Radiology’s Private-Practice Squeeze

It’s no secret that US radiology’s traditional private-practice model has been slowly fading away, but new numbers published in AJR illustrate the magnitude of the shift. The number of radiologist-affiliated and radiologist-only practices has dropped, even as the total number of US radiologists has gone up. 

Radiology has long prided itself on a cozy business model in which radiologists banded together as owner-operators of small private-practice groups that contracted their services with hospitals. 

  • This model has had many benefits for radiologists, but it’s begun to fray in the face of competitive threats like teleradiology providers, health system consolidation, and large national radiology groups like Radiology Partners.

Many radiologists have chosen to switch rather than fight, selling out to national groups or taking positions as employees within health systems.

  • Meanwhile, some practices that want to stay independent are finding strength in numbers by joining with other like-minded groups or seeking out multi-specialty medical groups. 

In the new study, researchers from the ACR’s Harvey L. Neiman Health Policy Institute analyzed CMS data from 2014 to 2023, tracking not only changes in the number of US radiologists but also their type of employment, finding …

  • The number of radiologists grew 17%, from 30.7k to 36k
  • But the number of radiologist-affiliated practices fell 15%, from 5.1k to 4.3k
  • The number of radiology-only practices fell 32%
  • The number of small radiology practices fell, with the decline varying by practice size: 1-2 radiologists -19%, 3-9 radiologists -34%, and 10-24 radiologists -25%
  • The number of large practices jumped, with the biggest increase – 349% – at very large practices (over 100 radiologists)
  • The mean number of radiologists per practice shot up 84%, from 9.7 to 17.9

Why the shift? The researchers theorized that much of it was driven by federal policy and reimbursement changes that incentivize consolidation, mostly to spread the risk and cost of compliance with various regulations like ACA and MACRA.

The Takeaway

There’s no question that radiology is changing – the question is what impact the changes will have on how radiologists perceive their work. The old guard may choose to rage against the dying of the light, while younger generations embrace the new model and its benefits for both professional careers and patient care. 

Radiologist Pay Rebounds

Radiologist pay grew 5.6% and radiology moved up one notch on Doximity’s list of highest-paid US medical specialties for 2023. Physician salaries generally rebounded last year after a decline in 2022.

The Doximity survey of 33k doctors found that overall physician pay grew 5.9% last year, a welcome rebound after a decline of 2.4% in 2022. 

  • In other good news, medicine’s gender pay gap narrowed in the new survey, with women making 23% less than men, down from 26% in 2022 and 28% in 2021.

For radiologists, their average annual compensation was $532k, up from $504k a year ago, and radiology jumped ahead of urology on the top 10 list to occupy the ninth spot. 

  • Still, radiology lagged a number of other specialties in terms of salary growth, ranging from hematology (+12.4%) to psychiatry (+7.2%). 

Other findings in the survey include …

  • Some 81% of physicians reported they are overworked, a number that’s actually down from 86% in 2022
  • 88% of respondents said their clinical practice has been affected by the physician shortage
  • 86% of those surveyed said they are concerned about the US healthcare system’s ability to care for its aging population

The Doximity results roughly track recently released salary data from Medscape, which pegged radiologist salaries at $498k in 2023, up 3.1% and ranking sixth on the list of highest-paid specialties. 

The Takeaway

Say what you want about rising workload and burnout in radiology – radiologists are still among the best-compensated physicians in medicine. And the situation in the US is in sharp contrast to Japan, where radiology is one of the lowest-paid specialties (see our article in The Wire section below).

Teleradiology Malpractice Risk

A new study in Radiology comes to an explosive conclusion: medical malpractice cases involving teleradiology interpretation of medical images more frequently involved patient death and had higher payment amounts. 

Perhaps no technology has wrought greater changes on the field of medical imaging than teleradiology. 

  • By leveraging radiology’s conversion to digital imaging and the rapid expansion of Internet bandwidth, teleradiology makes it possible for medical images to be interpreted independent of the radiologist’s location, with studies sometimes literally sent around the world. 

But teleradiology has had its share of unintended consequences, such as the emergence of nighthawk and specialty teleradiology firms that have seized hospital contracts from traditional radiology groups. 

But this week’s study in Radiology adds a new wrinkle, suggesting that teleradiology could actually have an additional malpractice risk. Researchers analyzed 3,609 malpractice claims, of which 135 involved teleradiology, finding that teleradiology cases…

  • Saw patient death occur more often (36% vs. 20%)
  • More frequently saw communication problems among providers (26% vs. 13%)
  • More often closed with indemnity payments (59% vs. 41%)
  • Had higher median indemnity payments ($339k vs. $214k) 

Why might problems be more frequent in teleradiology? The authors offered several reasons, including …

  • Teleradiologists may not have access to EMR and other patient data
  • Teleradiology interpretations are often provided at night and on weekends/holidays
  • Claims involving neurology and the emergency setting were more common, illustrating the challenges in these areas

Potential solutions could involve making sure that teleradiologists have access to EMR data, and by performing overreads of interpretations delivered on nights and weekends. 

The Takeaway
The findings have disturbing implications, not only for dedicated teleradiology providers but also for traditional radiology practices that use teleradiology as part of their service offerings. And as noted in an accompanying editorial, they could provide ammunition to teleradiology’s opponents, who continue to rail against the technology that has done so much to change radiology. 

Medical Students Return to Radiology

Medical students are flocking to apply to U.S. radiology residency programs, with diagnostic radiology seeing the most growth among nearly two-dozen medical specialties. The trend underscores the strong job market for radiologists.

The number of applications to diagnostic radiology residency programs has grown more than 10% a year over the past three years, according to an analysis by Dr. Francis Deng of Johns Hopkins Medicine. Deng has been tracking applicants for 23 medical specialties, and posted a now-viral table containing his analysis on March 13. 

The annual growth rates for diagnostic radiology and the related fields of radiation oncology and interventional radiology exceeded every other medical specialty for the past three years:

  • Diagnostic radiology: 10.5%
  • Radiation oncology: 8.9%
  • Interventional radiology: 6.8%

Diagnostic radiology’s growth is all the more intriguing given the decline it saw in residency applications from 2018 to 2020. Applications fell by 9.5% from 2,033 in 2018 to 1,839 in 2020, before rebounding to 2,409 applicants in 2023. 

What’s behind radiology’s rebound? RadTwitter offered multiple reasons:

  • Generational shifts in preference among medical students.
  • Medical students favoring “money or lifestyle over human interactions.”
  • Reduced worries about the impact of AI on radiologist jobs.
  • The trickle-down effect of a good job market.

RadTwitter pundit Dr. Saurabh Jha expanded on this latter point. A rising volume of imaging studies in the 2010s led to calls to expand the number of residency lots; these calls were ignored, leading to today’s scarcity of radiologists

Indeed, other data confirm his analysis. The ACR’s job board last year had the highest number of open radiologist positions ever, while recruiters have been flooding radiologists with job proposals for at least the last two years.

The Takeaway

The medical students entering radiology who celebrated Match Day on March 17 are likely to encounter a robust job market 5-6 years from now, as imaging volume grows while radiology residency slots remain static. Fear of AI’s impact on radiologist jobs appears to be receding, as evidenced by strong growth in radiology applications since 2020.  

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