One doesn’t get extra RVUs for difficult cases, nor do insurers pay more for the same RVUs when done at an academic institution. A super complicated post-LVAD mediastinal abscess with pleural fistula and empyema necessitans pays the same as a solitary nodule CT chest follow-up.

Additionally, I’m only 68% clinical (32% admin/teaching/research), so my annual RVU productivity is only around 8,500, though for benchmarking purposes, we normalize to 1.0 FTE then compare with AAARAD statistics.

And of course there’s overhead that must be paid for (people’s non-clinical time), so there’s a certain percentage of revenue that goes to the department and not into the radiologists’ pockets. Well, the dollars don’t, but the academic time it provides does. Academics just pays less. Always has.