Changes in the Radiology Practice Landscape and Indicators of Practice Consolidation From 2014 to 2023

BACKGROUND. A range of economic and health policy incentives are leading to ongoing consolidation among payers, hospitals, and physician practices. OBJECTIVE. The purpose of the present study was to evaluate consolidation among radiologists' affiliated practices through 2023, analyze the impact of consolidation on such practices' specialty mix and size, and assess radiologists' new affiliations after prior practices cease. METHODS. CMS data from 2014 to 2023 were used to identify all radiologists nationally along with their affiliated practices. Based on the specialty mix of all affiliated physicians, practices were categorized as radiology only or multispecialty; multispecialty practices were further categorized as radiology majority, other specialty majority, or no majority specialty. Practices that ceased (i.e., became absent within CMS data) were identified. Temporal shifts were assessed to infer consolidation patterns. RESULTS. From 2014 to 2023, the number of radiologists enrolled in Medicare increased 17.3% (from 30,723 to 36,024), whereas the number of affiliated practices decreased 14.7% (from 5059 to 4313). The number of radiology-only, radiology-majority, other-specialty-majority, and no-majority-specialty practices changed by -31.8% (from 3104 to 2118), 10.9% (from 402 to 446), -5.7% (from 615 to 580), and 24.6% (from 938 to 1169), respectively. The number of practices with one to two, three to nine, 10-24, 25-49, 50-99, and 100 or more radiologists changed by -18.7% (from 2233 to 1815), -34.4% (from 1406 to 923), -25.2% (from 910 to 681), 33.2% (from 352 to 469), 121.6% (from 125 to 277), and 348.5% (from 33 to 148). A total of 3494 practices ceased, including 2281 radiology-only practices. Among 3854 radiologists whose only affiliation was a ceased radiology-only practice, their subsequent-year affiliation was a radiology-only practice in 54.3% and a multispecialty practice type in the remaining instances. CONCLUSION. An overall decrease in the number of radiology practices and concurrent growth in the number of radiologists was mirrored by shifts from small toward large practices and from radiology-only toward multispecialty practices, consistent with ongoing practice consolidation. Although determining the causes of consolidation was beyond this scope of this study, the shifts may relate to economic incentives and legislative changes favoring large multispecialty practices. CLINICAL IMPACT. The continued consolidation of radiologists into large multispecialty practices may facilitate subspecialization and greater negotiating power in payer contracting. However, radiologists may prefer smaller and/or radiology-only practices for reasons of autonomy and influence on practice structure.