Side Hustle Sit Down: Millionaire Doc

As much as I would like to be able to test every physician side hustle, there are some that are out of reach.  Amongst the jobs I will never be qualified to work is anything that involves radiology.

The internet is the great equalizer.  Like many physician side gigs, teleradiology allows physicians to make serious money from the comfort of their house.

We are lucky today to be joined by a radiologist who blogs under the name Millionaire Doc. He was kind enough to tell me about his side hustle in teleradiology.

What is your primary specialty and where do you practice?

My full-time day job is diagnostic radiology in a private practice setting in California.  My fellowship training is in body imaging.

How did you first get involved in teleradiology? What resources would you recommend for someone who wants to explore their options?

My full-time day job requires me to go in to the office every day.  I read all modalities including x-rays, ultrasound, DEXA, CT, and MRI. I also do minor image guided procedures.

I have a side hustle which is a teleradiology moonlighting gig.  I joined my buddy’s small teleradiology practice where he has a few contracts with county owned urgent care centers.  It’s his main gig, and I just help out after hours and on weekends. I work from my home office anywhere from 4 to 10 hours each week.

My arrangement is unique. Most radiologists who work in teleradiology do it full-time.  The typical schedule is one week on, one week off; or one week on, two weeks off. The shifts are predominantly  evenings and nights. Personally, I think the one week on, one week off schedule is pretty brutal and not conducive to a lifestyle with family and kids.    

There are many different teleradiology employment models.  

Large national teleradiology companies employ hundreds of radiologists across the country and service numerous hospitals

Private practice groups hire their own night teleradiologists to cover their nights

Individual radiologists can go out and cobble together their own contracts to practice  teleradiology on their own.

The American College of Radiology (ACR) has a job board that advertises these positions.

What is a typical hourly rate for teleradiology? Is it a fixed rate or do you get paid per study?

The compensation model varies.  Some companies pay a salary, while others pay by production.  Others operate a combination of both- a base salary with a productivity bonus.  Production based compensation is based on some RVU scale.

I’m on a production scale where I get paid per case.  It’s an “eat what you kill” model.

My expenses are relatively low and fixed.  Other than the initial investment for the computer, monitors, and other electronic equipment, the only other major expense is malpractice.  Other ongoing expenses include business internet line and electricity. And snacks. Lots and lots of snacks.

What is one thing you enjoy about teleradiology compared to your day job? Name one thing that is worse.

My teleradiology side hustle is uniquely flexible.  I work at my own pace and I create my own schedule. Other than the one evening shift I am expected to work each week, I can jump on almost anytime I want and start working.  I like the fact that I am purely working for myself.

One thing that is worse is the IT.  Compared to my day work, the images load slower, and the voice recognition software sucks.  I spend a lot of time proofing and editing my reports. This really wears on me after a while and my efficiency is nowhere as high as my day job.  In general, teleradiology can be a lonely job. You are reading studies from a distance so you don’t have the interaction with the techs and referring physicians.  You have much less control over the protocols, quality of studies, and continuity of care. Some of the study quality wouldn’t pass muster at my day job. But I have to just read it as is.  

Do most teleradiology jobs cover malpractice insurance or do you have to cover it yourself?

I purchase my own separate malpractice insurance for the teleradiology work, but most full-time telerad employers provide malpractice insurance.  

Does your telerads job pay you as an employee or an independent contractor? If IC, what tax breaks and self-employed retirement accounts have you taken advantage of?

I work as an independent contractor.  Taxwise, I am classified as a sole proprietor and I receive a 1099 each year.  I’m able to deduct all my business expenses including my home office. And because I am a sole proprietor, I can set up a solo 401k and put away more funds towards retirement.  This is in addition to my profit-sharing plan from my full-time job and other personal retirement accounts.

Teleradiology and telemedicine in general allows physicians to work 100% remotely. Do you think you could ever do it full-time?

There is a big difference between teleradiology and the traditional group practice.  If you work for a large national teleradiology group, your practice scope will be mostly limited to emergency radiology.  So the breadth of practice may be limited, but not always. If the telerad practice only does prelim work, the studies are overread by the onsite radiologist the next day.  They can be very critical and nitpick the details. This introduces another layer of stress because now you have three audiences – the patient, the referer, and the radiologist.

There is also the matter of practice building.  Unless you work for a private group, you are not really part of a pure medical practice.  Sure, you are part of the national telerad company, but those are usually large corporate structures, not a medical group.   In a traditional boots on the ground medical practice, you are able to build strong relationships with your radiology and clinical colleagues. It’s much easier to become part of the medical community when you are physically present in flesh and blood, presenting in multidisciplinary conferences, attending meetings, and showing your face in the doctor’s lounge.   I could not work 100% remotely because i would feel too isolated.

Computer algorithms are getting better at pattern recognition. Technology allows imaging studies to be read remotely. How do you think the specialty of radiology will change in the next 10 years?

There has been a lot of hype regarding AI (artificial intelligence).  The fear is that AI will replace radiologists and other physicians. I think AI would better be understood as “augmented intelligence”.  Many experts in the field don’t see AI as competitive but rather as an augmentation and expansion of the radiologist’s capabilities. Think of it as the “centaur” model- half man, half machine.  Or the bionic (wo)man, if you will. AI will initially be implemented behind the scenes. For example, AI can be used to leverage information in a patient’s electronic medical records to facilitate billing and exam selection appropriateness as well as more patient-focused diagnosis.  This might reduce the “clinical correlation advised” blurb you often find in a radiology report. In addition AI is being explored to help reduce CT and PET dose and faster MR exam times. AI aided image reconstructions can help also reduce motion artifacts.

The big impact of course is image detection and interpretation.  I think AI will help with the tedious and mundane tasks that radiologists are challenged with.  It’s hard to find that 3 mm nodule in a CT with hundreds of slices. Computers are better adapted to that kind of task than humans are.  But the infrastructure is not there yet. We need tons of image data and corresponding ground proof to corroborate the findings. Currently, data access, and patient privacy issues are problematic.  CAD (computer-aided detection) for mammo hasn’t lived up to its potential. It was first introduced in the 80’s so how long has it been now? It certainly hasn’t replaced the mammographer.

Health care is typically 10 to 15 years behind other industries in the adoption of advanced IT technology.  It think for the foreseeable future, AI will function in the background, aiding the radiologist. It will be a while before radiologists are replaced, if ever.

Does saying “clinical correlation is advised” feel as good when said remotely as it does when said in the hospital?

Ha!  The radiologist calling card.  No, I try to avoid using that phrase because I know clinicians don’t like it.  I try to add value whenever I can, but often times, we receive no clinical history and the imaging findings are often non-specific.

If you could go back to the first day of medical school and give yourself one piece of advice what would it be?

Choose your specialty carefully.  Talk to attendings at different stages of their careers.  Ask them about the challenges they face. Envision yourself in your specialty choice in your 40s, 50s, and 60s.  It’s a long haul and the choices you make in your twenties will carry with you for the rest of your career.

I’d like to thank Millionaire Doc once again for sharing this side hustle with us. For those of you who haven’t already discovered his blog, here are a few of my personal favorite posts:

Build Ladders to Generate Wealth

Five Things I Learned Growing Up in a Candy Shop

The Ultimate Guide to Self-Directed Retirement Accounts

How to Invest in Real Estate Crowdfunding

Interested in other medical side jobs? Check out these Side Hustle Sit Downs:

Financial Makeover Coach – Dr Cory Fawcett

Nursing Home Medical Director – Doc G of DiverseFI

Want to be featured on the Side Hustle Sit Down?  Email me at SideHustleScrubs@gmail.com and share your side gig with us!

Can’t get enough Side Hustle Scrubs?  Follow me on Twitter, Facebook or Pinterest and never miss another post!

11 comments

  1. Great interview! Having side hustles of any kind is great, particularly one that is high paying like this.

    I bet there is a certain amount of freedom that comes from this with the job security it provides. You have a fall back plan, if needed. I’d be curious to know what your main gig thinks about side hustles like this? In my world, there are non-cometes that prevent me from working other side hustle within a certain distance from my hospital. That would obviously be tough to apply to teleradiology.

    TPP

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    1. Thank you for sharing your hustle. Our radiology people remained independent from the rest of the docs who were corporate owned, They could have done this hustle. What we had though, was teleradiology on nights and weekends because our people didn’t want to work nights and weekends. Sometimes our radiologists would overread the teledoc.I found that there was sometimes delay in the service when I needed something done right away. I was put in a situation of having to read my own studies sometimes. This along with the physical exam led me to a plan of action –as it should.

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      1. Hi Badger, yes there are different ways a telerad position can be structured. I do final reads myself. If medicine is getting so corporatized, I’d like to see physicians benefit more instead of less. Maybe an UBER surge thing where rads get paid 2x more when the list gets backed up.

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    2. Thank you TPP. It is nice to have a diversified income source. My group had given me permission to pursue this side gig. The studies are generated hundreds of miles away so it does not violate the non-compete clause. But you are right, I couldn’t go work for a competing local group.

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      1. The great thing about these work from home side hustles is that it makes noncompete clauses irrelevant. My hospital’s noncomplete clause is ~25 mile radius from our ED. That still leaves 99.999999% of the country to make money off of. Not to mention the commute to my kitchen table is pretty easy.

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  2. Really outstanding interview again involving to favorites of mine in the blogosphere.

    I think the slower load time and voice recognition issues would drive me a bit batty because I know it can’t be as fast as what I have at work (and I often complain about that already). But it is nice to have a specialty where you can supplment your income even in retirement by reading from a laptop etc at home.

    When you do preliminary work versus finalized reads (i.e. you are the only one on report that is signed off), do they compensate you differently?

    How does licensing in various states needed for teleradiology accomplished? Is there one big license that allows you to do multiple states (or do you have to get licensed in each state individually)?

    The solo 401k is a great benefit in doing this. I always thought when I finally call it quits at my main job, I might supplement it here and there with teleradiology. But I assume it has to be a certain amount of times a month you have to do reads to make it worthwhile for the expenses you have to maintain.

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    1. Thank you Xrayvsn. I only do final reads. Prelims would drive me crazy because I’d feel like the loop is half closed. My side hustle is already in the state I practice in so it’s not a problem. Otherwise, getting licensed in multiple states is kind of a hassle. More than that, getting credentialed in numerous hospitals is a pain. I was a reference to a colleague who is getting credentialed and I think I filled out about 30 separate hospital evaluations. The solo 401k is a definite benefit. It’s handy for backdoor Roths too.

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  3. I enjoyed the interview and getting to know MD a little better.

    I prefer my side hustle to be different from the day job, not more of the same but doing it at home instead of at the Office/Hospital.

    Earlier in my career, I did do some telerad for our practice, mostly on weekend nights when the radiologist turned went home at 9P. I would pick up the cases on Saturday and Sunday nights when I was home and worked until 11 or midnight. I was essentially stealing them from our nighthawk service. Occasionally, my wife would have to pause the movie we were watching, but I would be back in 5 minutes or so. Our group paid me 90% of the telerad rate and did not have to read the exam the next morning, so it was a win-win-win situation.

    Nowadays, when I am home, I want to be home exercising, watching my series du jour, making smart aleck remarks on other peoples blog, forums, and tweets, walking the dogs, sucking up every iota of Steelers and Grateful Dead news possible, and planning my next vacation or two (Zion in December, Sicily in April, in case you are interested 🙂 ).

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    1. Thanks Vagabond MD. I started this side hustle many years ago when I was fresh out of training. I wanted to pay down my student loans and save for a down payment on a home in a VHCOL area. This allowed me to do those things. I think in the future, I’ll do less of it. Time is more valuable than $. Those vacations sound awesome.

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