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Changes in the Pediatric-Adult Academic Subspecialists Compensation Gap.
Salika Gadiwala1,2, Ankita Shukla1,2, Lubaina Ehsan1,2
1Arkansas Children's Hospital, Little Rock, Arkansas.
Pediatrics
|April 25, 2026
Summary
The lifetime earnings gap between pediatric and adult subspecialists in academic medicine widened between 2014 and 2024. This growing disparity impacts the sustainability of the pediatric workforce.
Area of Science:
- Medical Economics
- Academic Medicine
- Pediatrics
Background:
- Pediatric subspecialists in academic medicine historically earn less than their adult counterparts.
- The trend of this earnings disparity over time remains unclear.
Purpose of the Study:
- To compare the net present value (NPV) of lifetime earnings between pediatric and adult subspecialists in 2014 and 2024.
- To evaluate changes in the relative earnings differential over a decade.
Main Methods:
- Retrospective economic analysis using Association of American Medical Colleges Faculty Salary Reports (2014, 2024).
- Lifetime earnings modeled to age 67 with a 3% discount rate and three promotion pathways.
- Relative earnings differential calculated as ((Adult NPV - Pediatrics NPV)/Pediatrics NPV) × 100.
Main Results:
- Adult subspecialists consistently had higher lifetime NPVs than pediatric subspecialists in both analyzed years.
- The average relative earnings differential increased from 15.7% in 2014 to 20.2% in 2024.
- Disparities were more pronounced at higher salary percentiles and with limited career progression.
Conclusions:
- The lifetime earnings gap between pediatric and adult subspecialists in academic medicine has widened significantly from 2014 to 2024.
- This widening gap raises concerns regarding the long-term sustainability of the pediatric subspecialist workforce.
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