The authors discuss certain market and political forces buffeting the traditional structure of radiology, both in practice and in the academic setting. These forces can be, to a certain degree, disruptive and produce fragmentation of what are now integrated radiology services and specialties. The potential fallout from the current rapidly changing environment of health care, including strategies for delivering care along service lines or within discrete episodes of care, may have a profound impact on the future of radiology. Understanding the dynamics of the current environment may help plan strategies for dealing with the potential impact on our specialty.