Vienna -- Freedom, money, and more personal patient care: For many radiologists, setting up a private practice is the dream. But this path comes with plenty of hurdles, from financial worries and bureaucracy to the difficulties of attracting patients and competition. During a special ECR 2025 session on 26 February, lessons from Austria and New York showed both the opportunities and downfalls, giving insights into what works and what doesn't.
"Yes, it costs money, and it totally pays off," said Dr. Patrick Wunderbaldinger, a radiologist at a high-volume center specializing in breast diagnostics in Vienna, adding that setting up a private radiology practice in Austria requires a high initial investment. "Get the best advice you can get -- legal, financial, architectural, technical, and marketing."
Dr. Patrick Wunderbaldinger emphasized the importance of expert advisors for a successful private practice. All photos courtesy of Claudia Tschabuschnig.
Private radiologists must navigate a complex system of licensing, reimbursement negotiations, and location strategy, but those who invest in high-quality imaging equipment, staff, and expert advisors are more likely to succeed, he explained. At Diagnosezentrum Favoriten, where four radiologists work in parallel, over 500 patients are seen daily, 5.5 days a week. The center's success is partly due to its strategic location near Vienna's main train station, making it very accessible to patients, he commented.
With its social security net, Austria's socialized healthcare system presents unique challenges for private practices. "The majority of patients are paid via social security, thus a refunding contract is essential. Patients are used to getting everything for free," Wunderbaldinger said.
At the same time, public hospitals are reducing outpatient services, shifting diagnostic imaging demand to private clinics. Private examinations now make up approximately 20% of cases, as the public system struggles to meet demand.
"This pushes more patients to private clinics," he stated, noting that public hospitals also refer out low-margin procedures while keeping high-revenue scans in-house, which impacts private clinics. "Referring hospitals is the most important thing as patients need a reason to come."
One of Austria's biggest challenges is that decisions in socialized healthcare are often made to serve political agendas rather than patient well-being, which differs from private entrepreneurs, who can adapt based on market needs and financial realities.
"Decisions are based on political needs and agendas to suit voters. People in charge are mainly neither doctors nor healthcare managers. They are not liable for the decisions and the money spent," he continued. As a result, policies change slowly, and medical professionals have little say. On the flip side, the system protects those within it. "Slowness can be a protection. You know the system, know what to do," he said.
The Wild West?
With high market freedom and extreme competition, New York offers a stark contrast. Unlike Austria, anyone with funding can open a practice, but securing patients poses a different challenge altogether.
Dr. Christopher Riedl knows all about the financial and operational challenges of running a private imaging practice in a competitive market.
"To run a successful radiology practice, you really only need two things: patients and contracts," pointed out Dr. Christopher Riedl, a dual board-certified nuclear medicine physician and diagnostic radiologist based in Hawthorne, New York, who runs a private imaging practice specializing in PET-CT scans for oncological diagnostics.
While practices may initially thrive, changes in referral patterns can quickly impact financial stability -- and he said he learned this the hard way. "Half our patients came from one hospital. When they opened their own PET-CT, the numbers crashed," Riedl said. This shows the importance of diversifying in terms of referral sources and adapting to market changes.
