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WFH Radiology, help with $/wRVU

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  • xraygoggles
    replied
    Originally posted by pierre View Post

    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.

    Leave a comment:


  • pierre
    replied
    Originally posted by xraygoggles View Post

    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?

    Leave a comment:


  • Turf Doc
    replied
    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?)

    Leave a comment:


  • xraygoggles
    replied
    Originally posted by Turf Doc View Post
    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.

    Leave a comment:


  • jacoavlu
    replied
    Originally posted by Panscan View Post

    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

    Leave a comment:


  • jacoavlu
    replied
    Originally posted by Turf Doc View Post

    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

    Leave a comment:


  • Panscan
    replied
    Originally posted by Turf Doc View Post

    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.

    Leave a comment:


  • Turf Doc
    replied
    Originally posted by jacoavlu View Post

    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.

    Leave a comment:


  • jacoavlu
    replied
    Panscan where you at these days? still a resident?

    Leave a comment:


  • jacoavlu
    replied
    Originally posted by Turf Doc View Post

    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

    Leave a comment:


  • Turf Doc
    replied
    Originally posted by Panscan View Post

    It's unrelated to working from home but just a general critique of tele. Yes nearly everyone wants to work from home and PPs are increasingly offering people to work from home to varying degrees.

    Yes its different in rads re fee for service because all other specialties have built in buffers which are inherent. You have to physically walk through the hospital to see a consult, you have to wait for the OR to spend 40 min to turnover (unless you're ortho or spine and they give you 2 rooms)

    PACS lines studies up where the only limiting factor is basically how fast your internet works, truly. It would be like if there was a general surgeon who had people carted to him/her in the same operating room and they just removed the appendix all day, rinse and repeat, a race to see who can remove the appendix the fastest. That's how PACS is and it enables people to go too fast if they want to.
    yep, totally agree. it's obviously the reason why rads get paid a lot. if other specialties could work how rads does they'd get paid more too.

    Seems like PACS is a blessing and a curse for the field. one reason i'm interested in radiology though is because im a big tech person so i think i'd like post-PACS rads more than when it was all film

    Leave a comment:


  • Turf Doc
    replied
    Originally posted by jacoavlu View Post




    desired location
    crappy corp jobs

    there you go
    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

    Leave a comment:


  • jacoavlu
    replied
    Originally posted by Turf Doc View Post

    reading back, i have no clue what those were, lol

    Originally posted by Turf Doc View Post

    if the only options in my desired location were crappy corporate jobs anyway i'd prefer to be a commodity who could at least work from home...
    desired location
    crappy corp jobs

    there you go

    Leave a comment:


  • Panscan
    replied
    Originally posted by Turf Doc View Post

    seems like as long as we have fee-for-service you're going to get those negative incentives. it's just that in rads because there's so much less BS involved you can see the consequences of it more easily. if i want to go unsafely fast in other specialties i have to find that number of patients, i still have to walk to them, chat with them, chart, etc. but if you're a rad you can do the most important part of your specialty (interpreting) slow or quick and that's affecting your pay and read quality inversely (at a certain point)

    how does that affect if you want to work from home or not though? if youre referring to slacman on auntminnie hes talked about it a lot, hes a fast reader and also does a bunch of super easy prelims
    It's unrelated to working from home but just a general critique of tele. Yes nearly everyone wants to work from home and PPs are increasingly offering people to work from home to varying degrees.

    Yes its different in rads re fee for service because all other specialties have built in buffers which are inherent. You have to physically walk through the hospital to see a consult, you have to wait for the OR to spend 40 min to turnover (unless you're ortho or spine and they give you 2 rooms)

    PACS lines studies up where the only limiting factor is basically how fast your internet works, truly. It would be like if there was a general surgeon who had people carted to him/her in the same operating room and they just removed the appendix all day, rinse and repeat, a race to see who can remove the appendix the fastest. That's how PACS is and it enables people to go too fast if they want to.

    Leave a comment:


  • Turf Doc
    replied
    Originally posted by Panscan View Post

    its a much more complex issue than that. It's also an inherently perverse reimbursement situation. You get paid for how fast you go, so you are incentivized to go fast, and some likely go too fast. I can call every 18 yr old headache head CT normal in 10 seconds and make a lot of money but the 1 of a million of those cases where there is actually a finding, you made a difference. overall it's just not a good thing for radiology as a field and makes you a commodity behind a screen and you could be halfway across the world if there weren't regulations to prevent it. It does stem for PP radiologists failure to innovate and respond to demand, ie cover nights internally or work together with other neighboring groups. They also failed to innovate in terms of remote workers and/or flexible work hours, things which tele capitalizes on.

    the perverse reimbursement for speed thing is the biggest critique overall. I didn't sign up to run on a wheel and read as much as I can, as fast as I can. I am very fast tbh like numerous peers comment on it and volumes read are through the roof relative to others but some of the numbers I read on aunt minnie from telerads people just make you blush and wonder how it can be safe. There are some people who can produce at 99th percentile and be really good but there are far, far more people who produce at 99th percentile because they produce 5th percentile quality reports and miss important stuff left and right.

    It can't be reduced just down to if you want to work from home or not and is a very complex thing.
    seems like as long as we have fee-for-service you're going to get those negative incentives. it's just that in rads because there's so much less BS involved you can see the consequences of it more easily. if i want to go unsafely fast in other specialties i have to find that number of patients, i still have to walk to them, chat with them, chart, etc. but if you're a rad you can do the most important part of your specialty (interpreting) slow or quick and that's affecting your pay and read quality inversely (at a certain point)

    how does that affect if you want to work from home or not though? also if youre referring to slacman on auntminnie hes talked about it a lot, hes a fast reader and also does a bunch of super easy prelims

    Leave a comment:

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