Collins Career Corner

Still Top Choice for Rad Grads—But is Allure of Private Practice Fading?

October 7, 2019

When you’re preparing to spread your radiologist wings and—practice, you face some vital decisions that will impact your future, namely, choosing the right practice type.

In this next series of blog posts, we’ll explore the different practice types in greater depth with the aim of providing insights that may assist in your decision-making process and ultimately, empower you to feel confident you’re making the right choice. 

We’ll begin our expedition in the realm of private practice.  

In the days of yore (say, twenty-five years ago), a graduating radiology resident or fellow would be asked, “Are you going into private practice or academics?”  

In those days, the questions young radiologists faced about their career futures were, perhaps, simpler. Although these remain the most common practice types, and indeed most radiologists go into private practice, other practice environments have emerged that are replacing private practice positions.  

This post gives a big-picture overview and some key context.  Note: radiology practice types have been defined by the ACR [1] and those definitions are used in this and upcoming posts.

ACR definition of private practice: radiologists or ancillary personnel are employed or are partners or shareholders in a private physician-run practice whether practicing in a hospital or office.

The origins of the species known as private practice radiologists 

The independent private practice model emerged in the 1960s and 1970s when legislation allowed licensed professionals to incorporate [2].  Around the same time, the entity now known as CMS, allowed the separation of technical and professional fees as components of radiology practice. 

Thus, a fee-for-service system was born and became the prevailing mechanism for physician reimbursement throughout most of the US [2].  The capacity to issue separate billing made for many happy radiologists. This is because private radiology practice profits greatly from a fee-for-service model.

Then, the rising cost of healthcare prompted the federal government and payers to reexamine the traditional fee-for-service payment model and seek alternatives that could reduce cost while preserving outcomes. Sounds great in theory, but it has spelled bad news for some radiologists. Any change to the fee-for-service model has the potential to dramatically impact radiologist reimbursement, especially in the private practice environment. Private radiology practice is less well-positioned for the transition to a new form of healthcare reimbursement with bundled payments and decreased reimbursement.

Other changes afoot

There are several other major factors contributing to the changing nature of private radiology practice today. 

  • Advances in digital imaging and information technology have facilitated the proliferation of teleradiology services to provide 24/7/365 interpretations to hospital systems around the country.  
  • National radiology groups have emerged and radiology groups have grown larger as a result of consolidation.
  • Hospital systems are buying traditional private practice radiology groups to create large hospital systems, employing physicians to manage care in an accountable care organization environment.  

Diminishing perks of private practice 

The trend towards consolidation can be seen as something of a double-edged sword. Larger-sized practice groups are capable of providing subspecialty expertise and have greater leverage to work with larger health systems in a shared risk environment.  On the other hand, larger-sized groups reduce the independence of individual physicians in decision making.  

Traditionally, private practice groups offer more autonomy to its members compared with other practice types, allowing members/partners to dictate their own standards of performance and efficiency, and determine their own work schedules, benefit and compensation structures, and group governance. 

Now, this leads us to the crux of the matter. Since coming into existence, private practice has been the prevailing radiology practice model, representing 41% to 57% of radiologists from 2012 to 2018—but the percentage of private practice radiologists used to be larger [3]. 

In sum

Many of the distinct benefits and most enticing aspects of private practice are changing. 

The salary and volume differentiation between academics and private practice has narrowed. Academic radiologists are generating more RVUs than they did in the past and private practice radiologists are not making as much money as they did before reimbursement cuts.  

Most graduates will still go into private practice, but that number is shrinking (slightly) due to the aforementioned changes and new considerations now in play. 

For some, what may have once been deciding factors in a decision between private or academic practice, for example, may no longer carry as much weight.  

Stay tuned – upcoming posts will continue the discussion of private practice as well as alternative practice types.

Reference

  1. Bluth EI, Cox J, Bansal S, Green D.  The 2015 ACR Commission on Human Resources workforce survey.  J Am Coll Radiol 2015; 12:1137-1141
  2. Dutton SC, Sze GK, Lund PL, Bluth EI.  Radiology practice environment: options, variations, and differences – a report of the ACR Commission on Human Resources.  J Am Coll Radiol 2014; 11:352-358
  3. Dunnick NR.  Employment in radiology is even higher in 1998.  Acad Radiol 1998; 5:868-869