Radiology Market Consolidation

[Bbqchickenman]

Can you guys address the move toward consolidation of radiologists becoming employees of major health systems? Can this lead to centralized reading centers, where fewer radiologists cover multiple outpatient imaging sites and maybe even low volume community hospitals owned by the health system? This surely would lead to a decreased demand for radiologists, layered on top of owning them as employees... i can definitely picture a scenario where CMS could then slash reimbursment until radiologists are paid like $200k

I’m worried that could be the scenario 15-20 yrs down the road.

-Lost MS3

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[Cognovi]

Group consolidation and hospital employment/ownership are trends across medicine, not just radiology.

I don't see how these issues would decrease demand for radiologists and lead to reimbursement cuts.

 

[Bbqchickenman]

If fewer employers own the jobs, physicians become price takers and lose all bargaining power.

As they consolidate, fewer jobs translates to physicians willing to take salary cuts in the conpetition for a spot.

My worry is that radiology may be uniquely susceptible among the fields because radiologists don’t have patient panels like say a cardiologist. They are much more mobile than direct patient care providers that serve a local population.

Was wondering if you guys have some views that argue against that kind of trend.

 

[scootad.]

There is a fair amount of consolidation in Radiology. But its nowhere near as extensive as in Pathology nor as widespread as Anesthesia or ED (yet). There are still a good number of independent private practice groups all over the country. In fact, many of the largest corporate groups (Envision, RadPartners, etc.) have been having trouble filling because they can't provide competitive offers to newly trained Rads compared to the more traditional practices.

 

[Bbqchickenman]

There is a fair amount of consolidation in Radiology. But its nowhere near as extensive as in Pathology nor as widespread as Anesthesia or ED (yet). There are still a good number of independent private practice groups all over the country. In fact, many of the largest corporate groups (Envision, RadPartners, etc.) have been having trouble filling because they can't provide competitive offers to newly trained Rads compared to the more traditional practices.

Has this trend driven compensation decline yet? If so what has been the extent?

I heard that rads used to be on top of the food chain but have suffered since 2009

 

[scootad.]

No, rads salaries have held up for the past several years. There was a dip ~5-10 years ago due to a law called DRA (Deficit Reduction Act), where they started bundling codes and paying less for certain types of advanced imaging, but things have stabilized since then. I prefer not to discuss #s on public boards like this one, but suffice it to say, consolidation has not had much impact on this aspect (as far as I'm aware).

Now, Telerads is a different can of worms and a whole other discussion.

 

[scootad.]

Also, beware that just because things are a certain way now, is not a predictor of the future.

 

[TCOM12]

Pick a subspecialty because you like it, not for the compensation.

A lot of the pay is based on region. Some of it is also getting lucky.

When it comes to the politics, the ACR is one of the top 3 subspecialty lobbies. They are the ones who make sure that we get fairly compensated.

 

[Tiger100]

If fewer employers own the jobs, physicians become price takers and lose all bargaining power.

As they consolidate, fewer jobs translates to physicians willing to take salary cuts in the conpetition for a spot.

My worry is that radiology may be uniquely susceptible among the fields because radiologists don’t have patient panels like say a cardiologist. They are much more mobile than direct patient care providers that serve a local population.

Was wondering if you guys have some views that argue against that kind of trend.

I dont' see why consolidation results in less demand. In fact, the opposite happens. Private practices usually are more efficient and their radiologists read more cases. Once they become employees, usually the number of radiologists go up because of decrease in efficacy.

And if a community hospital becomes part of a major health system I don't see how other physicians can work independently. For example, in Kaiser system I don't see how cardiologists can negotiate for higher salary or if a cardiologist wants to leave Kaiser how they can take the patients with them to their own office. Also most hospitals have their physicians sign non-compete clause for good reasons. The only bargaining power that some clinicians especially surgical fields happen is at the time of transition between a well established private practice to employee position where they can negotiate for a little better terms (like 10% bonus or ....) but it will go away after probably 2 years of being employee and does not exist if they don't have a well established practice. It is a one time during your career that may not even happen.

But I want to talk about something more important.
If you choose your career based on only compensation, you are going to be miserable. I guarantee that. Now if you tell me that you are interested equally in primary care and neurosurgery (very unlikely scenario), I will tell you to go into NS. But except for the outlier, most specialists make similar salary and 50K or even 100K more or less should not be a game changer for you because the location, the type of job that you choose, your working hours and your investments will have more impact on your total saving eventually.

No matter what you choose, you will make more than enough money. Choose the field that you like more.

 

[RadiologyExternships]

There is a fair amount of consolidation in Radiology. But its nowhere near as extensive as in Pathology nor as widespread as Anesthesia or ED (yet). There are still a good number of independent private practice groups all over the country. In fact, many of the largest corporate groups (Envision, RadPartners, etc.) have been having trouble filling because they can't provide competitive offers to newly trained Rads compared to the more traditional practices.

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The job market is smoking hot right now in Radiology and Teleradiology. Plenty of jobs and practice opportunities to go around. Plenty of increasing demand with aging baby boomers, clinicians losing the art of the physical exam, and all patient management ever dependent on the Radiologist's utterances. There is consolidation but there are still a LOT of private practices out there.