Radiology at a crossroads: Hopes and concerns for a second Trump administration

New data reveals what many Americans already know in their bones: Our healthcare system is reaching a breaking point. Not the dramatic, sudden collapse that makes for attention-grabbing headlines, but the quiet kind of crisis that builds in crowded waiting rooms and manifests in canceled appointments, delayed diagnoses, and the erosion of medical care. The radiology industry sits at the heart of this crisis—a field where technological advancements promise transformative care but financial pressures threaten access, especially in underserved areas.

A recent article from Radiology Business outlined seven of the most pressing challenges facing radiology practices today:

• Declining reimbursement
• Corporatization and consolidation
• Inadequate labor force
• Imaging appropriateness
• Burnout
• Turf wars with nonphysicians
• Increasing workflow efficiency

Dr. Bettina Siewert, the author of the piece, aptly described these issues as a "perfect storm" of pressures on radiologists and their institutions. Each of these challenges is significant in its own right; together, they create what experts call a "wicked problem"—one with no clear solution, multiple competing interests, and differing worldviews on how to address it. As the radiology industry contemplates the potential policies and priorities of a second Trump administration, it must consider how these challenges might evolve and what steps policymakers could take to either alleviate or exacerbate them.

Declining reimbursement

One of the most pressing issues for radiologists today is declining reimbursement. The mathematics of healthcare access is simple: When reimbursements fall, providers face hard choices, from limiting Medicare patient volumes to reducing investments in the technology that enables timely, accurate diagnoses. For some practices—especially in rural and lower-income communities—this financial strain is severe enough to force closures, leaving these areas with fewer resources and increasing travel times for necessary care.

President Trump has stated his intention to protect Medicare and Social Security, yet it remains unclear whether this commitment extends to physician payments. During his prior administration, there was a noticeable shift in reimbursement focus from specialty to primary care, alongside an expansion of Medicare Advantage plans. However, policymakers are likely to continue scrutinizing the use of prior authorization, and Medicare Advantage may still be targeted for savings through adjustments to rate setting, quality measures, and risk adjustment in a budget package. Many of these plans reimburse physicians at lower rates than traditional Medicare, so an increase in their popularity could further erode radiology reimbursements. Additionally, a rollback of Affordable Care Act subsidies, removal of “silver-loading,” and restructuring of insurance risk pools could be devastating to marketplace premiums, and lead to more uninsured individuals, creating a ripple effect throughout healthcare

Further, while ACA repeal is unlikely, a second Trump administration is likely to pursue short-term limited duration insurance plans Individual coverage health reimbursement arrangements, and continued expansion of health savings account flexibilities.  

A recent national survey illustrates the reality: Over a quarter of Americans reported delays in healthcare appointments last year, with delays for younger adults reaching 38%. For those experiencing delays, 56% waited more than four weeks to see a provider—a month of uncertainty and, potentially, worsening conditions. Declining reimbursement will only compound these issues if radiologists must stretch resources further to care for a growing population of under- and uninsured patients.

With the Medicare Physician Fee Schedule set to cut physician reimbursements yet again barring congressional intervention, there is growing consensus among policymakers that reimbursement stabilization is urgently needed. Rates have fallen by 29% over the past 20 years, and the complexities of the Merit-based Incentive Payment System are widely recognized as problematic. The Senate’s Medicare Payment Reform Working Group was a promising first step, and the bipartisan support behind Congressman Murphy’s proposed legislation to counter the current cuts is an encouraging sign. According to a recent poll, nearly 80% of Americans support a “fix” to this issue, recognizing that cuts to physicians ultimately translate to cuts in their own Medicare access.

These proposals, however, come with a price tag that Congress will likely try to offset. We anticipate that cost-saving measures such as Medicare site-neutral payment and pharmacy benefit manager reforms will receive much stronger consideration under the next Congress. The site-neutral reforms in the Lower Cost, More Transparency Act would save about $3.7 billion over 10 years, and the act’s PBM reforms would save about $1 billion over 10 years.  It’s also possible “Appropriate Use Criteria” receives another look both from a regulatory and legislative perspective. 

Corporatization and Consolidation

The financial pressures from reduced reimbursements are driving many radiology practices toward consolidation with larger hospital systems, where reimbursement rates tend to be more stable and predictable. While consolidation can lead to efficiencies, it also comes with trade-offs: reduced competition, higher administrative costs and, often, increased prices for patients. Larger systems may prioritize high-margin items, which can limit access to specialized radiology services in rural and underserved communities.

Historically, President Trump’s stance on deregulation suggests a likely easing of regulations that could otherwise limit consolidation and policies that may again encourage investment from private equity into the healthcare landscape. Regardless of investment type, maintaining access to specialized services, especially in underserved areas, should be a priority, even as consolidation reshapes the industry landscape.

Inadequate labor force and burnout

Radiology is also grappling with a significant workforce shortage; a crisis made more complex by an aging population that requires more imaging services than ever before. Radiologists are under pressure to meet demand, working longer hours and increasing their reading speed to keep up with patient needs. This intense workload can lead to diminished interpretive accuracy, widespread burnout and, ultimately, an exodus from the profession. These issues are particularly acute in rural areas, where hospitals are closing at a concerning rate, forcing patients to drive longer distances for necessary services.

Without immediate and significant intervention, these trends could lead to severe consequences. Rural areas, which already have a higher share of screening-eligible patients, often lack adequate access to preventive and diagnostic services. The resulting delays in care can lead to worse health outcomes, particularly for patients needing timely imaging for cancer or other serious conditions.

While a second Trump administration might prioritize deregulation that could streamline hiring practices, it is unlikely that such changes alone would resolve the underlying issues radiologists face. Addressing the workforce shortage will require targeted support, not only through reimbursement stability, but also through workforce investment and incentives that make radiology an attractive field for new medical professionals.

Return to the states

Shifts in party control of state trifectas (governor, state senate, and state house of representatives/assembly) can also influence the direction of health policy. Healthcare may not have been the central issue in this election as it was in years past, but a common theme emerged: “leave it to the states.” This message was particularly strong concerning access to abortion, yet it likely signals a broader trend where states will take on greater leadership roles in healthcare policy, including issues impacting radiology. Under Medicaid, for instance, we can expect states to receive renewed flexibility to pursue innovation waivers, potentially through work requirements or more substantial co-pays. This decentralized approach could reshape access and funding for radiology services in diverse ways across the country.

A promising example of state leadership is in women’s health; approximately 30 states have passed legislation guaranteeing access to supplemental breast diagnostic imaging. Given the trend, this number will likely grow in the upcoming legislative session, reflecting states' willingness to address critical imaging needs directly. State-level decisions will be pivotal as radiology adapts to this new policy landscape, where access and coverage may vary significantly by region.

Conclusion: A call to prioritize patient access 

The radiology industry faces daunting challenges, and the direction of a second Trump administration could significantly impact how these challenges are addressed—or exacerbated. In the radiology business community, we hope to see policies that respect the essential role of imaging in preventative and diagnostic care, supporting reimbursement levels that maintain access and alleviate workforce strain.

Radiology sits at a crossroads, embodying the tension between technological promise and financial practicality. Our hope is for policies that balance fiscal discipline with a commitment to accessible, timely diagnostics. Radiology is more than a service—it is a lifeline. If we are to sustain quality care, policymakers must recognize that cutting reimbursements, encouraging unchecked consolidation or overlooking the radiologist workforce crisis all have direct consequences for patients. By prioritizing sustainable solutions, the next administration can support radiology in its mission to provide lifesaving, accessible care to all Americans.

Linda Wilgus, MBA, is the co-executive director of the Radiology Business Management Association and Christopher “Kit” Crancer is its immediate past president.