From an article about RANT’s fight with BCBS in Radiology Business:

Under the No Surprises Act, enacted by Congress in 2020, physicians and payers can settle disputes over out-of-network healthcare services. This is meant to protect patients from unexpected bills, which proponents say the NSA is achieving. Radiologists and other docs are reportedly winning in the “independent dispute resolution,” or IDR, process at a high clip. The law allows these outside arbitrators to issue binding decisions for imaging and other services, but health insurers are now refusing to pay up afterward.

Radiology Associates estimates it has prevailed in about 95% of finalized IDR disputes with Blue Cross Blue Shield of Texas, the state’s largest insurer. However, more than $3.5 million in awarded balances remain unpaid. RANT estimated that $1.64 million of this total has been outstanding for over 120 days. As of Tuesday, BCBS Texas has paid approximately 2% of awarded balances.

RANT also expressed concern about restrictions around how radiology practices can batch together claims to be submitted to the IDR process. Current rules force the practice to divide similar claims into thousands of smaller arbitration filings, each carrying separate filing and IDR fees. Under current federal interpretation of the law advocated for by BCBS of Texas, Radiology Associates says it will file over 68,000 payment batches, with total administrative cost of nearly $53 million. Under an ideal process, RANT estimated it would have submitted 1,369 batches for a total administrative tally of $1.05 million.

Say what you want about the NSA, but it’s the law of the land. Losing in binding arbitration and then not paying the awards is bullshit. If an insurance company doesn’t like the awards when they lose, they can negotiate in good faith and get the physicians back in-network.

Also, the interpretation to limit the batching of essentially identical claims to tiny numbers will only make the process more cumbersome, less efficient, and more expensive. It also makes it challenging for real practices with limited cashflows to afford, which is, of course, the whole point. It’s a terrible implementation of the law.

I believe in the importance of thriving independent private practices for the field of radiology. True private practice—where doctors control the organization, are responsible to their peers and patients, and earn the full fruits of their labor—is the benchmark that sets the market and provides the anchor against exploitation from unscrupulous employers.

My group, like most groups in this market, is hiring. Here are several more 100%-independent radiologist-owned private practices across the US that are recruiting. If you’re in the market for a new position, consider reaching out with your CV. (Click the triangles for more information.)

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Radiology of Huntsville

(Huntsville, Alabama)

ROH is 60+ physician, high volume, private practice with a 2-year partnership track and nominal buy-in. Hiring for a remote partnership-eligible overnight position as well as onsite/remote openings in most subspecialites. Huntsville is a tremendously livable, high-tech, and growing mid-sized city (a #1 Best Place to Live in the U.S. by U.S. News and World Report).

Learn more at www.radiologyofhuntsville.com.
Contact: Brandy McCown at bmccown@radhunt.com or call 256.713.0621.

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Midwest Radiology

(Minneapolis – St. Paul, Minnesota)

Large 175+ subspecialized practice with 17 weeks of vacation. Two-year shareholder track for new graduates and a one-year track with experience.

Positions (On-site):

Positions (Remote):

Learn more at www.midwestradiology.com.
Contact: Barry.Lindo@MidwestRadiology.com

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South Texas Radiology Group

(San Antonio, Texas)

STRG is a well-established, expanding, independent subspecialty practice of 70+ radiologists serving 15 hospitals, multiple freestanding ED facilities, and a large outpatient imaging practice (STRIC). Both onsite and remote positions are available.

STRG is a forward-thinking practice with a strong and cohesive culture. Multiple AI projects are in place and in progress to improve efficiency and quality. Internal moonlighting opportunities are available.

Shareholder Track:

• Flexible associate period as short as 18-months.
• Leads to full partnership with board of directors membership.
• Equity ownership within a large expanding outpatient imaging practice (STRIC)
• Competitive salary with up to $800K starting salary for experienced applicants. Up to $600K starting salary for inexperienced applicants.
• Excellent benefits package
• Onsite and work-from-home options for daily work and call
• Hiring across all specialties, with a current emphasis on Body Imaging and Cardiothoracic/Body

Emergency Radiology Track:

• 1 week on/1 week off (7/7) and 1 week on/2 weeks off (7/14) positions available
• Competitive salary with excellent benefits package available.
• Fully remote and onsite options available.

Employee Mammography Position (Onsite):

• Competitive base salary with excellent benefits package
• No call. No nights or weekends.
• Remote opportunities available for general radiology or body imaging work if interested.

Employee Position – All Subspecialties (Onsite, Hybrid, or Remote ):

• Competitive base salary with excellent benefits package
• 5.5 weekends (day shift) per year. No evening or overnight call.

Learn more at https://stric.com/.
Contact: Waynea Finley at wfinley@strg-pa.com

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Reno Radiological Associates

(Reno, Nevada)

Serving Northern Nevada since 1947, RRA is a strong, highly subspecialized, democratic, extremely collegial, high-earning group of 25 radiologists working in perhaps the best city in the country for raising a family and enjoying unparalleled access to natural beauty, endless outdoor activities (perhaps the best ski-city in the US), and incredible weather (jokingly referred to as “the cheapest city in California” for its proximity to Lake Tahoe (<30 min), Napa Valley, national parks, and more without the super high cost of living and no state income tax).

Shareholder Track (onsite):

• 1 year to 75% partner, 2 years to 100%
• Top 90+% comp nationally, maximally generous benefits
• 8/9/10+ weeks of vacation
• Remote shifts + opportunities for extra income, $100 buy-in

Employee Track (remote or onsite):

• High comp, Maximally generous benefits, opportunities for extra income
• Onsite preferred, fully remote night available (8p-3a PST)

Independent Contractor:

• Flexible shift options, high compensation

Learn more at http://www.renorad.com/
Contact: CEO Anthony Dispenziere at adispenziere@renorad.com

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Vantage Radiology & Diagnostic Services

(Near Seattle, Washington)

~35 subspecialized radiologists practicing near Seattle and enjoying a quality lifestyle focused on work-life balance, located minutes from urban amenities, and with easy access to abundant outdoor activities in the natural beauty of the Pacific Northwest. We’ve provided professional services for two hospitals since 1970 and are co-owners of their affiliated imaging centers.

• Competitive salary ($370-570k) with a signing bonus for a 4-day work week and 8 weeks of vacation.
• Benefits include a CME allowance, memberships to professional societies, profit-sharing, malpractice and disability insurance, 401K contributions, and a commitment to associate mentorship.
• All partners and partner-track associates share in general call responsibilities (many from a practice-provided remote home workstation). Overnight call is covered by our internal nighthawk team.

Openings:

Learn more at https://www.vrads.com/
Contact: recruiting@vrads.com

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Kettering Network Radiologists

(Dayton, Ohio)

Kettering Network Radiologists, Inc. (KNRI) is a physician-owned, independent private practice serving Kettering Health’s extensive network. Our team consists of 56 radiologists, 8 physician assistants, and 8 radiology residents, providing high-quality imaging services across  8 hospitals (115-500 beds), 20 outpatient centers, 11 emergency departments, and 2 trauma centers (one Level II, one Level III).

When working ER or night shifts, you are never alone—always part of a team. We are a stable, well-compensated group, enjoying flexible scheduling with very comprehensive benefits.

Contact: Dr. Rachel Shikhman at rachel.shikhman@gmail.com

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RAPA

(Central Arkansas [Little Rock, Conway, Searcy, and Pine Bluff] & Northwest Arkansas)

40+ radiologists covering 20+ sites (hospitals + clinics) with a multi-subspecialty mix of inpatient, outpatient, and ED imaging.

Robust reading room assistants and IT presence to promote peak efficiency. Unified Clario reading list, Inteleviewer PACS, Powerscribe dictation (no switching stations or PACS to read other sites). RadAI automated impressions to improve efficiency.

Greatest needs are IR, mammography, body imaging, MSK, and nuclear medicine, but all subspecialties and general radiologists are welcome.

Learn more at http://rapaxray.com/
Contact: recruitment@rapaxray.com and Dr. Brandon Kelly at bkelly@rapaxray.com

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Eastern Radiologists

(Greenville & Coastal North Carolina)

Eastern Radiologists is a private practice in Eastern North Carolina that is physician-owned and operated and seeking to hire multiple radiologists due to growth and retirement. The well-established private practice serves a large geographic region through 14 area hospitals and several state-of-the-art imaging centers. Support is provided by nearly 70 subspecialty radiologists.

Currently seeking candidates in all subspecialties.

Details:

• Positions are available in Greenville and other coastal communities in Eastern North Carolina.
• Most are partnership track positions which include evening and weekend call responsibilities, but other employment options can be considered. Employment positions can be customized to fit desired schedule/income. Internal moonlighting is available for extra income.
• Most specialties can work nearly 100% in their desired field of interest.
• Great benefits, competitive salary including profit sharing and bonus, generous vacation and paid family leave, and business/educational discretionary account.
• Sign-on bonus

Learn more at https://www.easternrad.com.
Contact: Erica Askew at easkew@easternrad.com

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Radiology and Imaging Specialists

(Central Florida: Lakeland/Winter Haven, SW Orlando, Bradenton)

Independent and long-standing group covering a diverse mix of financially sound hospital partners, outpatient imaging centers, an ASC/OBL, clinics, and a multi-specialty group. 50+ radiologists and 10+ midlevel providers. In-house and experienced IT, Credentialing, HR, and Admin team including dedicated Radiology Liaison support 24/7/365.

Recruiting for Body, Breast, Cardiac, Neuro, IR, and General.

Partnership Track:

• 1-year track for diagnostic radiologists, 2-year track for interventional radiologists
• 10 weeks of vacation
• Sign-on bonus for diagnostic radiologists
• Call compensation for interventional radiologists
• Internal moonlighting available but not required
• Full benefits including CME allocation

Employee or Contractor:

• Flexible scheduling: Hospital (ED/IP) or outpatient coverage options available
• Fully remote, hybrid, or on-site depending on location(s) and coverage schedule desired
• Competitive compensation models (including benefits if employed/full-time)

Learn more at http://risimaging.com.
Contact: Alice Varnadore, Executive Assistant at avarnadore@risimaging.com

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Mecklenburg Radiology Associates

(Charlotte, North Carolina)

Established in 1917 and fiercely independent, MRA is a well-respected subspecialized practice of 60 radiologists and growing. They especially take pride in their group culture (seriously, there are some really nice people in that group including one of my old senior residents).

Partnership track:

• 3-year partnership track with 8 weeks of vacation per year
  $400K starting salary and an additional $75K sign-on bonus ($125K with 2+ years of experience)
• On-site daytime hospital and imaging center coverage. Hybrid evening and weekend call coverage, including the option to read from home.
• Available positions: Breast, Body, Cardiovascular, Neuro, Light IR, MSK, Nuclear Medicine, and General

Employee track:

• Fully remote, hybrid, or on-site options
• Competitive salary
• Available positions: MSK, General, Overnight ER, Swing Shift ER, Neuro, Body, and Cardiovascular

Learn more at www.meckrad.com/recruitment.
Contact: Morgan Reitz at mreitz@meckrad.com.

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Inland Imaging

(Washington, Oregon, Montana)

Inland Imaging is a 120+ radiologist-owned private practice proudly serving multiple outpatient, clinic, and hospital sites throughout the Inland Northwest region. We own and operate one of the first outpatient interventional labs in the West in addition to 7 outpatient imaging centers.

Our practice:

• Sub-specialty interpretations available across all locations.
• All studies are accessible on a common PACS system, one common voice recognition system, and one common worklist
• Internal Nighthawk System providing final interpretations on all ER, STAT, and Inpatient Exams. 24/7 Neuroradiology Coverage and IR Call Coverage.
• 2-year Partnership Track.
• Full-Time Radiologist Average Time Off = 15 weeks with the ability to decrease or increase total time off.
• Average after-hours obligations = 9 weekends per year and 22 evening/swing Shifts.
• Salary Range – $499,454-$624,318
• Full Benefit Package including health, vision, dental, disability, and life.
• 401k match, profit-sharing contribution, and cash balance plan.
• Hybrid Work Options

Current Openings:

• Remote overnight ER
• Neuroradiology (choice of Spokane, Seattle, Walla Walla, Tri-Cities, or Missoula)
• Washington
  • Tri-Cities (with $75k signing bonus)
    • Breast
    • Neuro
    • MSK
  • Spokane
    • Pediatrics
    • Breast
  • Moses Lake – General/Breast (with $90k signing bonus, $20k relocation benefit, and annual retention bonus)
  • Colville – General/Breast
• Montana
  • Missoula – IR
• Oregon
  • Pendleton – General/Breast

More information about these positions can be found on our Independent Radiology listing.

Learn more at https://inlandimaging.com/careers
Contact: Sarah Russell, CEO at srussell@inlandimaging.com

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If you’re a group looking to advertise, get in touch. The monthly post here is limited to just a handful of groups at a time, but last year, I launched Independent Radiology as a resource for the broader community, a dedicated private practice radiology job board featuring 160+ groups. If you’re in the market, please also check it out for your job-hunting needs.

After last week’s post about Radiology Partners’ new time-based work units, a reader helpfully shared a spreadsheet with the whole schema: the codes of millions of exams across the portfolio used in its calculation, their RVUs, their TBWUs, and the percentage adjustment for emergency, inpatient, and outpatient contexts. The spreadsheet has 4362 data rows, but it’s interesting, and I think the analysis yields some meaningful insights.

It’s just a huge table, so no methodology or explanation is contained, and we are still left to infer some of its motivations (which I did in the first post, I think correctly). We don’t know, for example, how “time-based” any of this really is. Whether well or poorly conceived, any custom system creates winners and losers, and the RP system is no exception.

Several RP rads have reviewed this data and feel that it’s accurate to their experience so far. I’ve asked around, and seemingly no one, including local practice leadership, had this data. The new system, until now, was essentially totally opaque at this level of detail. I assumed it would take time for some enterprising (or frustrated) individual rads to create even a partial picture from their personal dashboards. Instead, we have a snapshot during its first month in operation (I wouldn’t count on us getting the next iteration). As always, if something here is factually incorrect, I welcome correction from RP directly.

The high-level summary: big bump to plain films at the expense of overall hits to body CT and neuro CT/MRI as well as a general devaluing of ED work. On the breast side, a huge cut to screeners for a not quite commensurate increase for diagnostics. For IR, no delta. GI fluoro still isn’t fair.

The file sums to 47.8 million exams covering the period of 1/1/2025 through 3/9/2026. I’m not sure what if anything the difference between that and the referenced 52M exams on the recent email announcement signifies (I’m guessing nothing, or perhaps some outlier practices were excluded). That overall data foundation is a little less impressive as a baseline for novel weighting when you realize that 9.7M of that is just chest films, but it’s undeniably a big number and a lot of data.

System-wide and volume-weighted, the new TBWU production comes out to 99.7% of 2026 RVU production, so unsurprisingly very close to zero sum on day one, as promised (the only politically survivable way to roll out a proprietary work unit).

However, since the spreadsheet doesn’t break down exam volumes by ED/IP/OP, it’s actually impossible to know if there’s any baked-in reimbursement decline, since we don’t know the relative percentages for how those weightings are applied. It’s possible they net to zero as one would hope/assume, but that doesn’t have to be the case looking back, let alone going forward. Some codes are always valued higher, some are always valued lower, and some depend on the context. (In case you’re curious, the theoretical absolute lower bound using only the worst ED/IP/OP modifier for each code [which isn’t actually possible] would be 95.2% of RVUs.)

Regardless, averages don’t tell stories, because not everyone reads a general equal mix of the 4000+ exam codes.

Plain Films Ate Everything

On the whole, plain films increased +81% from 3.6 million RVUs to 6.6 million TBWUs. That single modality absorbs about 3 million net units of redistributed credit out of a total 5.6 million units increased where TBWU>RVU, more than half of the total upward adjustments.

Some examples:

• XR chest 1-view: 5.4 million exams. RVU 0.18 → TBWU 0.317. +76%.
• XR chest 1-view portable: 1.75 million exams. RVU 0.18 → TBWU 0.317. +76%.
• XR abdomen (KUB): 900k exams. RVU 0.18 → TBWU 0.392. +118%.
• XR lumbar spine 2-3 views: 450k exams. RVU 0.21 → TBWU 0.394. +88%.
• XR fingers (various flavors, ~160k exams combined): RVU 0.13 → TBWU 0.393. +202%.
• XR bone age hand: 21k exams. RVU 0.19 → TBWU 0.869. +357%.

I’m told that after the go-live of the new system, the plain film backlogs evaporated. Generalists and those reading heavy volume plain films are the short-term winners in this system.

Make no mistake, by RP’s own admission vis-à-vis Mosaic, this is temporary. Bumping XR at the expense of CT and MRI allows them to subsequently lower XR thanks to AI-drafting and ultimately skim more revenue off the top.

I won’t pretend to know exactly how they’ll do it. They may just lower TBWU as suggested previously. They also could make practices “internal customers” for their tech and “pay” for those Mosaic drafts as a way to avoid making the TBWU skim look too depressing on the daily productivity meter. By doing so, when they eventually start trying to peddle Mosaic to external customers, they can promise the RP groups that they’re getting a “special deal” or a “preferred rate.”

The ED / IP / OP Question

System-wide, volume-weighted, the multipliers land here:

• ED multiplier: 1.007
• IP multiplier: 1.143
• OP multiplier: 1.010

Inpatient reads are worth about 13% more than ER or outpatient reads on average, which presumably accounts for sicker patients, extra comparisons to pull, etc. That sounds fine.

But averages don’t tell the story here, because ED is discounted relative to OP for most of the highest-volume codes:

• XR chest 1 view (5.4M exams): ED 0.277, IP 0.393, OP 0.337
• CT head without contrast (2.8M exams): ED 0.654, IP 0.846, OP 0.665
• XR chest 2 views (2.5M exams): ED 0.266, IP 0.387, OP 0.259
• CT abdomen/pelvis with contrast (2.1M exams): ED 1.428, IP 1.829, OP 1.518
• XR chest 1 view portable (1.75M exams): ED 0.277, IP 0.393, OP 0.337
• CT abdomen/pelvis without contrast (1.0M exams): ED 1.380, IP 1.720, OP 1.397
• CT cervical spine without contrast (951k exams): ED 0.747, IP 0.930, OP 1.136
• XR abdomen 1 view (KUB) (901k exams): ED 0.351, IP 0.411, OP 0.393
• CT chest without contrast (703k exams): ED 1.437, IP 1.503, OP 1.486
• CT chest angiography with contrast (697k exams): ED 1.363, IP 1.510, OP 1.588

The logic for an ED penalty is presumably a shorter “average read time” in part based on the overscanning of normal people. But “average time to read” and “actual cognitive effort per read” are not the same thing. Part of the issue with the premise of this time-based weighting for an ER reader is that part of the faster read-time for ER cases is not the simplicity but the turnaround time pressure. It’s often stressful, rapid-fire work by necessity, not by default.

For any per-click ED and teleradiology contractors that RP uses to cover nights and weekends, a meaningful chunk of the ED worklist just got repriced downward relative to its RVU value and its IP/OP counterparts. If productivity thresholds don’t follow, individual carveouts made, and/or bonuses adjusted, then  effective compensation falls. I’ve already heard from ED and neuro readers that they’re looking elsewhere.

Modalities Paying for the Bump

The modalities that funded the plain-film bump, volume-weighted:

• CT: −10.5% (net −2.0M units)
• Mammography: −14% (net −650k units)
• MR: −7% (net −410k units)
• US: −2% (net −110k units)
• DEXA: −46% (net −70k units)
• Nuclear medicine: −19% (net −55k units)

Several big-volume and high-dollar CT/MRI workhorse codes got trimmed 15–25%:

• CT head without contrast (2.8M exams): RVU 0.83 → TBWU 0.680. −18%.
• CT abdomen/pelvis with contrast (2.1M exams): RVU 1.77 → TBWU 1.463. −17%.
• CT cervical spine without contrast (950k exams): RVU 0.98 → TBWU 0.767. −22%.
• CT chest angiography (700k exams): RVU 1.77 → TBWU 1.402. −21%.
• MR brain without contrast (500k exams): RVU 1.44 → TBWU 1.120. −22%.
• MR brain with and without contrast (360k exams): RVU 2.23 → TBWU 1.670. −25%.

You can read this two ways. The charitable reading is that the RVU system universally undercompensates plain films relative to a plethora of more desirable CT/MRI exams, and TBWUs attempt to correct for that, maybe even based on actual measured read times. The less charitable reading is that RP has looked at which study types Mosaic will make cheaper to produce and is setting itself up to reprice the work accordingly. These are not entirely mutually exclusive.

A subspecialized neuroradiologist takes a real hit in this system.

The Mammography Trick

Mammo has been extremely popular with trainees in recent years thanks to many flexible, no-call job openings and high-income opportunities, in large part due to the growth and generous reimbursement for screening tomosynthesis.

• Screening mammography with tomosynthesis is cut from RVU 1.33 → TBWU 0.778 (−41%) across 2.7 million exams.
• Whole diagnostic mammography bucket (622k exams, every diagnostic variant): RVU 1.412 → TBWU 2.571, +82%
  • Diagnostic tomosynthesis subgroup (550k exams, the dominant slice): RVU 1.487 → TBWU 2.586, +74%

Breast imaging as a modality loses about 650k units, or −14% volume-weighted. There are plenty of people, even breast imagers, who would agree that diagnostics are unpaid relative to screeners, but making this change is a serious adjustment to breast compensation, and it especially devalues a portion of the telemammo workforce, cutting the reimbursement for highly popular screening moonlighting by almost half, and only propping up the nonnegotiable must-staff-every-day part that deals with real-time patients.

This is exactly the kind of cut-then-compensate pattern you would expect for AI-assisted work. Screening mammo has always been one of the biggest targets for AI: the exam quality is guaranteed, the training sets are massive, outcomes data available, and the reporting is completely standardized. Drafts are coming very soon, but screeners are already fast. I wouldn’t be surprised if, after a couple of years of data collection, a very small number of people (maybe just the head of breast) are putting their name on a ton of basically autonomous negative screener reports for a couple of bucks a pop with humans only meaningfully reviewing the positives.

GI Fluoro is Still a Terrible Deal

I guess fair accounting for time doesn’t apply to fluoroscopy, since there’s no way anyone would consider these bumps to sufficiently account for the effort and time spent on these examinations unless most RP fluoro is performed by PA/NP/RAs?

• FL esophagus barium swallow with video (95k exams): RVU 0.52 → TBWU 0.610. +17%.
• FL esophagus barium swallow (63k exams): RVU 0.59 → TBWU 1.023. +73%.
• FL upper GI single contrast (28k exams): RVU 0.78 → TBWU 1.034. +33%.
• FL upper GI double contrast (12k exams): RVU 0.88 → TBWU 1.096. +25%.
• FL barium enema single contrast (5.6k exams): RVU 1.01 → TBWU 1.507. +49%.
• FL barium enema double contrast (1.5k exams): RVU 1.23 → TBWU 1.496. +22%.
• RF double contrast esophagram (7.2k exams): RVU 0.68 → TBWU 0.897. +32%.

Not sure how one justifies this except that seemingly no radiologists choose to do fluoro anymore; fluoro chooses you. You don’t need to incentivize it if you don’t have a choice: it’s not readable remotely, moonlightable, and no one will ever cherry-pick it.

Some other random highlights:

• Everyone’s favorite ultrasound was ruined: US lower extremity veins bilateral (275k exams): RVU 0.68 → TBWU 0.343. −50%.
• Nuclear cardiology was destroyed? SPECT perfusion changes range from −23 to −84% (but the majority are NM heart perfusion SPECT multiple, which was reduced 71.6%).
• A bilateral renal ultrasound (RVU 0.72 → TBWU 0.628) went down and is worth less than a unilateral, which went up (RVU 0.57 → TBWU 0.703).
• There are some random changes to very low-volume exams. For example, a rare unilateral breast MRI (~240 exams) was decreased 12% (RVU 2.05 → TBWU 1.807), whereas bilateral breast MRI (91k exams) was increased 19% (RVU 2.24 → TBWU 2.665). There are other examples of low volume as well as similar (but differently named) exam types presumably slipping through the cracks and being valued in somewhat arbitrary-seeming ways.
• “RECON” ordereables are valued wildly different than the same de novo scans, ranging from −41% to +45%. Not sure how much that makes sense, especially when they are sometimes read by the same person and sometimes not.
• IR was completely untouched (probably because it would cost too much to pay them fairly in a time-based system).

Takeaways

The study types most obviously in Mosaic’s near-term pipeline—plain films, screening mammography—are the ones with the most aggressive repricing. Plain films up now, to be cut later once the AI is more helpfully reading them. Screening mammography cut now while diagnostics are up, which is the distribution you’d expect in a world where AI handles the screening triage and the human reads the flagged cases; it presumably means RP is okay losing a significant fraction of their remote telemammo workforce. I wonder by next year how many screeners the head of RP breast and/or chief of breast AI will have their name on.

Time-based clearly doesn’t include procedures, as IR was left untouched. GI fluoro was bumped, but clearly “time-based” also doesn’t really reflect a simple weighted average of time spent.

The ED discounting on several high-volume codes and the contractor-hostile implications of the ED repricing are all consistent with a system optimized for one thing: extracting efficiency from the diagnostic read workflow as AI takes on more of it, while giving RP maximum flexibility to recapture that efficiency at the enterprise level.

For discussion in the broader radiology community, I’d like to share Radiology Partners’ March 9th announcement email regarding their new time-based work unit system.

I was really hoping to get more specific examples of this system after the April 1 go-live, but from what I’ve gathered, the transparency on the system is generally low, and most people really don’t know exactly what’s happening under the hood. If anyone from RP would like to provide concrete examples, I would absolutely love to share them.

I’m not including a small partial table circulating online, as I cannot verify its accuracy. The consensus I have heard consistently is that ER-style CT is down (head CT, c-spine, CTA chest); brain MRI is down; screeners are down, and diagnostic mammo is up; plain films are up.

The official language from RP does not describe the methodology. I’ve heard that exam weighting is different by context (ER, inpatient, outpatient), but I’m not sure how much. This would be more fun/interesting/fruitful if we had a fuller picture. Nonetheless, we can still discuss some consequences of this move regardless of the specifics, because the discussion here does not hinge on whether the actual custom weighting used today is bad/wrong.

RP Colleagues,

As you’ve heard from your leadership, your practice is moving to time-based work units (TBWUs) on April 1, 2026. This unit of measuring work is being implemented across all RP practices to ensure equity and transparency, creating a unified approach to scheduling, cross-practice coverage and compensation.

Note the framing. “Equity and transparency” is the marketing. “Unified approach” is the actual product. A PE-backed aggregator that has always insisted its practices are “locally led” is now standardizing the core work unit across every practice it owns.

I don’t think RP has a buyer, but certainly, finally exerting more operational dominance over its flock would be important to shoring up the argument that it is a single, stable, cohesive business.

Custom units can create new winners and losers overnight, so even the same system would feel different to radiologists if it were something built collaboratively by the team that everyone agreed to and not something forced onto it. Without transparency, such a change requires incredible and ongoing trust.

To inform this change, RP’s Clinical Transformation Team performed an in-depth analysis of a large, diverse dataset of 52M exams across most RP practices and all subspecialties to ensure statistical significance. TBWUs measure work based on the average time required to read an exam.

Fifty-two million is a big number. It also happens to be 52 million exams read by rads who were compensated on RVUs, where many radiologists are incentivized to cherry-pick and crush high-RVU studies.

Radiologists also know that exam type is only part of the puzzle. Context and complexity matter a lot. It’s easy to say that screening mammography and brain MRIs are overvalued, but there is a big difference between a non-contrast stroke protocol brain MRI and a GBM follow-up. In the example table floating on the internet, a non-contrast chest CT was valued higher than a CTA chest. The only way that would make sense is if we are ignoring context and letting healthy young person chest pain CTAs drown out cancer and chronic lung disease noncons.

Any time-based metric derived from this dataset inherits the distortions of the system it’s replacing. The CPT code is a terrible metric for effort, but just moving the slider up and down and down to get people to stop letting non-con chests, thyroid US, and plain films pile up is a crude lever.

It seems as though the exams that linger on a cherry-picked list are the ones that have been bumped by this system, so exam desirability is being tweaked, and the need to address pileups in the backlogs may be a significant weighting factor. But once rads are incentivized under the new system to crush plain films—which, oh by the way, are exactly the studies Mosaic is being positioned to pre-draft—those times will fall. And when RP applies the same methodology to recalibrate, the numbers will presumably move again. This is not going to be a one-time change; it is the beginning of a perpetual motion machine, and the initial settings are based on what’s backlogged or what Mosaic can/can’t do.

TBWUs offer:

Equity, balance and accuracy: Aligns compensation and productivity with actual time, not billing distortions.

In theory, complexity- and effort-based internal RVUs are fine, maybe even the exact right thing to strive for. I’ve written about them before. Some physician-led private practices run custom, zero-sum internal systems where total internal production matches CMS numbers in aggregate, and the group decides how to weight specific work relative to that total. That can work. It works when there’s transparency, governance, and buy-in. It works when the people affected by the weighting are the people doing the weighting.

Implementation and governance are the whole game. They’re also where corporate central planning has the hardest time earning trust. “Locally led” becomes a hollower phrase every time one of these corporate-wide pronouncements lands in the inbox.

Simplicity and transparency: Creates a predictable structure for compensation, enabling equitable comparisons across practices using one standardized measure.

The real transparency test is whether RP publishes the underlying data or at least the full breakdown. Show RP rads the distribution of read times by CPT code across those 52 million exams. Show how ED versus IP versus OP TBWUs were derived to see if even the pretense of context impact is respected. Show the process for future adjustments—who approves them, on what cadence, and with what rad stakeholder input. Publish the change logs.

I don’t know the size of the governance committee, but I strongly suspect they, like the RUC, will provide recommendations and not decisions. That power is almost certainly with the executive leadership, likely the CMO.

A standardized measure that only the standardizer can see inside of is not transparent. It’s just standardized.

Better support for practices: Enables a unified approach to scheduling, cross-practice coverage, compensation, workload balance and flexibility to adapt as payers, reimbursements and external environment shifts.

The need for practices to cover for each other in an insufficiently staffed enterprise would seem to be a key feature here.

Quality care: Creates conditions to balance workloads, allow for cross practice coverage and protect time for more complex exam types.

Reasonable in theory. RVUs aren’t great. Everyone agrees that GI fluoro is undervalued, for example.

If the system actually did this, it might even work. If each CPT code gets an emergency, inpatient, and outpatient weighting, that might even get part of the way there. But the reality is that even different groups and locations have different relative complexity. Level 1 trauma cases will be different on average from Level 3 trauma, even if both types of patients are in the ED. At most three buckets per code is a very coarse instrument in the AI era.

FAQs

Why can’t we stay on RVUs?
They reward reimbursement patterns, and because of how they are created and adjusted they are subject to potential political imbalances.

The RVU system’s flaws are well known, but “they reward reimbursement patterns” is the same thing as saying “they are based in shared reality.”

There is a meaningful difference between a flawed system where everyone in American radiology plays by the same rules and a proprietary system where one corporate owner sets the rules for the subset of the field it happens to own. The latter means the winners and losers are chosen by your boss, and your employer is actively tweaking things to guide your behavior and manipulate your compensation. To be clear, RP is totally within its rights to do this! It’s their business, and after all those group purchases have matured and those 5-year vesting cliffs have come and gone, they’re running it.

But this is a completely different level of trust than custom units for a democratic private practice, which would mean everyone coming together to hash it out and try to fix the failures of the RVU system together (and even that would be extremely contentious in most groups).

How will TBWUs affect physician compensation?
TBWUs more accurately measure physician work, shifting from exam volume to a model that reflects the time required to interpret studies. The intent is to better align the work being performed with productivity, minus the intent to negatively affect compensation. If the new measurement creates unintended shifts, productivity thresholds can be adjusted to maintain balance and consistency.

The announced rollout is reportedly zero-sum or close to it on day one. Presumably, almost all practices transitioning from CMS RVUs to a custom internal work unit would do it this way. Zero-sum is the only politically survivable first step. In the short term, it incentivizes reading the plain films, thyroid US, and non-con chests that have been piling up on the out-of-control worklists.

In the long run, zero-sum is not a promised constraint. There is no guarantee that adjustments will continue to track. As long as the changes are subtle enough, it could even feel like the frog in the slowly warming pot. To confirm this point, see RP’s answer about Mosiac below.

Even if the tables were never changed, one should expect the lowering of some CT and MRI vs radiographs to result in less money to radiologists over time as the growth of MRI and CT outpaces radiography. Zero sum today won’t be zero sum tomorrow.

Of course, plenty of radiologists are salaried, so we shouldn’t pretend that this directly impacts everyone’s compensation in a competitive job market. But whether or not it’s used this way, it remains possible for such a system to be used to clandestinely lower reimbursement. RP’s announcement doesn’t promise any specific communication, transparency, or accountability for future adjustments. No hard conversations with the thousands of radiologists they employ. It could just require updating a table.

A custom system actively creates winners and losers even when the underlying design is defensible. That’s tolerable when the people choosing the design are your partners. It’s harder to swallow when it’s a third party doing it to you.

Will TBWUs change how much I make on night shifts, weekends or high-volume modalities?
Existing compensation structures (productivity thresholds, shift differentials, etc.) still apply. TBWUs provide a more accurate measure of work, but practice-level decisions around comp structure remain.

In order not to lose their entire call team system-wide, they have to play nice.

But this is where the contractor and moonlighting workforce should pay attention. Salaried rads with productivity bonus thresholds are one population. Per-click readers, moonlighters, and the contractor army are a different population.

If the new TBWU table nukes the effective value of neuro CT and a practice’s productivity threshold doesn’t adjust in lockstep, an ED reader may have just signed on for a pay cut without a meeting. And anyone who was enjoying cherry-picking the status quo can also take their talents elsewhere.

Breast imagers are probably another cohort to watch. Diagnostic values are up and screeners are down, but screening moonlighting is a big draw for lots of mammographers. Given the possibility of running breast imagers off and their relative scarcity, it also makes you wonder how far off Mosaic drafts for screeners are (probably months).

If you’re being paid per study, and the studies you enjoy reading are now worth less, you’ll probably moonlight somewhere else.

How do AI tools like Mosaic fit in over time?
As Mosaic continues to deploy, radiologists find it easier to read in less time, and report quality and efficiency improve, RP intends to share the value created by these tools with radiologists both clinically and financially. If an AI tool meaningfully reduces average read time, the associated TBWU value would be adjusted by a smaller percentage so that radiologists generate more in total compensation in the same amount of time. The timing of any adjustment is still under discussion and is currently anticipated between July and September.

Read that paragraph twice.

The sequence is: deploy AI that reduces the time a study takes, observe the reduced time, adjust the TBWU for that study downward—but by less than the time saved, so rads keep “more in total compensation in the same amount of time.” The radiologist’s share of the productivity gain is set by the size of the adjustment. The size of the adjustment is set by RP. The data underlying the adjustment is held by RP.

(While rubber-stamping AI-slop AI-drafts would presumably be economically encouraged, the liability is on the rads, whereas any associated economic benefits are at best split. You can decide if you think that sounds reasonable or not.)

Notice also that plain films—one of the study types Mosaic is reportedly pre-drafting—got a big bump in the initial TBWU table. A time-based metric on a study whose time is about to fall because of a tool the same corporate parent is selling. That bump will presumably not survive recalibration over the long term. “Currently anticipated between July and September” is perhaps corporate-speak for we’re giving you Q2 to enjoy it.

The honest version of this FAQ reads: as Mosaic takes on more of the read, we will reprice the read. The share that rads receive is a policy choice made by us, not a guarantee. That choice will be defended internally with data the rads can’t see. This is the first step toward “AI drafted this for you, we’ll pay you what you’re worth to us.” Anything that still feels like a great deal will be adjusted down as radiology whack-a-mole.

To reiterate: I would argue it is different for a physician-owned practice to change its own internal accounting so its members feel valued and to guide desired behavior (and doing so is extremely challenging). It’s another thing for a third-party employer to change the game and leave you with the promise that, over time, you won’t make less money: that they will capture the benefits of increased efficiency thanks to the implementation of AI, but not so much that you’ll actually make less money than you do today per hour, even if you do make less money than you do today per study. (That may even be a real promise that they’ll stand by. It’s up to readers/radiologists/reality to decide. But even then, what happens long-term to reimbursement if AI is making you more efficient? Consequences have consequences. What will RP do about sharing then?)

We live in a tumultuous radiology market, increasingly full of loosely affiliated teleradiologists. More than ever, even fresh graduates are starting their careers in the tele market. Perhaps we will eventually see massive worklists with automatic assignment based on radiologists’ “skills,” demand, and preferences. Don’t want to read body CT? No problem, we can remove those from your list and adjust your comp. Oh, today we’re in surge pricing for MSK MRI. Maybe we’ll have a generation of rads who will describe their dynamically-priced, AI-assisted, per-study compensation as freedom. Or that may not happen at all; I won’t pretend to know where this is going.

But the first step to further cog-ifying the radiologist within a money-printing machine is to decouple the work they do from the revenue they generate while promising it’s not about compensation.

The first step is a zero-sum, equity-framed, transparency-branded transition to a new internal work unit.

That first step is now done.

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:

• RadNet’s much-hyped AI business is a sideshow

• The success of RadNet’s roll up business is also misunderstood

• The truth is buried beneath inconsistent disclosures.

• 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”

• 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.

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)

Back in 2019, I wrote A Deep Dive into the Tax Returns of the American Board of Radiology. It’s now 2026, and a lot has happened in the world, so I thought it was past time to look at the ABR again and also provide some (but not exhaustive) additional context as to how the ABR compares to other members of the American Board of Medical Specialties (ABMS).

As before, this is for informational purposes. I don’t work for or with the ABR, I am not an accountant or tax attorney, and I am certainly even less knowledgeable about other medical specialties and their boards.

I’ll provide the data—which is derived from the ABMS 2024-25 report, non-profit tax returns (Form 990s) from the ABMS members, and comparative average salary data (averaging Doximity, Marit Health, and Medscape)—as well as some commentary. It is perhaps no great surprise that my commentary here is again relatively critical, but I also want to make the somewhat obvious point up front that organizations are made up of largely good people doing what they feel is a reasonable job. I would like to think we can do better as a specialty and more broadly as physicians. You can and should draw your own conclusions.

I actually started doing this update (and more with the ABMS) about three years ago, but the broader data collection across the ABMS was extremely tedious and time-consuming, and I abandoned it. Now, this time around, I was able to deploy modern LLMs and voila. If you see a mistake, let me know.
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