Economies of scale, the ability to adapt and having a clear purpose in practice culture may bolster radiologists’ business and quality care delivery.
Consolidation in radiology does not mean the sky is falling. If anything, current trends could signal opportunity — in much the same way the pandemic compelled the specialty to pivot and rethink operational strategies. After all, with every challenge comes opportunity. Positive change and seeing consolidation through the lens of what it means for you and your practice begin with making sure everyone is on the same terminology page.
“What can we do for you? That is the most important question,” says Eric M. Rubin, MD, FACR, ACR Council Vice Speaker. “Some of our members think the College should work to stop consolidation. However, the ACR is not an organization that can influence market trends in that manner,” Rubin says. “Our job is to help you as an individual radiologist navigate the professional complexities of what you do, regardless of age or career level.”
“We have gotten ourselves into a very broad discussion of consolidation,” Rubin says. “But it is a mistake for people to view the concept of consolidation as related only to private equity investment in radiology practices.”
As in other medical specialties and even other industries, consolidation has impacted radiology, resulting in a landscape of fewer, but larger radiology groups. With increasing consolidation there has been the growth of ‘corporate’ entities in medicine — defined as entities backed by private equity funding, venture capital or publicly traded corporations. Within radiology, surveys show that many physicians believe these corporate entities negatively impact the specialty.
Corporatization, to many people, refers to the acquisition of radiology groups or practices by non-radiologist-owned, for-profit entities. As such, corporatization is a type of consolidation. Clarification, however, is needed. Most, if not all, radiology practices are organized under a corporate structure. This can result in confusing discussions among people as they may not agree on fundamental definitions.
Consolidation in radiology can be seen as smaller radiology practices combining to form larger entities. This may include private equity firms, universities, or hospital and healthcare systems. However, the ways in which radiology groups come together, are reorganized or dismantled are as nuanced as anything else in business.
Consolidation is not a corporate radiology versus non-corporate radiology concept, Rubin says. “And it is not necessarily corporate medicine that we fear, rather “big” medicine. Corporatization is usually the face of the bad news, but the bad news isn’t always in the form of corporate takeovers,” he says.
“We have to get the wheels turning, to get radiology groups to think about consolidation in a bit of a different way,” Rubin says. “This is really about whether or not radiology has come to a place where economies of scale — in various forms — are a necessary evolution in the practice of medicine and, in particular, radiology .”
We have to get the wheels turning, to get radiology groups to think about consolidation in a bit of a different way. This is really about whether or not radiology has come to a place where economies of scale are a necessary evolution in the practice of medicine and, in particular, radiology.
Economies of scale can be defined as a proportionate saving in costs gained by an increased level of production. This may be applied to radiology — where larger radiology groups may better negotiate with insurance companies, reduce overhead costs, provide a strong IT infrastructure, optimize work volumes across more radiologists and technologists, and invest in and support AI implementation. This concept applies to large academic institutions and multispecialty groups as well.
Would you be better off if you somehow had the ability to leverage scale? “Are we at a point where the market is forcing radiology to consolidate — to create scale that allows groups to succeed in an environment where we see 10% to 15% increases in volume, year after year?” Rubin asks. Add to that increasing regulatory burdens and the strained bandwidth of the workforce and it is not difficult to conclude that the specialty must adapt.
Continued consolidation of radiologists into larger or multispecialty practices may facilitate subspecialization and improved negotiating power in payer contracting. However, radiologists may prefer smaller or radiology-only practices for reasons of autonomy and influence on the practice structure.
Economies of scale can come in many flavors. It can be a consolidation of practices under a corporate umbrella as investor money is used to buy multiple practices and consolidate them. It can be consolidation of practices by large academic institutions, bringing in and employing individual radiologists or entire groups. Or it can be hospitals and multispecialty groups employing large radiology groups or large numbers of radiologists. “ACR data suggests that you are more likely to see employment by these academic institutions and consolidation under academic umbrellas than employed radiologists within corporate radiology,” Rubin says.
“One thing that troubles people stems from the belief that when corporate radiology comes in, they take their cut and they put it in their pockets and don’t reinvest in the practice — and by extension patient care,” Rubin says. Some corporate groups, however, are making large investments in comprehensive AI platforms (as an example) to build efficiencies, he says. “We see the same thing with academic institutions — they have the resources to invest. These are examples of the economies of scale.”
“Economies of scale are important,” says Lauren P. Nicola, MD, FACR, CEO of Triad Radiology Associates, a medium-sized physician-owned private practice in Winston Salem. Nicola specializes in pediatric and breast imaging, holds leadership positions within the ACR Commission on Economics and is a nationally recognized expert in reimbursement and healthcare policy.
“A lot of practices have felt disruptors in the market. Our practice has been impacted indirectly by consolidation,” Nicola says. “We have been able to hire some great radiologists who were unhappy with the sequelae of consolidation in their own systems. From a recruiting perspective, we’ve seen the upside,” she says.
Having more people to do certain things can make life easier, of course. “We know it is difficult for a three- to five-person group to cover nights and specialty reads and the crazy volumes we are seeing,” Nicola says. “Obviously, it’s much easier if you have a larger number of people to do that. You need back-office and IT and other support — including for AI implementation,” she says. “That said, if we keep the radiologists’ voices at the forefront, then we are doing the right thing for our profession and our patients — whatever the practice model is.”
“We need to democratize AI to avoid reinforcing the “consolidated” model of radiology,” Rubin says. “One of my biggest concerns is that if we don’t find a way to democratize AI and find ways to make it broadly affordable and with a clear ROI, we are going to end up reinforcing this consolidated model of radiology,” he says. Why? Because it will only be large, consolidated practices that are going to be able to afford AI. This shift, Rubin says, is going to be a necessary component of radiology in the next five years and beyond.
While the next five years of consolidation patterns aren’t clear, there is plenty of data that reinforces what has been happening in that arena. “We have the data on how radiology ownership arrangements have changed in recent years,” says ACR Principal Market Intelligence Analyst in Strategy Management and Foresight Dominick Parris. In 2023, 8% reported changes, with 10% for 2024. “You may not think that is a significant increase, but it does mean that one in 10 radiologists are seeing a change in ownership,” he says. “Based on the data, I’d bet that figure will only rise in the future.”
“Right now, radiology is almost perfectly split between a paradigm where physicians have some control and where they have nearly none,” Parris says. About one in 10 radiologists (8%–13% across different research) say they work in investor-owned practices (corporate). Recent ACR Member Tracker data found that 32% of practices are owned by hospitals; 32% owned by physicians (the ACR Member Tracker and the ACR Workforce Survey both show this); and more than 40% think of themselves as private practice — more than just those who are in entirely physician-owned practices.
“One of those phrases you’ll hear people says is, “If you’ve seen one radiology practice, you’ve seen one radiology practice,”” Parris says. “Well, if you’ve seen one consolidation arrangement, you’ve seen one consolidation arrangement. Consolidation is a thousand things to a thousand people.”
ACR efforts in advocacy and economics can help you to navigate the professional complexities of today’s healthcare landscape. “But we want to know more about what is keeping you up at night,” Parris says. “I would guess almost all answers would lead back to consolidation, in one form or another,” he says. Worries over volume, understaffing, no bandwidth or resources for training — these concerns run the gamut of practice types and sizes.
Misinformation often exacerbates worries over consolidation, as physicians are bombarded by conflicting representations of private equity backing and corporate takeovers. “We need a common understanding of what is happening out there,” Rubin says. “As it stands now, we don’t have fundamental terms defined that are necessary to make informed plans and decisions.”
At ACR 2025, one open microphone session focused on consolidation — with radiologists, radiation oncologists, nuclear medicine physicians and medical physicists taking part. There were insightful discussions during which members shared personal stories about perceived positives and negatives of a future shaped by consolidation. During the session, members were introduced to the new ACR Task Force on Consolidation in Radiology.
Ordinarily, creating a task force doesn’t exactly turn heads. “But this will be a new type of task force,” Rubin says. “This group’s work will be brief in duration because misinformation and misunderstanding are complicating existing problems. We have already started examining how consolidation in radiology is impacting ACR members, their practices and the specialty as a whole,” he says. The task force (whose goals and composition should be finalized by the BOC this month) intends to report out findings before the next ACR Annual Meeting. “The goal is not to explain how or why consolidation is happening, but to find out what it is doing to radiology and how members might better ensure both their personal success and success of their practices,” Rubin says.
Integrating radiology practices and cultures can be challenging, and staff morale and patient care may suffer in the absence of strong leadership. “From a leadership development standpoint, the ACR’s Radiology Leadership Institute® (RLI) can help,” says Richard L. Duszak, MD, FACR, professor and chair of the department of radiology at the University of Mississippi Medical Center and chair of the ACR Commission on Leadership and Practice Development. “Leaders need to understand the fundamentals of economics and management in radiology,” Duszak says. “RLI’s courses and programs can guide leaders as they work with staff transitioning into new organizational cultures.”
“One of the key concerns I’m hearing as I continue my “listening tour” and think ahead to the work of the ACR Task Force on Consolidation is a loss of agency and autonomy — not only personally but with regard to medical decision making and practice decisions,” Duszak says. “That’s an area where I believe the College can help, particularly with tools for leadership development.”
“Consolidation is a reality — how we respond as leaders is what matters most,” says Anne Marie Pascoe, senior director of the RLI. “The RLI is committed to providing radiologists with practical, actionable resources to navigate challenges like these.”
The 2026 ACR-RBMA Practice Leadership Forum is a key part of that commitment, Pascoe says, and just one of the ways ACR is working to support members through change. “We encourage practices to attend as a team to make the most of the experience and return aligned, energized and ready to lead together.”
Leaders must keep their people in the loop when consolidation looms. “We all need to be speaking the same language when it comes to consolidation,” Parris says. “We need to remember that consolidation is not necessarily bad — consolidation gone wrong is the problem.”
To that end, the College recently hosted a town hall, Radiology’s Reckoning with Consolidation — an ACR all-member event where attendees had an opportunity to learn more about consolidation within the specialty. It was also a chance for ACR leaders and panel experts to hear what radiologists want and need when evaluating and possibly changing the structure or organization of their practices.
To create a clearer path to understanding the implications of consolidation for practices of all types and sizes, moderators and panelists posed a series of questions to fuel the conversation — emphasizing that member input matters to tackle similar challenges together, and to adopt work cultures that will help ensure a successful business model.
“If you’re not at the table you’re on the menu. We must give people what they need to be part of the conversation,” said Duszak, who co-moderated the town hall with Rubin.
With the goal of educating members on consolidation while hearing their individual or shared experiences, the panel posed the following questions:
“We are hard at work on this,” Rubin says. “Share your voice with us. Send us an email. Reach out so we can better understand what you need to navigate consolidation — on your terms.”
By Chad Hudnall, senior writer, ACR Press
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ACR leaders want to hear about the challenges facing your group or practice and how you believe the College can help.
Save the Date: Jan. 30–Feb. 1, Dallas, TX
With sessions focused on practice consolidation, leadership, recruitment and retention and AI, the forum offers practical strategies and real-world tools to help radiologists reclaim agency, lead with confidence and thrive in any practice type or organizational structure.
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