Gender Distribution and Lifetime Earning Potential in the Pediatric Subspecialties: Implications for the Workforce

Background: There are wide differences in lifetime earning potential across the pediatric subspecialties, differences that have only worsened over time. Lower earning pediatric subspecialties have workforce shortages and lower fellowship fill rates compared to higher earning pediatric subspecialties. Other areas in medicine that have higher proportions of women tend to have lower compensation than male-predominant fields. Subspecialty gender composition may play a role in pediatric workforce shortages if pediatric subspecialties with higher percentages of women have lower lifetime earning potentials.

Methods: We obtained compensation data for academic pediatric subspecialist physicians from national surveys for 2019-2020. In order to estimate lifetime earning potential, we calculated the Lifetime Net Present Value (NPV) of each subspecialty, defined as the present value of the net income generated from a career in a pediatric subspecialty over a working lifetime. We obtained gender distribution data for pediatric subspecialists and first-year subspecialty fellows from the American Board of Pediatrics. We utilized linear regression analysis to evaluate the relationship between Lifetime NPV for each pediatric subspecialty and the proportion of female subspecialists and first-year subspecialty fellows. Because we used publicly available, aggregated, and deidentified data, this study did not meet the criteria for human subject research and did not require institutional review board approval.

Results: Our study included compensation data from 11,454 pediatric subspecialists, gender distribution data from 26,203 subspecialists, and fellowship data from an average of 1,351 subspecialty fellows per year from 2014-2019. The results of the simple bivariate linear regression analysis showed that the subspecialties with higher proportions of women had lower Lifetime NPVs; there was a decrease of $55,215 in Lifetime NPV for each one percent increase in the percentage of females (95% CI -$24,429 to -$86,000). Similarly, higher proportions of female first-year fellows were associated with lower Lifetime NPVs; there was a decrease of $61,808 in Lifetime NPV for each one percent increase in the percentage of female first-year fellows (95% CI -$9,210 to -$114,405).

Conclusion: Pediatric subspecialties with higher proportions of women tended to have lower lifetime earning potentials than subspecialties with higher proportions of men. Lower earning subspecialties also tended to train higher proportions of women, suggesting that this trend may worsen over time. Moreover, the pediatric subspecialties with higher proportions of women and lower lifetime earnings potentials are the same subspecialties with current and future workforce shortages. This suggests that gender-based disparities in compensation may play a role in workforce shortages not only today but also in the future.