International travel is one of life's exotic pleasures. Until 9/11, most radiologists hoping to combine career and travel signed work contracts in the Middle East. Now, thanks to information technology (IT) developments, a staggering new world of career travel opportunities exist.

Three years ago, Seattle-based Philip Lund, MD, and his 26 partners in Valley Radiologists endured intolerable night call. Eventually, they concluded that the traditional approach of working day-night-day was unsustainable. Turning adversity into advantage, Lund's group became early adopters of an offshore reading office. "The only call coverage option that seemed to offer any fun was physically going offshore ourselves."

The Seattle radiologists conferred with international business consultants before siting their reading office in Cambridge, England. Key determinants were language, cultural amenities, telecommunications, and legal or tax implications. Group members volunteer to man the Cambridge three-bedroom condominium/office Monday through Friday (7 AM to 4:30 PM English time equates to Sunday to Thursday, 10 PM to 7:30 AM PST). Tours of duty are 6 weeks or longer. One Valley Radiologist is now completing a 6-month tour, with school-aged children in tow.

Other early adopters were the 21 members of Sacramento Radiology Medical Group who launched a Barcelona, Spain, reading office in 2001. Barcelona was selected for its culture, architecture, affordability, and weather. Sacramento Radiology staffs the Spanish luxury condo/office with group volunteers; tours are 3 weeks or longer. Spokesperson Brian Fellmeth, MD, credits the offshore office with aiding in the recruitment of three radiologists. A new European office location is under discussion, to further spice up professional life.

Many radiology groups are too small, or too understaffed, to consider their own offshore reading office. Locum tenens relief exacts a hefty premium, if it can be found at all. Picture archiving and communications systems and the Internet are also playing important roles here. In New York, radiologist Allen Rothpearl, MD, often finds his  six-person, Internet-based daytime-only practice too busy to leave. The ability to read cases on his laptop a few hours per day from Antigua, or Hawaii, has meant the difference in being able to actually get away on holidays.

New York-based radiologist Norman Schoenberg, MD,  employs the Internet while overseas in yet another way. Even when he is on holiday, an occasional complex orthopedic case still requires Schoenberg's involvement. Once alerted by cellular phone, Schoenberg heads to an Internet cafe. Over the past 2 years, his patients in New York City have been served from cafes in London, Paris, Rome, Madrid, and Rio de Janeiro.

The marketplace is demanding travel-friendly technology, and the imaging equipment industry is responding. One vendor is already a market leader in comprehensive offshore reading gear. Its CEO is also making available for rent outfitted villas in Antigua, Malaysia, Switzerland, and Australia. When another temporary location is better suited to a radiologist's needs, this vendor will rent and install turnkey read-ing equipment.

Getting Hitched

Individual radiologists eager to live offshore full-time might consider employment with an on-call outsourcing teleradiology company. To recover the many licensing costs, these companies are often looking for a minimum of 3 years of radiologists' service. This industry is growing with many of the features of a booming economy, including the attendant opportunities and pitfalls. 

One outsourcing company will employ 30 US-accredited radiologists in its Sydney, Australia, or Zurich, Switzerland, offices by July 2004. The company's vice president thinks many radiologists and would-be competitors underestimate the logistic challenges in creating an offshore reading office. An established outsourcing company takes care of the licensing hurdles, billing, IT, marketing, legal issues, leases, and leaseholds. All the radiologists have to do is schedule a mutually acceptable 1,800 to 2,000 work hours per year. The centralized reading sites of this company also facilitate ease of second opinions and socialization between its radiologists.

Another outsourcing company's 22 radiologists are encouraged to live, work, and travel wherever broadband Internet is available. At least two radiologists are being added to the operation per month. Current home offices include Florida, Colorado, Hawaii, Sydney, Hong Kong, India, France, and Spain. This company's radiologists work 7 days on, 7 off. In a typical 10-hour shift, a radiologist will issue preliminary reports on 60 studies.

Yet another outsourcing company based in Adelaide, Australia, employs a different business model. The vice president is a behavior analyst and is convinced a radiologist will be content for the long term if he or she practices close to where they (or their spouse) grew up. Thus, this company plans 10 to 20 US-accredited interconnected solo practices around the globe.  It currently has such radiologists in Australia, Hong Kong, Spain, Bahrain, Egypt, and France. Client hospitals are 80% in the United States, and the remainder are currently from the United Kingdom and the Middle East. (The US dollar is the currency of teleradiology exchange for each.)

PACS and Internet developments have also changed the way radiologists plan retirement. Brian Wistow, MD, is a 56-year-old radiologist with Sutter-Gould Medical Group in Modesto, Calif. Eight imaging partners serve the 150-member multi-specialty group. Over the next few years, three of the existing radiologists hope to relocate and work less. In a flexible schedule, the three hope workload conditions will allow their reporting of Sutter-Gould studies via the Internet. Wistow will live on the Greek islands, while the others are bound for Santa Fe and Hawaii. Wistow hopes such part-time work could continue even when he is away from his Greek base...while on a world cruise.

IT developments have rewritten the lifestyle menu radiologists can chose from. Enticing offshore travel options now exist for on-call posts, working holidays, international living, and "retirement." Radiologists already traveling express a mixture of glee and an embarrassment of riches. Yet, participants all agree that the next 10 years will see exponential growth in international radiology career opportunities. Thank you, IT!

Kelly Silverthorn, MD, is a solo radiologist at Kootenay Lake Hospital of the Interior Health Authority, British Columbia, Canada.