Radiologists increasingly affiliating with multiple practices, a trend most pronounced among young rads
Radiologists are increasingly affiliating with multiple institutions as telework continues to blend boundaries between organizations and states—a trend that’s especially pronounced among young rads.
That’s according to a new analysis penned by members of the profession and published July 4 in the Journal of the American College of Radiology. Among the 15 most common medical specialties, diagnostic radiologists had both the highest average number of group (2.03) and state affiliations (1.31) as of last year.
This amounts to nearly twice as many (1.7x) group affiliations when compared to all other non-radiologist physicians, experts concluded. Between 2017 and 2024, diagnostic radiologists saw a +2.23% compound annual growth rate in their number of practice affiliations and +1.63% annual uptick for number of states in which they work. That’s compared to roughly -0.12% and +0.14%, respectively, for other physician specialties examined.
“Newly trained radiologists are leading this movement, holding the highest average number of affiliations among their colleagues,” Curtis L. Simmons, MD, MBA, with Phoenix Children’s, and co-authors wrote Friday. “Early adoption of geographic arbitrage by recent radiology graduates suggests that multi-affiliation will become the norm rather than an exception. This may be in part due to the perceived benefits related to work-life balance and caregiving responsibilities that early career radiologists value. Remote options may also lead to expanded career paths, opening up diverse choices for working hours, case mix and compensation.”
Simmons and colleagues obtained their data from Centers for Medicare & Medicaid Service public files. They compared these figures against other specialties such as neurology, cardiology and orthopedic surgery, measuring changes in practice patterns seen before and after the COVID-19 pandemic. Altogether, the analysis included nearly 636,000 unique physicians, who accepted Medicare between 2017 and 2024.
All physician specialties in the study saw an increase in the number of group and state affiliations during this time. However, the trend most impacted diagnostic radiologists, with a more recent graduation year “significantly” increasing their likelihood of having multiple affiliations. Meanwhile, the number of radiologists per state is “closely associated” with population density, with more crowded geographies employing more members of the specialty. Conversely, radiologists in less populous states are likelier to have multiple affiliations.
“All these associations were not only statistically significant but are also economically and practically significant. These results should be used to plan future radiology staffing strategies and radiology recruitment efforts,” the authors noted.
Interventional radiology had the second highest number of group affiliations at 1.63, followed by nuclear medicine (1.5), interventional cardiology (1.35), neurology (1.34), cardiology (1.34) and orthopedic surgery (1.28). On the state side, neurology was No. 2 at 1.14 followed by interventional radiology (1.11) and radiation oncology (1.09). As of 2024, radiologists had between 1 and 36 group affiliations and 1 and 22 state affiliations versus 1 to 27 and 1 to 40, respectively, among other physician specialties. However, when removing extreme outliers, radiologists typically work for between 1 and 10 groups and across 1 and 4 states (vs. 1 to 3 and 1 to 2 for other non-radiologists).
There are likely multiple reasons why diagnostic radiologists have more group and state affiliations than other physicians. They have long benefited from early innovations in teleradiology infrastructure and regulatory acceptance that arose in the 1990s. Plus, advancements in cloud-based platforms, centralized data services and virtual reading rooms have allowed radiologists to perform their work from almost anywhere for years.
Simmons and co-authors believe these continued trends will help radiology practices and departments to support “diverse employment models.” This has begun to shift the radiology job market “in ways that are not yet understood.” They urged imaging leaders to embrace these trends to combat staffing shortages.
“Radiology and multi-specialty groups also have strong incentives to attract multi-affiliated radiologists,” the authors concluded. “By recruiting individuals who can read remotely, these groups can scale their reach across state lines without forcing candidates to relocate. Smaller practices and those in underserved regions, particularly low population states and rural areas, can benefit by gaining access to specialized radiologists who might not be justifiable under smaller case volumes.”
“The long-term consequences of geographic arbitrage by radiologists remain uncertain,” Simmons et al. added. “Possible economic trajectories for radiology include the emergence of ultra-consolidated groups, increased fragmentation of smaller groups, or a mixture of the two spread geographically.”
Read more, including potential study limitations, in the Journal of the American College of Radiology.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.