Experienced teleradiologist shares 3 ‘remedies’ for work-from-home ailments
During the COVID-19 pandemic, many radiologists discovered hospital-based reading environments could be downright inhospitable to productivity goals as well as lifestyle preferences.
More than a few found they could read up to twice as many exams—and ably enough manage domestic duties—working from home.
Avoiding communicable pathogens? The cherry on top.
However, remote radiology is not without its formidable challenges. Longtime veteran of the model Samir Shah, MD, discussed a number of these in a session at RSNA 2022.
By now, he surmised, “probably every group has realized that, to be competitive during an extreme shortage of radiologists, they’re going to need to have a way to accommodate radiologists who want to work from home.”
And that’s during the day, not nighthawking.
Among the most pressing challenges this presents the practice are communications issues with referrers, technologists and other colleagues; pay disparities vis-à-vis radiologist coworkers; and, where subspecialist reads proliferate, cherry-picking of desirable cases by onsite rads.
“What I’ve seen happen over and over is a lone onsite rad letting remote teammates handle STAT cases” while he or she, the onsite radiologist, “skipped all X-rays, picked up all the head CTs from 18-year-olds, et cetera.”
For practices looking to attract younger radiologists with long futures ahead, these and other challenges add up to a demand to design “a very good and efficient work-from-home system,” said Shah, who worked a combined 15 years at Nighthawk Radiology Services, vRad (Virtual Radiologic) and Radiology Partners.
He joined Nashville-based Envision Healthcare this past July and is now that organization’s chief clinical officer of teleradiology and senior vice president of radiology.
Shah briefed session attendees on three “remedies” he recommends practices take to mitigate operational drags likely to impede the success of hybrid onsite/work-from-home models. These are, as follows:
1. Establish behavior and worklist rules to ensure that the onsite workflow closely mimics the remote. “Everyone has to follow the same rules and share [the practice’s overall workload], or you’re going to have cherry-picking and case-dumping, and people are going to be unhappy,” Shah said. “You have to have consequences for cherry-pickers.”
Shah noted that many PACS can flag readers who skip around for covetable cases or otherwise take cases out of order.
2. Set and manage workload expectations. “If you’re planning to have a significant portion of your group read from home during the day, or if you yourself are interested in doing so, you can have work lists set up with certain rules that enforce load balancing and automatic assigning,” Shah said. “All these things can be set up in certain PACS so these balancing measures can apply without you having to go out of your way.”
Shah said it’s typical for daytime remote teams to either hire subspecialists to handle most everything in their expertise or to organize reading norms around global worklist pressures. “Again, just be aware that [the latter approach] is going to result in some people being really productive but getting paid less.”
3. Demand an equitable pay structure. Noting that this is the issue with which most groups and individuals struggle, Shah reiterated that the typical private practice model has historically been one in which everyone shares in the work and, with it, the rewards.
“The teleradiologists need the IR folks to do what they do, the body readers to do what they do and so on,” he said. “Everyone shares in the workload. That egalitarian, ‘everyone makes the same pay’ model is not really applicable nowadays. These days, you are going to need to create a pay differential to give people the privilege of working from home, not having to commute and the other benefits of working remotely.”
“In my personal experience,” Shah added, remote radiologists take “anywhere from a 22% to a 28% discount per RVU based on total salary.”
Many groups, he concluded, “have started telling remote readers, ‘You’re going to make one quarter less—but you’re going to be easily more than a quarter more productive.’ So it ends up working out.”
Additional coverage of RSNA 2022 is available here and here.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.