It is not polite to discuss money, politics, or religion but no one has ever accused me of being polite.
In my department, there is an apparent dearth of chest radiologists. For those of you who are uninitiated to the world of radiology, chest radiologists are specialists who are experts in imaging of diseases of the chest, including heart and lungs. They complete a radiology residency and a chest radiology fellowship (which is very similar to my own training path, only I completed an interventional radiology fellowship after my radiology residency). The point is that both training paths are identical in duration.
As of July 1, 2026, I passed a landmark: 30 years of IR. Doesn’t feel like 30 years honestly but if you look at my practice from when I started and what I do today, it is a remarkable journey. In fact, I’d argue that IR is the most evolved medical specialty in that past 50 years. This same era has given rise to laparoscopy and surgical robots. As impressive as those tools are, I think the overall impact that stents (drug eluting, bare, bioabsorbable, etc), endografts, embolotherapy, thrombectomy, and image-guided treatments in general far outweighs both those innovations. It is fair to say that the procedures that I do today look nothing like what I did 30 years ago.
Where was I? Oh, right, dearth of chest radiologists. Well, if you’re a chest radiologist, these are salad days indeed. There is no shortage of work for you. In fact, there’s too much work for you. Radiology departments are being overwhelmed by the volume of imaging. Utilization of imaging services has exploded: at our institution, the volume of studies has consistently increased about 5% annually, which means volumes have more than quadrupled over my time in practice.
In practical terms, radiology practices and hospitals need to hire more radiologists to keep up with the demand for imaging. But the expansion of radiology residency programs has not kept pace with the exponential growth in imaging utilization. When I finished my residency, there were around 1000 newly minted radiologists entering the work force. This year, about 1250 radiologists will graduate, representing a roughly 25% cumulative growth over the past 30 years, compared to an over 300% expansion in imaging study volume.
Today, if you’re a chest radiologist and you just graduated from residency/fellowship and are looking for your first job, you can come to my department and get paid $100* as your starting salary. Conversely, I’ve been doing my job for 30 years. I’ve published almost 150 papers, written book chapters, trained hundreds of residents, mentored some very impactful physicians in my specialty, helped develop and market medical devices, and personally cared for thousands of patients. On the same day you sign your $100 contract, I’m getting paid $94.74. Oh, and you as a chest radiologist don’t have to take any overnight call. You might have to work a few swing shifts but you won’t ever be woken up in the middle of the night like I am (unless you’re lying in bed sleepless, trying to think of fun ways to spend your new-found fortune).
I understand the basics of supply and demand. The same economic forces apply to breast imagers and nuclear medicine specialists as well- there just aren’t enough of them so they can command a premium in compensation. I also know that markets change and it might be that chest radiologists will be replaced by AI and that fat $100 contract suddenly becomes $50, or even less.
So is it that chest radiologists are overpaid, or appropriately paid right now? Or is it that I am, as an IR, underpaid? Here’s one way to think about it: am I still providing value for the $94.74 that I am paid? The answer is yes, otherwise, according to prevalent market forces, I wouldn’t get paid that amount for the exact same reason that a chest radiologist won’t get paid $100 when AI starts to replace him or her.
Maybe the supply of IRs is there, but the demand isn’t and that’s why there’s a gap? That doesn’t seem to be the case- The job market is excellent for my profession. Suffice to say, there is way more work than workers. I wouldn't have any problem finding employment.
Here’s a more provocative question: am I providing MORE value for my $94.74 than a brand new, untested chest radiologist who gets paid $5.26 more? To paraphrase Dylan: you don’t need an economist to know which way the wind blows. The practical experience that I’ve accumulated is, quite literally, priceless and of great value to my patients and colleagues. The relationships I’ve built with my clinical partners are priceless and of great value to my patients. The intangibles that come with a long career, although immune to measurement, are as real as the patients who benefit from them. Combined with objective measures of my clinical productivity, some or even most economists (or weathermen) might conclude that I’m actually worth more than $100.
If this premise is true, in order to “prove” my worth, I would have to leave my job and take another one that pays me $110, $125, or whatever I think the market should pay me. That would be disruptive to my patients, my partners, my clinical colleagues, and my administrative partners. It would also be costly to my department which would have to bear the substantial expense of yet another costly recruitment (which is ironic, since if they just paid fair market value, they wouldn’t have to recruit replacements).
This is not about the $5.26. At this point in my career I am playing with house money, so to speak (in other words, while I would love to have the extra $5.26, it won’t make a material difference to me in the long run, not to sound like an entitled dick). What hurts is the feeling that you and your expertise are being taken for granted. The feeling that your accumulated efforts aren’t valued, let alone praised. The feeling that you’re disconnected from a greater purpose and your hard-earned skills are unworthy of note. The feeling that the leadership just doesn’t care about you. That’s when their attempts to inspire don’t ring true and fall flat on your ears. Unless you’re a chest radiologist in which case, enjoy it while you can.
*not literally $100- I’m just trying to draw a comparison.