Changes in the practice landscape that have grown out of necessity with economic and regulatory pressures are creating a difficult environment for radiologists to thrive in.
By Elizabeth Y. Rula, PhD
Executive Director, Harvey L. Neiman Health Policy Institute®
In 2025, for the third year in a row, AuntMinnie.com named radiology workforce shortages as the biggest threat to radiology. The runner-up in the latest “awards” was increased imaging volumes. Classic supply and demand issues are creating enormous stress for radiologists and creating unparalleled practice management challenges. Our work at the Harvey L. Neiman Health Policy Institute® (Neiman HPI) offers a clearer understanding of the driving forces behind these workforce issues and is helping shape policy to ensure workforce sustainability and patient access to imaging. This edition of Research Rounds provides an update to ACR members on the workforce landscape, including the interrelated factors that are influencing sustainability and sufficiency of the radiologist workforce.
The COVID-19 pandemic sent a shockwave through the U.S. and had the aftershock known as the “Great Resignation,” when an unprecedented number of U.S. workers quit their jobs in 2021 and 2022. The initial wave of workforce exits across sectors transitioned into the “Great Reshuffle” in which workers have increasingly left their jobs for roles with better work-life balance and that better align with their values. Flexibility and hybrid work are a deciding factor for many workers, particularly of younger generations.
The healthcare sector is no exception. According to a December 2025 report by the Health Resources and Services Administration (HRSA) National Center for Health Workforce Analysis, there will be a projected shortage of 141,160 full-time physicians in 2028 in the U.S., translating to 89% adequacy relative to demand. The shortage is estimated to grow slightly to a deficit of 158,990 physicians (88% adequacy) by 2038. There is variation in adequacy across specialties, and radiology is estimated to be in a slightly better position than physicians on average, with 90% adequacy in 2038.
The results of the new HRSA report mirror findings from recent Neiman HPI publications that focused specifically on the national radiologist workforce and projected workforce size and imaging demand out to 2055. Our work found that if radiologist attrition stays at post-COVID-19 levels, then the workforce will be 20.9% larger in 2055 than it is today, assuming there is no change in residency positions. This growth fell within the range of projected imaging growth by 2055: spanning from a 17% increase in MRI to a 25% increase in CT.
What do all these data points tell us? Basically, the radiology workforce shortage is going to remain fairly static — not worse, but also not better — if no action is taken. To help inform solutions to the current gap between supply and demand, the Neiman HPI is exploring the specific factors underlying the aggregate trends, and the work to date has revealed interesting insights about which segments of the workforce are at highest risk of attrition.
With respect to attrition, a 2025 HPI study published in collaboration with Jay R. Parikh, MD, FACR, found that radiologist attrition rates in the U.S. more than doubled from 2014 to 2022, from 1.1% to 2.5% each year, respectively. Although there was a sharper increase in 2020 during the height of the COVID-19 pandemic, the attrition rates had already increased from 1.1% to 2.0% from 2014 to 2019. In other words, growing radiologist attrition was occurring well before the pandemic. However, these rates differed according to certain radiologist characteristics. The largest difference we observed was between subspecialists and generalists, with subspecialists being 37% more likely to leave the workforce. Additionally, nonacademic radiologist attrition was 37% higher than academics and female radiologist attrition was 26% higher than males, who averaged 1.9–3.5 more years of practice, depending on the nature of their practice.
Differences were also evident across different practice types. Attrition was approximately 20% lower among radiologists in multispecialty practices with one dominant specialty (radiology or other) compared with radiology-only and diverse multispecialty practices. Practices with one or more rural sites had 16% higher attrition than practices without any rural sites.
If the larger forces cannot be readily changed to reverse this cycle, then other solutions to promote workforce sustainability must be considered.
Subspecialty radiologists being 37% more likely to exit the workforce was a striking finding that we are seeking to understand in greater detail. For example, is this effect driven by specific subspecialties or are attrition levels relatively uniform across subspecialties? Early insights came from an HPI workforce study focused on pediatric radiologists that found a decline in the absolute number of these subspecialists (defined as performing at least 50% of work in pediatric patients), from 2,190 in 2016 to 2,032 in 2023. This absolute decline in number is the inverse of the trend among all radiologists, which have grown in number despite increasing attrition. Accordingly, pediatric radiologists have had an even sharper decline as a proportion of all radiologists, dropping from a 6.4% to 4.6% share during this period of time. These findings show that certain subspecialties are affected more than others and that developing a deeper understanding of the subgroups and practice types most affected can allow for more targeted solutions to mitigate existing workforce shortages.
Other workforce dynamics are also at play among those radiologists who remain in the workforce. Practice consolidation in radiology is growing — and, similar to workforce shortages, mirroring the broader healthcare trends. A 2024 HPI study found that the number of medical practices with affiliated radiologists decreased 14.7% from 2014 to 2023, even though the number of radiologists increased 17.3%. As such, the average number of radiologists per practice increased from 9.7 to 17.9 radiologists (+85%) over that period. Consolidation is occurring amid economic pressures including decreasing reimbursement, size-advantage in insurance negotiations, growing reporting requirements through the CMS Merit-based Incentive Payment System and legal liability — all while managing high imaging volumes that have grown faster than the number of radiologists.
Overall, the consolidation trend is leading to larger practices that are shifting away from radiology-only practices to multispecialty practices. The number of radiology-only practices declined more than any other type, shrinking by almost one-third from 2014 to 2023 (−31%). Conversely, the number of multispecialty practices grew by 12%. The average practice size nearly doubled during this period, increasing from 45 to 89 physicians. Radiology-only practices that remained in 2023 were 75% larger than the average size in 2014.
One may ask how consolidation is impacting radiologist practice patterns. We investigated this and found that consolidation is linked to growing subspecialization among radiologists. Radiology-only practices are the only category that are majority radiology generalists (65%) — all multispecialty practice types are mostly comprised of radiology subspecialists. When our researchers modeled shifts between general and subspecialty practice, we found that when a radiologist’s practice closes (i.e., acquired by a larger entity), they are more likely to practice as a subspecialist in their next practice. Although nearly all radiology residents pursue fellowship training, as noted above, radiologists practicing as subspecialists are more likely to leave the workforce.
Is this a vicious cycle? The changes in the practice landscape, which have grown out of necessity with economic and regulatory pressures, are creating a difficult environment for radiologists to thrive in. Small private practices are being absorbed by larger entities. Radiologists are leaving practice entirely at over twice the rate that they were less than 10 years ago — perhaps due to burnout. Imaging volume continues to rise as the population ages. Technology advances and the inappropriate use of imaging remains pervasive (which I discussed in a prior Bulletin article). If the larger forces cannot be readily changed to reverse this cycle, then other solutions to promote workforce sustainability must be considered. These potential solutions are not easy. Practices are implementing AI to reduce task-load and improve efficiency while adapting workplace culture to improve radiologists’ well-being and job satisfaction. The number of residency positions continues to increase to fill the gap, but this is not a short-term fix given the years of training required.
While each of these solutions can help maintain patient access to radiologists, ultimately the volume of imaging cannot continue to grow without perpetuating the current cycle of adverse pressures on practicing radiologists.
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