Variability in first academic medicine job offers in pulmonary and critical care medicine

BACKGROUND: A minority of Pulmonary and Critical Care Medicine (PCCM) graduates pursue careers in academic medicine. Although compensation is only a portion of the career decision, job negotiations remain shrouded in ambiguity and inconsistency. Additionally, while role-level salary tables exist through the Association of American Medical Colleges (AAMC), to our knowledge there is no resource that includes important non-salary. OBJECTIVE: We sought to describe key components of first PCCM academic job offers for both physician scientists and clinician educators, including salary, start-up packages, non-clinical full-time equivalent (FTE) breakdown, and bonus ranges. METHODS: An electronic survey was distributed via a snowball sampling method between May-June 2025. PCCM graduates between 2020 and 2025 who accepted a job in academic medicine were included. Mann-Whitney Wilcoxon tests were used for ordinal comparisons. Qualitative analysis of free text responses was performed with a social cognitive career theory framework. RESULTS: There were 60 respondents who provided information about 103 job offers, with 50% (14/28) of physician-scientists and 66% (21/32) of clinician-educators reporting more than one job offer. Physician-scientists received lower salary offers compared to clinician-educators (respective median ranges: $150 000-$199 999 vs $250 000-$299 999, P < .001). Only 35.7% of physician-scientists (10/28) received a career development award prior to negotiation, which was associated with a higher start-up package offer (P < .05). For all clinician-educator jobs (n = 59), 42.4% had non-clinical FTE in the initial offer. Many respondents commented on the lack of negotiating power. CONCLUSION: PCCM physician-scientists and clinician-educators experience wide variability in their initial job offers. Recognizing differences is essential to improve transparency in job negotiations in academic medicine.