Meet Jeanine McNeill, MD. A board-certified radiologist with Renaissance Radiology Medical Group, Dr. McNeill, 49, works occasionally at the practice's outpatient imaging center, Parkview Community Hospital and Riverside County Regional Medical Center. But about two thirds of the time, she works from home, enjoying the benefits of the growing telemedicine trend.

Her at-home practice environment is an historic Riverside neighborhood dating back to the 1910s and 1920s. The Tudor faŤade of her home belies what's inside. Two high-speed computers, three oversized monitors, two Internet connections, two phone lines and a fax machine enable Dr. McNeill to do her job reading images from even higher-tech equipment--digital X-rays, MRIs, CT scans and ultrasounds.

Southern California Physician joins her Tuesday, Aug. 1, 2006:

Before work--I have about six business hours before my shift starts at 2:30 p.m. My top priority is to visit Mom, who, at 92, is recovering from a broken hip at a local rehab facility. I get there early to catch the doctor rounding so I can get an update from him directly. Mom's making good progress.

Back home again, I meet with the cabinet guys about my kitchen renovation. Later, I spot the neighbor's pool contractor across the street. I talk him into coming over to bid on my pool renovation. It's great that I'm home and can get so much done during the day.

2:30 p.m.--I checked my e-mail after lunch, so the computers have been on for a while. I lower the roman shade, save a six-inch slit of light across the bottom. I turn on the ceiling fan to mix up the summer air. I'm ready. I sit down to a list of 20 cases and start reading. The computer screen on my left shows the case inventory, while the center and right screens reveal the images. First up, a spine. I view the images and dictate the case, concluding: "New paragraph. All caps. Impression. Colon. Unremarkable lumbar spine. Period."

"Go to top," I say. The cursor jumps to the beginning of my dictated case. I read back the words, fix a typo by repeating the incorrect word, then say, "Go to end." Last, I say, "That's done," and the file is saved. With a single keystroke, the report is delivered to the appropriate fax machine--thanks to the essential, but behind-the-scenes clerical work of our Renaissance support staff.

I work my telerad system with two hands. My left hand controls my dictation screen and case inventory, while my right hand works the images. It's much more efficient this way. And after years of practice with speaking clearly, crisply and evenly, my speed and accuracy are excellent. In fact, the words I say aloud to Dragon Naturally Speaking are practically the only things I verbalize during my shift. To connect with the four other telerad physicians on duty with me, I use an instant messaging program, called Skype. We type occasional notes back and forth. I type 150 words a minute.

2:40 p.m.--The next case is a cervical spine. "An endotracheal tube is in place. Period. There has been surgical fusion of C5 and C6. Period. A discectomy appears to have been performed. Period. The alignment of the frontal projection is anatomic. Period. A surgical drain can be seen. Period. New paragraph. All caps. Impression. Colon. Postoperative changes as described. Period."

2:55 p.m.--My Skype chirps. It's an instant message from my CEO, Monika Kief-Garcia, MD. She wants me to look at a case for a second opinion. She's at Parkview right now, but can easily forward the images. Working together this way is fantastic. She sends the case to me; I send my opinion back. We don't waste time with telephone calls. It's a hip CT for fracture, but she has a question about a cyst. I message back, "Is it the acetabulum?" Right. We confirm a bone cyst on a 59-year-old male.

3:01 p.m.--I review X-rays of a diabetic foot, post amputation, for possible infection. Then a gall bladder ultrasound. Then another spine CT. Many of the cases today are from Riverside County Regional Medical Center, our biggest local contract. But because Renaissance has about 40 telerad contracts, the work can come from anywhere.

4:07 p.m.--A mobile diagnostic company sends images taken onsite at nursing homes in Virginia and North Carolina. I grab these cases, because I have licenses in those states. Not all my colleagues are licensed in as many places as I am. Across time zones and through the Internet, the time between the test and the result is about two hours. That's not bad considering it can take about 45 minutes to get a reading on most hospital inpatients.

4:30 p.m.--Two hours gone. I'm used to the long stretches of silence between my dictations. Only the occasional clatter of a passing truck on the street breaks it up. I'm reminded that some radiologists just don't like practicing like this. The concentration, the isolation can be too much. One radiologist I recruited to the practice tried it for three weeks. After that, she said, "I'm outta here."

But I've been working this way at least part of the time for about eight years, and as the technology has improved, I am enjoying telerad even more. This job is portable. I can do it from anywhere I go. I feel like I have job security.

Next up, a gall bladder ultrasound of an inmate (we have a contract with the local jail) and a congestive heart failure patient from Victor Valley Community Hospital (like many hospitals, it is understaffed, so we are helping out).

4:41 p.m.--There's a problem with a case from Victor Valley. It's a leg X-ray, but the legs are stretched really long. Someone pulled the film through the digitizer and distorted it. So I Skype Angel, a new member of the clerical staff, and tell him to get the hospital to scan the film again. He will call there and handle the issue, so I can keep going. Our clerical staff has a very important job in the telemedicine system. When a case comes in, they don't let us see it until every image has arrived. And they control where the results get delivered.

In the meantime, since I'm caught up, I work a bit on recruiting. There are 30 radiologists in our group, but we could take on more business if we had three or four more. I check for e-mail from a recruiter I've engaged in Iowa and from a telerad doc based in Maine.

We're trying something new by recruiting the Maine physician as an independent contractor, paid by the case. But the new model is complicated because of who pays for what, with high credentialing and equipment expenses. It can cost about $18,000 to set up a doc at home. Still, the Maine guy seems worth hashing out the details. There's a huge shortage of radiologists generally--telerad-trained docs especially.

Technically, I get one "administrative day" per month to work on recruiting. But I do it constantly, scheduling interviews, reviewing contracts, negotiating. Renaissance is a corporation I love, so I want it to prosper.

4:55 p.m.--I answer a rare phone call. Alfonso Carrillo, MD. There's a multidisciplinary meeting at Riverside County Regional Medical Center on Thursday about how to improve hospital practices related to trauma cases. Can I go in his place? It's at 7 a.m. My response: "Oh, bless your heart!" But since I'm the co-chair of the radiology department and I'm on duty at the hospital that day, I say yes--after making him sweat it.

5 p.m.--Time to sweat myself. Even though I haven't talked to them all day, I've been teaming with four other telerad docs. But at 5 p.m., they abandon me. So the goal is to have the board cleaned before then. I'm on my own from about 5 p.m. to 7 p.m., and things can go crazy with trauma cases.