Consolidation: Listen, Learn, Adapt, Survive and Thrive

From the Chair of the Board of Chancellors

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As a little kid, before ubiquitous ATMs or online banking, I always enjoyed going to the neighborhood bank with my mom or dad. While I didn’t understand paychecks and mortgage payments, I loved that everyone knew my name and my favorite treat: “Would Richie like a root beer Dum-Dum?”

Fast forward 50 years. I now bank at the nation’s largest financial institution — facelessly and electronically. I have visited a brick-and-mortar branch only twice and both times to show identification to open or unlock an account. No one there knows my name — and they surely don’t know my favorite lollipop. Despite the depersonalization, my ability to track and access my money anytime and anywhere makes this an overall favorable tradeoff. Even if it weren’t, there’s no going back to my childhood bank.

Whether in banking or almost any other industry, business consolidation is accelerating nationally and globally — with shareholders and other stakeholders increasingly prioritizing organizational efficiencies over employee and customer autonomy and agency. It’s happening with supermarkets, utilities, airlines, hotels and, not surprisingly, healthcare.

As far as physicians go, radiologists are not the only ones experiencing consolidation. In fact, a recent report indicates that we are overall still more independent than many of our colleagues, with a higher percentage of radiologists still working in physician-owned private practices. But consolidation in radiology, whether driven by not-for-profit health systems, academic medical centers or private equity, isn’t going away. Such change often translates into pain.

Most of us went into medicine to make a difference by helping patients. Physicians practicing patient-centered care thus often find themselves at odds with the productivity-driven one-size-fits-all conveyor-belt care models being pushed by many C-suites. Increasingly, hierarchical and geographically broad health systems can create threats, both perceived and real, to physician autonomy and agency in distinct but often interconnected decision-making domains: practice governance, medical judgment, clinical workflows and work-life balance.

The practice of radiology today is much different than it was when I finished my fellowship 30 years ago. In some ways, it’s worse, but in a lot of ways, it’s better.

“ACR needs to do something!” is a cry I often hear interacting with radiologists across the country. But “something” means very different things to different people. To some, it’s outlawing private equity. To others, it’s banning hospital mergers. To yet others, it’s staying out of the regulatory space, focusing instead on building networks and educational programs to help radiologists adapt to practicing in consolidated systems. In contrast, others tell me they are happily employed as shift-based workers, free of administrative and leadership duties. Regardless of their opinions, almost all agree that they have less autonomy and agency than in the past.

As an ACR leader charged with co-chairing the new ACR Task Force on Consolidation in Radiology, I know the importance of figuring out what the College needs to do — and what it can do. Over the last few months, supported by an incredible ACR staff and Council Vice Speaker and Task Force Co-Chair Eric M. Rubin, MD, FACR, we have embarked on a “listening tour” to help guide ACR’s future activities in this domain. We have led discussions at multiple meetings of ACR’s Board of Chancellors and Council Steering Committee, moderated a plenary open-mic session at ACR 2025, facilitated a breakout “lunch and learn” session at that Annual Meeting and led a moderated virtual all-member town hall in June. As our task force discovery work continues, I have learned a few things.

ACR cannot stop consolidation. Consolidation is an accelerating international trend impacting nearly all industries. The College has neither the power nor resources to turn back time. But there are things we can do to mitigate its impact on radiologists and our patients — and to help our members adapt.

Not all radiologists think consolidation is bad. As former ACR Vice President James Rawson, MD, FACR, wisely stated at the ACR Annual Meeting, the problem isn’t as much consolidation itself, but rather consolidation done poorly. Many radiologists are deliberately choosing to join larger practices of various ownership structures. These organizations can better support the increasingly complex world in which we practice — think regulatory and technology changes — while simultaneously offering them more desirable lifestyles and income. In contrast, other radiologists are frustrated by their inability to deliver high-quality care in faceless systems. ACR clearly has an opportunity to better understand what’s working and what’s not to help members identify and shape organizations that better meet their needs and their patients’ needs.

Most concerns about consolidation are rooted in threats to physician autonomy and agency. Better understanding such threats at both the individual-radiologist and group-practice levels will help the College identify solutions to mitigate the bad and facilitate the good. To be truly member-focused, our thinking and our actions need to acknowledge this core goal.

As with any complex marketplace changes, predictive crystal balls and scenario action plans are imperfect. Neither should stop ACR from recognizing that this trend is both real and important to our members. As ACR begins its second century of service to its members, our mantra remains “Focused, Forward, Together.” Our approach to helping members navigate consolidation relies on all three. Communication about our task force findings and future plans will continue.

Read the accompanying article “Consolidation : What Does It Mean to You?” for more on consolidation and what ACR is doing to educate and guide members through challenges impacting the success and outcomes of practices and patients.