[alvarezgga1]

I m in a similar set up about 8 years into my current private practice, although a lot is my work is still onsite. I ve had similar thoughts but you have to remember that rad markets tend to be cyclical. While tele may be great now but who knows what things might be 5-10 years from now. 
 
I would also imagine the daytime tele folks would be the first to be axed if job markets tighten in the future.

[kbrough_732]

I was in community private general practice with mammo and small procedures for 7 years and recently went full tele. Made my own entity and now contract directly with private practices, hospitals, and private equity entities (gasp). I enjoy choosing who I work with and when I work. My former practice was lifestyle oriented but I was constantly competing with others for desirable weeks off etc. Also now make more money, not subsidizing old, slow partners. My kids sit by me in the morning before school and I’m not rushing to get to the hospital. I have a station at the cabin and can work from there if I want. Won’t be going back. I think the human / radiologist shortage will be the dominant factor in ensuring efficient, remote rads will be in constant demand going forward. PM me if you’d like to discuss.

[kiqbns_134]

Im in year 3 at your old practice type. Ill probably head in your direction as a remote maybe next year. Should I continue for any reason? Why did you stick out 7 years? Do you regret not doing this sooner?

[afazio.uk_887]

How does one go about forming ur own business entity and then how to win telerad contracts individually?

[kbrough_732]

I had 2 years of overlap where I was working for my own entity and at the private practice at the same time. The transition to full time for myself was just organic and it felt like time to switch over to full time at my own thing because I had developed solid, consistent contracts so I felt safe leaving the group. I don’t regret the 7 years but probably could have left sooner. Everyone has to get to the point where they feel they are ready to take a “risk” and leave the group. Also, covid changed everything permanently in my opinion. Remote is here to stay and is disrupting the competitive market for diagnostic rads. I think if I were in the current environment rather than the one I started with 7 years ago I would leave sooner. A fair number of the rads in my community have left the local groups to do remote and I’m in the process of purchasing a small office for all of us remote people to work together so it is less isolating.

[afazio.uk_887]

 
My PMs are messed up so I couldn’t reply but:
 
1. How does one develop these relationships for Tele work, mostly search the ACR?  Use recruiters? 
 
2. Do you buy your own medmal for the Tele side gigs? 
 
3. Do you use a separate PACS workstation for the tele work?  I have a hospital provided workstation, but unsure it is OK to use that for outside work also. 
 
Thanks to all who are sharing.  As I said, my current hybrid gig is “OK” but seems like there is significant money I am leaving on the table by not at least developing some Telerad work.  

[kbrough_732]

Just my experience/opinion 
1) I’ve used prior colleagues, ACR website, and recruiters. I contract directly with a hospital that I found by getting a lead from a locums recruiter that I then called hospitals in the area they were advertising and found a hospital looking for help. Just like anything just put a lot of lines in the water and see what you catch. 
2&3) My goal is to have as few expenses as possible. I make each place I work supply med mal and a workstation. At this point I don’t need monitors so just have them send a tower. I have 8 monitors set up and hook up the computers that I need to the monitors each day/week. Each monitor has 2 DP inputs at least so you can leave 2 towers hooked up to each monitor set up and toggle inputs when needed. I only hook up 2 towers to each monitor set up that I wouldn’t use at the same time during a given workday so you aren’t toggling during a workday. At this point I’m really only reading for 5-6 different contracts and 2 make up 80% of my work. My suggestion is to contract a small amount of work with a private equity backed practice so they send you Eizos and then work minimally for them. I also request 2 workstations for each contract so I can put one at the cabin.

[tdetlie_105]

Whats ballpark $/wRVU? Current group is mid $60’s, plus solid benefits.  

[afazio.uk_887]

Hmmm… some logistical challenges to this approach but nothing too major.   I think easing into it with one tele contract would be my approach.  

[tdetlie_105]

Quote from Waduh Dong

Hmmm… some logistical challenges to this approach but nothing too major.   I think easing into it with one tele contract would be my approach.  

 
On top of your current job or after you’ve resigned?

[nasosmunfc_332]

The real question who would want to work in house anymore if theres no premium? Remote is more productive and easy

[afazio.uk_887]

I would have to keep my current W2 gig with bennies for while. A slow transition over several years I would guess.

Might keep the W2 gig indefinitely and just supplement with some 1099 income from Tele.

[afazio.uk_887]

To be honest starting this year my W2 gig has gotten significantly busier so makes me wonder if I could pull of doing Tele also without getting burned out.

[kmh0667]

I do full time tele. I think all jobs are a bit different as to what you read, if you take breaks, money, etc. Probably the best route, although not sure, is to read for a pp or hospital owned group. I have been doing this about 5 years now and at first I missed colleagues, talking over cases, shooting the breeze. But no more, I save 40 minutes to an hour in commute a day. Honestly, I don’t think I will leave tele. I do days only for pp. Make very good money. Tele is not going away anytime soon, I think it is just going to grow or at least hybrid.

[cody.a.keller_68]

Do you worry that a PP group will drop their tele readers if times get tough? That’s my concern in leaving traditional PP for the tele world. It may be psychological, but feels less secure if you’re not a partner.

[pranav.devata]

Great discussion. I have actually had similar thoughts. I have a number of friends who have been dumped by their telerad providers and are drowning. I pondered starting my own tele gig and offering essentially equal pay for all. Nobody needs to get rich off of the guys doing the work like typical tele companies. This especially rings true since our tele company demanded a monthly stipend in order to continue to provide service. Our payor mix is pretty good, but we are a small practice. I don’t relish the idea of night shifts though.

[afazio.uk_887]

 
A truly democratic and equal Telerad group which owned and operated by all the Rad and exists to benefit Rads only would be a big winner IMO.  
 
Every Rad shares in the requisite overhead expenses etc and all share the profits equally.  
 
Lotta Rads would join imo. Of course, night shifts, weekend etc would pay a premium. 

[kmh0667]

I am considered a partner, hospital owned/pp more hospital run group. I suppose things could change, but right know we are actually drowning in volumes. If you are careful and diligent looking there are Tele jobs that treat you much better than advertised by aunt Minnie posters. It’s not for everyone. Good and bad to both on site and tele- do what works for you- or do both if you can get it!

[Unknown Member]

The complaint of some radiologist partners in traditional groups is that the volume is too high  / they have to read too fast for too long, causing burnout. They would like to work from home but earn similar income. I wonder though, is it possible to be a contractor teleradiologist working from home, read slower than you would in a traditional radiologist owned group, and make the same amount of money?  My sense has been that the telerads making a killing are doing it on volume, and that the benefit from working from home is that you don’t have the distractions of a traditional practice so you can be more efficient and work faster, not slower. 

[tdetlie_105]

Quote from Flounce

The complaint of some radiologist partners in traditional groups is that the volume is too high  / they have to read too fast for too long, causing burnout. They would like to work from home but earn similar income. I wonder though, is it possible to be a contractor teleradiologist working from home, read slower than you would in a traditional radiologist owned group, and make the same amount of money?  My sense has been that the telerads making a killing are doing it on volume, and that the benefit from working from home is that you don’t have the distractions of a traditional practice so you can be more efficient and work faster, not slower. 

 
Thats the rub, and why one needs to know what the $/wRVU is doing tele. 

[22002469]

Quote from Flounce

I wonder though, is it possible to be a contractor teleradiologist working from home, read slower than you would in a traditional radiologist owned group, and make the same amount of money? 

 
No
 

Quote from Flounce

 My sense has been that the telerads making a killing are doing it on volume

 
Yes
 
 
Full tele can certainly be a good idea for the right person in the right situation, but barring some unicorn type job you have to read a lot of volume to get the same or better pay. 

[Unknown Member]

To answer OP — I did exactly what you suggested, in my mid40s, and it has been great. I don’t miss the interaction (or commute) at all. But obviously everyone is different — only you can know if it is right for you, but if you stay with your current group and go tele, you can try to leave the door open to return to on-site if it doesn’t work for you. I had a situation like jd4540 — when on-site I was not really interacting with Docs, mostly dealing with tech questions and admin nonsense. So I don’t miss it. 
 
I have more than one contract. Networking/likeability is important. National meetings, former co-trainees, etc.  Figure out if you want to have a timed shift (e.g. ER shift) or a set number of cases or a per click, whatever. My schedule is much more flexible — can pop out to run kids to school or get groceries, but then maybe I log in late that evening to read some cases to make up the RVUs. Much more customizable, but it has to suit the practice too — they can’t just have you disappear if they expect 30 brain MRs a day or whatever from you. 
 
“Who would want to work in house?” Well, if you’re slow. You can add value by virtue of butt-in-seat and make up for that. Or if you are very academic/administrative by preference. Or you like procedures. Or the group makes the remote workers do 10% or 15% or 20% more RVUs to compensate until people are equally likely to pick remote or on-site.
 
If times get tough and new grads are banging at practice doors to work on-site, tele definitely at risk, though if you do a good job groups are reluctant to axe. Also if you do it mid-career there is less at risk. But yeah that is a concern. 
 
Agree with West Rad’s comments. 
 
Flounce — I think what you mean is: can you curate work contracts such that from an $/rvu perspective you make just as much reading less from home, and the answer is definitely yes. You have to have some combination of: luck, entrepreneurial spirit, special skillset, networking. For example, maybe there’s some plum job for an East Dakota hospital that needs a second shift but the volume is pretty low and you’re getting good money to read a couple CTs and a handful of x-rays an hour. But you gotta go out and find that – it’s not going to fall in your lap. That being said, I think if you have a decent work product the required extra productivity versus in-person to equalize income is not +50%. Might be closer to +15-20%. 
 

[afazio.uk_887]

 
Can we get into more specifics on this topic from those who have made the leap? 
 
What kind of independent entity did you create?
 
I am no longer in touch much with former residency friends etc, so how to find leads for Telerad IC work? 
 
What is a reasonable charge these days, $35 per RVU is primarily ER/IP type work?  Is $40 per RVU possible? 

[Unknown Member]

I don’t believe any entity is necessary. You can use your SSN for 1099 income. One advantage of incorporation is creating your own 401k (Keogh). If you don’t need or want that, I am not sure there is too much of an advantage, but I did not do it so perhaps others can chime in.
 
RVU rates are variable and I wouldn’t post mine, personally. Complexity (or lack thereof) should be one of the most important determinants of whether or not you accept an RVU rate. Some studies are undervalued, RVU-wise, so if you are reading those you’ll want a higher rate. Can they promise infinite volume? Maybe then you accept a lower rate. Etc. 

[ruszja]

Quote from Waduh Dong

What is a reasonable charge these days, $35 per RVU is primarily ER/IP type work?  Is $40 per RVU possible? 

 
RVU or wRVU ?

[afazio.uk_887]

 
wRVU

[ipadfawazipad_778]

I found a gig paying 30/rvu with daytime hours and all outpatient work with 24-48hr TAT. Minimal commitment too. Basically give them my availability and they usually give it to me. Im pretty happy.

[ruszja]

Quote from Waduh Dong

wRVU

 
That would be pretty good if you can get it. Keep in mind, average per wRVU medicare is about 56. Commercials are a bit more, no-pay ERs are 0.  So that’s the pie you are starting with, someone still has to collect the money and pay the medmal bill etc.

[afazio.uk_887]

 
Can anyone expand on how to drum up business?  How best to gain contracts?  
 
Ultimately, all a Rad needs is a couple contracts to basically be his or her own small business.  

[ruszja]

Quote from Waduh Dong

 
Can anyone expand on how to drum up business?  How best to gain contracts?  

Ultimately, all a Rad needs is a couple contracts to basically be his or her own small business.  

Look at recruitment ads. Research the practice, find the decision-maker. Cold-call.

[lisa.kipp_631]

This is my big worry and the reason I havent pursued it as my primary job. During the covid dip my two 1099 tele jobs said thanks, well contact you when we need you. If I had dropped my W2 job I would have been out of work for awhile. So yes, volumes are crazy and there is plenty of work to be had but that disruption was only 3 years ago.

[stianp20_888]

Im also early/mid career looking to make the switch to full time tele-for those of you who did so, how flexible really is your schedule? Do you take breaks to chauffeur your kids around, work out, etc? Or do you have to commit to a specific time frame to be tied to your computer to answer any tech/protocol questions, etc. And how is a case list assigned? Do you just read whatever you feel like off a main list and quit whenever youve had enough? Sorry, I am very naive and havent put much thought into switching until recently. 
 

[bzarambo435]

So then do you leave your entity uncovered for malpractice?

[kiqbns_134]

Hey Steely,
Ive had this thought. Just get a good group of rads to remote work from a fun coworking space might be the winner. What area of the country are you in? If we were close Id want in on your space.

[afazio.uk_887]

thanks for all the replies
 
So the basic concept would be:
 
1. Keep current W2 (small K1 component) gig. 
2. Form my own S-corp / PLLC etc.  Get EIN number.  Open bank account for said entity. 
3. Contact groups looking for Telerad help, using ACR website, personal contacts. 
4.  Sign contact, ask them to provide workstation/medmal but no need for bennies and pay me as IC / 1099 income. 
5. Setup of switches so I can read from one set of monitors with two different towers. 
6. Proft? 
I welcome any other thoughts / experiences.  Getting Telerad contacts would be the part I am most inexperienced with. 

 
 
 

[lisa.kipp_631]

1) Former co-residents and colleagues looking for help. This takes time to ensure its consistent work. All the recruiters I know are looking for on-site or REALLY low pay tele.
2) Yes, you need medmal. Can get a policy that covers you everywhere you work.
3) Unlikely your hospital would like you using their workstation. But that’s between you and them. I have 2 workstations that are plugged into the same monitors and a usb switcher for peripherals, takes 15 seconds to toggle them. If you go this route consider a second powermic – I’ve found they don’t like the usb switcher.
 
Edit: Steel was faster with their good advice

[alvarezgga1]

tried PMing you but AM is having issues it seems.
 
I have two standing offers for fulltime day tele and have thought about it but too nervous to pull the trigger 🙂

[stlmchenry_510]

I am also having issues sending and receiving messages

[lisa.kipp_631]

I guess the grass is always greener. Ive been full time tele for 3 years now and Im going a bit nuts with the isolation. I really love my family and home so its not like Im dying to get out. But I really miss colleagues, the business side, talking over cases. Hybrid like what OP says he has seems like the dream.

[stlmchenry_510]

Types of tele jobs vary. Id see whats available and go from there. Have a good employment attorney review your contract. Maybe two.

[tdetlie_105]

Quote from brickydragon

I guess the grass is always greener. Ive been full time tele for 3 years now and Im going a bit nuts with the isolation. I really love my family and home so its not like Im dying to get out. But I really miss colleagues, the business side, talking over cases. Hybrid like what OP says he has seems like the dream.

 
I would say that my non-tele job is pretty isolating.  I am alone 95% of my onsite shifts (aside from a few techs etc), and all call shifts are from home (or onsite alone if one choses).  I’ve been at my current job for around 2-3 years and have had about 5 physicians actually come down for a in-person consult during this time.  A small part of me looks forward to the occasional fluoro day…Some of this must be a post-covid phenomenon but don’t see it going back to our prior normal. Compensation difference between the boots-on-the-ground premium and tele-rad discount seems to be shrinking which makes this a more complicated decision.  

[william.wang_997]

I am mixed tele and on-site ( 70 percent tele and 30 percent onsite ). Absolutely love what I do. Will not do 100 percent tele was intellectually stymieing.

[Unknown Member]

I took the plunge. No more flouro or biopsies. I have a primary W2 job (for benefits etc) for a great private practice and then have a couple of side 1099 gigs that I carefully selected. One of the gigs even pays me to sit at their outpatient  site for a day or two during the week to cover contrast and I read for all of my jobs there (this helps break the isolation of being at home). I work about 10 hours a day and have no commute. I am actually healthier as I go to the gym right after my shift almost every day. Will make near 7 figures doing this. If one entity decides they don’t need my services (doubtful) I can titrate another up. I can see myself doing this until I retire or semi-retire. I don’t have a business entity as wife is an IC physician and we try to deduct as much of the 1099 stuff through her. I am later 40s. 

[mircea.cg_544]

No reason for any reasonable sized pp to be onsite today more than 40%, unless Mammo. That being said, pp has ways to screw that up tele here I come.

[buckeyeguy]

Quote from Sir Read Alot

I took the plunge. No more flouro or biopsies. I have a primary W2 job (for benefits etc) for a great private practice and then have a couple of side 1099 gigs that I carefully selected. One of the gigs even pays me to sit at their outpatient  site for a day or two during the week to cover contrast and I read for all of my jobs there (this helps break the isolation of being at home). I work about 10 hours a day and have no commute. I am actually healthier as I go to the gym right after my shift almost every day. Will make near 7 figures doing this. If one entity decides they don’t need my services (doubtful) I can titrate another up. I can see myself doing this until I retire or semi-retire. I don’t have a business entity as wife is an IC physician and we try to deduct as much of the 1099 stuff through her. I am later 40s. 

 
I was wondering why you would work this much given the tax code. I don’tknow if it’s me, but I absolutely [b]love [/b]not working that much, and not paying the rat race/tax man. But this could be that I love investing and doing other things as well, and tend to get bored working shifts, but they pay well. I also love taking naps. If we don’t die in a nuclear or civil war, I’ll probably be living a long time due to low stress and continued exercise with savvy weight training.

[Unknown Member]

I nap daily. I exercise daily. If you are paying a lot of taxes you are making a lot of money.  I am not a savvy investor and don’t have any passive income streams. I have maxed out all the 529s, 401 etc…I am not interested in any rental properties and I have said no to many “opportunities of a lifetime investments.” That being said I may start to stack some CDs or some other low risk ways to preserve wealth.

[lisbef3_453]

Quote from jd4540

I would say that my non-tele job is pretty isolating.  I am alone 95% of my onsite shifts (aside from a few techs etc), and all call shifts are from home (or onsite alone if one choses).  I’ve been at my current job for around 2-3 years and have had about 5 physicians actually come down for a in-person consult during this time.  

 
Very true.   It’s been trending this way for a while and covid and the noctor takeover pretty much finished it off.    Nearly all visits are for paperwork or complaints. 
 
 

[tdetlie_105]

Quote from Waduh Dong

 
Has anyone who has had a traditional on-site community general rad gig ever made the switch to full time Tele mid-career? 

I am in a fairly stable, lifestyle focused gig currently.  Overall, I am content with the situation and have been in the gig for 16 years. 

I do a fair amount of my job already WFH, but still go into the hospital and do light IR procedures etc. 

It seems to me the Telerad market is healthy right now and I would only switch if I became a Telerad for a traditional PP.  I would not be looking to do SNACman level volume nor do I need an exorbitantly high income at this stage. 

Part of me thinks I will miss interacting with other human like I do currently albeit not super frequently. 
Basic procedure skills are also useful I think and is Mammo. 

Thoughts?  I am mid to late 40s and would like to keep going 20 more years full time Rad if feasible.

 
Good post.  I’m right around where you are career-wise (looking at another 15-20 years).  Overall in a solid group (though there are a few mild/mod legit issues), and I do wonder if I can get a “better” deal given the job market whether it be a pure tele-rad job versus onsite gig.  Maybe a case of FOMO?…Switching to pure tele would be nice in the sense that I would have better control of my schedule/hours but the isolation is an issue.  I would have the option of being geographically mobile which could actually be a negative since this may create conflict with my wife.  Long term job security is also an issue.  A lot to consider…We start negotiating a new contract next year and I suppose how this process goes will dictate my next move.  

[Unknown Member]

Quote from Waduh Dong

 
Has anyone who has had a traditional on-site community general rad gig ever made the switch to full time Tele mid-career? 

I am in a fairly stable, lifestyle focused gig currently.  Overall, I am content with the situation and have been in the gig for 16 years. 

I do a fair amount of my job already WFH, but still go into the hospital and do light IR procedures etc. 

It seems to me the Telerad market is healthy right now and I would only switch if I became a Telerad for a traditional PP.  I would not be looking to do SNACman level volume nor do I need an exorbitantly high income at this stage. 

Part of me thinks I will miss interacting with other human like I do currently albeit not super frequently. 
Basic procedure skills are also useful I think and is Mammo. 

Thoughts?  I am mid to late 40s and would like to keep going 20 more years full time Rad if feasible.

Aren’t you making like 600k with 16 weeks vacation in warm state, TX, AZ, or FL? Why not continue indefinitely? Group politics got you down? 

[afazio.uk_887]

 
Just thinking outside the box a bit and seeing what is out there…. not in any hurry to make a change. 

[Unknown Member]

Quote from Waduh Dong

 
Just thinking outside the box a bit and seeing what is out there…. not in any hurry to make a change. 

Not many jobs as good as you have. Certainly nothing in the tele market. Don’t know why you would look there.
 
Let me know if you leave. I’ll take your spot.

[afazio.uk_887]

 
I hear Telerads these days are stacking bills.   This at least piqued my curiosity. 

[Unknown Member]

Quote from Waduh Dong

 
I hear Telerads these days are stacking bills.   This at least piqued my curiosity. 

SLAC making 100-150k per month doing tele. He sold his soul to the devil. You don’t want to do that. Eternal damnation not a great lifestyle.

[afazio.uk_887]

 
You make a good point. 

[reza800p_368]

For working remotely, covering ER for a private practice in another state what set up do you recommend? 

–  Do you have or need a back up internet line? How often does your primary internet line break? 

– Do you have or need a back up work station or have you installed PACS software on your laptop in case the main workstation breaks? How often have you faced software, hardware or monitor problems? 

– Power outage in your area? 
– Any other recommendations?  
 

[benoit.elens]

.

[Unknown Member]

Quote from OnsiteRad

For working remotely, covering ER for a private practice in another state what set up do you recommend? 

–  Do you have or need a back up internet line? How often does your primary internet line break? 

– Do you have or need a back up work station or have you installed PACS software on your laptop in case the main workstation breaks? How often have you faced software, hardware or monitor problems? 

– Power outage in your area? 
– Any other recommendations?  

Yes to all. Have backup internet, multiple UPS’s, and backup laptops that can be used as PACS-brain on the move. Had a power outage all day one day and carried stuff to a neighbor who had power. Very infrequent issue. 

[buckeyeguy]

One thing I can tell you for sure, having experienced multiple different speeds, is that the system is almost entirely dependent on the site of origin sending to you. You won’t have problems with dloading images as long as it’s even remotely reasonable. I thought most of you’d like to know that by experience I’ve confirmed it.