Structural Inequities in Pediatric Versus Adult Interventional Cardiology: A Lifetime Earnings and Productivity Analysis

AbstractBackground Compensation for interventional cardiologists varies substantially by patient population and practice setting, yet no prior study has compared lifetime, discounted earnings between pediatric and adult interventional cardiology. Understanding these differences is essential for workforce sustainability and equitable access to congenital heart interventions. Methods We conducted an economic evaluation using benchmark compensation and productivity data from pediatric academic, adult academic, and adult private. Lifetime earnings were estimated using a net present value (NPV) framework over a 32-year career (age 35–67) at a 3% discount rate (2025 USD). Models incorporated academic promotion scenarios, private-practice fixed and ramp-up structures, and a 10, 000-iteration Monte Carlo simulation varying salary percentile, career length, and promotion timing. Productivity was assessed using daily relative value unit (RVU) and NPV per career RVU. Results At the 50th percentile, lifetime NPVs were 8. 03 million for pediatric academic, 10. 45 million for adult academic, and 15. 73 million for adult private practice—gaps of 30% and 96% relative to pediatrics. Median Monte Carlo NPVs were similar (7. 81 million, 10. 29 million, and 15. 01 million, respectively). Pediatric interventionalists generated fewer daily RVUs (20. 6) than adult academic (41. 0) and adult private (43. 0) cardiologists, whereas compensation per RVU was comparable. These disparities reflect lower achievable procedural throughput and occur within an RVU framework that has repeatedly under-recognized the time and intensity of congenital work. Limited private-practice opportunities in pediatrics further widen earnings gaps. Conclusions Pediatric interventional cardiologists experience pronounced lifetime earnings disadvantages compared with adult counterparts because of throughput constraints, RVU valuation shortcomings, and labor-market structure. Addressing these systemic inequities will be essential to sustaining the congenital interventional workforce and ensuring equitable access to advanced cardiovascular care for children