Practical advocacy, strong data and broad engagement across every practice setting will ensure a strong economic future.
FROM THE CHAIR OF THE COMMISSION ON ECONOMICS
Lauren P. Nicola, MD, FACR
As I begin my term as chair of the ACR Commission on Economics, I am struck by both the extraordinary opportunity and the extraordinary pressure facing our specialty.
Radiology sits at the center of modern medicine. Nearly every clinical pathway depends on imaging, yet the economic structures that support our work continue to face sustained strain. Reimbursement instability, increasing administrative burden, workforce shortages, rapidly rising operational costs and the accelerating integration of AI are reshaping how radiologists practice, and how practices survive.
This is not a temporary challenge; it is a defining moment for our specialty.
For years, radiologists have delivered value while being asked to do more with less. Repeated Medicare payment reductions, budget neutrality adjustments, site-of-service shifts and payer policies that often undervalue the cognitive and consultative work of radiologists continue to threaten practice sustainability. Staff shortages and technology investments further compress already narrow margins. At the same time, demand for imaging services continues to rise, and patients need timely access to high-quality imaging more than ever.
The Commission on Economics has a critical responsibility: to ensure that radiology remains not only clinically indispensable, but economically sustainable. Our work must help create an environment where practices can invest in quality, innovation, workforce development and patient access. Several current priorities will define our efforts in the coming years.
Our work must help create an environment where practices can invest in quality, innovation, workforce development and patient access.
First, we must continue to advocate for fair, stable and predictable reimbursement. The annual cycle of payment uncertainty is unsustainable for physician practices and health systems. Cuts to the Medicare Physician Fee Schedule (MPFS) and private payer contracts disproportionately affect specialties like radiology that rely heavily on advanced technology, highly trained staff and substantial infrastructure. Payment policies must recognize the full value radiologists provide. We not only interpret images, but juggle consultations with referring physicians, protocol optimization, quality oversight, AI governance, radiation safety, multidisciplinary collaboration and leadership in patient care pathways. Sustainable reimbursement is not simply a professional issue; it is fundamentally a patient access issue. The Commission on Economics must continue working closely with advocacy leaders to advance policies that reduce friction, promote evidence-based imaging and hold payers accountable for transparent and fair reimbursement.
Second, we must address the growing operational burden facing practices of every size. Rising labor costs, shortages of technologists and support staff, increasing compliance requirements, cybersecurity risks and major capital investments in imaging equipment all create significant financial pressure. Smaller independent groups, rural practices and safety-net institutions are especially vulnerable. As consolidation accelerates across healthcare, preserving diverse practice models — including independent and community-based radiology — must remain a priority.
Third, we must lead, not react to, the economics of AI. It is already influencing workflow, efficiency and expectations around productivity. But its economic implications are only beginning to emerge. We need thoughtful frameworks for adoption, valuation, workflow integration and reimbursement that strengthen radiologists rather than commoditize them. AI should support quality, reduce inefficiency and improve patient care, instead of becoming another mechanism for undervaluing physician expertise. Radiologists and the specialty should define these standards, not respond to them after the fact.
Fourth, we must continue to define and communicate radiology’s value in an increasingly value-based healthcare environment. Too often imaging is viewed as a cost center rather than as a driver of diagnostic accuracy, treatment planning and improved outcomes. We know radiology prevents unnecessary procedures, reduces downstream costs and improves clinical decision-making across nearly every specialty. If we do not clearly measure and articulate those contributions, others will define our value for us. Data-driven advocacy must remain central to our mission.
My vision for the Commission is straightforward: practical advocacy, strong data and broad engagement across every practice setting. Academic and private practice, urban and rural, hospital-based and independent — we all share a common economic future. The challenges may look different across settings, but the underlying issues are deeply connected.
I also believe our work must be collaborative. The best solutions will come from listening closely to members who are navigating these pressures every day. The Commission should serve not only as an advocate, but as a forum where those real-world experiences shape policy and strategy.
Radiology has always adapted to change. Our challenge now is to ensure that adaptation happens on our terms with patients, physicians and the long-term strength of our specialty at the center. I am honored to serve in this role and look forward to working with all of you in the years ahead.
Reflections on What We’ve Accomplished Together
Through a global pandemic, pressure on the Medicare conversion factor, the emergence of AI and more, the ACR Commission on Economics did not just react — it led.
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A New Era for the Commission on Economics
Outgoing Chair Gregory N. Nicola, MD, FACR, reflects on recent wins — and his hopes for the future of the Commission and the specialty.
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Workforce Economics
The state of the radiology workforce has affected many practices across the country, but there are ways to navigate these challenging times.
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