For teleradiologists, the decision to read from home is often a lifestyle choice. But doing good work requires equipping your office with the right hardware, software, and support.

In 1999, David Koch, MD, then a practice-based radiologist in Chicago, bought a home in Keystone, Colo, in which he planned to live out his postretirement years. Located in Summit County, billed as “Colorado’s playground,” Keystone offers exhilarating skiing in the winter and breathtaking hiking during the summer. Retirement seemed a long way off, and wanting to spend more time enjoying the resort area as well as his family, Koch decided to leave behind his share in a busy practice and relocate to his vacation home.

But boredom and a depressed economy established Koch’s need to work, although not a need to return to long hours, a long commute, or long faces in his family. Teleradiology offered a viable solution. “Teleradiology for me is a lifestyle thing,” said Koch, who now reads cases from his home for TeleRad Service Inc, based in Albuquerque, NM.

Koch currently works an 8 am to 5 pm schedule 5 days a week. The workload is not guaranteed but is flexible. “I doubt very much you could run out and go skiing for 15 minutes in between cases, but there is all that freedom of choice for living,” said Koch.

David Koch, MD

Vishal Verma, MD, staff radiologist and medical director for StatRad, a teleradiology service headquartered in San Diego, has arranged his schedule to maximize the sunshine of his location; Verma is also based in San Diego. He provides nighthawk service, maintaining a schedule from 7 pm to 3 am or 8 pm to 4 am for 7 consecutive days, followed by 7 days off. “I’m up by 11 am and have the entire day. The lifestyle is better for me,” said Verma.

Of course, it’s not all sunshine and perfect ski conditions—there are some challenges to working as an independent radiologist from home. The first can be finding the right fit. Should the aspiring teleradiologist work for an existing corporation or attempt to develop an independent business? Are the hours actually compatible with the desired lifestyle? Does the opportunity provide an adequate salary?

A second challenge can be setting up an effective and efficient workstation at home. What type of space is available? Is it enough? What hardware and software are necessary? What sort of investment is required to achieve reading readiness? Will there be limitations in the reading capabilities?

Technology can be a major source of frustration, particularly if the home workstation is inadequate or plagued by technical difficulties. The teleradiologist often works alone, meaning not only less collegial interaction, but also often no easy tech support. How does an individual physician handle these challenges? What sort of support is available? Do the advantages outweigh the disadvantages?

Vishal Verma, MD

The Right Fit

If a radiologist can find the right situation for teleradiology, then the advantages very often do outweigh the disadvantages. It may, however, take a few tries before hitting upon the perfect scenario. Koch held positions with two other teleradiology firms before landing his current contract. One firm had declared bankruptcy; the second lost its contracts with the facilities located in the states in which Koch was licensed.

By contrast, Verma joined StatRad after completing his residency in 2003 and has never worked in a traditional practice setting. “It was originally a moonlighting opportunity for me, but I decided the lifestyle was better and stayed in the industry,” said Verma.

Verma has since become a partner in StatRad and also participates in sales activities. Marketing and business roles appeal to radiologists with an entrepreneurial spirit, while others focus solely on readings.

“There is a direct relationship between how hard I work and how much I earn. Success or failure is driven more by one’s personality and work ethic than it is in a traditional practice setting,” said James Turner, MD, a radiologist with Virtual Radiologic Corporation, headquartered in Minneapolis. Teleradiologists have the freedom to work at the level that suits their goals.

“We have plenty of people who like the lifestyle and want to spend more time with their families. Once they sign off at night, they don’t think about the job again until they sign back on,” said Verma.

Plenty of teleradiology opportunities can be found online, according to Koch, who suggests Internet job boards, company searches, and association listings, such as those of the American College of Radiology (ACR). “I think a lot more radiology practices or teleradiology entities are advertising that they are looking for people, and so you basically look for those businesses. See if they have practice opportunities in the states where you have licenses,” Koch advised.

Having the appropriate license, and often more than one, will often determine a physician’s eligibility for open positions. “One thing that [teleradiology companies] look for is a radiologist with multiple state licenses,” said Verma.

Many teleradiology companies work across multiple states and need physicians who are able to work existing contracts in those regions, as well as contracts being targeted in new areas. Koch holds eight licenses (Colorado, Kentucky, Indiana, Illinois, Ohio, Pennsylvania, Virginia, and West Virginia); Verma holds 16.

Managing multiple licenses, however, can pose its own challenges. Obtaining a new one can take up to 6 months, according to Verma, and costs can run $200 to $400 to renew annually or biannually, depending on the state, adds Koch. Hospital credentialing can add further time and/or complication. “When I switched to StatRad, it took over a year to get fully credentialed,” said Verma.

Once prepared, however, a typical teleradiologist stands to earn a salary equivalent to that of an on-site daytime radiologist with a typical group practice, estimates Verma. “But we probably work slightly less, and we definitely do a lot less administrative work,” said Verma.

The Right Equipment

Despite this difference in workload, the teleradiologist’s home workstation will need to match the technological capabilities of his clinical colleague. This includes hardware, software, communications, and general tools, such as workstation space.

“The computing hardware is increasingly available as industry standard components from world-class sources, such as Dell,” said Rick Jennings, chief technology officer of Virtual Radiologic. Both Koch and Verma note they use PC devices with enough RAM to provide the needed processing capability.

Koch acquired his system independently; Verma received his from StatRad; and Jennings notes that Virtual Radiologic supplies its teleradiologists with all the equipment they will need to perform readings and reports, both hardware and software.

Perhaps the most important hardware component includes the monitors. The viewing instruments must offer display capabilities, which include resolution, size, and color, appropriate to the types of reads to be completed. Verma, who does not complete first-report reads, uses a dual-monitor configuration with a resolution of 1900 x 1200. “These were relatively inexpensive, about $400 or $500 apiece,” said Verma.

Koch wanted monitors with higher-grade capacities but without too high a price. He found them through NEC Display Solutions of America.

Monitors offering greater resolution are often more expensive, running up to $5,000 per device. Jennings estimates the cost of hardware components can range from $2,700 to $8,000, depending on the choice of monitor.

Koch wanted monitors with higher-grade capacities but without medical grade costs. Working with NEC Display Solutions of America in Itasca, Ill, he was able to find monitors offering higher resolution (2560 x 1600) and color capabilities at an affordable price point. He purchased four monitors, though he is currently using only three. Two 30-inch devices are for viewing images; the third displays administrative tools, such as Internet search engines, e-mail, and PACS.

“They’re big enough so that I’m not having to do a lot of zooming and scrolling. My eye can move faster than I can move a mouse or scroll a scroll wheel, so that was important to me,” said Koch.

Functionality was also key. “If someone does a horrible chest x-ray, you can’t make it look good, but you can at least manipulate it to make it as good as possible to try to see things,” said Koch.

Consistent and broad grayscale and color representation are also important. “The bulk of the teleradiology work I have been performing over the last 6 months has been reading plain films and plain x-rays, and there are an awful lot of shades of gray that exist on these images, so it’s important to be able to display that,” said Koch, citing particular instances, such as when looking for small pulmonary nodules or hairline bone fractures, where the depth of gray can be especially relevant.

Similarly, color is particularly important when reading PET, CT, or color Doppler ultrasound scans. “In previous work situations, when color studies came up, I had to drag the images onto another smaller color monitor associated with the system. In this case, they pop up in the typical location,” said Koch.

Voice recognition software, PACS, RIS, networking, and transfer software make up the remaining portion of a teleradiologist’s technology portfolio. Many home radiologists rely on the fastest local broadband service offering to provide communication capabilities. In some cases, this is cable; for others, it’s DSL.

“The professional-level DSL services are usually four to six megabits and that works, but the faster your Internet connection, the better,” said Verma who uses fiber-optic service to download 18 megabits per second. “I can download 1,000 megabytes in under a minute,” said Verma.

Koch has also found that cable works a bit faster than DSL. “My Internet connection is never the weakest link or the bottleneck in my being able to work,” said Koch. He estimates his broadband cost at about $50 per month.

Software in total can run more than hardware, with performance and functionality often increasing along with cost. Software as a Service (SaaS) models can sometimes help to reduce the expense. “SaaS not only avoids the up-front software costs, but also includes the actual processing and management of the environment,” said Jennings.

Koch invested a total of $12,000 acquiring and setting up the hardware and software within his home office, but found the personal investment worth having the control over the quality of his equipment, as well as his freedom.

The Wrong Stuff

In general, freedom is not actually free. Teleradiologists do make some sacrifices, and not all involve the cost of capital purchases. Working independently includes challenges that impact technological support, collegial interaction, and convenience.

Koch acknowledges it took some work to figure out the right equipment and its appropriate configuration on his own and that troubleshooting can be a challenge. “I am the technology department, and I pretty much have to try to figure things out,” said Koch.

On the other hand, teleradiologists who work for larger institutions, such as Virtual Radiologic, may find they have more support. “We have a 24/7 technology team that provides all the necessary support for our radiologists. We can remotely access the radiologist’s workstation and correct most issues,” said Jennings.

Yet, even though remote tech support may help solve a problem, it’s still remote, as are most of the teleradiologist’s colleagues. “On the professional side, you do not have that much social interaction,” said Verma, who relies on instant messaging for collaborations and consultations. “Sometimes, [the instant messaging] is work related, and when it’s a little slower, sometimes it’s not.”

Although Koch couldn’t be happier living in his resort location, he does sometimes miss the advantages of an urban center. “Denver is an hour away, and so there aren’t 20 different computer stores to run to for a part or a broad choice of specialty lawyers to help with contracts,” said Koch.

The hours can also pose a problem. Although they may be ideally suited to the desired lifestyle, they may require some getting used to, particularly for teleradiologists working nighthawk shifts. “Your sleep schedule is kind of hit or miss,” said Verma.

Yet even so, neither Koch nor Verma would give up their teleradiology practices. “I think the drawbacks are fairly minimal and I’m willing to trade off for lifestyle and location,” said Koch. While he is living in “Colorado’s playground,” his “interruptions” are family and recreation, rather than colleagues and medical challenges—it’s a good life and for many a good lifestyle choice.

Renee Diiulio is an contributing writer for Axis Imaging News.