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7 myths and misperceptions about teleradiology

 

My journey to teleradiology started with an invitation during residency to join several vRad radiologists for dinner in San Diego. Having trained in a busy academic setting that came with nearly 2 hours per day spent commuting and a never-ending queue of studies to read, I was curious about my options.

As I learned more about the day-to-day work of teleradiology over dinner and in subsequent conversations, I came to realize a lot of what I had thought about teleradiology was outdated and wrong. As I approached my graduation from residency in June 2020–in the midst of the 1st peak of the COVID pandemic–I decided it was an opportune time to give teleradiology a try and so I signed on with vRad in lieu of continuing on as a Fellow in the hospital setting. When I did, I saw firsthand how much reading remotely has to offer in comparison with traditional onsite radiology practices. It also became more and more clear to me that the taboo surrounding teleradiology is often based on myths and misperceptions. Here are some of the biggest incorrect assumptions that I believe are worth debunking:

Myth #1. Teleradiology is where radiologists go to retire.

Of course, I’m living proof that this isn’t true since I started in teleradiology right out of residency. vRad radiologists actually fall into a wide range of age brackets: 36% are under age 50 and 76% under age 60.

In many ways, the pandemic was the perfect opportunity for all radiologists to re-examine whether their professional goals leave room for achieving personal goals. As many radiologists raising young families can acknowledge, the time in our lives when we need the most flexibility is typically early in our careers, not near retirement. In fact, I would wager that transitioning to teleradiology directly out of residency continues to become more and more popular going forward.

Myth #2. Teleradiologists work only nights and weekends.

This was one of my own misconceptions before I entered the field, and why I initially wrote teleradiology off early in residency as something that wasn’t for me. I knew that with young kids at home, working overnight just isn’t practical, and would likely preclude me from participating in many family activities.

My assumption was based on the way the industry used to work when companies were looking to hire radiologists to cover the dreaded middle-of-the-night hours and weekends so their staff radiologists didn’t have to. Today, the business model has drastically changed. Many more clients use teleradiology to cover daytime overflow, subspecialty volume, or ebbs in radiologist staffing. That means that when it comes to scheduling, all options are now on the table.

I was offered the opportunity to request my own preferred schedule of 8 hour shifts. I chose 3 pm to 11 pm because this would allow me to have every morning and early afternoon off, even on days when I’m working. Plus, I could still maintain a relatively normal sleep schedule. I knew that those hours would open up a whole new world for me, allowing me to attend kids’ school events and parties, etc. It also allowed a healthy amount of ‘me time’ to do anything I want – exercise, work on personal and home improvement projects, as well as see friends more.

I’ve never had to work an overnight shift in my time at vRad. Simply put, teleradiology is an excellent option for anyone looking for a flexible schedule tailored to their lifestyle.

Myth #3. Teleradiology is isolating.

Working from home definitely has a different vibe than reading in a traditional onsite setting. For me personally, the 10 extra hours per week not spent commuting was in itself entirely worth the change – hands down. Also, there are a variety of ways to connect with other radiologists while working at vRad. For starters, new hires are assigned a radiologist mentor for the first couple of months as a go-to person for any newbie questions. Two additional voluntary radiologists are available during your first few shifts for any unexpected questions that may arise in order to help you navigate the new system successfully. This setup provides a great opportunity to start building a virtual network with your new colleagues. As a matter of fact, I've ‘virtually’ run into old colleagues and professors from my training program through other networking opportunities here at vRad.

There’s also a formal consult platform where you can reach out to another radiologist currently on shift if you want a second opinion. You can even transfer a case to a subspecialist if something feels way over your head.

I’ve not only gotten to know other radiologist colleagues, but also many of the support team members who work with me during my shifts and take on virtually any administrative task I need done. A few examples would include requesting prior reports, prior imaging, more recons, pertinent lab values, or getting an ED physician on the phone for me to communicate a critical finding. Everyone I’ve ever interacted with at vRad has been nothing other than pleasant and helpful – it truly is a great work culture. And although I work alone in my office at home, I feel like I’m only a keystroke away from an entire community of friendly colleagues.

In my opinion, working as a radiologist in any setting can be isolating – never really leaving your reading room to roam the hospital corridors and/or limited opportunities to talk to your patients face to face. So I figured that if I’m essentially going to be working on my own, I’d rather be doing it in my own home.

Myth #4. Working remotely means that you have less of an impact on patient care.

Let me put it this way, one of my favorite things about teleradiology is how much more impact I feel like I have on patient care than working in the traditional solitary clinical setting I’d become accustomed to. So let me explain – the teleradiology business model is typically comprised of taking overflow studies when work volume exceeds staffing capacity and/or after hours, which by nature, typically consists of emergency or trauma cases. Rarely do I read cancer staging studies, which are not my favorite anyway.

Rather, I spend a good amount of time during my shifts delivering critical results to doctors all over the country in every clinical setting you can imagine. One minute I'll be talking to a ‘big city’ trauma surgeon in L.A. and the next minute I'm on the phone with a rural Kentucky doctor who’s running an entire small town hospital by themself and we’re casually discussing the results of the follow up study I’d recommended for that last patient earlier in my shift. The rural doctors working at smaller facilities in obscure parts of the country have got to be my favorite – I’ll often speak with the same ones multiple times per shift and they are always so grateful for my call.

On another note, I also love reading for rural clinical settings because of the unique opportunity for me as a newly graduated trainee straight out of a ‘big city’ academic hospital. I get to exchange ideas with well-seasoned rural ED doctors who truly know their patients – sometimes even on a personal basis. One particularly interesting case I can recall was a young 20-something year old male who presented with ‘abdominal pain’ and had at least a dozen prior abdomen/pelvis CTs with always the same impression: “No acute findings.” Although I also found nothing acute in the study that I read, there were a number of idiosyncrasies that I couldn’t quite put my finger on. So I reached out to the ED doctor on site, who was able to offer a gold mine of additional past medical history for context. Together, we came up with a good plan for this kid to get referred to an outside rheumatology clinic for more specialized testing. Long story short, the patient was ultimately confirmed to have IgG4-related autoimmune disease and can now finally receive appropriate treatment.

Myth #5. The reads are lower quality.

Perhaps this one stems from the misperception that only radiologists who can’t get hired anywhere else turn to teleradiology. This seems to me very antiquated and no longer relevant–especially in the ‘post-COVID’ era. With radiologists from all backgrounds and training programs such as Yale, Duke and UCLA, vRad works hard to recruit and retain high caliber radiologists.

It’s worth mentioning is that vRad has no minimum study requirement per shift, allowing radiologists to work at whatever pace they’re comfortable with to ensure the best quality reads. And their business model seems to be working for them, as vRad prides itself on a 99.7% accuracy reading rate they’ve consistently demonstrated for many years.

Myth #6. Teleradiology is a prelim sweatshop.

All I can say is that this has definitely not been my experience, and vRad is very transparent about work distribution. In fact, I receive a quarterly performance report detailing all the studies I’ve read including study modality and report type (prelims vs. final reads), as well as the practice’s averages across the board for comparison. As it turns out, over 70% of our volume is final reports.

When it comes to being a sweatshop, the reality is we’re encouraged to read at our own pace; there are no minimum read rates and no productivity floors. When your shift is over, you simply sign off. Any studies remaining in your queue are redistributed among hundreds of radiologists on duty per the platform’s algorithms of patient status, individual reading preferences, credentials, etc. In effect, there is no ‘worklist anxiety’ at vRad.

This setup also makes it easy to take a break without negatively impacting workflow. If I need to leave my desk for 15 minutes for any reason – even just to tuck my kids into bed – I simply let the operations center team know and they will release whatever is on my list for other rads to take until I return. I don’t have to feel like anyone is waiting on me. There has been absolutely NO element of sweatshop in my experience at vRad to say the very least.

Myth #7. Teleradiology pays less.

Here’s the thing about pay: the more you work the more you get paid, and the less you work the less you get paid. Amazing concept, right? Without context, the numbers don’t really mean much. How many days did you work? How many hours did you work? How many hours did you spend commuting to your job? How many studies are you expected to do per day? How many hours do you spend thinking about your job during your “off hours”? How many hours do you spend dealing with licensing/credentialing/CME paperwork?

When I look at the final number on my paycheck, these contextual questions are some of the things I take into consideration. Particularly the fact that with my seven-days-on/seven-days-off schedule, I only work 26 weeks every year—I would say that I’m very satisfied with my compensation and the control I have over it.

 Many radiologists at vRad actually make quite a lot of money by leveraging the many efficiencies of the technology platform, the lack time wasted on non-clinical tasks, and ability to avoid the distractions common to other work settings. Not to mention, you’re not limited to working only 26 weeks per year – there are ALWAYS extra shifts you can pick up. Additionally, vRad offers higher pay rates during busy times to incentivize radiologists to take on optional extra work in order to help vRad manage their turnaround times for their clients. These incentive-driven shifts are great opportunities to really cash in.

 
The major factors leading to my decision to go into teleradiology were two-fold. First, I really enjoy emergency radiology and wanted to strengthen my skills as a general radiologist while not limiting myself to a subspecialty. Secondly, the way I see it the first year out of training is always full of continued learning opportunities – regardless of whether you go into a Fellowship or not. That said, it was reassuring to me that if a challenging case were to arise, vRad offers 24/7 unlimited access to consultation with other radiologists as a safety net. Ultimately, the choice before me in my first year out of residency was to enter a fellowship with a drastically lower salary and mandatory call shifts (not to mention the 10 hours per week commuting), or learn on the job in teleradiology with a safety net made up of both back office and real time support that vRad offers.

Needless to say, I am very happy with the choice that I made.

In short: working in teleradiology can be very rewarding once you can get past the many commonly held misconceptions. For me, it’s been fantastic.

If you’re thinking about a career in teleradiology, please feel free to reach out to me. I’d be happy to share more about my experience and answer any questions you may have.

Author Megan Wood Hellfeld, MD

vRad Radiologist

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