‘Compensation remodeling’ and 9 other solutions to help preserve radiology’s core mission

Experts from across medical imaging are sharing 10 potential solutions to help preserve the profession’s core mission.  

Academic radiology has traditionally focused on the key trio of providing excellent patient care, educating trainees and engaging in research to advance the field. However, forces such as practice consolidation, rising imaging volumes and burnout have combined to undermine this mission, experts detailed March 9 in JACR. 

The American College of Radiology, which publishes the journal, recently convened 25 different medical societies to discuss this problem. From the 2025 ACR Intersociety Meeting, participants devised a list of recommendations they believe will help save academic radiology and the specialty in general. 

“Reversing the current erosion of the academic radiology mission in the face of adverse market forces will require a culture change, allocation of specific resources, and a dedicated longitudinal commitment,” lead author Jay R. Parikh, MD, a noted radiologist and researcher with the University of Texas MD Anderson Cancer Center, Houston, and co-authors concluded. 

ACR held its 2025 Intersociety Meeting last August in Santa Fe, New Mexico, bringing together 52 attendees. Participants spanned diagnostic and interventional radiology, radiation oncology, medical physics and several other subspecialties. Presentations and discussions focused around “The Degradation of the Academic Mission and the Impact on U.S. Radiology.” 

The intersociety, which dates to 1936, at a previous meeting detailed what it believes are the 7 most pressing problems facing academic radiology. This “perfect storm” also includes corporatization of the specialty, an inadequate labor pool, and inappropriate imaging orders that waste radiologists’ time. Parikh and colleagues noted that, while academic radiology stimulates higher thinking while also training its future workforce, most graduating trainees in the U.S. “consistently have pursued nonacademic careers.” 

Those involved came up with a list of 10 strategies and tactics they think can’t help maintain the academic mission and strengthen the profession overall, including private practice. They include: 

1. Rebranding academic radiology: “At its core, academic radiology needs to be rebranded in ways that lean into its strengths, rather than attempt to function as a larger, broader version of private practice,” the authors charged. “We need to market academic radiology not only as the ‘manufacturer’ of the future generations of high-quality radiologists but also where future generations of radiologists will want to work.” This could include recognizing that radiologists want something more than just clinical work and raising awareness about the virtues of academia, such as increased autonomy, flexibility and variations in practice. 

2. Creating ‘slack’ in the clinical work schedule: This can help reduce fatigue while increasing enthusiasm for education and research. “Fundamental to this culture change is fostering the value of ‘slack’ in the system and elimination of the clinical hyper-efficiency mindset,” Parikh and colleagues wrote. “Reading cases too quickly is a recognized stressor for radiologists, contributes to burnout, and compromises patient safety. Organizational leadership must protect academic time.” Actions could include allotting time for workstation teaching, weekday daytime hours for research, advocacy, mentorship and actively promoting wellness

3. Ensuring adequate staffing: Radiology leaders must act to bolster the supply of radiology professionals, with strategies that address both the short- and long-term supply of physicians. More immediate remedies could include offering flexible work arrangements such as shorter workdays and teleradiology options to retain retiring rads or using extenders to manage workloads. In the long-term, academia could form partnerships with private radiology groups or vendors to financially support more trainees. Options also include streamlining pathways for international grads and fighting for more funding from Medicare. “Over the last 5 years there have been approximately 1,000 more applicants annually for diagnostic radiology residency programs than available slots,” the authors reported. “Current and expected future imaging volumes warrant additional trainees supported by CMS for diagnostic and interventional radiology.”

4. Amending compensation metrics to contemporary realities: “The tradition of tying benchmarked [work relative value units, or wRVUs] to compensation is considered obsolete by some thought leaders, as the two metrics are largely disassociated,” the authors added. “Work RVUs reflect aspirations of contribution margins for academic healthcare systems whereas compensation is primarily driven by supply and demand market forces.” Possible solutions could include implementing value-based pay models, offering higher income for interventional rads, despite generating lower wRVUs, to address staffing imbalances. Leaders also could consider incorporating systems that support non-RVU activities such as teaching and tumor board participation. Internal moonlighting, which forces rads to choose between academic work and making more money, should be minimized. 

5. Quantifying the complexity of academic work: On top of needing to tackle academic duties, teaching radiologists also often manage more complex conditions that require additional expertise and time. Experts believe academic radiologists should have CPT “complexity code modifiers” to account for this, like in surgical specialties. “Similar CPT complexity code modifiers could be considered for particularly complex imaging cases,” the authors charged. “An agreed complexity-based upcoding billing framework for image interpretation, which recognizes the true costs and value of additionally complex care, could help ensure more equitable reimbursement.” Technological advances also have led to “exponentially larger number of images” than considered under the original CPT code descriptors, necessitating further revision.