Radiology leads on wRVUs. What does that mean for pay?

Commentary

Radiology is number one in reported annual work RVU production among the 26 specialties in Marit Health’s October report. Its median is 12,500 wRVUs. Family medicine’s is 6,000. That puts radiology at slightly more than twice the reported median volume.

That is the first thing I want readers to notice. Radiology leads this ranking, yet its median reported contract rate is $50 per work RVU. That rate sounds about right to me, although I have seen practices pay considerably less. Recognizing a number is not the same as believing it settles the question of fair compensation.

My frustration is that increasing productivity can become the answer to every compensation problem. When the value assigned to work falls, doing more can turn from an achievement into the price of standing still. That feels unfair.

Annual wRVUs, highest to lowest

Median annual work RVUs, not dollars. Equal values share a rank. All 26 specialties from the original report.

Rank	Specialty	Median annual wRVUs
1	Radiology	12,500 wRVUs
2	Radiation Oncology	11,270 wRVUs
3	Cardiology	10,500 wRVUs
3	Dermatology	10,500 wRVUs
5	Neurosurgery	10,400 wRVUs
6	Orthopedic Surgery	10,000 wRVUs
7	Ophthalmology	9,784 wRVUs
8	Anesthesiology	9,400 wRVUs
9	Gastroenterology	9,000 wRVUs
9	Urology	9,000 wRVUs
11	Plastic Surgery	8,800 wRVUs
12	Otolaryngology (ENT)	8,300 wRVUs
13	General Surgery	8,000 wRVUs
14	Pulmonology	7,800 wRVUs
15	Obstetrics & Gynecology	7,500 wRVUs
16	Podiatry	6,600 wRVUs
17	Endocrinology	6,000 wRVUs
17	Family Medicine	6,000 wRVUs
17	Internal Medicine	6,000 wRVUs
17	Physical Medicine & Rehabilitation	6,000 wRVUs
21	Hematology Oncology	5,658 wRVUs
22	Neurology	5,500 wRVUs
23	Infectious Disease	5,460 wRVUs
24	Rheumatology	5,150 wRVUs
25	Pediatrics	5,000 wRVUs
26	Psychiatry	4,964 wRVUs

What the chart does and does not say

Marit’s report was published on October 21, 2026, using 4,456 salary reports with wRVU detail as of October 2. Those reports cover all 26 specialties, not 4,456 radiologists. The $50 figure is presented as a median contract conversion rate, not as total compensation divided by annual production.

The two medians are useful context, but they are not a complete description of a radiologist’s job. This is not a ranking of production inside any particular hospital. It does not mean radiologists work twice the hours, generate twice the revenue, or provide twice the value of family physicians. The chart does not separate neuroradiology from other radiology work, day shifts from nights, or different employment arrangements. It cannot tell us whether a particular contract fairly accounts for its workload and responsibilities.

The pressure behind the number

There is also a policy issue beyond the chart. For 2026, CMS finalized a 2.5% reduction to work RVUs for most non-time-based services through its “efficiency adjustment.” Diagnostic imaging is among the affected services. If a compensation contract uses those updated work RVU values without an offset, the same services can generate fewer credited units.

That is not the same as saying every radiologist received a 2.5% pay cut. Medicare reimbursement and an employer’s compensation formula are different, and the effect depends on the contract. Nor does the chart establish that radiology has suffered the largest cuts of any specialty.

My point is simpler: a productivity benchmark should begin a conversation about compensation, not end it. Radiologists’ work should not be valued only by how much more we can produce. The $50 figure may sound familiar. The expectation that we can always make up the difference with more volume deserves a harder look. Radiology reports slightly more than twice family medicine’s median wRVU volume. What does that comparison really mean? That is the question I want to take up in the next conversation.

Sources

Marit Health: October 2026 wRVU report

CMS: 2026 Physician Fee Schedule final rule

ACR: What the 2026 rule means for radiology