Document Type

Article

Publication Date

10-31-2025

Keywords

academic general, lifetime earnings, subspeciality pediatric promotion, timelines

Abstract

Question What is the association between academic promotion timelines and lifetime earnings of general pediatricians and pediatric subspecialists? Findings In this cross-sectional study of 19 111 academic pediatricians, earlier promotion was consistently associated with significantly higher net present value of lifetime earnings, regardless of subspecialty or salary percentile. Physicians who were never promoted faced financial losses exceeding $2 million to $3 million in some fields and would need to work approximately 10 additional years to match the net present value of peers on a baseline promotion trajectory. Meaning These findings suggest that promotion timing is a critical determinant of long-term financial outcomes in academic pediatrics and underscore the need to address disparities in advancement to strengthen and sustain the pediatric workforce.

This cross-sectional study evaluates the association between promotion timing and the net present value of lifetime earning for academic general and subspecialty pediatricians across their careers.

Importance Differences in academic promotion timelines may contribute to long-standing disparities in pediatric physician compensation and impact workforce sustainability. Objective To evaluate the association between promotion timing and the net present value (NPV) of lifetime earnings for academic general pediatricians and pediatric subspecialists across salary percentiles and career lengths. Design, Setting, and Participants This cross-sectional study using a financial modeling strategy examined 2024-2025 compensation data from the Association of Administrators in Academic Pediatrics. The NPV analysis was conducted for 29 pediatric fields across 4 promotion scenarios (early promotion, baseline promotion, stalled promotion, and no promotion), 3 salary percentiles (25th, 50th, and 75th), and 3 career lengths (standard, part time, and early retirement).Exposure Promotion timeline and pediatric subspecialty. Main Outcome and Measures The outcome was NPV of lifetime earnings as measured in constant 2025 dollars. Results A total of 19 111 academic pediatricians and pediatric subspecialists were included from the compensation dataset. Early promotion consistently yielded the highest NPV across all subspecialties and salary percentiles (median NPV, $7 621 223.50), while remaining at the assistant professor rank for an entire career was associated with the lowest NPV (median, $6 967 428.72). Baseline promotion NPV peaked at a mean (SD) of $9 364 986.25 ($695 347.50), while no promotion NPV was significantly lower (mean [SD], $7 093 248.02 [$475 237.71]). Stalled promotion reduced the median NPV by $500 000 to $1.5 million; no promotion led to losses exceeding $2 million to $3 million in high-paying subspecialties, such as cardiology, critical care, and neonatology. Sensitivity analyses and Monte Carlo simulations found that delayed promotion was negatively associated with lifetime earnings under all tested scenarios. Conclusions and Relevance In this cross-sectional study of academic pediatricians, promotion timing was associated with lifetime earnings and often more influential than subspecialty or salary percentile. The findings suggest that physicians who were never promoted may need to work an additional 10 years to match the earnings of peers promoted via a baseline promotion trajectory. The findings highlight the financial consequences of delayed advancement and underscore the need for institutional efforts to support timely and equitable promotion across the pediatric workforce.

Comments

Web of Science

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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