Is Concierge Radiology a Possibility in 2026?

Many years ago, I heard about “concierge” medicine. Some wealthy individuals were willing to pay a premium to have on-demand access to their docs, bypassing the third-party entities that control health care for the rest of us.

It was like stepping back in time to when physicians were still in charge of their own profession. The docs needed far fewer patients to make ends meet and could spend as much time with each one as they wished. The patients didn’t have to navigate touch-tone phone mazes or deal with half a dozen go-betweens before communicating with their MD. Without all of the medical middlemen, finances worked out better for both parties, and a lot of hassles were eliminated.

It was only a matter of time before the concept got modified so non-rich people could get in on the action. “Direct primary care” (DPC) was the name of the game since a lot of folks hear words like “concierge” and assume it will be too costly. Access with DPC isn’t quite unlimited but for most people, it is sufficient just to have a few visits per year with basic in-office tests/procedures.

When I first heard about that on a docs’ forum, I loved the idea. Primary care types have gotten a raw deal for way too long, and it was nice to hear how some of them had found a way to reclaim control over their careers and boost their bottom lines in the process. Other, non-primary types on the forum were also enthused, expressing wishes that they could do the same.

Unfortunately, not all specialties have the option. Radiology is a prime example. We are not like a primary care doc who can buy some basic diagnostic gear and hang his or her shingle outside of a small office. We need enough square footage to house all of the machinery that generates the images we review, the machinery itself, and personnel to run it. That is much more overhead, and you need a lot more patient throughput just to break even.

Still, I imagined that sooner or later somebody motivated and innovative would find a way to make it work. The rest of us would see it and say, “Oh, of course, that’s how to do it,” and a bunch of copycats could follow. Meanwhile, we all stayed in the employed or contractor gigs controlled by regulators and third-party payors, because it was more of a “sure thing.”

It therefore grabbed the attention of a few of us when a radiology social media post recently turned up, talking about prepping a “small direct-pay/concierge-style practice” and asking for recommendations of healthcare-law types to be retained as consultants. It’s regrettably a necessity. Even the DPC guys can find themselves walking in a financial/legal minefield.

Of course, most rads tuning in were curious. Had the poster found a way to make concierge radiology viable? What was his breakthrough? (Alternately, what might he be overlooking that would make this fail?) Understandably, before launching his venture, he wasn’t eager to completely spill the beans.

Still, he did share a bit, and it was strikingly similar to a notion I had shared in this blog, a few years back, of a “radiology whisperer.” I wrote of my experience in explaining imaging (sometimes in the abstract, sometimes focused on actual reports if not images) to various friends and family.

Patients and their friends/fam get referred into the diagnostic imaging machine, and it can be a big old confusing mess. What’s this procedure they want me to have? It sounds kind of scary. Is it dangerous? What is it looking for? If it doesn’t find anything, does that really mean nothing is there?

It doesn’t end there. Once they have the imaging, one or more docs tell them what it supposedly showed (or didn’t show), and possible next steps. They might get the impression that their docs are leaving out, or don’t even know, some details. Increasingly commonly, they get ahold of their own imaging reports and try to understand them.

All of this becomes a lot easier for them if they happen to know a radiologist who can translate and explain for them. Whether it’s turning medicalese into plain speak or reassuring that a simple cyst is nothing to worry about, the rad has a lot to offer here.

Not everybody has a family/friend rad who can serve this purpose, of course, and so I started wondering if it might be a worthy side gig for some rads...or even a replacement role for instance if a rad was no longer actively reading cases but still wanted to contribute something. In my old blog about this, I considered whether there might be enough demand to make full-time radiology whispering a viable livelihood.

I envisioned a small but comfortable office for folks who wanted to come in for face-to-face consultations. You would want some nice, big monitors to showcase key images, plus a few creature comforts to contrast with the harsh, cold examination rooms people usually think of when contemplating a visit to the doctor. Hourly rates would be clearly indicated. Take as much time as you like with the whisperer. You are paying, not some insurer, so you call the shots!

Turning this into a full-on concierge practice would take a lot of fine-tuning because until one established a strong reputation, there might not be too many people knocking at the door. Advertising online and allowing for virtual consultations would help, but creating some other revenue streams would surely help one stay afloat. Maybe open the door to patients or even clinicians bringing imaging studies for second opinions.

Has anything changed in the past decade or two that could make concierge radiology more of a possibility than it was before? I couldn’t think of anything and maybe nothing has. If and when it does, however, whoever is sufficiently watchful for it and enterprising enough to move on his or her own observations will be in a very good place.