The state of the radiology workforce has affected many practices across the country, but there are ways to navigate these challenging times.
FROM THE CHAIR OF THE COMMISSION ON ECONOMICS
Gregory N. Nicola, MD, FACR
Radiology’s workforce challenge is often defined by a lack of radiologists and too many imaging studies. Beneath this imbalance, practices are experiencing a systems-level clash between how work in radiology has traditionally been designed, performed, valued, and supported.
Across every practice setting, imaging volumes continue to rise while the workforce pipeline expands slowly and unevenly. The traditional response to hire more people has proven insufficient and increasingly expensive, which risks becoming unrealistic in many markets. Frontier radiology organizations are helping to support culture as a primary workforce lever, shaping retention, adaptability and economic resilience in ways compensation alone will not.
Often discussed as a “soft” concept in a constrained labor market, culture can be a competitive advantage. Practices with clear purpose, psychological safety and shared ownership absorb service pressure more effectively, experience lower voluntary attrition and rely less on costly short-term staffing solutions. At scale, this shows up in measurable ways: greater coverage stability, more discretionary effort during peak demand and greater willingness among physicians to flex when systems are under stress. These outcomes emerge from consistent leadership behaviors, transparent decision making and organizational structures that align values with daily work.
A recurring insight from practice leaders is that workforce stress is rarely evenly distributed. High-acuity shifts, subspecialty scarcity and non-interpretive responsibilities often fall on specific individuals, until something breaks. Practices that are adapting successfully are redesigning work rather than redistributing exhaustion.
Methods for redesigning work include a greater focus on subspecialty teleradiology distribution, individualized work effort elections, workflow helpdesks to protect radiologist time for high-complexity work and expanded use of advanced practice providers in procedural and consultative roles. These models work best when radiologists help design them. Shared ownership in decision making increases adoption and durability, especially when tradeoffs are unavoidable.
These models work best when radiologists help design them. Shared ownership in decision making increases adoption and durability, especially when tradeoffs are unavoidable.
In one powerful example, a practice demonstrated culture’s central economic role in retention and transition. When an experienced subspecialty senior radiologist announced plans to reduce clinical work, citing sustained workload intensity, leadership helped reframe it as a bridge to the workflow redesign in the section. The radiologist agreed to a modified role focused on onboarding one new hire and upskilling another radiologist to lead a new team with greater clinical collaboration, conference leadership and expanded technical protocols. Clinical responsibilities on high-intensity shifts were reduced to allow time for mentoring, multidisciplinary conference standardization for handoff, protocol refinement and consultative support to accelerate integration of incoming radiologists.
This structure provided continuity for referring teams and created a safety net for the new team to develop confidence and efficiency for the new workflows. Compensation was aligned to match the non-interpretive contributions and reinforce the notion that experience and mentorship carry value. Such retention strategies are not about accommodation to save a partial full-time employee (FTE) but are geared toward recognizing that institutional knowledge, mentorship and stabilization capacity are economic assets that can help prepare for the future, especially when supply is constrained.
One large group struggling with uneven subspecialty coverage noted chronic backlogs in several areas while others operated below capacity, creating frustration for both referring clinicians and radiologists. The traditional staffing models that focused on incremental FTE expectations and fixed schedules proved increasingly misaligned with individual preferences and evolving demand in the practice.
Rather than enforcing standardization, the group redesigned coverage around capability and individual preference. Radiologists helped co-create variable FTE tracks that allow focused subspecialty work and better aligned daily work intensity as well as overall vacation scheduling to individual preferences. Centralized scheduling and subspecialty pools ensured consistent coverage, and the practice found an additional 10% of extra capacity while accepting a nearly tenfold differential in the FTE contribution, which allowed individuals to contribute where they are most effective.
The result was improved subspecialty access, more predictable turnaround times and higher physician engagement. By aligning individual effort with system needs, the practice increased effective capacity without increasing headcount and demonstrated that flexible FTE design can function as a practical workforce strategy to reduce service pressure.
Importantly, workforce economics in radiology extends well beyond physicians. Technologist and support staff shortages increasingly represent a key constraint on imaging capacity, regardless of technological availability. Practices that ignore this reality risk solving one bottleneck by creating another.
Here again, culture matters. Departments that invest in technologist engagement, predictable scheduling, career development pathways and cross-training demonstrate greater resilience under service pressure. From an economic perspective, stabilizing the broader care team protects throughput, reduces overtime and burnout costs and preserves access — outcomes that directly affect both quality and financial performance.
As ACR prepares for its 2026 Annual Meeting with a focus on culture, the timing is intentional. Workforce pressure is not a temporary disruption, and we must work together to design new solutions to combat this enduring challenge. Practices that thrive will be those that treat culture as part of a deliberate system designed to align people, purpose and economics. Through its leadership in workforce research, quality and safety initiatives, economics and advocacy and forums that convene practice and academic leaders, ACR is actively helping radiologists design cultures and systems that sustain the workforce, preserve access and support high-quality patient care in an era of persistent service pressure. With ongoing change at the federal level, the ACR Annual Meeting offers radiologists the opportunity to learn the latest workforce strategies, share solutions with colleagues and participate in Hill Day to help shape the policies that will define the future of imaging.
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