{"id":15887,"date":"2026-10-05T06:36:52","date_gmt":"2026-10-05T06:36:52","guid":{"rendered":"https:\/\/medical-article.com\/?p=15887"},"modified":"2026-10-05T06:36:52","modified_gmt":"2026-10-05T06:36:52","slug":"the-rural-radiologist-who-already-exists","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=15887","title":{"rendered":"The Rural Radiologist Who Already Exists"},"content":{"rendered":"
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By STEVEN GOODMAN<\/p>\n

The future of rural healthcare won\u2019t be determined by how much money is invested. It will be determined by how wisely that money is used.<\/p>\n

That line gets nodded along to at every rural health conference, then quietly ignored the moment the conversation turns to solutions, because the solutions on offer are almost always capital solutions: build a wing, buy a scanner, recruit a specialist who will not, in fact, be recruited. I spent a career building infrastructure for GE Medical Systems, standing up systems for remote patient monitoring before \u201ctelehealth\u201d was a word anyone used. The lesson that career taught me is one rural health policy still hasn\u2019t absorbed: the expertise a small hospital needs is usually not missing. It\u2019s just licensed in the wrong state.<\/p>\n

The Equipment Isn\u2019t the Bottleneck<\/strong><\/p>\n

Consider radiology, because it\u2019s the clearest version of the problem. A critical access hospital in rural Wisconsin can afford a CT scanner. What it cannot afford, and cannot realistically recruit, is a subspecialist radiologist sitting in the building waiting to read scans that come in one or two at a time. That expertise exists \u2014 in large quantities, at hospitals and reading services in Chicago, Minneapolis, or Milwaukee, often sitting idle overnight.<\/p>\n

The technology to connect the two has existed for two decades. A scan can move from a rural imaging suite to a subspecialist\u2019s screen in seconds. What can\u2019t move nearly as fast is the paperwork \u2014 and there\u2019s more of it than most people outside a hospital credentialing office realize.<\/p>\n

A radiologist licensed to practice in Illinois cannot legally read a scan for a patient in rural Wisconsin without a separate license, a separate credentialing process, and \u2014 even after clearing both \u2014 a payer-enrollment process that may not be worth the trouble.<\/p>\n

Multiply that by every specialty a rural hospital can\u2019t staff, and by every state line a patient\u2019s data has to cross, and you get the actual shape of the rural healthcare gap. It isn\u2019t a hospital-building problem. It\u2019s a jurisdiction problem.<\/p>\n

Three Fixes, None of Which Require a Capital Campaign<\/strong><\/p>\n

Fixing licensing and reimbursement rules would do more for rural healthcare than another round of capital funding<\/p>\n

<\/span><\/p>\n

The first fix is licensing reciprocity. The Interstate Medical Licensure Compact<\/a> has made real progress \u2014 most states now participate, and the process is faster than it used to be. But \u201cfaster\u201d isn\u2019t the same as \u201csolved.\u201d A specialist who wants to read for a dozen rural hospitals across a dozen states can now apply through a single Compact application, but still ends up holding a dozen separate licenses, paying a dozen state fees, and tracking a dozen renewal dates. For an individual physician deciding whether to take on rural coverage as a side practice, that friction is often the deciding factor, and it decides against.<\/p>\n

The second fix is credentialing, and it\u2019s the one hospitals are most likely to overlook, because it sounds like an internal formality rather than a policy problem. It isn\u2019t. Even after a radiologist clears licensing, Medicare\u2019s Conditions of Participation still require the rural hospital\u2019s own medical staff to independently verify that physician\u2019s training, work history, and competence before granting privileges \u2014 a process that can take months and is functionally identical whether the physician is joining the medical staff full-time or reading a handful of scans a week from three states away. CMS created a fix for this back in 2011<\/a>: \u201ccredentialing by proxy,\u201d which lets a rural hospital rely on the credentialing already done by an accredited distant-site hospital or telemedicine group instead of repeating it from scratch. The catch is that it\u2019s optional. A hospital\u2019s governing board has to choose to adopt it, negotiate the written agreement, and update medical staff bylaws to allow it \u2014 and plenty of rural hospitals, already short-staffed, never get around to it. The result is a rule that could eliminate months of delay sitting on the books largely unused.<\/p>\n

The third fix is payment and enrollment, and it\u2019s the least glamorous of the three, which is probably why it gets the least attention. Medicare, to its credit, doesn\u2019t treat a remote read as telehealth; it pays for the interpretation much as it would an in-person one. The friction is in the plumbing. A radiologist has to enroll with Medicare based on where they physically sit while reading<\/a>, even if that\u2019s a home office, and every new reading location or billing arrangement is another enrollment to manage. Some state Medicaid programs won\u2019t pay out-of-state radiologists for remote reads at all<\/a>, which for a rural hospital, where Medicaid often covers a large share of patients, can be enough to sink the arrangement. Commercial insurers each set their own rules on top of that. Those rules were written for a world where care was inseparable from geography. That world is gone in every other part of the economy. In healthcare, the rules haven\u2019t caught up, and every year they don\u2019t, they quietly make remote specialty coverage a worse business decision than it needs to be.<\/p>\n

Fix all three, and the staffing model for a rural hospital changes completely. It no longer needs to recruit and retain a subspecialist it will likely never successfully hire, wait months for its own medical staff office to independently verify a physician it will never meet in person, or lose payment for care because it arrived over a network connection from across a state line instead of from down the hall. It needs a technician trained to operate the equipment, a credentialing agreement it actually adopts, and payment rules that make providing the service worth someone\u2019s time. That\u2019s a realistic ask. Recruiting a full-time rural radiologist, in a national shortage that leaves even large urban systems struggling to fill radiology positions, is not.<\/p>\n

Not Charity \u2014 A Business Case<\/strong><\/p>\n

This isn\u2019t only a rural hospital\u2019s problem, and treating it that way undersells the case for fixing it. Urban academic medical centers and large health systems already run radiology departments with unused overnight and off-peak reading capacity \u2014 coverage they\u2019ve built and staffed regardless of whether a rural hospital\u2019s scan lands on the worklist. Extending that capacity to a rural affiliate is close to pure margin: the capacity already exists, and the incremental cost of one more read is low. The more durable benefit runs downstream. A rural patient whose scan surfaces something serious \u2014 a mass that needs oncology, a valve that needs a cardiac surgeon \u2014 becomes a referral to whichever system read the scan. For an urban system\u2019s outreach strategy, remote radiology isn\u2019t a favor to rural hospitals. It\u2019s a growth channel that happens to also be the right thing to do.<\/p>\n

That distinction matters for how this gets built. A wave of commercial teleradiology staffing companies already exists to solve the coverage half of this problem \u2014 pooled radiologists, contracted by the read, available around the clock \u2014 and they\u2019ve kept plenty of critical access hospitals staffed overnight who otherwise wouldn\u2019t have been. But a pure staffing vendor has no stake in the rural hospital beyond the individual read. There\u2019s no referral relationship to protect, no shared reputation on the line, and no particular reason to prioritize the hospital\u2019s actual case mix over whichever study on the shared worklist pays the vendor\u2019s radiologists the most. A hospital-to-hospital arrangement has skin in the game on both ends: the urban system wants the rural hospital\u2019s trust and its referrals; the rural hospital wants a partner it can hold accountable, not a rotating cast of contracted readers. If licensing, credentialing, and reimbursement get fixed, they should be fixed in a way that makes it easier for hospitals to build these relationships directly with each other \u2014 not just easier for staffing vendors to scale.<\/p>\n

\u201cWisely Used\u201d Is a Policy Choice, Not a Spending Level<\/strong><\/p>\n

None of this requires a new grant program. It requires state legislatures and reimbursement bodies to treat licensing and payment rules as the infrastructure they actually are \u2014 as consequential to whether a rural patient gets a timely radiology read as the scanner itself. That\u2019s a cheaper fix than it sounds, and a more durable one, because it doesn\u2019t depend on any single hospital\u2019s ability to win a grant or recruit a specialist against the odds. It changes the odds for every rural hospital at once.<\/p>\n

Money will always be part of the rural healthcare conversation, and it should be. But the quote at the top of this piece has it right: it\u2019s not the only variable, and in this case, it may not even be the binding one. The expertise rural patients need already exists. The question is whether we\u2019re willing to let it cross a state line.<\/p>\n

Steven Goodman is Senior Director of Technology at Marquette University\u2019s Klingler College of Arts and Sciences and a former Chief Technology Architect at GE Medical Systems.<\/em><\/p>","protected":false},"excerpt":{"rendered":"

By STEVEN GOODMAN The future of rural healthcare won\u2019t be determined by how much money is invested. It will be determined by how wisely that money is used. That line gets nodded along to at every rural health conference, then quietly ignored the moment the conversation turns to solutions, because the solutions on offer are…<\/p>\n","protected":false},"author":0,"featured_media":15886,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-15887","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15887"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15887"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15887\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/15886"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15887"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15887"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15887"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}