Managing to Succeed: Decline of the Radiology Group
By Jennifer Coakley
Radiology Today
Vol. 26 No. 8 P. 26

Is the shift from radiologist group to locum coverage the future of imaging?

The landscape of radiology practice in the United States is undergoing a profound transformation. Once stable, independent community radiology groups are now shifting to hospital-employed models and increasing reliance on locum coverage. The dismantling of longstanding radiology groups has far-reaching consequences for the communities they serve. Patients face reduced continuity of care, limited transparency about who interprets their imaging, potential delays in critical result turnaround time, and diminished subspecialty expertise. These changes present a clash between utilitarian efficiency and deontological duty— between doing what seems expedient and what is ethically right.

Are traditional radiology groups at risk of extinction in favor of locum and hospitalemployed models? More importantly, what are the ethical implications of prioritizing flexible, short-term coverage over community- based radiologists who have long served as the backbone of imaging care?

Background
According to Bapna and Kattapuram (2023), in Journal of the American College of Radiology, “locum tenens, also referred to as ‘locums,’ loosely translated from Latin means ‘to hold a place,’” and it is reshaping the radiology profession. Historically, radiologists have provided consistent, high-quality imaging and interventional service, with teleradiology (“nighthawk”) models filling the overnight gap. Originating in the 1990s, nighthawk services allowed US hospitals to outsource night coverage to radiologists abroad, ensuring around-the-clock reads while maintaining continuity during the day.

Today, however, the landscape is far more fragmented. Radiologists are increasingly leaving their traditional 9-to-5 positions to pursue higher-paying, flexible locum roles. The post-COVID “hybrid” and “remote” work models are accelerating this shift. Developed in the 1970s, locums is not a new concept. However, with radiologists experiencing significant burnout, they are turning to another solution: travel. Hospitals unwilling to adapt are losing radiologists to agencies willing to offer flexibility and higher financial rewards.

Recruitment companies are competing aggressively for radiologists, often bypassing hospital oversight and charging exorbitant fees for on-demand services. By contracting directly with staffing agencies, hospitals can rapidly fill workforce gaps without lengthy coverage. This streamlined approach supports continuous imaging services during staffing challenges, though it also raises concerns about reduced organizational oversight, inconsistent practice standards, length of time utilizing coverage, and higher costs per shift compared with an employed-radiologist model.

Ethical and Patient Safety Considerations
The use of locum tenens radiologists introduces significant ethical and patient safety challenges. One primary concern is inconsistency in care that can arise from rotating staff who may be unfamiliar with hospital systems, workflows, or technology challenges. This unfamiliarity can result in diagnostic delays, communication breakdowns, and increased potential for error, especially when radiologists are overextended or managing multiple assignment locations simultaneously. Ethically, hospitals have a duty to ensure accurate, timely diagnostic interpretation, regardless of staffing status. Transparency is often lacking; patients typically have no idea who is interpreting their studies or the difficulties that the hospital is facing with delayed dictation times.

Radiologists are deeply specialized. Staffing an entire hospital with locums capable of covering all subspecialties is a logistical nightmare, if not an impossibility. The lack of subspecialist when needed—such as MRI cardiology, interventional procedures, or neuroradiology— can have serious consequences if that specialty is not available to read for an indeterminate amount of time. When critical imaging cannot be interpreted promptly, particularly for time-sensitive conditions such as stroke or brain bleeds, the absence of specialized dictations could be the difference between life and death.

The question remains whether the temporary status of a locum radiologist is intended to be finite. If so, can hospitals maintain this stopgap solution? Replacing a community radiology group, which has all the necessary elements for a functioning team, with a hodgepodge of locum radiologists who have never worked together raises a critical question: Can they maintain their function without serious consequences?

The potential consequences are profound. First, patient safety may suffer due to inconsistencies in interpretation quality, leading to increased diagnostic error rates. A study published in the European Journal of Radiology found a diagnostic error rate of roughly 30% across radiology practices, including 3% to 5% real-time interpretive errors. The increasing pressures of speed and productivity on locums to read outside their subspeciality can degrade communication gaps between rotating radiologists and clinical teams, leading to missed or delayed reporting of critical findings and putting patients at risk for irreversible harm. Even the most skilled radiologist is not immune to the fatigue and cognitive overload that compromise accuracy. Additionally, accountability may be weakened—when radiologists frequently change, there is no clear ownership or oversight. Finally, the erosion of long-standing relationships between radiologists and referring providers breaks the continuity of care within the community. Over time, these compounding issues can destabilize the entire diagnostic department, leaving the hospital with a crisis that is far more costly and complex than the workforce shortage they set out to address in the first place.

Financial Implications
The financial burden of relying solely on locum tenens radiologists are substantial. According to Medicus Healthcare Solutions, hospitals can expect to pay between $3,000 and $3,500 per day, not including the agency fees tied to each imaging dictation when using a per-click radiologist. When considering the range of subspecialists required for continuous hospital operations, this model becomes prohibitively expensive as a long-term strategy.

The 2025 Doximity Physician Compensation Report lists radiologists among the top 10 for most in-demand locums’ specialties. Approximately 63% of physicians are already working in locum tenens or considering a switch. At the same time, Azmed reports radiologists pay has increased by 7.5%, with national averages exceeding $570,000 annually—nearly double the rate of increase seen across other medical physician specialties. This surge reflects a supply and demand imbalance. As more radiologists pursue locum opportunities, hospitals face higher staffing costs and increasing difficulty maintaining continuity of care and accuracy. What began as a stopgap measure is rapidly becoming an unsustainable financial burden.

The solution is not eliminating locum tenens—they now have a place—but redefining their role within a sustainable, ethical staffing framework. Locum coverage should remain temporary. It is a solution to bridge short-term gaps, not a replacement for a dedicated, community-based radiology group. Hospitals that invest in stable, locally integrated radiology groups strengthen not only their operational resilience but also the trust and safety of the communities they serve. Building long-term partnerships with permanent radiologists, supported by flexible work arrangements and professional development, will help preserve the integrity of imaging that will endure well into the future. Ultimately, patient safety and diagnostic excellence depend on ethical accountability and collaboration that is committed to a cohesive radiology team, not by convenience or expedience.