Thousands of radiologists now work for private equity, up sharply from a decade ago

About 12% of all radiologists in the U.S. work for private equity-backed entities, up sharply from estimates tallied 10 years ago, according to research published Wednesday. 

The specialty has seen growing interest from investors, given its high demand and favorable reimbursement rates for imaging services, experts write in the American Journal of Roentgenology. 

Brown University healthcare economist Yashaswini Singh, PhD, MPA, and MD candidate Mihir Khunte aimed to better understand these trends, analyzing info from the PitchBook deals database. They found that private equity acquired 151 radiology practices between 2013 and 2023, with a highwater mark of 26 in 2019.

“Healthcare has witnessed a surge of private equity acquisitions,” the two wrote March 5. “In general, PE firms consolidate fragmented practices within a geographic market to enhance market share and profitability, with PE acquisitions being associated with higher prices and service utilization. Theoretically, PE acquisitions may also enhance access to capital, facilitate technology investments, and improve operational efficiency, although these mechanisms remain understudied.”

Singh et al. manually verified transactions using publicly available press releases, industry reports and practice websites. They also searched the web to identify National Provider Identifiers of practice owners and partners, linking them to Medicare data to identify tax ID numbers. 

The tally included 73 deals identified via PitchBook and 78 more through internet searches. At least one PE acquisition occurred in 34 states and Washington, D.C., during the study period. Texas led the way with 27 acquisitions, followed by Louisiana (17) and Florida (13). All told, about 12% of all radiologists (4,071/34,853) were employed by private equity-backed entities as of December 2023 compared to 1% (282/31,995) in December 2013. This included about 12% of all diagnostic radiologists (3,917/32,557) as of the end of 2023 and 7% of interventional rads (154/2,296). 

The states with the highest percentage of PE-employed radiologists at the end of the study were Nevada (47% or 115/247), Arizona (44% or 316/715), Alaska (29% or 21/72), Texas (27% or 681/2,527) and Florida (24% or 553/2,312). Meanwhile, the private equity-backed practices accounting for the largest proportion of employed radiologists nationally as of December 2023 were Radiology Partners (70% or 2,866/4,071), LucidHealth (8% or 334/4,071), and U.S. Radiology Specialists (7% or 272/4,071). Private equity was associated with 3,463 practice locations in 2023 or about 16% of the 21,556 total across the country. 

The research letter is limited by its possible failure to capture smaller acquisitions or undisclosed transactions, the authors cautioned. Also, certain data were not available between 2014 to 2021, impacting the calculations of percentages. Private equity ownership also comes with some potential upsides, they added. 

“High PE penetration may allow PE firms to negotiate higher reimbursements and increase imaging utilization,” Singh and Khunte wrote. “Although poorly studied, PE firms may also facilitate investments in IT infrastructure and technology. PE acquisitions often shift physician ownership to external investors, transforming radiologists from owner-stakeholders to employees. This shift can result in cultural changes, leadership challenges, and increased productivity demands, potentially exacerbating clinician burnout and turnover. Further research is needed to assess impacts of PE involvement in radiology on healthcare delivery, patient outcomes, imaging access, and the specialty’s workforce, including effects of secondary buyouts and factors making certain regions attractive to PE.”

Researchers published a similar study in the Journal of the American College of Radiology on Jan. 30. Authored by NYU’s Jefferson Chen, MD, the analysis found that corporate-backed entities acquired about 113 radiology practices and imaging centers over the 11 years ending in August 2024. Other private equity-supported entities in the specialty include SimonMed Imaging, Rezolut, Solis Mammography, Premier Radiology Services, Capitol Imaging, Rayus Radiology and MedQuest Associates.