Please note: The opinions and ‘fixes’ described below regarding teleradiology are the personal opinions of a radiologist, which are found on Reddit. They do not reflect the official stance or views of our company.
I’m on Reddit quite a lot, and the other day a post from a doctor offered a striking opinion on the state of radiology – specifically, teleradiology. It came from a community called r/Residency, which is essentially an online break room where tired, overworked doctors-in-training go to vent.
This post, by a fully-qualified radiologist, stopped me in my tracks. It started with a bombshell: “As a radiologist, teleradiology is terrible for patient care”.
My thought was, “Wow, are the remote doctors that bad?
But then I read his next line, and that’s the whole point of this story: “Teleradiologists are not worse than normal radiologists”.
The problem, he explained, wasn’t the doctors; it was the system.
The problem: A System That Forces Bad Choices
Indeed, he was upset because the business model forces good doctors to make bad choices. Here’s the gist of his complaint :
- They’re paid “per-click.” Many remote radiologists don’t get a salary. They are paid “case to case”.
- This makes them rush. If you get paid only for your readings, then you have to “read more and faster to make an income”. One teleradiologist even went so far as to post on his blog that his income “depended solely on the number of cases I read”.
- The reports are “trash.” The example of a rushed, low-quality report given by the Reddit doctor was one that said simply: “brain mass get MRI.” That is it. No context, no help.
The scariest part: He claimed they sort their worklist by “highest bidder over highest acuity”. ( Acuity = severity of a medical condition )
Frankly, that last line is chilling. He’s saying that, if a doctor is paid by the scan, he is incentivized to read the easiest, fastest scans first-to make more money-and leave the sickest and most complicated patients for last.
It got me thinking: is this teleradiology technology that’s supposed to be good for medicine actually breaking it?
First, what is teleradiology?
Before discussing the challenges this radiologists’s opinion brings up, let us first define what “teleradiology” is.
How does that work? It’s simple: You go to your local clinic for a CT scan. A tech takes the picture. But that expert doctor, who actually reads that scan, might be in another city or another state. The hospital sends the image over a secure network; the expert reads it and sends a report back to your doctor.
Here’s a simple way to think about it.
Imagine waking up at 2 a.m. to a loud “pop” from your basement. You walk down and find a scary, new crack in your home’s foundation. You smell dampness in the air.
You take a perfect, high-resolution photo and send it to the best structural engineer in the world, who lives 1,000 miles away from you.
That engineer is a real professional: They can look at the photo and write a perfect, technically correct report: “Yes, that is a 3-inch vertical crack.”
The “Flying Blind” Problem: A Simple Analogy
But…. they’re “flying blind”.
They can’t smell the dampness. They didn’t hear the “pop” that woke you up. And most importantly, they don’t have your house’s original blueprints – the patient’s chart. They’re disconnected from the whole story.
That’s the problem with teleradiology this radiology professional is highlighting. The technology-the “tele” part-isn’t the problem. It’s the human separation. When the doctor is in the hospital, your ER doc can run down the hall, stand over their shoulder and say, “This patient just doesn’t look right, I need you to look at this now.”
You can’t do that when the doctor is a “faceless and nameless” name on a report from 1,000 miles away.
Why We Have Teleradiology (It’s Not All Bad)
To be fair, inventors created teleradiology to solve some huge, life-or-death problems.
The “3 a.m. problem.”
Sickness and accidents don’t just happen from 9-to-5. Before this tech, if you came into the ER in the middle of the night, the hospital staff had to call a radiologist, wake them up, and beg them to come in. Now they can instantly send your scan to a “nighthawk” doctor who is wide awake, working, and ready to read it, which means you get your diagnosis in minutes, not hours.
The “small-town problem.”
What if you live in a small rural town? Your local hospital just can’t afford to keep a full-time brain specialist or children’s scan specialist on staff. Teleradiology is a lifeline, giving people in small towns the same access to top-level professionals as people in big cities.
The “not enough doctors” problem.
This is just simple math. The number of scans we need is growing way faster-about 15% a year-than the number of doctors who can read them – only 2% a year. This has created a huge shortage. Teleradiology helps by spreading the work around to a whole network of qualified doctors, not just the few who are available at your local hospital.
When it works, it’s a miracle. One story described a remote doctor reading a 3 a.m. scan, finding a “life-threatening” issue, and using a 24/7 call center to “track down the patient’s physician” to get them into surgery. That’s a life saved.
The problem, as that Reddit post pointed out, is what happens when the business gets in the way of the mission.
So, Where Does Teleradiology Go Wrong?
Let’s go back to that doctor’s complaint about money.
He used the term “RVUs,” which is the “pay-per-click” system. It is a billing code, but it has become the primary method of compensation for many physicians. And that creates what I can only call a backward setup.
The “Highest Bidder” vs. The Sickest Patient
Think about that scary claim: “highest bidder over highest acuity”. ( Acuity = severity of a medical condition )
It’s not a real auction. It’s about a choice that a doctor, who gets paid by the scan, has to make every minute of the day.
They log in, and a list appears.
- On that list is a really complex scan for a very sick patient. It will take 30 minutes to read properly. It pays, let’s say, $50.
- Also on that list are ten easy scans, like a simple X-ray. They can read all ten in the same 30 minutes. They pay $10 each.
Do the math now. The doctor can make a choice: either to spend the next half-hour earning $50 or $100.
Literally, the system punishes the doctor for taking the sickest patient first. The sick patient’s scan stays at the bottom of the pile – what one person refers to as “scraps on the list”.
Unfortunately, this rush for speed is combined with that other problem: the doctors are “flying blind.”
A top comment on the post nailed it: “I agree that tele reads are often trash but I also imagine they don’t have the same access to”.
They’re absolutely right. These remote doctors often get the scan but not the story. They don’t know the medical history of the patient.
When Poor Communication Becomes Deadly
In a teleradiology system, that is no minor oversight; it’s a disaster waiting to happen.
One case study told the story of a 30-year-old woman in Pennsylvania. She went into the ER, and her scans were sent out to teleradiologists. But because of a “breakdown in that communication,” “several radiologists failed to communicate” the life-threatening fluid building up around her brain. They “failed to diagnose” the abscess that was killing her.
She spent 11 weeks in a coma.
Now you can see the terrible cycle. The doctor is “flying blind” and should pick up the phone to talk to the ER doc. But the “pay-per-click” system punishes them for that! A phone call is time not spent reading the next scan, which is time they’re not getting paid.
So, to make a living, they’re pushed to write that lazy, one-sentence report— “brain mass get MRI” —that covers them legally but completely fails the patient.
How Teleradiology Affects the Next Generation of Doctors?
And what about the young doctors, the “residents” that this community is named for? This is the system they are learning in.
They’re seeing their senior doctors working alone. They’re seeing posts about teleradiologists making over $1 million a year by being “high-volume readers”. We are teaching them that the goal is to be fast, not to be a good teammate.This is a critical issue for the future of radiology.
Research into teleradiology workflows has even shown that when senior doctors work from home, the doctors-in-training read “substantially” fewer cases. They’re losing the chance to learn.
How Do We Fix This? (It’s Not Hopeless)
The good news is that the problems are well-known and that the fixes are pretty simple. This radiologists’s opinion on teleradiology also points towards solution.
First and foremost, the “pay per click” system is the big one. We have to change how doctors get paid and eliminate the model that rewards physicians for volume. Instead, we need to reward them for delivering quality, efficient care and good patient outcomes.
We also have to fix the “flying blind” problem. This is a tech issue. When a hospital sends a scan, they need to send the whole story with it. The remote doctor must have real time access to the patient’s complete medical record, not just the image.
Another key is fixing the “faceless” problem. This is about people. Instead of sending scans to a random pool of 500 doctors, a hospital should be partnering in “teleteams.” This means it works with a small, dedicated team of remote doctors with whom they work repeatedly, building a good working relationship. It’s a human fix for what is really a human problem.
Finally, we must stop the lazy reports. It’s simple. We can have structured radiology reporting templates and checklists to make sure the doctor filled out all the important parts. There needs to be peer reviews where other doctors check their work to make those useless one-sentence reports impossible.
The Takeaway
So that Reddit doctor was right. The technology—the “tele” part—isn’t the problem. The business of teleradiology is. This is a business problem within modern radiology.
The wire carrying a scan is just a wire. It may be a conduit to a 3 a.m. lifesaver. Alternatively, it may be part of a “faceless” system that leaves a woman in a coma.
This radiologist’s opinion on teleradiology is a warning that we need to built a system that values people over clicks.
As the blog from one radiology group said, so succinctly, “Radiology is a field defined by images. But if we stop at the images, we risk losing sight of what really matters: the person behind the scan. Every Image Has a Story”.
The challenge is to build a teleradiology system that remembers to send the story along with the scan.