Exploring the Merits of a Teleradiology Fellowship, Part 1

A prospective teleradiologist recently posted on one of the social media outlets I prowl. Still in residency, he wanted to know what sort of fellowship, if any, would be valuable in that line of work since, as he put it, there aren’t any programs for telerad.

That last bit gave me a chuckle. Considering the lengths to which many academic types will go to carve out personal niches, why hasn’t anybody put forth a formal telerad fellowship? Surely, some entity would consider it worth the bragging rights if only to be the first one.

I could envision it. To properly train people for working in telerad, you would force them to work overnights, seven days on/seven days off, and constantly tell them to read more cases, faster, and with greater accuracy. Of course, they would need to “practice” the tele lifestyle by never actually physically showing up in your facility.

One of the funny things I have noticed over time is that if I think about how ridiculous/stupid/laughable an idea is, I can wind up taking it more seriously. It reminds me of a psychological experiment in which subjects were given the task of representing the opposite of their usual political views for a few weeks. Afterward, a surprising number of them reported that their views shifted as result of the play-acting.

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

The more I thought about how absurd a telerad fellowship would be, the more I came to realize it could actually be a valuable experience, perhaps more so than some other radiology fellowships I have seen out there.

I won’t poke at any particular subspecialty or institution. Let’s just say that a lot of fellowships seem to be a matter of doing more of the work already done during four years of residency. Granted, additional experience is valuable, especially if the subspecialists in your fellowship are better than their counterparts wherever you did your residency program, but how often does a fellow really do or learn something that had not been doable/learnable during his earlier training?

By contrast, the telerad fellowship I imagined would have trainees doing things truly new to them in addition to getting well prepped for a subsequent career of remote radwork. The more I thought about it, the more convinced I became that it’s a matter of when, not if, such a program gets brought into being.

To really be worthwhile, the fellowship would have to be offered by an outfit that already had a robust telerad practice in place. This might be obvious to some. If you were considering subspecialty training in pediatrics or oncology, you might lean toward programs offered by Boston Children’s Hospital or Memorial Sloan-Kettering Cancer Center rather than taking your chances with Random Community Hospital in Anytown, USA.

It goes beyond that though. A lot of the issues and special challenges faced in telerad are often off the radar and even complete unknowns in traditional onsite practices. Literally everyone I’ve known who has gone into telerad, myself included, faced substantial learning curves for things that were foreign concepts when working onsite. Someone claiming to offer telerad fellowship training outside of an established telerad milieu would be at best misguided and arguably fraudulent.

One of the key elements of a telerad fellowship would be the teaching of its logistical aspects. That might get left to administrators and ancillary staff in a traditional, onsite practice. If things are less than streamlined and efficient, they might be annoying, but it is far from a deal killer.

A telerad group that wants to stay afloat can’t be so cavalier. If you misjudge your rad-to-work ratio one time too many, the places you are covering may lose faith in your ability to manage their volumes and kick you to the curb. Err in the opposite direction — too many rads routinely emptying the worklists and having nothing to do — and your workforce might get angry about not being able to hit their productivity targets.

Fellows would learn all about this stuff, and other things that a successful teleradiology service needs to get right in getting/keeping contracts for coverage. Vital concepts may include typical referrer expectations for turnaround times (TATs); how to predict case volumes at various times of the day/week/year, and accurately staff for the same; and addressing the vagaries of credentialing when you are covering multiple different facilities. In other words, there are “business aspects of radiology” that get mentioned but are rarely comprehensively covered during residency training.

Running a telerad group isn’t all about appeasing and managing expectations of the referrers. There is also plenty to be learned about recruiting, retaining, and otherwise managing the radiologists and ancillary staff on your team. Fellows would learn about relative value units (RVUs) as well as the pros and cons of various models for compensation (salaried, per-click, hybrid). One would also learn about the differences between 1099 and W-2, and how only some telerad situations allow a real choice between them.

Formal sessions to discuss these issues with the telerad group’s leadership could be augmented by routine communications as “learning opportunities” occurred. For instance, one could send an email to the fellows when an unexpected spike in case volume one night was either successfully handled by contingency plans established by the practice, or when such a spike created trouble due to a lack of safety net coverage.

That is far from all I’ve got for my teleradiology fellowship. Tune in next week for more.