Consolidation may be driving radiologists away from practicing as generalists
Consolidation in the imaging industry may be driving radiologists away from generalist practice, according to new research published Monday.
Previous research has documented the growing subspecialization of the radiology workforce, with rads increasingly focusing on one part of the profession such as breast imaging. Researchers with the Neiman Health Policy Institute recently examined how radiology consolidation might be shaping this trend, sharing their findings in JACR.
They found a clear correlation, with radiologists who experienced a practice closure more likely to operate as subspecialists afterward. This amplified likelihood is distinct from the overall trend of increasing specialization in radiology, established in previous studies, the authors emphasized.
“Hence, closure among practices with radiologists may be associated with increased subspecialization beyond the general trend,” Eric W. Christensen, PhD, research director of the Neiman Health Policy Institute, and co-authors concluded. “Given ongoing consolidation trends—and our observation of greater subspecialization among radiologists in larger and multispecialty practices—the results of our study suggest that consolidation in radiology is a factor contributing to greater subspecialization of the workforce.”
For the study, researchers used Centers for Medicare & Medicaid Services data spanning 2014 to 2022 to analyze radiologists’ practice patterns. Those who dedicated less than 50% of their workload in a single segment of imaging were defined as generalists while those who crossed that threshold were labeled subspecialists.
The year-over-year increase in the share of radiologists practicing as subspecialists was about 2.5 percentage points following a practice closure, the study found. That’s compared to about 1.8 percentage points for those whose practice did not close. Radiologists who experienced a workplace closure had roughly 10% higher odds of practicing as a subspecialist the following year, after adjusting for various mitigating factors, the authors determined. Physicians with more years of practice, in larger doc groups, and operating in multispecialty organizations were significantly associated with increased subspecialization after closure.
The 10% uptick is above and beyond the 21% higher likelihood of subspecialization among all radiologists that occurred between 2014 and 2021. During that same time, the percentage of radiology subspecialists rose from about 45.6% up to 57%, noted Elizabeth Rula, PhD, study co-author and executive director of the Neiman Health Policy Institute. Those working for an organization with at least one rural site were less likely to practice as subspecialists, a difference that could potentially exacerbate disparities.
“Growing subspecialization in medicine has the benefit of advanced expertise for complex care, but it can also cause access challenges for care across more common clinical needs,” Rula said in an Oct. 27 announcement about the study results. “The increasing trend toward practice consolidation may inadvertently affect the distribution of subspecialization in the field of radiology. In particular, we observed a rural/urban difference in subspecialization trends that could result in discrepancies in access to specialized care.”
The study did not attempt to determine why radiology practice closures might lead to increased specialization. However, the authors speculated such closings might push rads toward larger and potentially multispecialty groups, with greater opportunity to focus on one specific area of imaging. Additionally, rads may desire to practice within a specific subspecialty because of interest in the field or fellowship training, with joining a larger practice affording them this opportunity.
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.