Remote Arbitrage in Radiology: Multiple Affiliations as a Specialty Specific Adaptation to Changing Practice Demands.

Objective: To analyze trends from 2017 to 2024 in the number of group and state affiliations among Medicare-serving physicians, with emphasis on diagnostic radiologists.

Methods: Affiliation data were obtained from the CMS Physician and Other Supplier Public Use File (2017-2024). Group and state affiliations per physician were analyzed across specialties and compared between diagnostic radiologists and nonradiologist physicians. Statistical analyses included descriptive measures, compound annual growth rates, t tests, correlation, mixed-effect models, and regression models. Subgroup and generational analyses were also conducted.

Results: From 2017 to 2024, 635,961 unique physicians were included in this analysis. All physicians had an average of 1.19 group and 1.06 state affiliations. Among physician specialties, diagnostic radiologists had the highest average number of affiliations, with 2.03 groups and 1.31 states on average. This is 1.7 and 1.2 times as many affiliations, respectively, compared with all nonradiologist physicians. From 2017 to 2024, the compound annual growth rates of affiliations per nonradiologist physician was -0.12% for groups and +0.14% for states, whereas for diagnostic radiologists it was +2.23% for groups and +1.63% for states.

Conclusions: Compared with all other types of physicians, diagnostic radiologists are much more likely to expand the reach of their services through use of multiple group and state affiliations. Despite recent technological and policy advances with the potential to expand access to care through use of affiliations across groups and states, there has only been modest use of these strategies among other physician types.