Is one more year – or two – worth it? A net present value analysis of career earnings for physicians pursuing academic pediatric cardiac critical care

Pediatric cardiac critical care has emerged as a distinct field at the intersection of the broader fields of pediatric cardiology and pediatric critical care, and the training for this field requires one or more additional year of training after a usual 3-year fellowship training period in pediatric critical care or pediatric cardiology, but also has multiple pathways through this training. The long-term financial outcomes of this additional training have not been evaluated and may be useful in mentorship and career planning for trainees interested in this field. To determine whether additional cardiac intensive care unit (CICU) training is financially beneficial compared with standard pediatric critical care medicine (PCCM) or diagnostic cardiology pathways. Economic modeling study using net present value analysis of lifetime earnings for physicians in cardiac critical care through one- or two-year training pathways, pediatric critical care, and diagnostic pediatric cardiology utilizing the 2024–2025 Association of Administrators of Academic Pediatrics Faculty Compensation and Productivity Survey data, incorporating training duration, promotion trajectory and salary percentile, and applying a 3% real discount rate with sensitivity analyses from 0 to 5%. Using the 50th salary percentile and standard promotion trajectory, cardiac critical care lifetime earnings surpassed other fields. Lifetime net present values were: pediatric critical care - $7.19 million; diagnostic pediatric cardiology - $7.36 million; 1-year cardiac critical care pathways - $7.84 million; 2-year dual-board cardiac critical care pathways - $7.52 million. The range in lifetime net present value across salary percentiles exceeded $3 million, and variation by promotion trajectory exceeded $1.5 million, indicating that these exert greater influence than training pathways alone. Despite requiring one to two additional years of training, CICU specialization is financially comparable to, and in many cases slightly more favorable than, standard PCCM or diagnostic cardiology careers. These findings suggest that CICU training provides meaningful career flexibility without sacrificing long-term financial outcomes, while salary percentile and academic advancement remain the strongest determinants of overall lifetime earnings. • Advanced training in pediatric cardiac critical care can be financially advantageous. • Salary percentile and promotion play a large role in lifetime earnings. • Physicians can be confident in the financial outcome of entering their desired field.