How practical is this opportunity in the future? Like 10-20yrs from now? Would you still be able to read american films from abroad? Would you need experience as a traditional radiologist first to gain some reputation and contacts in order to read remotely? I heard radiologists make much of their $$ from sharing service fees with the hospital... I.e. they got like a $5 professional fee for reading an x-ray and a $200 service fee...
You are right, most of the money in radiology comes from the technical component of the fee (running the machines, setting up, etc) than the reading itself.
However, nighthawk is usually done in one of two ways: the most common are the large international firms that hire US-certified doctors and pay them a strict salary for a very churn-and-earn schedule. Just do a quick internet search and you will see what are decent salaries (but involve an incredible amount of slogging). You don't need reputation and contacts because the hospitals that are hiring you have decided to go with the large firm. It is the equivalent of joining a Big Law firm instead of hanging out your own shingle -- the reputation (and more often, low cost) of the nighthawk group is what gets them hired, which in turn is what gets you paid. The in-hospital group may or may not overread your calls, depending on what firm you are working for.
The second option, which is not as available, is to be the nighthawk rotator or third-shift hire of a private practice group. These groups would rather have one of their own providing overnight reads than contract out to the large groups. I know of at least two groups that require partner-track hires to rotate through their away site for a year or two at a time, which is a house in Australia/New Zealand. So you'd be sharing in the technical fee and initially trading off the practice's reputation as well, but with the ability to develop your own connections over time.
To go back to your first question: why would 10-20 years change things? Nighthawk groups have been around as long as teleradiology. For the infinite foreseeable future, US malpractice requires reads by US-certified radiologists. Nowadays, all you need is a good screen and a fast internet connection to read films anywhere you want. The only barrier that even remotely concerns me is the requirement of US certification, but it has held firm since the early 90s and I don't see a serious challenge coming down the pipeline at this point.
All in all, if you want to practice radiology in a different country it's much easier if you do (or redo) all your training there as well. But nighthawking is at least viable on paper. If your goal is really to practice in country X but you don't want to go through the trouble of retraining, a career change might be easiest.
**would appreciate commentary from practicing radiologists. most of my perspective comes from a business background, an eye to the political winds, and extended, candid conversations about finance with radiologists of many types.
