Academic General and Subspecialty Pediatric Promotion Timelines and Lifetime Earnings

Area of Science:

• Medical Economics
• Pediatric Workforce Studies
• Academic Medicine

Background:

• Disparities in academic pediatric physician compensation are linked to differing promotion timelines.
• These disparities can affect the sustainability of the pediatric workforce.

Purpose of the Study:

• To assess the relationship between promotion timing and the net present value (NPV) of lifetime earnings for academic general pediatricians and subspecialists.
• To analyze this association across various salary percentiles and career lengths.

Main Methods:

• A cross-sectional study utilizing financial modeling with 2024-2025 compensation data from the Association of Administrators in Academic Pediatrics.
• Net present value (NPV) analysis was performed for 29 pediatric fields under four promotion scenarios (early, baseline, stalled, no promotion), three salary percentiles, and three career lengths.

Main Results:

• Early promotion yielded the highest NPV ($7.6M median), while no promotion resulted in the lowest NPV ($7.1M mean).
• Stalled promotion reduced NPV by $0.5M-$1.5M, and no promotion led to losses of $2M-$3M in high-earning subspecialties.
• Delayed promotion was consistently associated with lower lifetime earnings across all scenarios.

Conclusions:

• Promotion timing significantly influences lifetime earnings for academic pediatricians, often outweighing subspecialty or salary.
• Physicians facing no promotion may need an additional decade of work to equal baseline-promoted peers' earnings.
• Institutions should prioritize timely and equitable promotion to mitigate financial consequences and support the pediatric workforce.