October 13, 2026
New Commentary Challenges Outdated Claims About Imaging Use and the Radiologist Workforce
Neiman Health Policy Institute authors say current evidence shows increasing imaging complexity, growing workload pressures, and mounting concerns about patient access
A new commentary from the Harvey L. Neiman Health Policy Institute challenges a recent claim that declining imaging use has allowed the United States to meet imaging demand without increasing the number of radiologists. The Institute argues that the claim — made in a 2026 JAMA Health Forum article — relies on outdated utilization data and overlooks a growing body of evidence showing increasing imaging volume and complexity, rising radiologist workload and worsening capacity constraints. The first author of the JAMA article was David Cutler, PhD, Harvard economist and dean, former White House economic advisor.
“In healthcare policy, influential observations can quickly become accepted wisdom, making it critically important to ensure they are grounded in the best available evidence,” said Elizabeth Rula, PhD, executive director of the Harvey L. Neiman Health Policy Institute. “The Neiman Institute and its collaborators have published much of the recent research on imaging utilization, workforce trends, reimbursement and patient access. Collectively, that evidence paints a very different picture from one of declining demand and adequate workforce capacity.”
The commentary notes the JAMA article relied heavily on a study examining imaging utilization from 2003 through 2016. While that study documented a slowdown in imaging growth during part of that period, it did not examine recent utilization patterns or radiologist workload. It also coincided with Medicare coding changes that affected how imaging services were counted.
“Our study provided an important historical perspective on Medicare imaging claims through 2016, but healthcare delivery and imaging practice have evolved substantially since then,” said Vijay Rao, MD, Emeritus Endowed David C. Levin professor and chair, Thomas Jefferson University, and coauthor of the primary study cited in the JAMA article. “Findings from that time period should not be interpreted as evidence that imaging demand or radiologist workload is declining today, particularly when more recent data show continued growth in advanced imaging and examination complexity.”
The commentary highlights several recent studies that show imaging demand remains strong. Research projects imaging utilization will continue to grow in the coming decades, driven largely by population growth and aging. Medicare data also show substantial increases in CT and MRI use since 2016. Meanwhile, radiologist workload, measured using relative value units that account for exam complexity, increased over time and reached historic highs in recent years.
Additional indicators suggest growing strain on the imaging system. Research this year from the Institute found that the imaging turnaround time—between imaging acquisition and interpretation—increased dramatically during the past decade, with most of the increase occurring in the last several years. Other studies documented rising radiologist turnover associated with workload pressures.
“Accurate workforce planning depends on accurately understanding demand,” said coauthor Richard Duszak, Jr, MD, professor of radiology at University of Central Florida College of Medicine and chair emeritus at University of Mississippi School of Medicine department of radiology. “If policymakers or healthcare leaders are led to believe that imaging demand is shrinking or that radiology capacity is sufficient, they may underestimate emerging access challenges and the need for evidence-based workforce planning. At the same time, we must continue efforts to reduce truly inappropriate imaging and ensure patients receive the right examination at the right time.”
Commentary authors emphasize their concern is not simply academic. Policy decisions about reimbursement, workforce development and imaging utilization directly affect patient access to care. The commentary notes that inflation-adjusted Medicare reimbursement for radiologists has fallen substantially over the past two decades even as workload has increased, and recent research has linked reimbursement pressures to widening access disparities in underserved communities.
“Radiology plays an increasingly important role across nearly every area of modern medicine,” added Rula. “As policymakers evaluate strategies to improve healthcare value, it is essential that decisions reflect current evidence rather than outdated assumptions. Failing to recognize growing workload and capacity pressures risks compromising timely access to imaging services for the patients who need them most.”
To arrange an interview with a spokesperson, contact Nichole Gonzalez at ngonzalez@neimanhpi.org.
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 www.neimanhpi.org and follow us on X, BlueSky or LinkedIn.