The Adaptive Value of Teleradiology: Enlarging the Petri Dish

Teleradiology is a polarizing issue for a lot of folks in our field. Mention it to the wrong person and you are liable to get an earful of bellyaching, if not a lecture on the subject.

It doesn't need saying for anybody who has read more than a couple of my blogs, but I am firmly in the pro-telerad camp and have been, even prior to most people hearing of the concept. (However, I did stumble across a historical writeup which identified the first transmission of rad images over phone lines back in 1947, if you can believe that.)

In a recent blog, I mentioned that when I was in med school and thinking about specialties for myself, society was just getting familiar with the Internet. The Web was relatively new, and most connections were dial-up. Compared to what we take for granted today, data moved at a snail's pace, which was way insufficient for modern telerad purposes.

Still, I knew how things progressed and it seemed to me that diagnostic radiology might soon be practiced for anywhere and from anywhere with a little more technological oomph. I liked the idea of being able to tap into remote job markets without relocation should I happen to be living somewhere with less opportunity. It was one of the reasons I ultimately went for a rad residency.

That benefit of telerad is a two-way street. Rad groups situated in less geographically desirable locations have been able to meet their staffing needs without enticing new recruits to relocate. Even rad groups in densely populated places have turned to telerad to fill skill set gaps. I recall hearing about a hospital in Boston that was having trouble hiring pediatric radiologists. A big-name telerad company obliged by moving one of its peds people to daytime shifts.

(Editor’s note: For related content, see “Teleradiologist Overcalls and Hedging: We Are What You Make Us” and “Issues and Answers with Outsourced Teleradiology Night Coverage.”)

During a recent conversation about the pros and cons of telerad, I found myself pointing out another telerad gain which I have always had in mind but never put into words before. Telerad increases competition by putting a lot more rads – and their groups – into play with one another.

I don't just mean competition in terms of dollars and cents, or other movable levers typically found in contracts. That part is obvious or at least it was to me during the first half of med school. I am also talking about competition of ideas and methods, or “best practices," to borrow a phrase.

Wind back the clock a couple of decades and you return to an era when most rads didn't interact much with peers outside of their own group. Maybe there was another rad group or two in the area, but that was usually it. They wouldn't see anybody outside of their little world unless they went to a conference or the like. It was the same deal with local referrers and hospitals. Their view of radiology was the local pool of talent, and maybe an occasional interviewee who considered moving there.

As the rads competed against each other (and other local cogs of the health-care machine competed for their service), there was a microcosm of evolution. Better ideas and methods would gradually replace inferior ones. The area was akin to a petri dish, in which stronger and/or more adaptable elements generally succeeded in the long term.

Fast forward to the current day. Telerad effectively puts all of those previously isolated petri dishes into contact with one another. A good idea that results in increased productivity, efficiency, or diagnostic accuracy can spread across the country (or the world) practically in the blink of an eye, whereas it might otherwise have stayed isolated or been forgotten in some remote locale. Even an idea that is maladaptive in one situation might be recognized by others as perfect for where they are.

Increasingly rapid and widespread dissemination of info is, of course, not exclusive to our field. The news (and tabloid) industry has been even more fundamentally transformed. It used to be that today's events were something you would read about tomorrow if you had a newspaper that was on top of things, or maybe hear about today if the 6 p.m. television broadcast happened to mention it. Now, not only do all serious news outlets have a constantly updated online presence, they are regularly scooped by folks posting on social media, whether or not such postings ultimately pan out to be accurate.

For my pre-telerad jobs, there were a couple of local outpatient imaging centers where I had maybe half a dozen other rads on my team at a time, and perhaps a few referring physicians with a pool of patients numbering at most in the thousands. Contrast those gigs against my first telerad job, where I had hundreds of other rads on my team alone, plus all the onsite rads working in the hundreds of hospitals we covered.

That is a lot more of a talent pool to learn about different ways of doing things both as role models and as cautionary tales. Add to that the even more vastly increased pool of referring clinicians and the exponentially larger patient population, and I would have a hard time not growing as a professional.

It gets even better when you consider that I am far from the only one who is adapting and growing in the mega-petri dish. Put two telerads together, let alone a whole team of them, and you are dealing with a synergistic effect as each of them brings his or her own set of multipliers to the table.