Memoirs of a Teleradiologist, Round 3

Previously, I addressed one of the major reasons why I would advise anybody considering telerad to work with a large, established entity as opposed to a smaller outfit: Support. That is, a large staff of non-radiologists working tirelessly to take care of anything that didn’t need the doctor’s personal attention.

“But wait,” someone hypothetically says. “I’m a computer-savvy guy, and I do my own tech support. I can multitask with the best of them, and it doesn’t bother me to simultaneously read cases, call in critical results to the ER, and wait on hold to talk with the CT tech so I can tell him that I need recons, delayed images, and old studies loaded up for comparison. I’m already licensed in all of the states I need, and hospital-credentialing is something I do in my sleep. I’d rather not have part of my reimbursements diverted to fund other people to do this stuff for me. Are there any reasons other than support staff for me to work with one of the Big Boys rather than a local startup telerad operation?”

(Incidentally, during my admittedly-brief search of teleradiology options, I didn’t find that the smaller guys were paying any more per study than the Big Boys. More often, they paid less.)

Which brings me to Reason No. 2: Volume. Let’s assume that two companies, Big Telerad and Little Telerad (BT and LT, for short) each have perfect ratios of radiologists versus contracts to provide coverage. BT has ten times as many docs as LT (say, 50 as opposed to 5), and also has about ten times as many imaging studies getting piped in. Both operations have enough docs to get the work done in a timely fashion without sitting idle and grumbling about how there’s not enough work. Remember, time spent not reading studies equals zero income, whether instantaneously or when renegotiating contracts.

Now things get shaken up a little. One radiologist is out of commission (sick, retired, whatever). BT has quite a bit of reserve built into their system; One lost from 50 is only a 2 percent deficit in manpower, and when you spread that 2 percent over the other 49 docs, it’s much more manageable than when one of LT’s radiologists scrams, resulting in a 20 percent deficit in their operation.

If one of LT’s ten coverage contracts goes sour, that’s 10 percent less work to go around and keep everyone afloat. One of BT’s 100 contracts expires, that’s just a 1 percent loss -much more endurable.

Similar dynamics allow BT to more easily jump on a new contract-opportunity without worrying whether they really have enough rads to get the work done. Even without adding or subtracting docs and contracts, BT’s bigger numbers give its operation greater elasticity if they hire a new doc who doesn’t work quite as fast as the others, or, conversely, if they hire a real speed demon. There’s less of a need to precisely calculate how much work each individual doc will do, since the surplus or shortfall, divvied amongst the other dozens, will be negligible.

Such redundancy and resiliency allows the radiologists more flexibility when they want to tweak their hours, whether to go on vacation or to pick up some extra work. It also gives outfits like BT more options when one of their hundred hospitals starts making unreasonable demands; LT might desperately need to hang on to every single contract they can, whereas BT has a little more freedom to let a troublesome client go.

This feeds into another general advantage of BT over LT: All other things being equal, BT, being more established and proven, will weather more storms than LT. As a radiologist, you certainly don’t want to go to the trouble of restructuring your life for telerad only to have your company vanish from under your feet overnight.

So, is there any reason at all to even consider working with LT if you’re going into this biz? Well, there might be. Stay tuned.