The U.S. radiology workforce has been consolidating over the past number of years, resulting in larger group practices and fewer single-specialty ones, according to a new study published online April 2 in the Journal of the American College of Radiology. But how will the consolidation trend affect patients?
Fewer single-specialty practices could result in less access to radiology services for patients, wrote a team led by Dr. Andrew Rosenkrantz of NYU Langone Medical Center in New York City.
"As large groups increase in attractiveness for new physicians, remaining smaller practices in rural or other underserved areas may have difficulty in recruiting new members, which may be particularly problematic for ensuring access to interventional radiologists and other radiology subspecialists," Rosenkrantz and colleagues wrote.
Physicians are practicing in a different environment today than they were a decade ago, and they now face pressure from the government and insurers to improve healthcare service quality, control costs, and coordinate care among their patients, according to the researchers. But how this trend toward consolidation is manifesting in radiology hasn't been clear.
To address the question, the group conducted a study to assess trends in U.S. radiology practice consolidation using data from 2014 to 2018 from the Medicare Physician Compare database. The team classified radiologists by largest practice affiliations and identified single-specialty radiology practices using practice names.
The team found considerable consolidation of the radiologist workforce in a relatively short timeframe. The number of smaller practices shrank, while the number of larger ones grew.
| Consolidation trends among individual radiologists | ||
| Group size | 2014 | 2018 |
| 1 to 2 members | 3.2% | 2.1% |
| 3 to 9 members | 10.2% | 6.7% |
| 10 to 24 members | 18.2% | 14.1% |
| 25 to 49 members | 16.6% | 15.1% |
| 50 to 99 members | 13.3% | 11.5% |
| 100 to 499 members | 15.7% | 21.8% |
| More than 500 members | 22.9% | 28.7% |
At the practice level, the team found the following:
- The percentage of all practices with 1 or 2 members decreased from 26.9% in 2014 to 22.8% in 2018.
- The percentage of all practices with 100 to 499 members increased from 7.6% in 2014 to 10.2% in 2018.
- The percentage of all practices with 500 members or more increased from 2.5% in 2014 to 4.1% in 2018.
Single-specialty practices showed similar trends: Between 2014 and 2018, the percentage of radiologists affiliated with single-specialty practices declined 21.2%, from 2,812 to 2,216.
It's true that larger groups can access operational and financial benefits from economies of scale, find greater access to capital and technology, and more easily participate in population-based care and alternative practice models, as well as federal and private payor value-based payment programs, Rosenkrantz and colleagues noted.
But it's not clear whether consolidation actually improves quality, cost, or access to care. That's why it's important to carefully assess the effects of consolidation, according to the researchers.
"Further investigation is required regarding the impact of radiology practice consolidation on patient-centered outcomes," the team concluded.
