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Most conversations about the imaging technologist shortage start with the same handful of suspects: an aging workforce, long training pipelines, burnout, and pay. All of those are real. But there is a quieter force at work, one that rarely shows up in staffing reports but shapes the daily reality of every imaging department in the country. It starts with your payers.

Here is the chain reaction in plain terms. Insurers have been denying more claims, so hospitals responded by ordering more imaging up front to document medical necessity. That extra volume landed on a workforce that was already too thin to handle the scans it had. The result is a supply-and-demand mismatch that no amount of overtime can fully bandage. If you have watched your CT and MRI backlogs grow while your open requisitions sit untouched for months, this probably relates.

Why Care Denials Surged

The scale here is hard to overstate. According to the American Hospital Association (AHA), care denials rose by an average of 20.2 percent for commercial claims and a staggering 55.7 percent for Medicare Advantage claims between 2022 and 2023. As a result, administrative costs now account for more than 40 percent of what hospitals spend to deliver care. The AHA analysis points to a growing reliance on machine learning and other automated tools as one driver behind the spike, with algorithms generating denials faster than humans can.

What makes denials so corrosive is that most of them do not stick. The AHA notes in the analysis that 75 percent of denied claims are eventually overturned, but only after hospitals grind through multiple rounds of appeals. One health system cited by the AHA saw its Medicare Advantage denial rate climb as high as 15.5 percent, but about 56 percent of those were reversed on appeal. In other words, a large share of these denials were never valid to begin with. Instead, they force providers to spend time and money proving what should have been obvious.

How it Impacts Imaging Volume

So how does a fight over claims turn into more work for your CT techs? Here’s the simple answer. When payers tighten the screws on medical necessity, the safest defensive move for a hospital is to build a stronger evidentiary record before the claim ever goes out. That often means ordering the imaging study up front because a clean scan is one of the most persuasive pieces of documentation a provider can put in front of a payer.

Multiply that instinct across thousands of encounters and the pattern becomes structural. Defensive ordering, prior authorization requirements that demand imaging as a precondition, and the simple need to document everything twice, all funnel more work into the same departments. Ultimately this means, demand for scans keeps climbing while the people qualified to perform them do not.

The Pipeline Issue

Imaging staffing was tight before denials increased workloads. The American Society of Radiologic Technologists found in 2025 that vacancy rates were at or near all-time highs across nearly every imaging discipline. This included CT hitting a record 19.4 percent, MRI rising to 17.4 percent, and bone densitometry seeing the sharpest jump of all by climbing from 6.9 percent to 16.3 percent.

The downstream impact of these shortages can be detrimental for hospitals and patients. When a scan cannot be scheduled, follow-up care stalls behind it: additional imaging, biopsies, and specialist consults all wait their turn.

It’s reasonable to think the gap may eventually close on its own, but the numbers point to it being unlikely. The Bureau of Labor Statistics estimates roughly 15,400 new openings for radiologic and MRI technologists through 2034. Pair that with the four to six year path to becoming an MRI technologist and long waitlists at community college radiology programs, and it becomes clearer why the shortages will not resolve without strategic intervention. You cannot recruit your way out of a pool that is shrinking faster than it can be refilled.

What Hospital Leaders Can Actually Do About It

Naming the cause is satisfying, but it does not move waiting scans off your backlog. Making real progress on this issue means treating the volume-versus-supply mismatch as something to manage deliberately rather than absorb passively. Here are some recommendations to consider:

• Measure demand and supply against each other, not in isolation. If your imaging orders are climbing because of defensive documentation, that trend is forecastable. Track scan volume alongside your fill timelines so you can see the gap widening before it lands on the schedule.
• Treat denial reduction as a staffing strategy. Every inappropriate denial you prevent on the front end is imaging volume you do not have to staff for on the back end. Tightening prior authorization workflows and documentation quality lightens the load on the very techs you are struggling to hire.
• Hire for modality, not just for headcount. A CT vacancy and an MRI vacancy are not interchangeable problems. Filling them well requires recruiters or staffing experts who understand the certifications, the equipment platforms, and the small, specialized candidate pools behind each one.
• Build staffing relationships. Hospitals can use external partnerships to help create supply rather than competing for a fixed pool of professionals. This can include partnering with staffing agencies, fostering relationships with academic programs, or sponsoring existing staff through apprenticeship pathways. Some imaging specialties have reported jumps in applicant interest, suggesting the appetite to enter the field is there if the clinical training capacity exists to meet it.
• Use contingent staffing as a bridge, not a habit. In practice, this means travel or agency technologists would keep your scans and revenue flowing, while you focus separately on building a permanent team. The trouble often starts when temporary coverage quietly becomes the permanent plan because no one ever addressed the underlying vacancy.

The Takeaway

The imaging tech shortage did not appear out of nowhere, and it is not only a workforce problem. It is partly a payer problem wearing a workforce issue costume. When denials rise, imaging volume follows, and that volume slams into a pipeline that was already running on fumes. Setting your hospital up for success in this environment means no longer treating denials and staffing as two separate conversations and starting to manage them as the single, linked problem they have become. You may not be able to control the factors impacting increased care denials, but you can control whether your staffing strategy is built to ride out the demand it creates.

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