Radiology's survival as a specialty is threatened because of the significant changes that have occurred in the healthcare environment over the past five years. Changes in reimbursement, expectations by referring physicians, and demands by insurance carriers and the employees they represent have all had an impact on the volume of patients admitted to hospitals and being referred to various physicians. This has directly impacted radiology practice in terms of the types and numbers of procedures performed as well as through competition which has developed for providing traditional radiology services. It is clear that changes will continue to affect radiology practice in terms of reimbursement and specialty needs far into the future. Various entities that are involved in providing services to hospitals as well as to radiology practices will continue to have an impact on what radiologists do and how they do it. It is important that radiologists be willing to restructure their own individual radiology practices and modify their educational background and experience so that they can provide the best possible services to the referring physicians and the best support to the various insurance programs that are provided to them. The greater the extent to which radiologists are willing to improve the quality as well as effectiveness of their support services, the greater the likelihood that their practices will be successful into the future.