Takin’ Down Teleradiology: Should We, and Is It Possible?

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imageDavid Levin, MD, is not a big fan of teleradiology. In this morning’s session on “Addressing Threats to Radiology,” he stated his case bluntly: “There’s nothing that does a better job of commoditizing imaging than outsourcing to a teleradiology company.”

Of course, radiology groups are always going to feel the temptation of working with nighthawk firms, Levin said. It’s only natural – they handle the shifts no one else wants to take, such as nights and weekends, and can offer a degree of subspecialization that small groups just can’t provide on their own. But for a laundry list of reasons, Levin does not believe teleradiology offers the best quality: teleradiologists work quickly, have little or no contact with referring physicians or patients, little opportunity to consult with colleagues on tough cases, and sparse access to patient charts or imaging that has been done to the same patient in other modalities.

In a 2010 JACR article, Cynthia Sherry, MD, recounted the disastrous results of her group’s decision to outsource its night and weekend call to a teleradiology company. First, some referring physicians got so angry that the group lost one of its hospital contracts; then they had to let some radiologists go; they lost credibility with the administration at their major hospital client; and the local newspaper printed an unflattering story about the decision. And financially, it didn’t work out to be a great deal: they had to pay the nighthawk company on a per-click basis, but their night ER population was poorly insured.

All in all, Sherry said, the decision “reinforced the impression that we were not a necessary part of the medical team . . . we were viewed as abandoning our colleagues and our patients.”

So what should radiologists do? Levin took a hard line: don’t go to work for teleradiology companies and don’t contract with them, no matter how tempting it might be. Smaller groups, who might lack the strength in numbers for 24/7 and/or subspecialized coverage, should consider consolidating with out groups in their region, or at least work out a cooperative arrangement whereby groups can share night and weekend call.

Harsh words? Maybe. Unwelcome words for the many radiology groups who have come to rely on their teleradiology service? Definitely. But, Levin said, “Radiologists nationwide need to wake up and realize that being identified as the highest paid medical specialists with the most time off is a dubious distinction.” In other words: show that you’re willing to work harder and better, or face the consequences, whatever they may be.