One alternative to selling to private equity or the hospital? An employee stock ownership plan (ESOP), a type of tax-favored internal buyout where practice equity is sold to an employee trust and ownership is transferred over time as stock is allocated to employees.
Terry Godier, writing about the little red unread icons that are part of every app/service in the world:
PHANTOM OBLIGATION (noun): The guilt you feel for something no one asked you to do.
Great term that captures the cognitive and emotional weight of all of the little red dots clamoring for your attention like emergencies.
We’ve been laundering obligation. Each interface inherits legitimacy from the last, but the social contract underneath gets hollowed out.
The red dot on a game has the same visual weight as a text from your kid.
We kept the weight and dropped the reason.
Great essay (and nicely formatted as well).
Isaac Asimov, from his memoir, It’s Been a Good Life:
To me it seems to be important to believe people to be good even if they tend to be bad, because your own joy and happiness in life is increased that way, and the pleasures of the belief outweigh the occasional disappointments. To be a cynic about people works just the other way around and makes you incapable about enjoying the good things.
I come at these sorts of analyses totally primed for confirmation bias, but I really enjoyed this critical view of “Radnet: The AI Story That Doesn’t Add Up,” published by Hunterbrook. The authors argue that:
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RadNet’s much-hyped AI business is a sideshow
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The success of RadNet’s roll up business is also misunderstood
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The truth is buried beneath inconsistent disclosures.
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That “RadNet’s soaring stock relies” on “manufactured profits” based on “adjusted margins that strip out both stock-based compensation and some R&D spending”
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Insiders are cashing out. Over the past two years, RadNet insiders have sold more than 780,000 shares — worth $50.9 million — without any open-market purchases.
It’s a good read.
AI is real, but it doesn’t mean there isn’t a lot of BS and plenty of companies that are going to lose badly. The touted growth of RadNet’s AI business appears, unsurprisingly, “to come from sales to its own imaging centers.” Even when it bought a real company with customers like iCAD, folks were immediately less interested:
That friction played out in real time after the iCAD acquisition. Before the deal, iCAD counted SimonMed, one of the country’s largest imaging chains, which now sells Mammogram+, as a critical customer. Yet almost immediately after RadNet announced the buyout, SimonMed signed on with a different provider, Lunit. The message was clear: RadNet’s potential customers for its DeepHealth business view the company as a predator, not a partner.
No one wants to help a predator by using their software, whether that’s RadNet or Radiology Partners. Since companies that don’t compete directly also make radiology software, the practical addressable market is far smaller than the total market (as long as these guys don’t have something truly unique, truly better, and, ideally, also cheaper).
Then, some of the reported same-center growth appears to actually be the closure and combination of nearby centers. Owning an imaging center can still be a good business, but perhaps consolidation and scale didn’t bring the magical efficiencies folks were hoping for. The roll-up primarily makes it easier for bigger players to buy what used to be a bunch of small businesses; it is, in many cases, a capital game more than an operational one.
RadNet may have a valid business case for closing a center and consolidating, but the move plays havoc with same-center sales math. Imagine two centers, A and B, five minutes apart. Each does $3 million in revenue. Together, they make $6 million in a year. If demand is flat, the next year they’ll still make $6 million. The same-center growth is zero.
Now, say that RadNet closes center B and routes its patients to A. B is gone from the same-center calculation — but its revenue has simply shifted to A, the RadNet location a few minutes away.
So A can show 100% same-center sales growth, thereby helping to drive up the company’s average. But nothing fundamental happened. This isn’t DeepHealth helping RadNet get more business. The volume didn’t grow, it merely changed addresses.
The article goes on. Again, perhaps overly credulous as I am about companies being dishonest to investors and the public, I find this compelling reporting.
One of the greatest issues with stock-based compensation and bonuses is the outsized incentive to make money on short-term storytelling or through other questionable means, even when it’s bullshit or when you are mismanaging the actual business. Over the past few years, slap AI on something middling, and even if it’s vaporware or commoditized features, as long as somebody buys your stock after the story +/- dubious financial accounting maneuvers, you can sell your stock and make your money.
When the article was published in December 2025, RadNet was trading at a serious premium thanks to this AI narrative. It has since fallen:
Seems like at least this specific AI narrative bubble is popping, but not before insiders sold a bunch of inflated stock and probably won the game they were playing.
From the excellent and illuminating Everything is Tuberculosis, written by YA author (e.g. The Fault in Our Stars) John Green:
I want to pause here to note a defining feature of humans, which is that we like to know why things happen, especially when really bad things happen. And if a reason is not immediately apparent, we will find one.
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We all engage in the punitive act of giving a disease a meaning.
The ability to tell a convincing story is very different from the ability to be right. The narratives about TB that Green describes are both historically fascinating and unfortunately still very relevant today.
I would like to make a little collection.
I would love it if you sent me pictures of radiology workplaces over the years, especially but not limited to folks who have been in practice for a while: workrooms, offices, hospitals, scanners and imaging units, computers and computer systems, light boxes, dictaphones, and screenshots or images of software at different time periods. Basically, as diverse and interesting a mix of what the physical and digital landscape has been for working radiology over the decades. Images can have people or just be places, machines, rooms, other objects, etc.
I don’t exactly know what I’m going to do with this, but I think it would be fun to make a tour through time.
You can upload your contribution using this Google Form. (If you can’t use the form, then please feel free to email me at ben@benwhite.com).
A Harvard professor argues there has been an “imaging slowdown” in a brand new paper, mostly referring to data prior to 2020 and even referencing the “Choosing Wisely” campaign as a possible reason for how “the reduction in imaging use has helped to minimize a potential [sic] shortage of radiologists.”
(Note: there is a shortage of radiologists, and, for example, turnaround times sharply rose after the studied period. Also, slowing growth is not a decrease in volume and does not help with a shortage in a stable or declining workforce; even modest annual volume increases compound over time.)
Just as imaging is ground zero for the health care spending slowdown, it might show the way to a new health care system. Radiology is on the front lines of the health care billing and prior authorization travesty. More than 90% of radiologists have some interaction with prior authorization in a year. Often, this interaction is manual in that staff at a radiologist’s office and the insurance company look at records and determine if an imaging test is justified; frequently, radiologists spend hours on the phone getting approval. These administrative costs add to the high price of imaging.
The tech bros don’t have a monopoly on being wrong about radiology. This is an almost nonsensical passage from a person who seemingly has never meaningfully spoken to a radiologist or understands what prior authorization looks like for diagnostic imaging. For the academics out there, one option would be simply getting a collaborator with subject-matter expertise.
As Vinay Prasad once said, “Many papers serve no purpose, advance no agenda, may not be correct, make no sense, and are poorly read. But they are required for promotion.”
(h/t Radiology Business)
The summary list of mistakes from Morgan Housel’s excellent sequel to the Psychology of Money, The Art of Spending Money:
- Direct your gaze at the socioeconomic group just above you, assuming that within it you will find a level of durable happiness.
- Pursue status at the expense of independence.
- Let money—the making of it, the spending of it, the accumulation of it—become a core part of your identity.
- Spend so much of your income that you become completely reliant on the decisions of other people, like bosses and bankers,
- Fantasize that having more money is the solution to all your problems.
- Assume money can solve none of your problems, and that it is the root of evil and ego.
- Have such a fierce saving ideology that you’re never able to treat yourself to a good life you can afford.
- When taking stock of your own life, assume that all your success is due to hard work and all your failure is due to bad luck.
- Compare your inside with other people’s outside, envying others’ success without having a full picture of their lives.
- Ignore the hidden social, emotional, and expectations costs that come from certain purchases.
- Have no sense of your own tendency to regret.
- Associate net worth with self-worth (for you and others).
- Treat all financial decisions as math decisions with no appreciation for reasonable emotion, sentimental value, and desire to feed your soul.
- Be persuaded by the advice and lifestyle of those who need or want something you don’t.
- Anchor your lifestyle expectations to the most successful people you know,
- Become so optimistic that your expectations grow faster than income.
- Risk what you need in order to gain what you don’t need.
- Overestimate the attention you get from having nice stuff,
- Assume you have all the right answers.
In the end:
When you accept how messy money can be, you value good-enough simplicity over the false comfort of complexity.
So:
Spend less than you make. Quietly compound. Money serves you, not the other way around. No one is thinking about you as much as you are. Independence is wealth. Health is wealth. Aim to be a good ancestor. Love your family.
Nothing but simple, timeless truths, most of which you’ve seen before. And yet: Very easy read, good financial CME. Highly recommended.
I wrote “The Radiologist Shortage is Here” in 2023. A new paper in JACR showed that imaging turnaround times more than doubled between 2013-2024, mostly occurring and steeply rising in 2022 and 2023. The author’s conclusion? “These sudden increases suggest that the radiology workforce has reached maximum capacity.”
I read (okay, intermittently skimmed) Walden. The style hasn’t aged all that well, and Thoreau is very preachy…but, this is a good line:
Simplicity, simplicity, simplicity! I say, let your affairs be as two or three, and not a hundred or a thousand; instead of a million, count half a dozen, and keep your accounts on your thumbnail. In the midst of this chopping sea of civilized life, such are the clouds and storms and quicksands and thousand-and-one items to be allowed for, that a man has to live.
Essentialism, minimalism, etc, about 150 years before it became popular again. The best line:
As if you could kill time without injuring eternity.