-outsourcing= No. Licensing/Medicare laws, hospital privileges too tough for this to have a significant impact
-self referral= Tough to say, probably wont change. Some private insurers are already buckling down. Increasing media attention.
-manpower shortage= Will correct. Increasing #s of residency positions, increasing efficiency with PACS and night hawk services.
-depletion of academic staff= Correcting as # of residency grads increases and academic pay scales increase to be more competitive with market conditions.
-something else= Clinician vultures trying to bite a piece of the radiology pie more and more, especially in IR.