National entrepreneurial radiology initiatives: what are they, and what can they do to and for you?

National entrepreneurial radiology companies have evolved over the past 3 decades. In the 1990s, a few initiatives were established to implement business principles and reward shareholders with gains derived from management expertise, practice efficiencies, and economies of scale. The next decade saw the emergence of night call coverage and "specialty read" companies. As the market for these services became saturated, the established corporate entities scrambled to find new revenue streams. Hospital radiology contracts were the obvious source for this needed capital. The pursuit of these contracts led to aggressive, nontraditional competition. If radiologists are to respond appropriately, they must understand the reasons behind the strategies used by these national entrepreneurial radiology companies. The author explores the goals and actions of these entities and describes why hospitals may find these national companies to be an attractive alternative to their incumbent radiology practices. Both the benefits and the problems associated with entrepreneurial companies are covered, and concepts such as disintermediation are discussed. Finally, the author suggests appropriate actions for radiologists seeking to retain their hospital contracts. Nontraditional competition is now a way of life for many radiology practices. Relationships, subspecialization, service, and measurable quality indicators are the foundation for the maintenance of tenure at hospitals.