Teleradiology as a First Job

From an opinion piece in AJR recently titled “The Case for Presence as a Source of Professional, Educational, and Social Fulfillment“:

Although the long-term impact on social wellbeing of working virtually compared to working in-person is not yet fully understood, physical presence is likely to be conducive to establishing connectedness.

This is a valid knock on teleradiology. Working alone by yourself just isn’t the same as having real colleagues, hanging out with peers, and enjoying spontaneous interactions throughout your work day. I absolutely agree. Sure, having some remote work is great. It’s flexible and efficient. But I took the specific job in private practice I did precisely because I wanted to have peers, teach residents, and otherwise have a varied work-life experience (yes, including working from home sometimes).

All things being equal, we really benefit from spending time with real, live humans. The data show that having a “best friend at work” is a powerful force.

But.

The problem with this kind of article is that it’s a reflection of the academic bubble. When we draw a comparison between a typical academic center or hospital-based practice and teleradiology, we miss the fact that many, many radiology jobs are not team-based daily work. Yes, there are still jobs where you’ll drive to the hospital and work with your peers. There are even some with communal reading rooms and the chance to socialize. But the reality of modern private practice is that a lot of radiologists drive around town to sit by themselves in small reading rooms in the back of outpatient imaging centers located in strip malls.

The false dichotomy (tele = inescapable loneliness, non-tele = Shangri-La) misses the fact that the so-called downside of a remote/at-home practice applies equally well to the reality of private practice in many locales. If you’re commuting just to cover contrast from a dark closet somewhere, you’re not really benefiting from the perks of presence.

The key to meaningful comparison always rests on a foundation of fairness (apples to apples, not apples to oranges). Considering the enrichment you might get from physical presence in an academic medical center radiology position is one important consideration, but it’s ultimately a poor reference when comparing the jobs that many residents in many markets will decide between.

The more salient distinction between a teleradiology position and a local private practice job is the difference between sitting in your pajamas at home versus providing contrast coverage and the occasional procedure at an outpatient imaging center. Realistically, for better or worse, plenty of recent graduates don’t like doing procedures and don’t socialize with the techs. With that reality, it’s not hard to see why even trainees are interested in jumping straight into teleradiology. They’ve never experienced the relative isolation of being the only radiologist at a facility, let alone the isolation of being entirely remote.

Radiologists can argue themselves red in the face about how important it is to be visible and available to clinicians in order to demonstrate our value and the importance of face-to-face communication. That’s all well and good. But it is also outside the locus of control for an individual radiologist pursuing an individual job. The majority of imaging volume is outpatient imaging, and the majority of communication we do is over the phone. The volume is there, and the positions exist. How can we blame radiologists for taking the jobs that are available? The market consolidation from the growth of massive academic medical centers and nationwide private equity conglomerates coupled with a worsening radiologist shortage has fundamentally changed the workforce.

The reality when assessing an individual position is that there are good and bad types of every job. There are assuredly some teleradiology positions that have good support with built-in ways to reach out to colleagues for second opinions and reasonable productivity demands. And there are jobs that are local and in-person but spread out enough with bad IT infrastructure that you may feel even more alone.

You have to know what it is you want, and you have to evaluate each job on its own merits. You have to ask questions.

Yes, we’d probably all be happier feeling like we were part of something. I like my remote work days, but I have no interest in an exclusively teleradiology position. I agree with the thrust of the paper: presence matters. Unfortunately, most conventional jobs simply don’t offer that much presence and many that do are so busy that you can’t enjoy it.

So, ultimately, the distinction isn’t really just teleradiology versus in-person. It’s community vs isolation.