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Time to bring back Prelims
Why aren’t private groups and Telerad companies bringing back Prelims?
This is the most obvious thing to do, as it will allow for Rads to live anywhere they want and work and earn US dollars.
I would spend half the year working overseas Telerad from a hut in Bora Bora or live in Singapore or Dubai and work.
This would alleviate overnight staffing issue majorly.
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37 Replies
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Increased overall cost (if outside tele) and/or duplicated effort (over reading the prelims). Not worth it for me.
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Our nighthawk servicer switched to prelim reads a few months ago. This change really screws up the workflow in the morning as we try to assign overnight studies for finalization. It’s been a huge problem on the weekends. Changing to prelim reads only is a big issue for small groups like my group.
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The financials don’t work for a lot of groups
They’re already stretched thin and have too much volume in the day. They can’t *both* be paying a telerad service *and* be expected to read the same cases again the next day.
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We are doing the exact opposite of what you are suggesting.
It requires more FTE, in particular on the weekend, to dig out from underneath all the prelim reads and overread them. Not worth the dollars collected any more, espescially in a market where their is a labor shortage.
We are moving to final reads for the first time in our history.-
The thing I find interesting with prelims, the Ed complains about all their misses; which are relatively rare.
In the end, we find the misses the next day by double reading.
If we read final, probably the same % of misses, but no double read.
When they make a great call, they dont get a gold star.
Our overnight cases are the highest quality in the end, the only with double reads.
We havent seriously considered final reads; its kind of giving up on practice autonomy. But I get it, something has to give and it would be nice not to see them in the morning.-
Final reads also solve the overnight problem.
For overnight prelim reads to make financial sense to the group 2 things must be true-
1) There must be a *significant* discount in cost compared to finals
2) The group has to have enough FTEs to make that few bucks a case they save per case worth the efforts of the rads reading them the next morning. Currently most groups are so short staffed that they use their night telerad service (or day) as de facto extra FTEs to get the work done.
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Spot on.
As we have added business but found recruiting to be very difficult this is a way to add an fte in the current market situation.
There is definitely a lull most mornings before 9am or so. We plan on using that to read the OP studies done the evening before instead of reading prelims. Another way to shift work around and free up some man power.-
Quote from frank the tank
There is definitely a lull most mornings before 9am or so. We plan on using that to read the OP studies done the evening before instead of reading prelims. Another way to shift work around and free up some man power.
If you have leftovers from prior days or a continuous list of stale Ortho films, there are financially more efficient uses for the lull. You can also have people start later and run into the early evening. But if you run the kind of shop where everything is cleaned up at 10pm, the lull is real.
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Prelims are back and Thank God.
We were getting finals, but our group was being woken up almost every night to cover huge TATS (2hrs+) for because our overnight group couldn’t do it. We now have a 45 min TAT, and its been nights full of sleep. if needed they help us clear out the back log.
Signing finals in the morning isn’t a problem at all. We even found it faster to use their system to do it because they have a better PACs.
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What PACS is that? It sounds great. Were looking for a new, efficient system, hopefully soon.
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We used to have an excellent tele company that provided prelims only. A paragraph with pertinent information and they were usually right on.
Over-reading their prelim was no extra effort. In most hospitals there is a ‘lull’ in the morning before your on-site modalities kick into gear. If everyone on day shift grabs a few, it gets done quickly.
The money for the prelim was the price to pay to get a night of sleep. We still made money on most overnight studies, just less than if we prelim them ourselves.
Then we switched providers and now we get get templated verbal diarrhea to sort through. They are considered ‘finals’ by the tele outfit, however as they have limited history and no access to our EMR, its often a gi-go situation. I wouldn’t want to put this in the chart as a final.
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Quote from Waduh Dong
Why aren’t private groups and Telerad companies bringing back Prelims?This is the most obvious thing to do, as it will allow for Rads to live anywhere they want and work and earn US dollars.
I would spend half the year working overseas Telerad from a hut in Bora Bora or live in Singapore or Dubai and work.
This would alleviate overnight staffing issue majorly.
There isn’t a large number of US trained rads who don’t live in the US.-
I would be interested in moving abroad and doing prelims. But the problem is if people think “no us trained rads living abroad” there is just no market for such work. Means if job market tightens up just a little I’d be the first to get fired and at the same time moving and getting a new job would be more complicated than for someone getting fired(or getting pay cut by 1/2) in the USA.
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Radcog –
There are “alot” of US trained rads working overseas – vRad has at least 20 and maybe more. Not sure about other groups. You could read prelims overseas and make decent bank – especially if you work deep night usa time. I’ve personally done it on 2 occasions and it was awesome.-
Had a few people ask me privately, so figured I’d post in the group.
We’re using Lifetrack for nighttime coverage and it’s better PACs than what our hospital uses, which is Carestream.
I do not know if they’re taking on new clients or hiring overseas, but we’ve had great experiences with them.
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Some US insurance companies will also pay for final reads by us trained rads living abroad, its just Medicare and Medicaid and some other insurance companies that dont pay. I believe vRad and maybe a couple other big tele outfits are able to curate lists according to payor type so that their abroad providers can even provide final reads on only the cases which will pay for it, prelim others. Its still mostly prelim from what I heard
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TRS told us they could do some finals overseas, which seems interesting and not fully opposed to that. Problem was I talked to a few colleagues and 2 major red flags hit. They also said they do not regularly hit their promised TATs.
The first being their homegrown PACS (not opposed to that) regularly goes down for hrs and they call your RADs to start reading in the middle of the night… I heard this happens every other week. I can understand this once in a blue moon, but a few times per month is ridiculous. They seem to think this is common place and they are the only game in town to offer overnight service.
The second issue I had was the have non US trained rads signing using the US rad credentials. I don’t really care if someone uses AI or a pre-reader model, but I do require a US trained rad to read the exam. It just seemed all around shady and illegal. The person who told me this said they cancelled their contract with them within a few weeks.
You get what you pay for with them.-
Prelims are great. Our PP group does it. Cheaper and unless youre slow AF or an idiot, you can pound out the overnight stuff quickly. 12 hours of overnight work done in one hour!
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Quote from sartoriusBIG
Prelims are great. Our PP group does it. Cheaper and unless youre slow AF or an idiot, you can pound out the overnight stuff quickly. 12 hours of overnight work done in one hour!
What are you paying for prelims? What about plain films?
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There was non-US board certified rads reading US rad studies?
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Quote from Waduh Dong
Why aren’t private groups and Telerad companies bringing back Prelims?This is the most obvious thing to do, as it will allow for Rads to live anywhere they want and work and earn US dollars.
I would spend half the year working overseas Telerad from a hut in Bora Bora or live in Singapore or Dubai and work.
This would alleviate overnight staffing issue majorly.
Guy in warm state practice making 90th percentile income and vacation talks about doing tele and now prelims? Just doesn’t add up.
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Preliminary reads are a form of double reading and decrease final errors.
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My past experience with overnight prelim reports over-read and signed off the next day was horrible.
Main issue was there was no “lull” in the morning where I was working. There’d usually be about 20 or so CT/MR and another 40 plain films from the day before (OP studies done after 4pm) waiting for you when you arrived. Add another 15-20 prelim cross sectional exams from overnight to that and I constantly felt like a hamster on a wheel going nowhere. As can easily be imagined, the daily schedule just added to that. Sure, the money was fantastic (but not as much as you might guess because the system skimmed off so much overhead), but overall it was just a grind. Most miserable I’ve ever been as a rad. Lasted about 3 years and had to get out.
However, I can see that in a different practice with different workflow patterns, prelims might be useful. For me, I’m so scarred by the experience, I think I’d have PTSD type symptoms if asked to consider it again. LOL
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Yeah. We have no significant lull either
Using internal voluntary moonlighting the number of studies on our all unread list will drop to around 300 late Sunday.
Perhaps on Monday am there is a slight gap as new studies populate.
By Monday afternoon there are at least 1500 unread studies and it wont drop below 1200 again until the next weekend.
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Sure, if you are understaffed and you allow routine work to spill from one day to the next, there is never a lull. Well there is, you just don’t see it as you are continuously buried in past due work.
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Haha yeah the people with no lull are just chronically understaffed and the list is never zero.
I personally would HATE that. It feels like an accomplishment to grind on the list and make it hit zero by the time you leave. Staring down the barrel of hundreds on the list would literally be a like a rat on a wheel.
I also hate being called by clinicians backroom staff and told to read this study ASAP bc clinic visit same day. Our TaT is so good it rarely happens- like maybe once or twice a year and usually due to some scheduling snafu.
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Morale with an endless list is undoubtedly lower. With a properly staffed small group, you can plow through studies to meet demand and keep list at zero. When list is endless, even fast readers are like WTF should I go fast? Then you have to create moonlighting because its a race to the bottom to see who can read the bare minimum during the normal workday. This is of course assuming youre on salary or splitting the pot evenly and not production based. But lets be honest, not many gigs out there where you are production based and actually getting 100% of accounts receivable.
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They are. The group I just signed with does 75% prelims if you work in the US, and 100% prelims if you work abroad.
I’ve been all around Asia already and not so much Europe, so the plan is to start in Spain/Portugal and go East, pick up a few passports and languages over the next few years. Guys are earning $300-$1000+/hr in this group. Best of all you can work full or part time as you want.-
what group is that which allows preliminary reads from overseas
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I would very much like to move to Norway. My wife is a Norwegian citizen. If anyone knows of any practice wanting to hire an over-night radiologist, willing to do over-reads, please post or DM me. It would be a life-chaning thing for me. Or if anyione has an idea how to find such a job, please speak up. Thanks!
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What is the name of the group?
Quote from Re3iRtH
They are. The group I just signed with does 75% prelims if you work in the US, and 100% prelims if you work abroad.
I’ve been all around Asia already and not so much Europe, so the plan is to start in Spain/Portugal and go East, pick up a few passports and languages over the next few years. Guys are earning $300-$1000+/hr in this group. Best of all you can work full or part time as you want.-
I am also curious….. name of group?
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Isn’t this what AIs supposed to do?
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I was told by someone close to me that TRS does use not USA trained rads to read USA exams and sign as a USA rad. they call it magic rads or something. He gave me some additional details regarding quality to support his theory. I cannot confirm they actually do this, but based on what I was told it seems to be true and really scary.
I was really skeptical when looking at other groups, but found a prelim group that works for us.-
I would love to read prelims for someone. I want to move to Oslo with my wife. Maybe an easy arrangement could be set up, beneficial to both parties? DM me if this is up you alley, anyone.
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Our group prelims on-call by our own rads (after normal workday) and then prelims from our nighthawk service. The establishment rads don’t want to dictate from home (where we take call). So we have massive list of unread from both our own evening call and overnight. Some of us have tried (and failed) to get them to change at least the evening prelims so our list is thinner in the AM. The mornings are nightmarish. If all cases were dictated by our own rads and then nighthawk, the day would be 50% better. Feels like this is a dinosaur setup from 10-15 years ago. Anybody else still doing this?
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It happens all the time. I’ve even seen the reports as .pdf types, or scans, or whatever, that you can’t even copy and paste easily into a tweaked report. Let’s be honest, what you want in a busy PP is essentially a resident report that if you generally agree with (given nonsense ER ordering anyway), they get the idea and the idea has already been conveyed (no acute disease).
I would also love to work overseas, and I find the CMS restriction to be outrageous, as I’m a natural born citizen, went to a US medical school, and licensed in multiple states. It actually hinders patient care to a large degree, to boot. Why the US can’t treat a citizen of its country well is beyond me. I’d even throttle down my work and pay just to live in other countries where you can actually meet women who want to have a family at a young age, otherwise what’s the point of all this $$$ anyway – dudes don’t need it, that’s for sure.
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