Changes in the Pediatric–Adult Academic Subspecialists Compensation Gap

OBJECTIVE: Pediatric subspecialists in academic medicine earn less than adult subspecialists, but whether this disparity has changed over time is unclear. We compared the net present value (NPV) of lifetime earnings between pediatric and adult subspecialists in 2014 and 2024 and evaluated changes in the relative earnings differential. METHODS: We conducted a retrospective economic analysis using Association of American Medical Colleges Faculty Salary Reports from 2014 and 2024. Salaries at the 25th, 50th, and 75th percentiles were extracted across academic ranks for pediatric and adult subspecialties and converted to 2024 dollars. Lifetime earnings were modeled through retirement at age 67 using a 3% real discount rate and three promotion pathways (baseline, plateaued, and no promotion). The relative earnings differential was defined as (Adult NPV - Pediatrics NPV)/Pediatrics NPV × 100. RESULTS: Across subspecialties, adult subspecialists in academic medicine had higher lifetime NPVs than pediatric subspecialists in both years. In 2024, lifetime NPVs for pediatric subspecialists ranged from $4.9 million to $7.6 million, compared with $5.3 million to $9.4 million for adult counterparts (50th percentile, baseline promotion pathway). The average relative earnings differential widened from 15.7% in 2014 to 20.2% in 2024. Disparities were amplified at higher salary percentiles and with plateaued or absent promotion, reaching 41.5% in a no-promotion pathway at the 75th percentile. CONCLUSIONS: From 2014 to 2024, the lifetime earnings gap between pediatric and adult subspecialists in academic medicine widened, with potential implications for pediatric workforce sustainability.