Abstract 4360523: Lifetime Earnings in Pediatric Cardiology: A Net Present Value Analysis of Academic and Private Practice Pathways

Introduction: Pediatric cardiology requires extensive training, yet the long-term financial implications across academic subspecialties and private practice remain poorly characterized. A clearer understanding of these differences is essential for career decision-making and workforce planning. Methods: We used a net present value (NPV) framework to model lifetime earnings for pediatric cardiologists across three academic subspecialties (diagnostic, cardiac intensive care, and interventional) under five promotion trajectories and compared them with private practice. Compensation data were sourced from the Association of Academic Administrators in Pediatrics (AAAP), the Association of American Medical Colleges (AAMC), and the Medical Group Management Association (MGMA). Monte Carlo simulations (10,000 iterations) and sensitivity analyses accounted for variation in salary percentile, discount rate, and career length. Results: Lifetime earnings were substantial across all pediatric cardiology career pathways, with NPVs exceeding $7 million (M) in most modeled scenarios (Figure 1). Interventional cardiology yielded the highest NPV at the 50th percentile (Figure 2) under a typical academic promotion trajectory ($7.99M), followed by cardiac intensive care ($7.76M) and diagnostic cardiology ($7M). Private practice produced an NPV of $7.08M at the 50th percentile, with a ramp-up model increasing this to $7.30M; still below interventional and CICU tracks. Academic earnings rose by up to $2.44M through early promotion compared to no promotion, and by up to $867,000 through leadership roles, depending on subspecialty. Salary percentile was the most influential driver of NPV; interventional cardiology at the 90th percentile exceeded $10.4M, and private practice reached $10.76M. Private practice exhibited the widest range of lifetime earnings (Figure 3). Conclusion: Pediatric cardiologists; particularly those in interventional subspecialties or academic leadership; achieve substantial lifetime earnings. At the 50th percentile, academic and private practice careers offer comparable financial outcomes, but private practice shows greater variability. Optimizing academic career pathways through early promotion, high-percentile salaries, or leadership roles can match or exceed private practice earnings. These findings can guide trainee decision-making and inform strategies for recruitment, retention, and compensation equity in pediatric cardiology.