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The mission of the Harvey L. Neiman Health Policy Institute® is to establish foundational evidence for health policy and radiology practice that promotes the effective and efficient use of health care resources and improves patient care.

November 28, 2017

Generalist vs. Subspecialist Characteristics

A new study by the Harvey L. Neiman Health Policy Institute analyzes the generalist versus subspecialty characteristics of the U.S. radiologist workforce in the Medicare population from 2012-2014. The study is published online in Radiology.

“We found that nearly half (55.3%) of U.S. radiologists practice predominantly as generalists but dedicated on average 36.0% effort to one subspecialty. Among radiologists practicing as majority subspecialists, neuroradiologists and breast imagers are most common,” noted Andrew Rosenkrantz, MD, MPA, lead study author and a Neiman Institute affiliate research fellow. “Subspecialization is more common among radiologists who are female, are earlier in their careers, work in larger practices, have academic affiliations, and practice in the Northeast.”

In carrying out their work, the researchers leveraged CMS Medicare Physician and Other Supplier Public Use Files for the three years. They identified 33,090 radiologists who billed for professional services and used a validated classification system to map services to seven subspecialties and quantify subspecialty-focused effort on the basis of work relative value units (RVUs). The work RVUs were assigned to imaging modalities and body regions according to the Neiman Imaging Types of Service (NITOS) system for claims-based classification of radiology services. Radiologists with more than half of their billed work RVUs in a single subspecialty were designated subspecialists; those with less than half were classified as generalists.

“Currently, the Center for Medicare & Medicaid Services (CMS) recognizes only interventional radiology and nuclear medicine, as self-designated by those practitioners, as distinct specialties within radiology. All other radiologists are generically characterized as diagnostic radiologists. That simple grouping system limits the utility of existing CMS physician directory files to evaluate subspecialty work characteristics,” added Richard Duszak, MD, FACR, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University and senior affiliate research fellow at the Neiman Institute. “Definitions based on methodologies such as ours could potentially be leveraged by CMS as it seeks to promote subspecialty-based metrics in its efforts to advance value-based payments under its new Quality Payment Program.”

To obtain a copy of the study or to arrange an interview with a Neiman Institute spokesperson, contact Nichole Gay at (703) 648-1665 or


About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at and follow us on TwitterLinkedIn and Facebook.


Nichole Gay