The Evolution and Future of Radiology in the United States

In the last 30 years the landscape of radiology has changed dramatically. Advances in imaging technology have made medical images increasingly detailed, requiring ever increasing anatomical knowledge, but ironically easier for non-radiologist clinical specialists to interpret. Under fee-for-service and with decreasing reimbursement, clinicians have had incentives to assume some of the previously acknowledged imaging services of radiologists. Today, under the Affordable Care Act, American medicine is moving from a fee-for-service system to one of over-arching capitation where reimbursements are fixed by covered lives and risk is transferred to the clinical provider. This inevitably means fewer diagnostic imaging studies, laboratory examinations and other activities that will reduce the margin of the capitated provider. What is unclear is whether radiologists themselves ultimately will be regarded as a luxury that need not be consulted for all imaging. Thus, radiologists are currently threatened not only by an expected decrease in imaging utilization, but potentially also a reduction in their utilization. To maintain their place in medical care, the specialty will need to adapt, assume new roles and reconsider their traditional work model.