACS.  Regulatory matters such as credentialing, reimbursement, privacy, and security were of less concern.  

Although smaller practices have previously been reported to be more likely to use offhours external teleradiology [3], smaller practices may lack the IT, financial, and administrative resources to oversee successful external teleradiology integration, as well as more fundamentally, the staffing to support the provision of internal teleradiology.  

Ultimately, this information reveals a shift from an initial conception of teleradiology as most helpful in temporal coverage to teleradiology as a technological solution for optimal geographic coverage in day-to-day practice.  

Teleradiology has been around for over a decade but is now better accepted, with higher quality, affordable technology, and better communication [4].  Teleradiology groups are growing rapidly and finding it hard to keep up with volume. They can find radiologists, but not enough who can meet the quality standards and are licensed to read in states within their time zones.  In addition, it has become difficult to hire radiologists at the price that teleradiology companies want to pay [4].   

Teleradiology as a career choice

Many radiologists now see teleradiology as a viable career path and not just a source for temporary or additional income.  On average, teleradiologists are out-earning traditional radiologists. In 2017, the average radiology salary was $436,000 while the average teleradiology salary was $494,000 [4].  

Many radiologists now see teleradiology as a viable career path and not just a source for temporary or additional income.

While five years ago, teleradiology companies offered independent contractor jobs without benefits, today they are offering competitive salaries and guarantees, and more. Additional perks include signing bonuses, the option of home-based or office-based work, flexibility in call schedule, paid medical malpractice coverage, licensing and credentialing services, 24/7 information technology/information system support, no start-up costs, and no cap on work volume.  In exchange, the radiologists must guarantee a certain case load.  

If you’re considering a teleradiology position, I encourage you to talk to someone with experience working in this type of practice environment.  There are unique aspects of teleradiology that distinguish it from other practice types, especially if the position is entirely home-based.  

True tales of a teleradiologist convert

One happy teleradiologist talked about his transition from private practice to teleradiology [5].  A year after leaving a successful radiology practice, he experienced a substantial pay raise, had more time for his family, and became a better radiologist, all while staying connected with clinicians.  

In his previous employment in a private practice group, revenue was shared among partners and associates; a few high-performers made up for low-volume producers.  By contrast, in his teleradiology position, the volume he read determined how much money he made. Furthermore, because he was freed of the distractions and inefficiencies associated with a traditional practice setting, he was more productive than before.  Instead of making a phone call to talk to a physician, he clicked a button and his phone rang when the physician was available to talk; the report and images popped up automatically at the same time.  

He was able to work from home, eliminating a commute that used to consume as much as three hours every day.  About 70% of what he did were preliminary reports in the middle of the night, and he received feedback from a variety of providers who looked at his reports the following morning.  He was surprised at how he came to be on a first name basis with many ER doctors around the country and regularly talked to a small group of doctors who worked the same hours he did.  

That’s it – be sure to tune in to the next blog post, where I conclude my discussion of different radiology practice types.

References

1. Rosenkrantz AB, Hanna TN, Steenburg SD, et al.  The current state of teleradiology across the United States: a national survey of radiologists’ habits, attitudes, and perceptions on teleradiology practice.  J Am Coll Radiol 2019, in press.  Available online July 1, 2019 at: https://doi.org/10.1016/j.jacr.2019.05.053.  Accessed July 4, 2019
2. Ebbert TL, Meghea C, Iturbe S, et al.  The state of teleradiology in 2003 and changes since 1999.  AJR Am J Roentgenol 2007; 188:W103-112
3. Lewis RS, Sunshine JH, Bhargavan M.  Radiology practices’ use of external off-hours teleradiology services in 2007 and changes since 2003.  AJR Am J Roentgenol 2009; 193:1333-1339
4. Kaplan DA.  Job market looks good for radiologists.  Diagnostic Imaging.  August 24, 2017.  Available at: https://www.diagnosticimaging.com/job-market-looks-good-radiologists.  Accessed July 2, 2019
5. Lee J.  4 Reasons I’m happy I left private practice for a career in teleradiology.  Radiology Business.  Available at: https://www.radiologybusiness.com/sponsored/1065/topics/medical-imaging-review/4-reasons-im-happy-i-left-private-practice-career.  Accessed June 25, 2019