P4.006: Academic Promotion Timelines in Pediatric Subspecialties: A Financial Analysis of Lifetime Earnings Impact.

Background: The structured promotion pathway for academic pediatric subspecialists—from Assistant to Associate to Full Professor—affects not only career progression but also has significant salary implications. Delays in promotion or failure to advance can substantially reduce lifetime earnings, an issue particularly relevant in pediatrics, where baseline salaries are lower than in adult medicine. This study evaluates the net present value (NPV) of career earnings across pediatric subspecialties using Association of Administrators in Academic Pediatrics (AAAP) salary benchmarks, comparing early, typical, late, and no-promotion scenarios.

Methods: We used 2024–2025 AAAP compensation data for 29 pediatric subspecialties. We modeled a 35-year academic career for subspecialists (38 years for general pediatrics and hospitalists). Median (50th percentile) salaries at each academic rank were used to calculate total career earnings under four promotion scenarios:
• Early Promotion: Assistant to Associate at 5 years; Full at 10 years.
• Typical Promotion: Assistant to Associate at 7 years; Full at 17 years.
• Late Promotion: Assistant to Associate at 10 years; no promotion to Full.
• No Promotion: Remained at Assistant Professor throughout.
NPV was calculated using a 3% discount rate and 2% annual salary growth. Sensitivity analyses tested variations in discount rates (1–5%) and salary growth (0–4%). Monte Carlo simulations (10,000 iterations) incorporated random variation in promotion timelines.

Results: Across all pediatric subspecialties, early promotion resulted in the highest NPV of lifetime earnings (Figure 1). Remaining at the Assistant Professor rank for an entire career led to the lowest NPV. Notably, typical promotion provided a substantial financial advantage over no promotion, with lifetime earnings 20–30% higher. Figure 2 illustrates the financial losses associated with delayed or absent promotion compared to the typical promotion scenario. Across all subspecialties, late promotion resulted in a median lifetime earnings reduction of approximately $500,000–$1.5 million, while remaining at the Assistant rank for an entire career resulted in losses exceeding $2–3 million in some subspecialties. Pediatric cardiology, critical care, and neonatology showed the greatest losses associated with promotion delays, likely due to their higher salary differentials between ranks. Sensitivity analyses confirmed that promotion delays had consistent negative financial impacts across all tested scenarios.

Conclusion: The timing of academic promotion has a substantial financial impact on pediatric subspecialists, with early promotion maximizing lifetime earnings and delayed promotion leading to significant losses. Given the lower baseline salaries in pediatrics compared to other specialties, supporting timely promotion is essential to reducing financial disparities, improving faculty retention, and supporting long-term career sustainability.