Unionizing Radiology: A Potential Response to Increasing Corporatization.

Abstract

Recent work has highlighted the trend of consolidation within radiology and health care at large [ 1 Fleishon H.B. Vijayasarathi A. Pyatt R. Schoppe K. Rosenthal S.A. Silva E. White paper: corporatization in radiology. J Am Coll Radiol. 2019; 16: 1364-1374 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. Traditionally, the practice of radiology has been highly fragmented, organized into local and regional practices, owned by radiologists. In the past few years, there has been an increase in local practice acquisitions by corporate-, venture capital–, or private equity–backed national entities (NEs), described collectively herein as “corporatization” [ 1 Fleishon H.B. Vijayasarathi A. Pyatt R. Schoppe K. Rosenthal S.A. Silva E. White paper: corporatization in radiology. J Am Coll Radiol. 2019; 16: 1364-1374 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. Corporate acquisitions in radiology have trended upward since 2000, when there were 0 transactions to a recent peak in 2015 when there were approximately 50 publicly disclosed transactions [ 1 Fleishon H.B. Vijayasarathi A. Pyatt R. Schoppe K. Rosenthal S.A. Silva E. White paper: corporatization in radiology. J Am Coll Radiol. 2019; 16: 1364-1374 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. As such, the radiologist workforce is in a period of transition from equity partners in small practices to employees and minority shareholders of large NEs. Though the structure and terms of each practice sale differ, the common tenet is that radiologists exchange their ownership stake for a mixture of cash or stock considerations in the larger NE, with future radiologists joining the practice as employees of the larger NE. According to the ACR 2018 Workforce Survey, approximately 6% of radiologists are currently practicing in a corporate structure, although this number may be underreported [ 2 Bender C.E. Bansal S. Wolfman D. Parikh J.R. 2018 ACR Commission on Human Resources workforce survey. J Am Coll Radiol. 2019; 16: 508-512 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar ]. If this trend continues as projected, the private practice radiologist workforce could soon be predominately organized into a few large employers. Over time, this may shift disproportionate control into the few employers that capture the largest market share and out of the hands of practicing radiologists. One potential response to the impact of corporatization in radiology is for radiologists to organize into a labor union. This commentary will briefly review the history and role of labor unions in the United States, outline the potential benefits of labor organization in radiology, and highlight the concerns and obstacles that may be encountered.