WFH Radiology, help with $/wRVU

[jacoavlu]

gotcha. i agree that if you're tied to a location no matter what that's desirable and/or has bad jobs you're more likely to be treated as a commodity

if you are only a name at the bottom of a report sorry but you’re basically a commodity

not much more to it than that

[jacoavlu]

Panscan where you at these days? still a resident?

[Turf Doc]

if you are only a name at the bottom of a report sorry but you’re basically a commodity

not much more to it than that

couldn't a hospital just say "all rads are commodities so we're gonna contract to vrad and they'll bring in some IRs for anything needed in person. we like jacoavlu but if we find another board-certified rad they'll do just fine, it's not like our patients care"

i guess i'm just not seeing how we cant say all radiologists, even physicians, are basically commodities. doesnt medicine rely on board certification basically to say this person is legit? a surgeon straight out gets reimbursed just like one practicing for 40 years. and that doesn't even get to radiologists, anesthesiologists, EM etc who are more commodifiable.

[Panscan]

couldn't a hospital just say "all rads are commodities so we're gonna contract to vrad and they'll bring in some IRs for anything needed in person. we like jacoavlu but if we find another board-certified rad they'll do just fine, it's not like our patients care"

i guess i'm just not seeing how we cant say all radiologists, even physicians, are basically commodities. doesnt medicine rely on board certification basically to say this person is legit? a surgeon straight out gets reimbursed just like one practicing for 40 years. and that doesn't even get to radiologists, anesthesiologists, EM etc who are more commodifiable.

well since rads just sit behind computers, usually never meet patients and crank out BS/incidentals/things that aren't clinically significant for the most part, they are most easily replaced. Other specialties that "own" the patient and bring them into system are very valuable to a health system, such as oncology, high-end surgery subspecialties or even medical specialties. These specialties are gold mines for health systems because they patch patients in to extensive regimens of seeing other system physicians, getting expensive therapies and using other services that the system likely provides, rehab, etc. If those specialists aren't treated well by a system(assuming they aren't employed), they can simply send their patients and the huge associated $$$$ somewhere else.

Since there is little to no direct patient interaction the patients also don't really know or appreciate the rads contribution. You could make the most baller/subtle finding and while it may help the patient's care, no one is going up to the patient and saying " wow you are lucky john smith look at your temporal bone CT and found this very subtle abnormality that I think is causing your symptoms." While I don't know a ton about pathology I would imagine it's fairly similar in this respect.

Concept of owning patients is very important in the physician/medical system power struggle.

edit: this is about DR, not IR. IR less so for basically everything I mentioned.

[jacoavlu]

couldn't a hospital just say "all rads are commodities so we're gonna contract to vrad and they'll bring in some IRs for anything needed in person. we like jacoavlu but if we find another board-certified rad they'll do just fine, it's not like our patients care"

i guess i'm just not seeing how we cant say all radiologists, even physicians, are basically commodities. doesnt medicine rely on board certification basically to say this person is legit? a surgeon straight out gets reimbursed just like one practicing for 40 years. and that doesn't even get to radiologists, anesthesiologists, EM etc who are more commodifiable.

this is the glaring difference in perspective between a student and resident and an actually working physician

sure the hosp i work at could outsource to a Corp entity and bring in a wam body to do “IR”

but it would not be the the same as what i do. i am not a commodity

[jacoavlu]

well since rads just sit behind computers, usually never meet patients and crank out BS/incidentals/things that aren't clinically significant for the most part, they are most easily replaced. Other specialties that "own" the patient and bring them into system are very valuable to a health system, such as oncology, high-end surgery subspecialties or even medical specialties. These specialties are gold mines for health systems because they patch patients in to extensive regimens of seeing other system physicians, getting expensive therapies and using other services that the system likely provides, rehab, etc. If those specialists aren't treated well by a system(assuming they aren't employed), they can simply send their patients and the huge associated $$$$ somewhere else.

Since there is little to no direct patient interaction the patients also don't really know or appreciate the rads contribution. You could make the most baller/subtle finding and while it may help the patient's care, no one is going up to the patient and saying " wow you are lucky john smith look at your temporal bone CT and found this very subtle abnormality that I think is causing your symptoms." While I don't know a ton about pathology I would imagine it's fairly similar in this respect.

Concept of owning patients is very important in the physician/medical system power struggle.

edit: this is about DR, not IR. IR less so for basically everything I mentioned.

IR (doesn’t have to be high level)
breast
other local factors, most often MSK

[xraygoggles]

im interested in rads and think telerad is a nice option to have since i have no clue how the corp landscape will look in 10 years plus im likely not going to live in a flyover state.

Tele is great, for certain people, but it really depends on your skillset and what you value in term of lifestyle/career.

I went straight to tele from fellowship 3 years ago with no looking back, and love it. I could never envision going to some in house place, working every week, ugh. In terms of comp, ofc you will be paid less compared to working for pp for same # of wRVUs, but that's just market dynamics, and unlikely to change given the commodification of rads. Having said that, my buddy contracted with a pp in his hometown to read tele for them at a very high hourly rate (400-500/hr). But he is a 1099 and its a one-off situation, so if you work for a large corporate W2 tele job, that will not be the case. If you are productive, you can make high comp, but then there are increased litigation risks too. It's a trade-off.

But in terms of lifestyle, nothing is better. You get every other week off, but downside is you have to work the weekends on your on week, although once you go higher up, the # of weekends can lessen, especially if you are a vip or high earner for the group. You can have carve-outs in your contract to work on-site if you wanted to keep your skills (I did arthrograms pre-covid for a practice to keep up my skills). Depending on the practice/company you work for, you will have access to their scale and reach, in terms of networking with academic sites and especially AI groups, as well as conferences/committees if that's your interest. For example, my group is on the cutting edge of AI platforms, and I would bet no practice in the US has as many AI resources and platforms that we are currently using on a daily basis. A big plus.

DM me if you want specific details on anything. I'm loath to discuss them here, since most people seem somewhat ignorant about tele, and base their opinions on hearsay or outsourcing to nighthawk or whatever, without ever having done it themselves. I have also been recruiting for my division for more than 2 years, so I have spoken to all types of rads who wanted to join tele, so I like to think I have a decent grasp of pros/cons in general.

[Turf Doc]

xraygoggles thanks for the thoughts, will definitely reach out in like the next decade

your friend's gig sounds sweet, if i was going to do tele i'd def try and set up something like that. seems like it could be a win-win for someone who wants to do tele and the practice that could use some extra hands on deck (which is allegedly everyone right?)

[pierre]

Tele is great, for certain people, but it really depends on your skillset and what you value in term of lifestyle/career.

I went straight to tele from fellowship 3 years ago with no looking back, and love it. I could never envision going to some in house place, working every week, ugh. In terms of comp, ofc you will be paid less compared to working for pp for same # of wRVUs, but that's just market dynamics, and unlikely to change given the commodification of rads. Having said that, my buddy contracted with a pp in his hometown to read tele for them at a very high hourly rate (400-500/hr). But he is a 1099 and its a one-off situation, so if you work for a large corporate W2 tele job, that will not be the case. If you are productive, you can make high comp, but then there are increased litigation risks too. It's a trade-off.

But in terms of lifestyle, nothing is better. You get every other week off, but downside is you have to work the weekends on your on week, although once you go higher up, the # of weekends can lessen, especially if you are a vip or high earner for the group. You can have carve-outs in your contract to work on-site if you wanted to keep your skills (I did arthrograms pre-covid for a practice to keep up my skills). Depending on the practice/company you work for, you will have access to their scale and reach, in terms of networking with academic sites and especially AI groups, as well as conferences/committees if that's your interest. For example, my group is on the cutting edge of AI platforms, and I would bet no practice in the US has as many AI resources and platforms that we are currently using on a daily basis. A big plus.

DM me if you want specific details on anything. I'm loath to discuss them here, since most people seem somewhat ignorant about tele, and base their opinions on hearsay or outsourcing to nighthawk or whatever, without ever having done it themselves. I have also been recruiting for my division for more than 2 years, so I have spoken to all types of rads who wanted to join tele, so I like to think I have a decent grasp of pros/cons in general.

Do you work days or nights? How much is the difference in pay between the two?

[xraygoggles]

Do you work days or nights? How much is the difference in pay between the two?

No I work evenings, but most tele jobs are overnight or swing. Yes pay difference ofc.