Post-residency, what is the best practice environment for a radiologist?

While in the past the vast majority of radiologists were in private practice, that has changed over the last 10 years or so. Today, approximately half of all radiologists still belong to private practices, while the remainder are taking advantage of a variety of practice options.

What's more , according to an article published this month in the Journal of the American College of Radiology, an increase in imaging volume in the first several years of the 21st Century; the growing importance of subspecialization in imaging; the delayed retirement of aging radiologists; the scarcity of jobs for aspiring radiologists; and the shift of care delivery from inpatient to outpatient settings have combined to drive changes in practice environments.

The authors, led by Sacramento, Calif.-based radiologist Sharon C. Dutton, M.D., pointed out that there are important differences between various practice environments in terms of autonomy, requirements for efficiency and productivity and the proportion of subspecialty and general practice opportunities within these practice options.

Physician autonomy is "a core issue" within these different practice environments, they wrote. For example, while radiologists in private practice traditionally have had a great deal of autonomy, that will change because of the move away from the fee-for-service payment model. In addition, the increasing attention paid to rising imaging costs means that payers are standardizing radiology protocols and interpretation, and curtailing medically unnecessary imaging studies.

"As a result, even radiologists in private practice will be subject to restrictions of autonomy in terms of what procedures will be reimbursed by payers in the future," the authors wrote.

They also pointed out that regardless of the practice environment, radiologists today are faced with increasing demands from stakeholders within the healthcare system to provide better quality, service and accountability. Hospitals, for example, are looking to incorporate "rigorous" service standards into their contracts with radiology groups that deal with issues like report turnaround times, measures of patient and staff satisfaction, and resource use and efficiency.

While generalists make up a substantial portion of radiology practitioners (around 35 percent), an article published in JACR in 2009 reported that more than 90 percent of residents and fellows planned on pursuing subspecialties. There is a growing demand for subspecialists in areas like breast imaging and interventional radiology, but, as the authors pointed out, many small to mid-size radiology departments don't have the resources to support a full subspecialty model, and even in larger practice environments subspecialists will probably have to perform a greater breadth of services to satisfy the demands of the practice.

Consequently, all of the different practice models will vary as far as the degree of subspecialty work they can provide "and that must be factored in decisions about employment options," the authors wrote.

The 2013 American College of Radiology Commission on Human Resources Workforce Survey found that 54 percent of radiologists reported they were in private practice, while 21 percent were in academic or university practice, 10 percent were hospital employees, and the rest worked for corporations or the federal government.

To learn more:
- read the JACR article
- see the ACR's 2013 HR workforce survey

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