O2061: The Financial Impact of Promotion Timing and Subspecialty Choice in Academic Pediatric Cardiology: A Net Present Value Analysis

Background: Career earnings in academic pediatric cardiology are influenced by multiple factors, including subspecialty selection, promotion timelines, and salary percentile placement. While previous studies have examined salary disparities between pediatric and adult medicine, financial modeling within pediatric cardiology subspecialties remains limited. This study applies Net Present Value (NPV) analysis to estimate 35-year career earnings across promotion scenarios (No Promotion, Early, Typical, Delayed Promotion) and salary percentiles (25th, 50th, 75th percentile). The findings provide valuable financial insights for pediatric cardiologists navigating career decisions.

Methods: Using 2024-2025 AAAP Compensation Benchmarks, we obtained salary distributions for pediatric interventional, critical care, and diagnostic cardiology, stratified by academic rank and percentiles. We modeled career earnings trajectories over a 35-year period, applying a 2% annual salary growth rate and a 3% discount rate to reflect the present value of future earnings. We constructed four promotion pathways: No Promotion (remains an Assistant Professor); early Promotion (Assistant → Associate: 5 years, Associate → Full: 6 years); typical Promotion (Assistant → Associate: 7 years, Associate → Full: 10 years) and delayed Promotion (Assistant → Associate: 10 years, remains an Associate). We calculated NPV across all scenarios and salary percentiles and conducted a sensitivity analysis to assess how discount rates impact career earnings. The results were visualized using bar graphs comparing subspecialties, promotion pathways, and salary percentiles (Figures 1 and 2).

Results: The NPV of future earnings for pediatric cardiologists is substantial but varies significantly based on pay percentile, subspecialty, and promotion timing, with discounted lifetime earnings ranging from $7.20 million (M) to $14.23M over a 35-year career (Figure 1). Early promotion consistently resulted in the highest career earnings, while delayed promotion or remaining at the assistant professor level led to significant financial disadvantages. Among subspecialties, interventional cardiologists had the highest present value of career earnings, ranging $8.28M – $14.23M across the different promotion scenarios, while diagnostic cardiologists consistently had the lowest NPV ($7.20M - $12.24M) (Figure 2), particularly at lower salary percentiles. Placement within a higher salary percentile substantially increased lifetime earnings, with pediatric cardiologists in the 75th percentile earning 30–50% more than those in the 25th percentile. Notably, diagnostic cardiologists in the 75th percentile had earnings comparable to interventional cardiologists in the 25th percentile, highlighting the impact of salary placement. Career earnings were highly sensitive to discount rates, with higher discount rates disproportionately affecting lower salary percentiles and widening the earnings gap between subspecialties.

Conclusion: Early promotion and higher salary percentiles significantly improve financial outcomes in pediatric cardiology. Interventional cardiology remains the most financially rewarding due to procedural-based compensation, while diagnostic cardiologists have the lowest NPV trajectories. Promotion delays lead to substantial financial penalties, highlighting the importance of institutional career advancement policies.