One professional makes a case for a career in teleradiology.

I remember thinking that it must be temporary insanity. The idea occurred to me as my closest friend from residency departed for Australia, a world away, to embark on a career in teleradiology, instead of joining me on my traditional path of a hospital-based career. He actually had to explain the concept to me several times, before I could understand how it worked. Meanwhile, I suggested that teleradiology was just a passing fad, as so many of us did back then. My friend knew better and got right on that plane, just like Robert Frost taking the road less traveled, as clich?d as that might sound.

Well, nearly a decade later, my friend and I are colleagues again, working in the same virtual reading room, but still half a world away from each other. Yes, I too am now a teleradiologist, and although my journey was more circuitous, our destinations were the same. Indeed, a career in teleradiology is now part of the mainstream, and is most certainly not a passing fad.

Teleradiology may not be the best career option for everyone; and just as each subspecialty will attract those with certain aptitudes and inclinations, such is the case with practicing telemedicine. I think that we are fortunate to have a vocation in radiology in general, given the immense rewards of the specialty. Imaging, after all, has become the bedrock of modern medicine. For me, teleradiology has been the perfect opportunity, and I always go downstairs to my reading room knowing that I made the right choice. I also find that I am surrounded with an amazingly like-minded team of coworkers, which is a great asset.

First and foremost, there must be a solid personal interest in emergent imaging. The attribute, which is essentially joined at the hip with teleradiology, is emergency radiology, which took root as a true subspecialty of radiology in part due to the growth of teleradiology. This could occur only when dedicated expertise in emergency radiology could be found in a significant number of practitioners. It is easy to forget that even emergency medicine itself as a specialty really evolved only in the last 25 years. The graduate seeking fulfillment as a teleradiologist will have to get intellectual stimulation from the various types of cases they see in the ER. If you never want to encounter a hepatic laceration, ovarian torsion, or bilateral cervical locked facets, then this diverse field will be of no interest to you. Of course, subspecialization within teleradiology is increasingly common, but all types of emergent cases can be expected to be encountered by most teleradiologists.

Part and parcel with the majority of teleradiology jobs will include working when most traditional radiologists are not working. This time period can span from evening to early morning depending on the time zone one is located in. For the newer generation of radiology trainees, who grew up with the concept of 24/7/365 imaging, this is a natural extension of the shifts to which they were exposed in training. However, even the large numbers of radiologists who have become teleradiologists without such exposure during training find themselves well suited to working these types of hours. Again, I think that those folks with a natural aptitude for nontraditional hours will seek out this type of career because of the associated benefits and flexibility such a job brings. After all, the corollary is also true—teleradiologists, in large part, are not working when traditional radiologists are working. This affords a great deal of flexibility in the schedule of a teleradiologist, and it is a boon for many who seek lifestyle advantages in their choice of livelihood.

Just as emergency medicine doctors discover in residency, there are known ways of acclimatizing to night duty properly, and techniques of good sleep hygiene and recovery are necessary to learn. This is one of the biggest challenges for those seeking a future profession as a teleradiologist. Radiologist, know thyself. Then you decide if the quiet hours of the night are either a boon or too great a hurdle. Personally, I know teleradiologists who will never choose to go back to traditional working hours, and have worked for years enjoying their nocturnal schedules.

More teleradiology is being performed entirely within the confines of the United States, where final reads account for more of the work (Medicare mandated to be read on our own shores); with most teleradiology companies, however, there is still the potential for working in a foreign country so that you are awake when it is nighttime in the States. This is an exhilarating lifestyle proposition for many entering the world of teleradiology.

Benefits and Drawbacks

Samir S. Shah, MD

Income for a teleradiologist is very much a market-driven proposition—the halcyon days are over for all radiologists. Generally, salary is commensurate with or above typical private practice salaries based on the American Medical Group Association data, and enough to encourage high-quality radiologists to enter the field. Many compensation schemata exist in the teleradiology world, the majority leaning toward a productivity-based model.

The productivity of a teleradiologist is higher than that of a radiologist in private practice or in academics. I have been in both academics and private practice prior to my teleradiology career, and can corroborate this without any doubt. So, is the workload therefore insurmountable and the pace frenetic? No, not at all—in many ways, reading more cases is done with much less effort in teleradiology. Efficiencies abound in teleradiology—this type of utterly “pure” radiology workflow is what attracts many to the specialty. The case mix, the lack of procedural work, the lack of interruptions and distractions (no techs or nurses knocking on your door), and the steady stream of emergent cases create a great type of focus for knocking out cases. Quite a few teleradiology companies are on the leading edge of technology, and use their workflow systems to further extend the radiologists’ productivity. Finally, there are no office politics in teleradiology, and a relative dearth of administrative duties/meetings to contend with.

Working from the comfort of one’s home is an advantage (or disadvantage) that many teleradiologists share. I must admit to working in my threadbare jammies, while waxing eloquent upon Le Fort fractures on a trauma patient. For me, the key is a separate office in my basement far separated from the rest of the house. It’s my own private imaging center, but I can walk up the stairs to the kitchen for meals! Not having to deal with more than a 30-second commute is a huge bonus, which is tough to match.

As far as isolation in choosing a teleradiology career, it has not been much of an issue for me—it is purely a perception factor. Thanks to instant messaging, videoconferencing, and the telephone, I have never felt alone. In fact, when top-notch subspecialists are available to consult on any challenging case, I actually feel like I am “surrounded” by my colleagues. We even share interesting cases among all of the radiologists working at any given time. In addition, discussing critical cases with the ER attending physicians, facilitated by our 24/7 Operations Center, is a huge boon, and I probably speak to more referring doctors now than I did in private practice. My own teleradiology company hosts and promotes regular CME conferences and social networking and hosts regular dinner gatherings across the country to foster a sense of community among the teleradiologists, and it has been fruitful. The flexibility of teleradiology has allowed me to serve as the president of our city’s radiology society, keeping me connected to the local community as well.

There are also many intangible things I have learned only through my exposure to teleradiology. For example, I have routinely seen at least 100 different protocols for the routine contrast-enhanced CT of the abdomen and pelvis—with different oral contrast preps, delays, reformats, and slice thicknesses. This has afforded me the opportunity to learn different ways to optimally image different pathologies, which has been invaluable. Additionally, being part of a networked practice has enabled us to develop one of the most robust and disciplined quality assurance programs in all of radiology.

As a proponent of teleradiology, I have tried to be objective in presenting my case as to why it has been such an ideal fit for me and so many others. During this time of a rapidly changing radiology landscape, the field has come within the crosshairs of some critics, who are likely hoping that teleradiology may still be a passing fad. Fortunately, I traveled this road much earlier. And that has made all the difference.

Samir S. Shah, MD, is a practicing teleradiologist and member of the Medical Executive Committee of Virtual Radiologic (vRad), a leading national radiology practice. He is also a member of  Axis Imaging News’ editorial advisory board.