Back in 2019, I wrote A Deep Dive into the Tax Returns of the American Board of Radiology. It’s now 2026, and a lot has happened in the world, so I thought it was past time to look at the ABR again and also provide some (but not exhaustive) additional context as to how the ABR compares to other members of the American Board of Medical Specialties (ABMS).
As before, this is for informational purposes. I don’t work for or with the ABR, I am not an accountant or tax attorney, and I am certainly even less knowledgeable about other medical specialties and their boards.
I’ll provide the data—which is derived from the ABMS 2024-25 report, non-profit tax returns (Form 990s) from the ABMS members, and comparative average salary data (averaging Doximity, Marit Health, and Medscape)—as well as some commentary. It is perhaps no great surprise that my commentary here is again relatively critical, but I also want to make the somewhat obvious point up front that organizations are made up of largely good people doing what they feel is a reasonable job. I would like to think we can do better as a specialty and more broadly as physicians. You can and should draw your own conclusions.
I actually started doing this update (and more with the ABMS) about three years ago, but the broader data collection across the ABMS was extremely tedious and time-consuming, and I abandoned it. Now, this time around, I was able to deploy modern LLMs and voila. If you see a mistake, let me know.
Part I: A Decade of ABR Tax Returns (2013–2024)
Important clarifying note on the fiscal year change: In the intervening period since the last post, the ABR changed its fiscal year from March to December around 2018. The “FY Dec 2018” filing is a 9-month transition period (April–December 2018) and is not directly comparable to full-year figures. All subsequent filings are for the calendar year. For the tables below, “TY” = my old “tax year” labeling convention; post-transition years use the calendar year.
Revenue
| Fiscal Year | Total Revenue | Program Svc Revenue | YoY Change (Total) | % Change |
|---|---|---|---|---|
| FY Mar 2014 (TY2013) | $14,089,494 | $13,540,170 | — | — |
| FY Mar 2015 (TY2014) | $15,777,660 | $15,175,589 | +$1,688,166 | +12.0% |
| FY Mar 2016 (TY2015) | $16,260,730 | $15,761,020 | +$483,070 | +3.1% |
| FY Mar 2017 (TY2016) | $16,920,053 | $16,291,444 | +$659,323 | +4.1% |
| FY Mar 2018 (TY2017) | $17,430,259 | $16,450,061 | +$510,206 | +3.0% |
| FY Dec 2018 (9-mo transition) | $14,097,350 | $13,470,443 | — | — |
| FY Dec 2019 | $18,955,195 | $17,877,627 | — | — |
| FY Dec 2020 | $16,750,924 | $15,914,889 | −$2,204,271 | −11.6% |
| FY Dec 2021 | $17,740,900 | $16,834,305 | +$989,976 | +5.9% |
| FY Dec 2022 | $18,356,752 | $17,562,271 | +$615,852 | +3.5% |
| FY Dec 2023 | $20,113,054 | $18,221,820 | +$1,756,302 | +9.6% |
| FY Dec 2024 | $22,031,770 | $18,748,412 | +$1,918,716 | +9.5% |
Program service revenue (certification/exam fees) has grown from $13.5M to $18.7M over the decade — a 39% increase. Total revenue is up 56% over the same span, boosted by growing investment returns. It is worth noting that the ABR has not increased its exam or MOC fees. If you are kind enough to adjust for inflation over the past decade, revenue is basically flat.
Expenses
| Fiscal Year | Total Expenses | YoY Change | % Change |
|---|---|---|---|
| FY Mar 2014 (TY2013) | $14,934,348 | — | — |
| FY Mar 2015 (TY2014) | $13,881,992 | −$1,052,356 | −7.0% |
| FY Mar 2016 (TY2015) | $13,758,299 | −$123,693 | −0.9% |
| FY Mar 2017 (TY2016) | $15,590,929 | +$1,832,630 | +13.3% |
| FY Mar 2018 (TY2017) | $16,468,080 | +$877,151 | +5.6% |
| FY Dec 2018 (9-mo) | $12,725,890 | — | — |
| FY Dec 2019 | $17,267,413 | — | — |
| FY Dec 2020 | $24,233,988 | +$6,966,575 | +40.3% |
| FY Dec 2021 | $18,830,135 | −$5,403,853 | −22.3% |
| FY Dec 2022 | $18,401,263 | −$428,872 | −2.3% |
| FY Dec 2023 | $19,638,082 | +$1,236,819 | +6.7% |
| FY Dec 2024 | $21,879,395 | +$2,241,313 | +11.4% |
An astute observer would notice a huge one-time jump in fiscal year 2020: This reflects the executive director transition paying two salaries thanks to overlap and severance compensation, as well as the costs of creating and finally transitioning to the online testing forced by the COVID disruptions. This was the single largest annual loss in the ABR’s recent history.
Net Income (“Non”-Profit)
| Fiscal Year | Revenue | Expenses | Net Income |
|---|---|---|---|
| FY Mar 2014 (TY2013) | $14,089,494 | $14,934,348 | −$844,854 |
| FY Mar 2015 (TY2014) | $15,777,660 | $13,881,992 | +$1,895,668 |
| FY Mar 2016 (TY2015) | $16,260,730 | $13,758,299 | +$2,502,431 |
| FY Mar 2017 (TY2016) | $16,920,053 | $15,590,929 | +$1,329,124 |
| FY Mar 2018 (TY2017) | $17,430,259 | $16,468,080 | +$962,179 |
| FY Dec 2018 (9-mo) | $14,097,350 | $12,725,890 | +$1,371,460 |
| FY Dec 2019 | $18,955,195 | $17,267,413 | +$1,687,782 |
| FY Dec 2020 | $16,750,924 | $24,233,988 | −$7,483,064 |
| FY Dec 2021 | $17,740,900 | $18,830,135 | −$1,089,235 |
| FY Dec 2022 | $18,356,752 | $18,401,263 | −$44,511 |
| FY Dec 2023 | $20,113,054 | $19,638,082 | +$474,972 |
| FY Dec 2024 | $22,031,770 | $21,879,395 | +$152,375 |
Cumulative net income (which is what we call ‘profit’ for a non-profit entity) from FY Dec 2019 through FY Dec 2024 (the six full calendar years post-transition): -$6,301,681, largely due to that tough 2020 year. After finishing that transition to online testing, the ABR is operationally “profitable” again.
Executive Director Compensation
In Part II of this post, I use the total compensation figure for comparison purposes, which is a combination of base compensation (i.e. W2) and retirement/benefits. So when comparing to your own salary, make sure you’re thinking apples to apples. He still makes much more than me no matter how you dice it.
| Fiscal Year | Base Compensation | Other (retirement + benefits) | Total Compensation |
|---|---|---|---|
| FY Dec 2021 | $653,699 | $51,482 | $705,181 |
| FY Dec 2022 | $701,356 | $68,530 | $769,886 |
| FY Dec 2023 | $767,129 | $28,219 | $795,348 |
| FY Dec 2024 | $770,591 | $110,820 | $881,411 |
The current Executive Director’s compensation has risen every year over the period reported, from $705K to $881K— a 25% increase in three years. Tax forms for 2025 won’t be out until later this year.
Rising Payroll
| Fiscal Year | Exec Comp | Other Salaries | Total Payroll | % of Expenses |
|---|---|---|---|---|
| FY Mar 2014 (TY2013) | $2,272,945 | $4,745,637 | $7,018,582 | 47.0% |
| FY Mar 2015 (TY2014) | $2,075,865 | $3,133,505 | $5,209,370 | 37.5% |
| FY Mar 2016 (TY2015) | $1,965,789 | $3,427,598 | $5,393,387 | 39.2% |
| FY Mar 2017 (TY2016) | $1,714,448 | $4,096,049 | $5,810,497 | 37.3% |
| FY Mar 2018 (TY2017) | $1,208,631 | $5,407,257 | $6,615,888 | 40.2% |
| FY Dec 2018 (9-mo) | $1,392,001 | $4,230,183 | $5,622,184 | 44.2% |
| FY Dec 2019 | $1,490,381 | $6,560,702 | $8,051,083 | 46.6% |
| FY Dec 2020 | $1,621,149 | $6,358,117 | $7,979,266 | 32.9% |
| FY Dec 2021 | $1,606,895 | $7,613,831 | $9,220,726 | 49.0% |
| FY Dec 2022 | $1,664,371 | $7,673,027 | $9,337,398 | 50.7% |
| FY Dec 2023 | $1,432,234 | $8,465,402 | $9,897,636 | 50.4% |
| FY Dec 2024 | $1,178,933 | $10,000,761 | $11,179,694 | 51.1% |
The “Other Salaries and Wages” category has grown from $3.1M in TY2014 to $10.0M in FY2024 — more than tripling. That’s more than just inflation talking. Total payroll now exceeds $11M and represents over half of all expenses for the first time.
If you’re wondering why executive comp was so ludicrously high in the old days: 1) substantial duplicative overlap and severance starting in 2013 for years during that Executive Director transition, 2) there used to be 3 or 4 paid Associate Executive Directors, and 3) even trustees/governors got small stipends. So the ABR did get leaner in some ways and really trimmed a lot of financial nepotism.
Key Employees: Compensation Over $200K (FY 2024)
| Title | Base Comp | Other | Total |
|---|---|---|---|
| Executive Director | $770,591 | $110,820 | $881,411 |
| IT Director | $246,879 | $71,027 | $317,906 |
| Assoc Exec Director (DR) | $227,261 | $0 | $227,261 |
| Managing Director | $221,508 | $73,014 | $294,522 |
| Director Exam Services | $210,353 | $106,236 | $316,589 |
| Assoc Exec Director (RO) | $210,000 | $0 | $210,000 |
| Director of Analysis | $205,453 | $36,722 | $242,175 |
In addition to the executive director, there are now six more employees who earn over $200K in base compensation. In contrast to the current seven positions, only three made that threshold back in 2017. Most of that is just increasing compensation. The only new position on the list is the “Director of Analysis.”
The War Chest
| Fiscal Year | Total Assets | Total Liabilities | Net Assets |
|---|---|---|---|
| FY Mar 2013 | $37,854,727 | $7,869,046 | $29,985,681 |
| FY Mar 2014 (TY2013) | $40,206,968 | $9,147,115 | $31,059,853 |
| FY Mar 2015 (TY2014) | $43,619,075 | $9,641,878 | $33,977,197 |
| FY Mar 2016 (TY2015) | $45,751,555 | $10,086,048 | $35,665,507 |
| FY Mar 2017 (TY2016) | $49,531,217 | $10,574,429 | $38,956,788 |
| FY Mar 2018 (TY2017) | $51,737,127 | $10,884,293 | $40,852,834 |
| FY Dec 2018 | $42,629,557 | $1,912,012 | $40,717,545 |
| FY Dec 2019 | $48,941,445 | $1,963,109 | $46,978,336 |
| FY Dec 2020 | $46,717,504 | $3,884,279 | $42,833,225 |
| FY Dec 2021 | $49,332,645 | $3,514,792 | $45,817,853 |
| FY Dec 2022 | $43,004,628 | $3,719,314 | $39,285,314 |
| FY Dec 2023 | $48,610,514 | $4,097,619 | $44,512,895 |
| FY Dec 2024 | $51,874,004 | $4,598,066 | $47,275,938 |
Total assets as of FY2024: $51.9 million — essentially unchanged from the $51.7M reported in TY2017, despite the ABR running $6.3M in cumulative operating losses since then.
How is that possible? Because most of the assets are invested, the ABR tends to gain a few million a year in investment returns despite revenues and expenses that are broadly similar. Keep in mind that not all of this shows up in the “Investment Income” line on the 990 — that line only captures dividends, interest, and realized gains (stocks/bonds that were sold for revenue). Just like your 401k/403b, the unrealized appreciation flows directly to the balance sheet, just like when you include your retirement savings as part of your own net worth. So in a year like FY2022, the 990 shows only a −$44K operating loss, yet total assets dropped by $6.3M because the portfolio got hammered by the 2022 market downturn. The reverse in FY2023: only +$475K in net income, but total assets jumped $5.6M as the market recovered. Given the size of the war chest, the operating P&L is almost a sideshow: the ABR’s net assets are really tracking the equity and bond markets more than certification fee revenue.
Now, why did liabilities drop from ~$10M to ~$2M? This is almost entirely the ~$8.9M in “deferred revenue” I discussed in the original 2019 post. Most ABR fees (MOC annual fees, exam fees) are collected on a calendar-year basis, clustering around January. Under accrual accounting, in the old March 31 fiscal year, if someone paid their $340 MOC fee in January for a service period extending through December, the ABR had to book much of that as “deferred revenue” (money received but not yet “earned”) as of the March 31 snapshot. Once they switched from their old accounting method to a standard calendar fiscal year, the phantom liability disappeared because the services that justified that revenue had all been delivered. Just a BS accounting artifact that gave the perception that net assets were lower than they really were. There may have been a change as the Chicago physical testing center lease expired, but the transition from in-person to computer-based exams had less of an impact there than I would have guessed (other than presumably leading to higher expenses at least in part related to increased support staff).
Part II: The ABR in the ABMS Landscape
ABR at a Glance (FY2024)
| Metric | Value | Rank (of 24 ABMS boards) |
|---|---|---|
| Active Diplomates | 68,325 | #5 |
| New Specialty Certificates (2024) | 1,723 | #7 |
| Executive Director Total Comp | $881,411 | #4 (of 21 boards reporting) |
| Avg Radiologist Income | $549,583 | #5 highest-paid specialty |
| Executive / Physician Income Ratio | 1.60× | #10 (median among boards) |
| Executive Comp Per Diplomate | $12.90 | #15 (efficient for its comp level) |
| 4-Year Comp Growth (FY20→FY24) | +38.8% | #5 fastest-growing |
| Compound Comp Annual Growth Rate | +8.5% | #4 (sustained, steady growth) |
The active diplomate count per the ABMS annual report is the very high number of 68,325, which does include medical physicists, rad onc, etc but the number of people enrolled in MOC/OLA per the 2024 Form 990 is 36,325. It’s not entirely clear to me what fraction of the radiology workforce is still composed of experienced radiologists who have been grandfathered with lifetime certificates.
The bottom four rows are those analyzing Executive Director compensation compared to the average radiologist, the cost of that compensation per diplomate, and its growth over recent years. If you use the active MOC diplomate number of 36,325 as the denominator, the cost per practicing (non-trainee) actively “paying” radiologist would be $24.26/diplomate. Given the revenues of the OLA program are something like ~$12,350,500 (36,325 * $340), that would mean that executive director compensation alone absorbs 7% of MOC revenues.
The ABR Pays Its Executive More Than You’d Predict
The ABR has stated in the past that its compensation is in line with other non-profits. They even have an Executive Compensation Committee.
However, even if you run a simple linear regression of executive compensation against diplomate count across all 21 boards with reportable compensation, the ABR’s predicted compensation based on 68,325 diplomates would be roughly $695,000. And that’s potentially generous, as a fraction of diplomates are grandfathered lifetime certificate holders who are long past needing much of anything from the ABR, and the costs of administering exams and rubber-stamping credentials do not scale linearly. The actual figure of $881,411 is $186K above the trendline — 27% over what board size alone would predict.
For context on who’s above and below the line:
| Position | Board | Actual | Predicted | Over/Under |
|---|---|---|---|---|
| Most over-predicted | ABS (Surgery) | $1,186,544 | $601,965 | +97% |
| ABOTO (ENT) | $679,304 | $479,545 | +42% | |
| ABOS (Ortho) | $767,263 | $544,725 | +41% | |
| ABR (Radiology) | $881,411 | $695,290 | +27% | |
| Most under-predicted | ABCRS (Colorectal) | $100,000 | $424,451 | −76% |
| ABNM (Nuclear Med) | $123,241 | $430,883 | −71% | |
| ABAI (Allergy) | $197,969 | $439,597 | −55% | |
| ABA (Anesthesiology) | $418,456 | $679,624 | −38% |
One can argue that ABR is a more complicated board than most, encompassing multiple specialties, subspecialties, exams, and exam types. One can also argue that a substantial amount of what would be expensive about running a medical specialty board is built on the efforts of unpaid physician volunteers.
Obviously, there are practicing radiologists who make more than $881k per year, but one suspects a higher work volume and density for most busy private practice positions that would generate such an income. It is worth pointing out that the executive director position does not require maintaining clinical practice, and the current director spends their time exclusively as an administrator. This is not true for all specialties.
Peer Group: Boards of Similar Size (30K–120K Diplomates)
Among the 10 boards with 30K–120K diplomates, here’s how the ABR fits in:
| Board | Diplomates | Exec Comp | Ratio | $/Diplomate |
|---|---|---|---|---|
| ABP (Pediatrics) | 119,989 | $876,928 | 3.34× | $7.31 |
| ABFM (Family Med) | 106,055 | $999,441 | 3.43× | $9.42 |
| ABPN (Psych/Neuro) | 83,554 | $866,115 | 2.55× | $10.37 |
| ABR (Radiology) | 68,325 | $881,411 | 1.60× | $12.90 |
| ABA (Anesthesiology) | 64,537 | $418,456 | 0.83× | $6.48 |
| ABOG (OB/GYN) | 52,809 | $799,904 | 2.12× | $15.15 |
| ABEM (Emergency Med) | 48,182 | $665,281 | 1.67× | $13.81 |
| ABS (Surgery) | 45,760 | $1,186,544 | 2.67× | $25.93 |
| ABPATH (Pathology) | 34,114 | $624,023 | 1.64× | $18.29 |
| ABOS (Ortho Surg) | 31,920 | $767,263 | 1.27× | $24.04 |
(I’m ignoring the American Board of Internal Medicine [ABIM], which is in a league of its own with 271k diplomates paying $1.33M [4.37x ratio and $4.90/diplomate].)
Of the comparable boards, the ABR pays the 3rd-highest absolute compensation in this peer group (behind ABFM and ABP, which are also both much larger). Because radiology incomes are also high compared to most physicians, the exec-to-physician ratio of 1.60× lands exactly at the median. Compare this to ABFM and ABP, where execs earn 3.3–3.4× what their primary care diplomates make. (Now you know one of the reasons why primary care docs have so much disdain for their boards).
The per-diplomate cost of $12.90 is middling — more expensive than the mega-boards (ABP at $7.31, ABFM at $9.42) but far cheaper than smaller boards (ABS at $25.93, ABOS at $24.04). Again, given differences in how MOC is structured across fields, I’m not sure if cost per diplomate really means the same thing across the ABMS spectrum. Nonetheless, we should expect the trend of larger boards being cheaper per diplomate, as the incremental costs of giving more tests and rubber-stamping more credentials don’t scale linearly.
Radiology vs. Anesthesiology
The ABA is the ABR’s closest peer by size — 64,537 vs. 68,325 diplomates — yet the compensation gap is substantial:
| Metric | ABR | ABA | Difference |
|---|---|---|---|
| Diplomates | 68,325 | 64,537 | ABR +6% |
| Exec Comp FY2024 | $881,411 | $418,456 | ABR +111% |
| Avg Physician Income | $549,583 | $503,092 | ABR +9% |
| Exec/Physician Ratio | 1.60× | 0.83× | ABR nearly 2× higher |
| 4-Year Growth | +38.8% | +46.7% | ABA growing faster from lower base |
The ABR’s exec earns more than double what the ABA’s exec earns, despite the two boards being almost identical in size and their physician incomes being within 9% of each other. ABA’s executive director actually seems to earn less than the average anesthesiologist, whereas the ABR’s exec earns 60% more than the average radiologist.
Perhaps there is an obvious difference in the jobs themselves that justifies the discrepancy, but I’ll admit my personal knowledge of their internal workings isn’t strong, and my imagination isn’t robust enough to think of one.
ABR Among High-Income Specialties
Among the 10 boards whose physicians average $450K+, the ABR stands out for paying its exec a higher multiple than all of them:
| Board | Physician Income | Exec Comp | Ratio |
|---|---|---|---|
| ABNS (Neurosurgery) | $749,140 | N/A | — |
| ABTS (Thoracic Surgery) | $689,969 | $389,469 | 0.56× |
| ABOS (Ortho) | $606,506 | $767,263 | 1.27× |
| ABPS (Plastic Surgery) | $582,722 | $527,396 | 0.91× |
| ABR (Radiology) | $549,583 | $881,411 | 1.60× |
| ABU (Urology) | $528,491 | N/A | — |
| ABA (Anesthesiology) | $503,092 | $418,456 | 0.83× |
| ABOTO (ENT) | $498,123 | $679,304 | 1.36× |
| ABCRS (Colorectal) | $487,085 | $100,000 | 0.21× |
| ABD (Dermatology) | $481,201 | $311,785 | 0.65× |
Among high-income specialties, the norm is for the board exec to earn less than the average physician (most ratios are below 1.0×). The ABR at 1.60× is the highest ratio in this group.
Of note, the ABNS and ABU director jobs are unpaid positions.
Exec Comp Trajectory: ABR vs. Top Boards (FY2020–FY2024)
| Board | FY2020 | FY2021 | FY2022 | FY2023 | FY2024 | 4yr CAGR |
|---|---|---|---|---|---|---|
| ABR | $634,937 | $705,181 | $769,886 | $795,348 | $881,411 | +8.5% |
| ABIM | $996,570 | $1,199,434 | $1,227,661 | $1,385,563 | $1,330,137 | +7.5% |
| ABS | $912,611 | $957,847 | $1,004,338 | $1,041,743 | $1,186,544 | +6.8% |
| ABFM | $642,459 | $662,910 | $769,863 | $956,913 | $999,441 | +11.7% |
| ABP | $924,489 | $1,040,307 | $1,015,110 | $853,423 | $876,928 | −1.3% |
| ABPN | $1,372,106 | $1,101,057 | $1,177,986 | $824,463 | $866,115 | −10.9% |
The ABR’s executive directorship 8.5% compound annual growth rate (CAGR) over recent years outpaces ABIM (7.5%) and ABS (6.8%). At this trajectory, the ABR’s exec comp would cross $1 million by FY2026 (though I bet for optics that it won’t). Only ABIM ($1.33M) and ABS ($1.19M) are “currently” (as of 2024 tax filings) above $1M.
Part III: Summary
| Metric | TY2017 (Original Post) | FY Dec 2024 (Current) | Change |
|---|---|---|---|
| Total Revenue | $17.4M | $22.0M | +26% |
| Program Service Revenue | $16.5M | $18.7M | +14% |
| Total Expenses | $16.5M | $21.9M | +33% |
| Net Income | +$962K | +$152K | −84% |
| Total Payroll | $6.6M | $11.2M | +69% |
| Other Salaries & Wages | $5.4M | $10.0M | +85% |
| ED Total Comp | $739K (Jackson) | $881K (Wagner) | +19% |
| Employees over $200K base | 3 | 7 | +133% |
| Total Assets (War Chest) | $51.7M | $51.9M | +0.3% |
| Net Assets | $40.9M | $47.3M | +16% |
| Investment Income | $926K | $1.2M | +31% |
Over the past decade, ABR revenues have climbed thanks to increasing numbers of radiologists forced to pay steady annual MOC fees, but payroll costs have almost doubled, leaving the ABR just barely cashflow positive only through selling investments.
The ABR has repeatedly claimed that it “collects fees to cover the expenses of administering the programs” and sets fees “as closely as possible to approximate administrative expenses.” That may be technically true, but also doesn’t fully capture reality or necessity. Expenses are not fixed or inevitable but are rather the result of deliberate choices. For one, executive compensation probably doesn’t need to be significantly more than that of most practicing radiologists. Doubled payroll expenses in the current era for an organization that largely exists to administer tests made by uncompensated volunteers is also a choice. Thanks to investment returns, even after absorbing $6M+ in operating losses, the ABR is sitting almost exactly as much money as it was when I first wrote about this 7 years ago. I, for one, would like to see fees come down, particularly for trainees.
The ABR has stated it doesn’t want to increase fees, and I agree that it shouldn’t.
It needs to control costs.