Living Internationally and Working Remotely for US Company

[19pieces19]

Does anyone have experience living in another country for prolonged periods of time and supporting yourself through teleradiology? As a US trained radiologist.

Do teleradiology companies actually care where you're living when you work for them?

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[colbgw02]

I haven't worked from abroad myself, but the answer to your last question is 'yes'.

Payments from CMS require the service to have originated from within the United States. For an imaging study's professional fee, that is wherever the radiologist is located, which is part of the reason locating radiologists in Hawai'i is increasingly popular. To separate out CMS patients is an administrative burden and it may not be financially tenable, depending on one's payer mix. Even some private insurance companies put stipulations on location. For example, in my state, final reads will only be reimbursed if performed in state, so virtually all overnight reads are preliminary.

Changes in reimbursement, mostly straight up paying less per exam, has really changed the calculus. I don't know enough to say that there are no viable abroad options, but I will say that the majority of teleradiologists are U.S.-based. And, if they're working for a big firm, they're probably practicing in a high volume/low compensation per RVU environment.

 

[19pieces19]

I haven't worked from abroad myself, but the answer to your last question is 'yes'.

Payments from CMS require the service to have originated from within the United States. For an imaging study's professional fee, that is wherever the radiologist is located, which is part of the reason locating radiologists in Hawai'i is increasingly popular. To separate out CMS patients is an administrative burden and it may not be financially tenable, depending on one's payer mix. Even some private insurance companies put stipulations on location. For example, in my state, final reads will only be reimbursed if performed in state, so virtually all overnight reads are preliminary.

Changes in reimbursement, mostly straight up paying less per exam, has really changed the calculus. I don't know enough to say that there are no viable abroad options, but I will say that the majority of teleradiologists are U.S.-based. And, if they're working for a big firm, they're probably practicing in a high volume/low compensation per RVU environment.

Hm, that's unfortunate.

What if you had a house or apartment in the US and wanted to go on an extended vacation for say 6 months or 1 year? Would it be possible to list your rightful US-based home as your residence and then just travel while doing reads? You would still be living permanently in the US.

Would they actually track your IP address or anything?

 

[colbgw02]

What if you had a house or apartment in the US and wanted to go on an extended vacation for say 6 months or 1 year? Would it be possible to list your rightful US-based home as your residence and then just travel while doing reads? You would still be living permanently in the US.

On paper, your domicile doesn't matter. Your location at the time of services rendered is what's relevant.

Would they actually track your IP address or anything?

Probably not, just like you're unlikely to get audited if you cheat on your taxes. Doesn't mean it's a good idea.

 

[Tiger100]

Not doable. It is a myth in year 2018.

 

[coroner]

Path, here wondering about this myself. I remember when I was a med student 10 yrs ago (U.S. trained) doing my ER rotation (7pm - 7am shift), we would get reports from Nighthawk out of Australia.

Were those reports prelim reads by an Australian radiologist? And, the next morning the U.S. hospital based radiologist would sign them out? If so, what if a U.S. trained radiologist lived abroad and worked for one of these companies?

I dunno as a pathologist, I had an impression that Rads was one of the rare fields you could probably make a career working remotely and solo (maybe Psych consults via Skype is possible?). I always wondered if the idea of living abroad, without needing to be hospital based, no techs, no secretaries, nor other docs bothering me and working at my own leisure was possible. Just having a desktop while sippin' a Cuba libre by the beach and signing out cases sounded kind of appealing...

 

[deleted103644]

Hm, that's unfortunate.

What if you had a house or apartment in the US and wanted to go on an extended vacation for say 6 months or 1 year? Would it be possible to list your rightful US-based home as your residence and then just travel while doing reads? You would still be living permanently in the US.

Would they actually track your IP address or anything?

Pretty sure this would fall under Medicare fraud.

So not the best idea, even if you might not get caught immediately.

 

[deleted103644]

Path, here wondering about this myself. I remember when I was a med student 10 yrs ago (U.S. trained) doing my ER rotation (7pm - 7am shift), we would get reports from Nighthawk out of Australia.

Were those reports prelim reads by an Australian radiologist? And, the next morning the U.S. hospital based radiologist would sign them out? If so, what if a U.S. trained radiologist lived abroad and worked for one of these companies?

I dunno as a pathologist, I had an impression that Rads was one of the rare fields you could probably make a career working remotely and solo (maybe Psych consults via Skype is possible?). I always wondered if the idea of living abroad, without needing to be hospital based, no techs, no secretaries, nor other docs bothering me and working at my own leisure was possible. Just having a desktop while sippin' a Cuba libre by the beach and signing out cases sounded kind of appealing...

Prelim only.

And it takes a fair amount of infrastructure to support teleradiology, and contracts to get volume.

It’s harder to do that on your own than start a small practice with a couple local contracts. Most who do it work for large corporate groups.

 

[coroner]

Ok, could you work for Nighthawk (or other company) overseas, solo, doing telerads only as a U.S. trained physician?

 

[Tiger100]

Ok, could you work for Nighthawk (or other company) overseas, solo, doing telerads only as a U.S. trained physician?

I have not very few.

Things may seem fine on paper, but in practice the story is totally different. It is like saying that you can own a restaurant in Vietnam and hire someone there to run it for you without being there physically. It may seem logical but doesn't happen in practice.

1- If you want to finalize a report, you have to be in the US soil.
2- It is not that easy to say you just work at your own pace. Every industry needs to know your productivity to some extent in advance.
3- Your job security is almost zero. in other words, you can easily be jobless tomorrow unless you sign something terrible.

example: My group dismissed the telerad company completely a few years ago. We had our own nighthawk guys. Some of them were local but other ones used to live out of state. Later, some people in the group decided that they want to work nights. So We dismissed half of our nighthawk guys. Whom do you think we dismissed? Obviously, the ones that were out of state and one local one who was not good.

My point is if you are not onsite, you will lose credibility. You won't have a face and you can lose your job in a drop of hat.