Each of the three most prevalent practice models is vying for complete domination of the realm of radiology. And, each of them wants to leave no survivors. They want to capture all the money, glory, and radiologists for themselves! Well, in honor of the up and coming last episode of the Game of Thrones, I figured I would narrate an all-out battle within the radiology Game of Thrones, which is happening right now as we speak.
So, first, who are the players and what are their armaments and defenses against the “battle-hardened troops” of each group? And then, who will be the winners and losers in the battle to obtain the “Radiology Iron Throne”? We will discuss the conflict in detail!
University Radiology
Armaments
Out all of the weapons that the Universities can use to maintain control over radiology, they can manipulate the credentialing boards and legislative bodies such as the American Board Of Radiology (ABR), American College Of Radiology (ACR), and the Accreditation Council For Graduate Education (ACGME). In other words, they can stack these organizations with their members to get the radiologists they want. Want to make it harder to become a mammographer? Just make a new exam! Decide you need to work at a university hospital to provide services for a specific need. Well, let’s make the rules for that. They hold the majority of the political cards and are willing to use it pronto!
Also, who trains the radiologists? The academics, of course! These organizations can manipulate the minds and careers of new radiologists coming out to meet their own needs! Want to lengthen the time to credentialing? (Which they’ve done already by creating the credentialing exam!) Go ahead and have fellows for a few additional years to meet the requirements of these practices!
Defenses
These organizations tend to be large and have lots of money and politics backing them. It is challenging to uproot the Massachusetts Generals and the Columbia Presbyterians of the world. Plus, they have reputations that precede them. If you are planning to root them from the face of the earth, good luck!
Corporate Radiology
Armaments
These large entities can slice and dice the cash flow coming in so that they can create efficiencies that did not exist before. How do they do it? Of course, economies of scale. And they find willing radiologists to join their ranks. How? By offering younger radiologists higher salaries but never giving them a complete slice of the pie when they become more senior.
Plus, they have the backing of large private equity companies who have large amounts of money to throw at the situation to make their cause more viable. Need more equipment or bodies? They can raise more funds and gather up their needs. They have economies of scale in their favor.
Defenses
Many radiologists want to have a quality lifestyle and are willing to pay for it in any way they can. So, they can always recruit teleradiologists, part-timers, and early retirees to fill their ranks. What better defense than having the ability to maintain a constant supply of low paid troops to protect the organizations!
Private Practice Radiology
Armaments
Which organizations tend to be the most efficient and provide the highest long term cost effectiveness for imaging centers and hospitals alike? The private practices, of course. When you have incentives to work, you create these opportunities to save money for the system with good quality healthcare. So, this is their strong point and mantra.
Defenses
Although they do not have large swaths of capital at their back like the other entities, they can recruit new radiologists who want to form long-lasting relationships and are committed to entrepreneurship while taking control of a slice of the pie for themselves. Also, it is very challenging to find new general radiologists to replace the old guard since training programs emphasize subspecialization over private practice. Good luck finding academic subspecialists to read general work in rural areas to replace the current radiologists, especially when the job market now is so tight!
The Battle For The Radiology Game of Thrones: Who Will Win?
The Current State Of Affairs
Well, the fight for the radiology Game Of Thrones is raging on right now. And, the swords are swinging. So, what’s happening in the current market wars?
Private practices have been losing some ground. Why? New radiologists that come out are no longer as committed to the lifestyle of an individual practitioner. Many do not want to perform the sacrifices that need to be made to work for these organizations. Working on weekends and call, indeed, do not entice these new radiologists. Also, programs no longer emphasize training of general radiologists over subspecialization, causing some private practices to wither and die. So, private practice overall has been at the losing end.
On the other hand, the large corporate entities have been enticing new applicants with the promise of a quality lifestyle. They have been the big winners of late. And, these numbers bear out at each of the AUR meetings that I attend. Teleradiology and corporate radiology have been increasing their numbers.
And then, of course, academics have continued along their merry way. They are a steady presence since they control the politics, research, and numbers of residents they produce.
The Future: My Predictions
But, what about the next several years? I mean there are fewer radiologists per job. So, where will they go? Well, corporate radiology can always jack up the salaries of its members when times are good. Therefore, they will continue to recruit well. And, when the cycle reverses, they will continue to squeeze radiologists for every penny they have! But, lifestyle alternatives in corporate structures will continue to trump private practice organizations for most new radiologists.
And, what about the academic radiology world? Well, as long as they continue to maintain control of the politics and entry into radiology, they will be around for a long, long time. They can also promise a better lifestyle for new radiologists as they enter the field as well as have the financial backing to do so. And, for those residents I interested in research and teaching, they will always be an option.
Where will the private practice radiologists fit into the equation? Well, I see continued mergers and acquisitions until the smallest groups can finally compete with the other entities. Only by protecting themselves with increasing size can these private practices compete in the real world. Until then, the overall numbers of private practice radiologists will continue to shrink a bit.
So, there you have it, folks. As we wait for the last episode of the Game of Thrones, we will finally learn who the clear winners and losers are. Similarly, for us, only time will tell if my predictions for the radiology Game of Thrones will come true. For those of us that are fans of the show, enjoy tomorrow’s episode. You will never think of radiology and its different career pathways the same!
