Alignment increasingly occupies the thoughts of health-care stakeholders—insurers, legislators, and regulators, but especially hospitals and physician groups. Because alignment sets the stage for service and quality improvements, as well as for the implementation of cost-control mechanisms, the interest is warranted. Hospitals have sought to employ both primary-care and specialty physician practices for the ability to impose quality and cost uniformity through top-down policies, procedures, and cultural mandates.

When hospital executives express dissatisfaction with professional radiology services, local radiology practices should put on their nimble-response shoes and communicate. If they don’t, national teleradiology companies will, and the experience at Stamford Hospital in Connecticut is a case in point.

With the rapid changes in health care, radiology (like other specialties) has had to adapt to survive. Smaller practices have been acquired or consolidated with larger practices. This allows greater emphasis on efficiency, shared risk, and economies of scale. There is also a perceived sense of security that comes with the size of the organization. Larger organizations, in addition, have greater negotiating power with both providers and insurers. These practices have the ability to attract top-level management and administrative talent as well.

In a fast-paced market, the ability to defend a business against (and to take advantage of) disruption is crucial for staying ahead of the competition. Disruptions have traditionally altered the trajectory of many industries: Digital photography has rendered film obsolete, music downloads have diminished CD sales, and tablets have largely replaced netbooks

As a most tumultuous year comes to a close, let’s reflect a bit on what makes the people of the United States unique, what drives us toward achievement and success, and why the health-care institutions in this amazing country will continue to thrive—despite significant headwinds and uncertainty. Our cultural DNA is structured in a way that makes it certain that whatever it is that needs to get done, we will get it done.

There was a time, not long ago, when radiologists were either organized into private practices or employed by academic medical centers. Today, they have more options. Representatives of different practice models—from teleradiology to hospital employment to megapractice/multispecialty-practice membership—vary in their views of increasing service and performance demands (and their business, clinical, and lifestyle implications).

Every year, when we produce the ranking of the nation’s largest private practices, we are reminded of the contributions that radiology makes—not just to the health of the nation, but also to its economy. For a number of reasons, the profession has fostered many large and exceedingly complex organizations that employ—in the case of Radiological Associates of Sacramento in California—up to 900 people.

You know how good it feels. You finally did the right trade and now own Boardwalk and Park Place. Everyone who has the misfortune of landing on your block of expensive property pays through the roof, and you smile all the way to the bank. It is great fun owning a monopoly—unless, of course, you have those pesky regulators at your back, asking