Academic Radiology Physician Financial Compensation in the United States: Trends and Distribution

Abstract

Background

The overall trends in academic radiology physician compensation are not well studied.

Purpose

To assess recent trends in academic radiology financial compensation and distribution based on rank, gender, race/ethnicity, and geography in U.S. medical schools.

Materials and Methods

This secondary analysis used deidentified data from the Association of American Medical Colleges (AAMC) Faculty Salary Report, which collects information for full-time faculty at U.S. medical schools. Financial compensation data for full-time academic radiology faculty was collected from 2017 to 2023, stratified by rank, gender, race/ethnicity, and geography. The faculty salary report includes median, 25th, and 75th percentile compensation values for each rank, which were used to analyze trends with linear regression. Median compensation values were used to compare groups based on gender, race/ethnicity, and region.

Results

The AAMC Faculty Salary Report data for 2023 included responses for 5847 faculty members across all radiology departments, including 306 instructors, 2758 assistant professors, 1409 associate professors, 1004 full professors, 226 chiefs, and 144 chairs. On average, median faculty compensation increased by 2.6%–4.4% per year from 2017 to 2023, with the greatest increase (by 4.4% per year) at the instructor level and smaller increases (3.4%–2.6%) at the more senior ranks. Male faculty members were consistently compensated more than women at all ranks throughout the study period. The overall salary gap remained at 6% ($455 000 for women vs $483 000 for men) throughout the study period but increased numerically from $24 000 in 2019 to $28 000 in 2023. Black/African American faculty had a lower median compensation compared with White faculty (by 4% overall; $452 000 for Black/African American faculty vs $472 000 for White faculty) at all ranks except at professor rank. Instructor compensation in the Northeast region was substantially higher (by $278 000) than other regions, but this geographic differential did not exceed $35 000 at other ranks.

Conclusion

This study summarized the trends of full-time academic radiology faculty compensation and showed persistent salary inequities that should be addressed as part of a broader drive to increase diversity, equity, and inclusion.

© RSNA, 2024

Supplemental material is available for this article.

Summary

Salary inequities persist in academic radiology and should be addressed as part of the broader drive to increase diversity, equity, and inclusion.

Key Results

• ■ Using the Association of American Medical Colleges salary survey data from 5847 full-time academic radiology faculty members, on average, median compensation increased by 2.6%–4.4% per year from 2017 to 2023.

• ■ Male faculty members received higher compensation than female faculty members (by 6% overall; ($455 000 for women vs $483 000 for men) at all ranks in academic radiology throughout the study period, and the salary gap has increased from $24 000 in 2019 to $28 000 in 2023.

• ■ Black/African American faculty had a lower median compensation (by 4% overall; $452 000 for Black/African American faculty vs $472 000 for White faculty) compared with White faculty at all ranks except at professor rank.

Introduction

The landscape of U.S. health care is evolving, and practices are experiencing high workload, economic strains, worsening physician shortage, and high rates of work-related burnout (1). The field of radiology is uniquely challenged due to rising demand for imaging services, physician shortages, and expectation for shorter report turnaround time (2). A recent survey on the workforce by the American College of Radiology revealed that academic practices hired the most radiologists in 2021 but had the lowest likelihood of physicians remaining in the same practice for at least 5 years (2). Although clinical productivity has increased for diagnostic radiologists, the revenue generated per relative value unit (known as RVU) has declined. When adjusted for inflation, reimbursement to radiologists per Medicare beneficiary declined 24.9% between 2004 and 2021, whereas RVUs per beneficiary performed by radiologists increased 13.1% (3). The COVID-19 pandemic notably influenced the practice of radiology with an initial decline in the volumes and RVUs, with subsequent rebound in volumes, which has not declined to prepandemic volumes (4,5). The impact of these factors and the overall trends in academic radiology physician compensation are not well studied.

Ensuring salary equity is fundamental to cultivating comprehensive equity within professional practices. Studies have shown that compensation for female physicians in the United States has historically been between 17% and 28% less than compensation for male physicians at all career stages and across specialties (6). This pay gap may be contributing to decreased satisfaction and possibly higher burnout rate among female physicians (7). In 2019, the Association of American Medical Colleges (AAMC) published an analysis of faculty compensation by gender for the first time, which showed that gaps existed in compensation for female faculty across specialties and regardless of faculty size (8). This led to the decision to start collecting compensation data by race/ethnicity in 2020 (6).

The aim of this study was to assess recent trends in academic radiology financial compensation and distribution based on rank, sex, race/ethnicity, and geography in U.S. medical schools.

Material and Methods

This study was deemed exempt from human subject research guidelines by the local institutional review board because it involves secondary analysis of existing deidentified data. The study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines.

Study Sample

The AAMC Faculty Salary Report survey was used, which collects information for full-time faculty at U.S. medical schools regardless of source of income (9). The data are reported by the institutions on behalf of faculty, who are classified by the department of primary appointment. Most medical schools participate each year (nearly 100% in the past 5 years), and approximately 70% of all full-time faculty are represented in the AAMC compensation data. From the AAMC survey report, the compensation data were collected for radiology faculty by type of medical school (public/private, geographic region) (9,10). Total compensation equals the sum of fixed/contractual salary, medical malpractice supplement, and bonus/incentive pay; total compensation excludes benefits. Primary outcome measures were compensation data for radiology faculty from 2017 to 2023, stratified by rank, gender, race/ethnicity, and geography.

Statistical Analysis

The faculty salary report includes median, 25th, and 75th percentile compensation values for each rank, which were used to plot trends. Simple linear regression was performed, with year as the independent variable, to assess significant change in the respective values across time. P < .05 was considered to indicate statistical significance. Widths of IQRs for all ranks were calculated from the reported 25th and 75th percentile values of compensation. IQRs were not reported for subgroups by gender and race/ethnicity. The differences in median compensation values were used to compare disparate groups, thus, statistical comparisons between groups were not performed. All statistical analysis and graphing were performed using Python version 3.10 modules SciPy and Matplotlib (Python Software Foundation).

Results

Study Sample Characteristics

The AAMC Faculty Salary Survey data for 2023 included responses for 5847 full-time faculty members across all radiology departments, including 306 instructors, 2758 assistant professors, 1409 associate professors, 1004 full professors, 226 section chiefs, and 144 chairs. Faculty characteristics by gender, race/ethnicity, and region are given in Table 1. The year-wise count of faculty members at each rank is provided in Table S1.

Table 1:

Counts of Included Faculty Members by Gender, Race/Ethnicity, and Geographic Region

Compensation by Rank

Figure 1 shows the reported median, 25th, and 75th percentile compensations from 2017 to 2023. Median compensation increased for all ranks, with the greatest average increase per year (in percentage) at the instructor level (by 4.4%), and smaller increases at the senior rank levels (between 2.6% and 3.4% per year) (Table 2). The IQR of compensation values was widest at the instructor level ($331 000 in 2023), and this range increased by an average of $11 000 per year (P = .007) since 2017. This significant increase was largely due to stagnant 25th percentile values, whereas the median and 75th percentile values increased proportionally (Fig 1). The widths of IQRs remained largely unchanged for all other ranks (Table 3).

Figure 1:

Plot shows trends in median and 25th and 75th percentile compensation (in U.S. dollars [USD]) for full-time academic radiology faculty from 2017 to 2023. The IQRs are the shaded regions between the 75th and 25th percentiles.

Table 2:

Trends in Median Compensation for Full-time Academic Radiology Faculty from 2017 to 2023

Table 3:

Trends in Width of IQRs for Compensation for Full-time Academic Radiology Faculty from 2017 to 2023

From instructor to chair, the increase in compensation for each subsequent promotion is plotted in Figure 2. The increase in compensation from instructors to section chiefs showed decreasing proportional increases with each subsequent promotion (from $75 000 to $21 000), until a substantial rise in compensation for chairs ($273 000), a pattern consistent throughout the study period (2017–2023).

Figure 2:

Bar graph shows increase in median compensations with each subsequent rank for full-time academic radiology faculty members in 2017, 2020, and 2023. USD = U.S. dollars.

Compensation by Gender

Breakdown of median compensation for male and female faculty members at each rank is shown in Figure 3. Trends are compared from 2019 to 2023. Male faculty members were consistently compensated more than female faculty members at all ranks throughout the study period (except instructors in 2019 and 2023). In 2023, the gender-based pay gap was $24 000 for assistant professors, $15 000 for associate professors, $18 000 for full professors, $30 000 for section chiefs, and $3000 for chairs. Figure 4 shows trend lines for difference in median compensation between men and women from 2019 to 2023. The gender pay gap mildly increased by $2000–$8000 for all professor ranks, increased for section chiefs (from –$3000 to $30 000), and narrowed for chairs to $3000 in 2023. According to overall weighted (by rank) average of median compensation, the gender gap in 2023 was $28 000 (a 6% difference) between men and women, up from $24 000 in 2019. Women made $0.94 on the dollar compared with men throughout the study period.

Figure 3:

Plot shows trends in median compensation from 2019 to 2023 for male and female full-time academic radiology faculty members. USD = U.S. dollars.

Figure 4:

Plot shows trends in difference between median compensation from 2019 to 2023 for male and female full-time academic radiology faculty members. USD = U.S. dollars.

Compensation by Race/Ethnicity Distribution

Breakdown of median compensation according to race/ethnicity is presented in Figure 5. Due to low sample size, median values were not displayed for the following underrepresented race/ethnicities: American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and Multiple Race–Hispanic. At the level of instructors, Black/African American faculty and “Other” groups (as reported by AAMC) reported a lower median compensation compared with White faculty by 45% ($208 000 for Black/African American faculty vs $375 000 for White faculty) and 66% ($127 000 for faculty in “Other” groups vs $375 000 for White faculty), respectively. Except for full professor, Black/African American faculty had a lower median compensation at all other ranks compared with White faculty, by 45% ($208 000 vs $375 000) for instructors, 1% ($448 000 vs $451 000) for assistant professors, 7% ($460 000 vs $494 000) for associate professors, and 2% ($537 000 vs $547 000) for section chiefs (Fig 5).

Figure 5:

Bar graph shows median compensation (U.S. dollars) for full-time academic radiology faculty by race/ethnicity compared with White faculty, plotted as cents on dollar. Omitted bars denote missing median data.

Compensation by Geographic Region Distribution

Breakdown of median compensation according to region of the United States is plotted in Figure 6. Instructor compensation in the Northeast region (median, $422 000) was substantially higher than in other regions, whereas median compensation was between $129 000 and $167 000, and was closer to the compensation for assistant professors nationally ($443 000). For the other ranks, this geographic differential was much smaller; the range of geographic variation of median compensation was only between $19 000 and $35 000.

Figure 6:

Median compensation at each rank for full-time academic radiology faculty, by region of the United States.

Discussion

The overall trends in academic radiology physician compensation are not well studied. Thus, we used deidentified data from the Association of American Medical Colleges Faculty Salary Survey to assess recent trends in academic radiology financial compensation and distribution in U.S. medical schools. For 5847 full-time academic radiology faculty members, our results show that, on average, median faculty compensation increased by 2.6%–4.4% per year from 2017 to 2023, with the greatest increase at the instructor level and smaller increases at the more senior ranks. Male faculty members were consistently compensated more than female faculty members at all ranks throughout the study period, and the salary gap has increased except at the level of chairs. The gender gap in median compensation in 2023 was $28 000 (a 6% difference) between men and women, up from $24 000 in 2019. Black/African American faculty had a lower median compensation compared with White faculty at all ranks except at professor rank.

The increase in median faculty compensation has barely kept pace with the U.S. inflation, which averaged 3.69% per year between 2017 and 2023 (11). Historically, medical care prices have grown even faster than prices in the overall economy (12). The long-term average U.S. health care inflation rate is 5.14% (13). Although there is a paucity of literature, there is popular belief that academic radiologists earn less than their private practice counterparts, similar to other specialties (14,15).

The percentage increase in compensation over the past few years has been highest at the junior faculty/instructor level. This is not surprising given the shortage in radiologist workforce, and the number of vacant positions is much higher compared with the number of trainees graduating; therefore, higher starting compensation may be important for recruitment (16). However, there is high variability at the instructor level, albeit with a stagnant 25th percentile compensation value. Of note, the instructor compensation in the Northeast ($422 000) is much higher than other geographic regions and closer to the compensation for assistant professors nationally ($443 000). This is likely because of the use of the instructor rank in the Northeast as the entry-level appointment for full-time regular faculty, whereas in the rest of the country, instructor position probably reflects hybrid fellowship/faculty positions.

Many academic institutions use the Association of Administrators in Academic Radiology benchmarks for deciding faculty compensation. However, academic institutions and their radiology practices have been expanding to the community to build larger networks (17). The actual impact of such expansions on the academic missions of the institutions is not yet clear. Many U.S. medical schools have introduced faculty tracks addressing the changing clinical needs/focus, but the salary differential between tracks is also not clear (18). The benchmarking of compensation for increasingly community-based academic radiologists is nebulous and should probably include benchmarks for nonacademic settings, such as data from the Medical Group Management Association (19).

Making salaries equitable can be an important first step toward an overall approach to diversity, equity, and inclusion (6). There is persistent underrepresentation of women in radiology, even when comparing with other nonprimary care specialties (20–23). Although more than half of all students entering medical school are women, the proportion of female applicants to radiology residency remains below 30% and has not significantly changed in the past decade (20,23). To our knowledge, the impact of salary inequity in academic radiology has not been previously studied. This study shows a salary gap at nearly all ranks, which has increased in the past 5 years. In a previous study, women were shown to have lower starting salaries in 42 of 45 specialties and lower mean annual salary growth in 22 of 45 specialties (24). Delay in promotion has also been shown to contribute to reduced earning potential for women (24). Gaps in median total compensation have been reported even in departments/specialties where women outnumbered men (6). Both institutional and cultural narratives continue to inhibit addressing salary inequity (6). Compensation in academic medicine is often a complex mix of base salary and clinical productivity supplement, supplement for research and academic productivity, and compensation for administrative responsibilities (10). It has been proposed that women and other underrepresented people might choose to earn less through their career and personal choices (6). There are societal expectations around caregiving, and people from underrepresented groups may not receive similar offers/benefits during negotiations compared with their White counterparts (25). These cultural norms and misconceptions need to be addressed for achieving salary equity in a practical way. A structured compensation plan has been shown to improve the gender-based pay gap in a short period of time (26).

Although the percentage of Black and Hispanic students entering radiology has increased in the past decade, the numbers remain low with Black residents constituting 3.83% and Hispanic residents constituting 7.35% of all radiology residents in 2021 (21). Black/African Americans and “Other” groups (as reported by AAMC) reported a lower median compensation compared with White faculty by 45% and 66%, respectively, at the level of instructors. The gap closes at higher ranks with a 7% lower compensation for Black/African American associate professors compared with White faculty at the same rank.

Our study had limitations. First, the compensation method was complex, and analyses using large, aggregate datasets were susceptible to misinterpretation due to the possibility of comparing dissimilar individuals. Second, the data did not account for differences in representation of women and underrepresented groups in subspecialties within radiology, which may explain some of the differences in compensation. Third, the data also lacked granularity in terms of facets of compensation that could influence the results, such as call compensation, bonus payments for productivity, and years in service within a rank. Fourth, intersectionality, where sexism, racism, homophobia, ageism, and other biases can compound in individuals with multiple marginalized identities and result in even greater compensation disparities, could not be assessed from the current study (6). Fifth, the proportion of section chiefs reported in each year was lower than expected, and our hypothesis was that many section chiefs may not be getting additional financial compensation (beyond their rank) but instead getting administrative time off. Finally, the impact of duration at a certain rank on financial compensation was not available in the AAMC Faculty Salary Report, and this may be especially pertinent to faculty at instructor level.

In conclusion, this study summarizes the trends of full-time academic radiology faculty compensation and distribution by rank, sex, race/ethnicity, and geography. The results show that salary inequities persist in academic radiology and should be addressed as part of a broader drive to increase diversity, equity, and inclusion. Additionally, salary trends should be monitored across time to ensure fair and adequate compensation for radiologists that can attract and retain talent to drive the academic mission and train the next generation of radiologists.