[Unknown Member]

You have a lot of mixed up information, a lot of it is true and some of it is not.  Teleradiology for the VA boils down to 1 game only – NTP or national teleradiology service.  You must read at the centers you have mentioned above because the VA is not going to trust you with a home computer (paranoid on someone gaining access to the government network).  You should get in touch with NTP and they can answer all your questions, they have many open opportunities because majority of the work is off hours.  There are 2 routes working for NTP – Sterling medical in which you are subject to their pay and rules, independent contractor I believe but you are not a government worker so they must pay your malpractice insurance or you have to on your own I guess.  OR NTP and directly employed by NTP/the government and you have same federal immunity from lawsuits as other government workers – basically lawsuits are brought up against the federal government if you do something wrong.
 
Shift Options – Full time work is typically 8 days on, 6 days off with 10 hours shifts (80 hours every 2 weeks, the same as all VA full time workers).  Part Time Work – Set hours and days, not sure how much is available this route but its a set schedule.  Per Diem – You choose the hours an days you want to work, no set schedule.  You pick up shifts as available, many of the shifts “available” will be off hours (you will be working some hours outside the typical 8-5 routine).  Full time job with NTP is probably the most secure out there, there will always be a need for VA hospitals to cover with NTP for off hours, even if older VA hospitals are closed down under Trump’s agenda next year.  I would say full time directly for NTP is the most secure job someone could possibly have.  Per Diem – you may not even get the shifts you want, its all based on demand.  Least stable of course. 
 
Salary – Full time Sterling Medical is 400k a year.  Full time NTP is a range 325-350k, likely 325 or 335k.  Per Diem – Paid by the case and capped at an hourly rate, only $200/hr max for weekday work.  The per case rate is very good, but so is the per case rate doing any fee basis work for any VA (fee basis work though is hard to find).    You are capped at annual max salary of the president at $400,000 – I suppose you could find the number of shits to do this as per diem if you want to work nights.  
 
 
In terms of cases, its just a general mix of cases.  Lots of ER cases covering for hospitals whose employees have finished their day shift at 4:30pm or 5:00pm, and now need coverage for those hours.  There is also “extra cases” dumped into VA telerad, these are the garbage cases that didnt get read at the local VA facilities.  Lots of plain films go unread because they are low rvu’s, the mri brains and spines the local facilities are happy to read themselves.  Overall I would say the cases are your standard mix of cases you would see on a weekend call shift.  
 
Pro’s – Great reimbursement on a per case basis per diem with virtually no malpractice liability if hired by NTP directly.   Great reimbursement for a slow reader if being paid annual salary for full time or part time work.
 
Cons – Most shifts include off hours, some are entirely night shifts.
Not really teleradiology because you have to work at a local center, instead of at your own home.
 
So your 2 basic routes for tele rad VA is NTP directly, or Sterling MEdical.  Get in touch with those 2 entitities directly to discuss details.  
 
Overall Verdict:
Good job to have if you are a slow reader as is the case with any VA job.  You can find similar onsite rates during regular daytime hours (8-5) at many other places that will pay you similar, so in my opinion those jobs trump this.  If you are going to read off hours, this is already an area in very high demand and pays very well, and can be done in your underwear from home.  For this reason, it makes no sense to sign up for NTP off hours unless you live right next to their reading centers.  If you are doing daytime work at salary, you are much better off just doing a regular VA radiologist job at any VA unless you really enjoy 10 hour shifts and 6 days off – this is a personal preference.
 
If you enjoy off hour work, then you should just work for a group remotely out of the comfort of your own home.  This job is always “secure” because there will always be high demand for off hours coverage.  If you like nights, lots of 7 on 7 off jobs that are much better than NTP.
 
 
 
 

[Unknown Member]

Thanks for the thorough summary.

[Unknown Member]

Thank you very much for spending the time to make a very clear and concise summary of the situation.  From what I can tell the perdiem would make most sense for me if I want to work weekends and holidays for a higher rate…but don’t need to be guaranteed the work. 
 
Sounds like from most other metrics, a normal daytime VA job is superior (day time hours, job security etc)- unless as you say I like working 8 10 hour shifts with 6 days off.  Actually, if part-time is 4 10 hour shifts with 10 days off, that could be enticing. 
 
I don’t know if the normal VA jobs let you work 10 hour days, but with the slower pace at the VA, I think that would be doable and thus lead to more days off- less commuting etc.  Sounds like the full time teleradiology jobs are not a great deal though.  Who really wants to work 8 nights with 6 off (even worse than the very common 7 on , 7 off). 
 
Thanks again

[blaoutliev]

Some of the newest VA hospitals are on the shutdown list, actually.

[cbzagaceta]

Where might one find this shutdown list?

[sraghuvanshi1]

Remember that the typical 7 on and 7 off doesnt include extra days off. VA full time gets the typical 26 days off, 10-12 federal holidays, 13 sick days, 4 CME days. And 3 months paid family leave if you have a kid.

VA pays 2-3x per case what corporate telerad does. No joke. Most fee basis docs are not working graveyard hours either.

[sraghuvanshi1]

You can do compressed schedule at normal VAs. 4 x 10.5 hour days a week (half hour lunch break).

[hugolpneves_898]

You can theoretically but all subject to approval by your Chief, who may just say nahhhh

[Unknown Member]

It is very rare for a chief to approve conpressed work shift unless you are working evenings, weekends, or nights.

[jgremmels]

Quote from golden gate

VA pays 2-3x per case what corporate telerad does. No joke. Most fee basis docs are not working graveyard hours either.

 
Do you mean 2-3x per case for the fee basis rads vs corporate telerad?  Are the VA employed telerads making 2-3x corporate telerad (which would be 50-75/case)?
 

[sraghuvanshi1]

Yes, essentially, but remember hourly pay is capped to $250-400/hr. No one is reading 12 cross sectional an hour at the VA. The situation is more like this: they read 3-4 cross sectional an hour and make similar to the corporate telerad guy reading 8-12.

[mgmacielendocrino_912]

Thanks for the summary.  I am a fast and efficient rad.  How would the NTP work for someone in my situation?  
 
Lets say it takes me half hour to read a volume of cases to reach the cap of $200/hr, can I just chill on my phone/laptop the remainder of the hour and start reading again next hour and repeat throughout the shift?  Or would people start calling me for reads?

[10607]

What are the actual schedule of hours of NTP for California facilities (not for the overnight hours)?  For an example is it 3pm – 10 pm etc?  I tried to get this info from their recruiter but he avoids answering this question and says when I get hired I’ll see the schedule.  

[g.giancaspro_108]

Seriously, their recruiters are incredibly terrible.  Minimal information can be learned prior to getting hired.  Nebulous information regarding salary and benefits.  No information about workload or schedule.  My guess is they do not want to recruit for (or fill?) the positions for whatever reasons.  We had a partner apply and over a year went by before the partner received an email confirming their application was complete and they would be contacted.  Last he mentioned it, over a year has passed since then and still no contact.  He didn’t cold call, he responded to an ad they placed for someone with exactly his skill set.

[ruszja]

Quote from sandeep panga

Seriously, their recruiters are incredibly terrible.  Minimal information can be learned prior to getting hired.  Nebulous information regarding salary and benefits.  No information about workload or schedule.  My guess is they do not want to recruit for (or fill?) the positions for whatever reasons.  We had a partner apply and over a year went by before the partner received an email confirming their application was complete and they would be contacted.  Last he mentioned it, over a year has passed since then and still no contact.  He didn’t cold call, he responded to an ad they placed for someone with exactly his skill set.

 
That reminds me of my hiring experience with the air force. It’s like a black hole.

[ljohnson_509]

Its like not knowing your salary until you get hired by the va. The committee meets and determines it. What kind of crap is that?

[ruszja]

Quote from Drrad123

Its like not knowing your salary until you get hired by the va. The committee meets and determines it. What kind of crap is that?

 
Its a set of regulations that make it so. Now in most other .gov jobs, your salary is simply a place in a table. You have ‘GS15 step 7 in GSA region X’ and every other fed employee at the same place in the table gets the same. With those kind of physician specialist jobs, there is your base salary and then there is a ‘market rate incentive’, but that incentive is indeed up to a committee and they somehow have no way of deciding on how much it is before a hiring decision is made.

[ljohnson_509]

^^ I get it but when your talking low salaries at va, 260k vs 310k may make a difference. Especially if your raises will be tiny over the years.

[Unknown Member]

They are not giving you the hours upfront, because they will schedule you for the graveyard shifts.  The pay is the same no matter whatr the hours, the only difference is increased pay on holidays and weekends.  You would be able to make a lot more reading remotely for a private practice comfortably from your home.  If you are slow (I consider 4-6 Rvu’s average speed, less than 4 is slow), VA should be your first choice.  Otherwise, you would do much better elsewhere.  
 
Also, its not like you can just read X cases and go home.  You are on the clock and expected to read the whole time expect for your lunch break and a couple 15 minute breaks.  If you are in a salaried position, the slow guy reading < 4 work rvu’s per hour will make as much as the fast guy reading 10-12 work rvu’s per hour….That is the problem with the system but it’s always been that way (In some cases the much slower guy is actually making more than the faster guy because he was hired at a hire starting salary).  If I were in charge of the VA, I would set up a base salary for X amount of work rvu’s and then productivity bonuses for each y number rvu’s above that baseline.  I would do that for all specialities in medicine and that would go a long ways to fixing the VA.  You can think of the VA pay system as a socialist system instead of capitalism.  
 
Lastly, rvu’s at VA’s are harder than private practice because the population is a lot more elderly and complicated.  Private practice has a lot of stone cold normal studies that take no time.  Also, don’t sweat lawsuits, thats what malpractice insurance is for.  

[abd.fawzi_217]

VA is communist while PP is socialist, no?

[10607]

Quote from striker79

They are not giving you the hours upfront, because they will schedule you for the graveyard shifts.  The pay is the same no matter whatr the hours, the only difference is increased pay on holidays and weekends.  You would be able to make a lot more reading remotely for a private practice comfortably from your home.  If you are slow (I consider 4-6 Rvu’s average speed, less than 4 is slow), VA should be your first choice.  Otherwise, you would do much better elsewhere.  

Also, its not like you can just read X cases and go home.  You are on the clock and expected to read the whole time expect for your lunch break and a couple 15 minute breaks.  If you are in a salaried position, the slow guy reading < 4 work rvu’s per hour will make as much as the fast guy reading 10-12 work rvu’s per hour….That is the problem with the system but it’s always been that way (In some cases the much slower guy is actually making more than the faster guy because he was hired at a hire starting salary).  If I were in charge of the VA, I would set up a base salary for X amount of work rvu’s and then productivity bonuses for each y number rvu’s above that baseline.  I would do that for all specialities in medicine and that would go a long ways to fixing the VA.  You can think of the VA pay system as a socialist system instead of capitalism.  

Lastly, rvu’s at VA’s are harder than private practice because the population is a lot more elderly and complicated.  Private practice has a lot of stone cold normal studies that take no time.  Also, don’t sweat lawsuits, thats what malpractice insurance is for.  

Thank you for that info Striker79.  So, they sign you up then try to put you on overnights?  Haha….position I was looking to apply for is a per diem.  I can’t imagine that per diems would agree to do overnights.  I certainly won’t.     
 
What do you mean by your last sentence of “Also, don’t sweat lawsuits, thats what malpractice insurance is for. ”  Are you referring to VA job where you are sort of shielded from lawsuits?

[Unknown Member]

Basically fear of lawsuits shouldnt sway you from taking a job outside of the VA where you will make a lot more.  

[ljohnson_509]

Lower volumes and an easier day is the big perk from my understanding. But I remember hearing that some have high volumes? Anyone know?

[y.rajshekar]

0 I work at VA and do PP tele on a side. While at PP I can roll through the list quickly with young/middle age patients that have one or two findings to describe, it’s common at VA to have old patients with complex history and underlying oncology. Making comparisons as well as chart digging is expected and does take time. 
 
Maybe my experience is skewed by working at a tertiary VA hospital vs small hospitals at PP? While I agree that at PP one has to work faster, anyone else can compare productivity in terms of time spent, not RVUs?

[Unknown Member]

VA Teleradiology cases are without a doubt more complex than bread and butter cases in a normal community practice.  Often more complex than Academic centers given the patient population.  Search prior posts on NTP and you will find discussion in regards to this.  
 
Not a bad gig, and one big advantage would be the need for only 1 license and malpractice coverage.  But train wrecks are the norm, not the outlier in terms of caseload.  
 
Hours vary.  If you can get reasonable hours, not a bad option.  

[philma.o_999]

VA telerad cases are much more complex than bread and butter telerad/community practice case mix.
More complex than Academia, in my opinion.
Moonlighting pay is capped.  RVUs do not correlate to the work done given the complexity of the exams.
It is not a bad moonlighting/PT gig.  Having the need for only 1 license and malpractice coverage is a big plus.
Expect cases to be complex oncological work with priors.  This will be the bulk of the work.  
There are other threads on NTP which discuss the same.  Search through the forum pages. Read at an average speed and you should be able to make the maximum per hour allowed or close to it.  
If you are above average speed, there are better options.

[y.rajshekar]

0 0 0 0 I read follow ups for NTP and I know that NTP gets lot of train wrecks.  
 
I am trying to gauge RVU conversion factor VA to a regular PP, as in my experience I can easily do twice RVUs in the same day at PP if I worked with same effort. I do get paid per piece at PP so comparison is complicated.

[ruszja]

Quote from boomerrad

VA telerad cases are much more complex than bread and butter telerad/community practice case mix.
More complex than Academia, in my opinion.
Moonlighting pay is capped.  RVUs do not correlate to the work done given the complexity of the exams.
It is not a bad moonlighting/PT gig.  Having the need for only 1 license and malpractice coverage is a big plus.
Expect cases to be complex oncological work with priors.  This will be the bulk of the work.  
There are other threads on NTP which discuss the same.  Search through the forum pages. Read at an average speed and you should be able to make the maximum per hour allowed or close to it.  
If you are above average speed, there are better options.

 
Are the local VAs dumping the complex stuff on NTP ?

[y.rajshekar]

0 0 0 0 0 0 0 0

Quote from fw

Are the local VAs dumping the complex stuff on NTP ?

 
Yes. We don’t do it unless we are short and even then we can send only couple studies which came at the end of the day. I think some VAs use it a lot more liberally. I believe it has to do more with money than NTP capacity but they never told us how much VA has to pay to their own NTP. Plus referring docs may start looking for read if routine study not read for several days which happens with NTP.  There has been talk about covering all late evening studies internally but several rads stated they would rather retire.

[ruszja]

Quote from DrBoogie

Yes. We don’t do it unless we are short and even then we can send only couple studies which came late in the day. I believe it has to do more with money than NTP capacity but they never told how much VA has to pay to their own NTP. [u]There has been talk about covering late evening studies internally but several rads stated they would rather retire. [/u]

 
The joys of working in an organization with a budget process.
 
When I read the underlined, in my head it was automatically translated into the voice of one of the VA attendings I worked with. He was a good radiologist, but 100% in the ’employee vs. management’ mindset. The kind that if he was 1/2 way through a chest abdomen pelvis when the factory siren blew at 5 would hit the delete button on the C-phone and leave the study up for the resident to read.

[y.rajshekar]

0 0 0 0 0 0 0

Quote from fw

Quote from DrBoogie

Yes. We don’t do it unless we are short and even then we can send only couple studies which came late in the day. I believe it has to do more with money than NTP capacity but they never told how much VA has to pay to their own NTP. [u]There has been talk about covering late evening studies internally but several rads stated they would rather retire. [/u]

The joys of working in an organization with a budget process.

When I read the underlined, in my head it was automatically translated into the voice of one of the VA attendings I worked with. He was a good radiologist, but 100% in the ’employee vs. management’ mindset. The kind that if he was 1/2 way through a chest abdomen pelvis when the factory siren blew at 5 would hit the delete button on the C-phone and leave the study up for the resident to read.

We cut 2 FTEs during Covid but volumes have been long above the pre Covid level. Somehow it did not translate to extra budget for NTP or more pay, so just another side of the budget coin.

[ruszja]

Quote from DrBoogie

We cut 2 FTEs during Covid but volumes have been long above the pre Covid level. Somehow it did not translate to extra budget for NTP or more pay, so just another side of the budget coin. 

 
Once they are cut, they are cut. A cloud of white smoke, and gone it is until the right congressman gets flooded with angry handwritten veterans letters. What did they expect, that the vets would just disappear after covid ?

[scandoc]

Whats the word on the pay per click VA tele gig? I live right next to one of their reading center. Is it worth picking up for extra? I am a fast reader but doesnt like excessive liability.

[Unknown Member]

It may. If you dont like excessive liability, Kaiser and the VA cannot be beat in that category. But cases will be complex. Pay is capped at $250 an hour. The hours available for PT are night hours primarily. If you know these things going in and believe it would be a good fit, it will likely meet your expectations.

[tovayalda]

Isnt NTP part-time 1099?

[philma.o_999]

It is as described above.  Pay is capped at 200-250/hr.  Cases are complex.  Hours are primarily night (not necessarily 3rd shift, but 2nd shift-3rd shift).  If liability is your primary concern, the VA and Kaiser cannot be beat in regards to this.  Fast reader or slow reader, you will not make above the cap.

[scandoc]

Is it the kind of situation where you can log in read an hour or two after work if you feel like it? Is there situations like that around?

[philma.o_999]

It is not that type of situation at NTP for PT work.
 

[Unknown Member]

My experience has also been that it takes about 2x as long to do the same amount of rvu work at the VA compared to tele, maybe 1.5x compared to tele private practice where you are constantly interrupted.  IF you are an a hole radiologist, you are bothered less of course.  

[Chris7549]

When I worked at the the nyc location, the per diem fee basis NTP rads that would come and go worked mostly daytime.