How Are Pediatricians Who Choose Lower Earning Subspecialties Doing A Decade Later?

Frintner MP, Freed GL, Byrne BJ, Gottschlich EA, Cull WL

Presented at the 2025 Pediatric Academic Societies Annual Meeting

Background: Studies estimate lower lifetime potential earnings for pediatric subspecialists in academic careers compared to general pediatricians in private practice except for cardiology, critical care and neonatology, who were estimated to have the highest earning potential. Longitudinal data can provide actual cumulative earnings.

Objective: Compare finances, job characteristics and satisfaction of pediatricians in lower earning subspecialties with generalists, hospitalists and higher earning subspecialists over 12 years.

Methods: Longitudinal data from the AAP Pediatrician Life and Career Experience Study (PLACES) 2009-11 Residency Graduates Cohort collected in 2012-23 were analyzed (n=871). Pediatricians self-reported income yearly in annual surveys (participation ranged 75-93%). Chi-square or ANOVA compared finances, job characteristics and career satisfaction (averaged across years) of 4 career groups: generalist, hospitalist, and higher earning (cardiology, critical care, neonatology) and lower earning subspecialists (all other subspecialties). Multivariable linear regression examined cumulative income in 2023 of the 4 groups, controlling for pediatrician and job characteristics (eg gender, work hours).

Results: The 12-year analyses included 871 pediatricians (>8,000 responses). Overall 45% were generalists, 14% hospitalists, 30% lower earning and 11% higher earning subspecialists. In 2012-2013, generalists and hospitalists reported significantly higher income than both subspecialist groups [Figure]. Higher earning subspecialists passed lower earning subspecialists in cumulative income at completion of fellowship training and generalists and hospitalists by 2019 (p<.05). Lower earning subspecialists trailed generalists and hospitalists across years, but the gap narrowed and by 2022 there was no statistically significant difference in cumulative income. In multivariable analysis, the same patterns held with no significant difference in cumulative income in 2023 for lower earning subspecialists compared to generalist and hospitalist.

Compared to generalists, lower earning subspecialists were more likely to report total debt repaid by 2023 (67% vs 52%, p<.05); Table. They also reported higher work hours, were less likely to be owners or in rural settings and more likely to be in academic settings (p<.001). 8 in 10 in all 4 groups agreed they are satisfied with their career.
Conclusion: The finances of pediatricians in lower earning subspecialties were more robust than previously predicted. Their reported cumulative income approximates generalists, but not higher-earning subspecialists, within a decade.

Table 1. Finances, Job Characteristics and Satisfaction of PLACES Pediatricians Graduating Residency 2009-2011 by Career Group: Study Years 2012-2023  

Figure 1. Mean Unadjusted Cumulative Pediatrician-Reported Income by Career Group Over Study Years (2012-2023): PLACES 2009-2011 Residency Graduates Cohort