Overview

A cardiothoracic surgeon is a medical doctor who specializes in surgical procedures of the heart, lungs, esophagus, and other organs in the chest. This includes surgeons who can be called cardiac surgeons, cardiovascular surgeons, general thoracic surgeons, and congenital heart surgeons.

Sometimes called a cardiothoracic surgeon or a general thoracic surgeon, this specialty gets its name from the Greek word for “chest.” As the name suggests, cardiothoracic surgeons specialize in surgeries on most organs and tissues found in the chest. This can include surgeries on the heart and connected major blood vessels, the lungs, esophagus (which connects your mouth to your stomach) and trachea (windpipe). Some thoracic surgeons may choose to only focus on conditions involving the heart, pericardium (a sac around the heart) and major blood vessels of the heart. Others may choose to focus on other conditions excluding the heart and major blood vessels.

What Is a Cardiothoracic Surgeon?

A cardiothoracic surgeon is a physician who specializes in surgical procedures involving the heart and lungs. These professionals perform treatments such as coronary artery bypass grafting, mitral and aortic valve repair and replacement, ventricle restoration, lung and esophageal resection, and radiofrequency ablation for atrial fibrillation. They may also install cardiac support devices and provide evaluation and treatment of mediastinal tumors for patients with lung cancer. Before surgery, surgeons consult with patients to discuss the diagnosis and answer questions about the operation. Afterward, they follow up with patients to ensure a smooth recovery.

Cardiothoracic surgeons will graduate from medical school and go on to complete either a 5-year general surgery residency followed by a 2- or 3-year cardiothoracic surgery residency program, or enter into a 6-year integrated cardiothoracic surgery residency.

Some cardiothoracic surgeons choose to do additional training in a subspecialized area but this training is optional with the exception of congenital heart surgery, which requires completion of a 1-year fellowship.

Cardiothoracic surgeons operate on diseases that occur in the organs inside the chest and in the bony structures and tissues that form the chest cavity.

Coronary artery disease is one of the most common diseases treated by cardiothoracic surgeons.

General thoracic surgeons treat primarily lung cancer and diseases of the esophagus and chest wall.

Congenital heart surgeons care for babies and children with holes between the heart chambers or abnormal connections within the heart.

Listed below are some examples of diseases treated by cardiothoracic surgeons.

A cardiac or cardiovascular surgeon could treat:

• Coronary artery disease or blockages of the arteries in the heart
• Blockages in the heart valve(s)
• Leaking heart valve(s)
• Abnormal enlargement or aneurysms of the large arteries in the chest
• Heart failure
• Atrial fibrillation

A general thoracic surgeon could treat:

• Lung cancer
• Severe emphysema
• Esophageal cancer 
• Gastroesophageal reflux disease
• Hiatal hernias
• Swallowing disorders such as achalasia

A congenital heart surgeon could treat:

• Atrial septal defects
• Ventricular septal defects
• Coarctation of the aorta
• Hypoplastic left or right heart syndrome
• Transposition of the great arteries

A cardiologist will primarily diagnose disorders of the heart and treat them with medication.  Cardiologists also perform interventions on the arteries in the heart working through puncture wounds in the groin, but they do not perform open surgery.

A pulmonologist will diagnose disorders of the lung and treat them with medication.  Some pulmonologists will perform interventions through the airway but do not perform open surgery. 

All cardiothoracic surgeons have the same general training and are certified by the same specialty board, except for congenital heart surgeons who have a subspecialty certificate in addition to the American Board of Thoracic Surgery (ABTS) certification.

An Overview About Becoming A Cardiothoracic Surgeon

The following chart provides an overview about becoming a cardiothoracic surgeon:

Degree Required	Doctor of Medicine (M.D.)
Training Required	5-year surgical residency and 2-year residency in thoracic surgery
Licensure or Certification	All states require doctors to be licensed; board certification is available
Key Responsibilities	Diagnose and treat patients who have diseases of the heart and lungs; perform surgical procedures on the heart and lungs to restore normal function; prescribe treatment and medication; order diagnostic tests and evaluate results
Job Growth (2020-2030)	3% (for all physicians and surgeons)*
Median Salary (2021)	$489,495**

What is Cardiothoracic Surgery?

Cardiothoracic surgery refers to surgery within the thorax, or the chest cavity. This includes surgery on structures such as the heart, aorta, lungs, mediastinum, esophagus, and diaphragm.

These are the surgeons who do procedures like coronary artery bypass grafts, or CABG for short, to treat plaque buildup in heart vessels. They perform valve replacements to replace poorly functioning heart valves, lung resections to remove lung cancer, and esophageal repairs to remove esophageal cancers. They can also perform heart and lung transplants, usually one or the other, but in rare instances both at the same time.

This specialty is not for the faint of heart. Most CT surgeons are workaholics, as CT surgery is a specialty with a more challenging lifestyle than most. Operations such as CABG or lung resections last from 4 to 8 hours, and when things go wrong, complications can result in a procedure lasting up to 12 hours!

That being said, many CT surgeons make time for their family and hobbies. After all, these are very smart doctors, and they understand the importance of a balanced life for sustainability and longevity.

CT surgery also has a reputation for a malignant culture, which is a term we use to mean you aren’t treated well by your superiors or colleagues. This may have been the norm in the past, but luckily things are changing for the better, and many CT surgeons love teaching residents and medical students.

There are a few ways to categorize CT surgery.

Cardiac vs Thoracic vs Cardiothoracic

First, we can divide the types of surgery based on anatomy. After finishing CT surgery training, surgeons can choose to specialize even further as cardiac or thoracic surgeons. Cardiac surgeons focus on the heart and aorta, performing operations such as CABG and valve replacements.

Thoracic surgeons mainly operate on the lung, such as lung cancer resections, but also work on the esophagus, diaphragm, mediastinum, ribs, and other structures within the thorax.

Alternatively, they can remain generalized and operate in both cardiac and thoracic domains, which is more common at community centers. However, if you work at a larger urban or academic hospital, you’ll probably be specializing in cardiac or thoracic.

Open vs Minimally Invasive Surgery

When you think of CT surgery, especially cardiac surgery, you may imagine an open chest, the heart stopped in the surgeon’s hand, and a giant machine circulating blood to the patient. And that stereotype is mostly true. The majority of cardiac operations, such as aortic valve replacements and CABG involve performing a sternotomy, whereby a saw is used to cut the breast bone in half to access the heart.

The cardiopulmonary bypass machine takes over the function of the heart and lungs while they’re stopped, such that the patient’s blood is drained into the machine, where it’s oxygenated, and then gets pumped back to the rest of the body. This allows the surgeons to operate as needed on the stopped heart.

On the other hand, minimally invasive surgeries include video-assisted thoracoscopic surgeries or robot-assisted surgeries, like the Da Vinci robot. Most lung cancer resections are performed in this manner. Four to six small incisions are made in the spaces between the ribs to insert ports for the robot arms or camera. Using long instruments and a camera, surgeons are able to maneuver through the thorax to cut, remove, and suture tissue. Certain cardiac surgeries, such as valve replacements, can also be performed with robot assistance.

Attributes That One Needs To Become A Cardiothoracic Surgeon

Cardiothoracic surgery is a highly demanding role for which you need a unique blend of skills and personal qualities. You will also need significant leadership expertise. In addition to the characteristics possessed by all successful surgeons, a cardiothoracic surgeon also requires skills in the following areas.

Physical

• Exceptional hand-eye coordination and dexterity.
• High perception of spatial relationships among and between objects.
• Ability to work long hours without a break.
• Undivided focus in spite of potential distractions.

Leadership

• The capacity to remain calm and level-headed in very stressful situations.
• The aptitude to monitor developing conditions in and out of the operating room.
• The foresight to anticipate potential issues and complications.
• The ability to thrive under pressure.
• The desire and proficiency to lead and direct a team.
• The capability to inspire confidence in others.

Emotional

• The resilience to cope with unexpectedly changing circumstances.
• A supportive disposition for the patient, their family, and your team in sometimes problematic circumstances.

What types of conditions do cardiothoracic surgeons treat?

Since the late 1940s, cardiothoracic surgery has experienced brisk growth and fast-moving technological changes. The specialty is considered young and evolving as science and research reveal more about the cardiothoracic area of the body.

The field of cardiothoracic surgery includes:

• Adult cardiac surgery.
• Congenital cardiac surgery.
• General thoracic surgery.
• Heart and lung transplant surgery.

Cardiac surgeons perform the following types of surgeries:

• Aortic surgery – replaces enlarged or damaged blood vessels leaving the heart.
• Coronary artery bypass surgery – bypasses narrowed coronary arteries, restoring blood flow to the heart.
• Heart valve surgery – repairs and replaces usually thin or leaking heart valves.

Surgeries completed by thoracic surgeons include:

• Pectus surgery – repairs chest wall deformities.
• Video-assisted thoracoscopic surgery (VATS) – treats some thoracic disorders without opening the chest.
• Lung surgery – inflates collapsed lungs and removes abnormal tissues from them.

Congenital cardiac surgeons treat diseases and correct physical conditions present in babies and children who have suffered with them from birth. These surgeons repair the following types of conditions:

• When the aortic or aortic and pulmonary valve is narrower than usual.
• When there is a hole between two of the heart’s chambers.
• When the arteries are transposed.

 

How to Become a Cardiothoracic Surgeon

After finishing medical school, there are three pathways to becoming a CT surgeon. The most common and traditional, called the independent pathway, is to complete a general surgery residency, lasting 5-7 years depending on the program, and then complete an additional 2-year CT surgery residency afterward. In this situation, the surgeon is board certified in both general surgery and CT surgery and is spending between 7 to 9 years of additional training after medical school.

The second option is the integrated pathway, lasting only 5 or 6 years in total. Residents rotate on general and CT surgery, but spend most of their time on CT. This is a smaller and newer format, but it’s growing each year. Residents in this pathway are only board-certified in CT surgery, not general surgery.

The third option is the combined pathway, also known as the fast track pathway. Rather than 5 years of general surgery residency and then applying separately to another program for a 2 year CT residency, you’ll do 4 years of general surgery and 3 years of CT surgery at a single program. These graduates are certified in both general and CT surgery.

Again similar to plastic surgery, most medical students want to obtain an integrated pathway position. After all, it’s fewer years in training. However, CT surgery integrated programs are new and small in number. Last year, there were only 37 individual positions available, meaning that fewer than 50% of applicants successfully matched. For this reason, most aspiring CT surgeons choose a general surgery residency, which is a less competitive path. Don’t think it’ll be easy however, as it’s still very challenging to match at a top-tier, big-name program.

What types of medical students apply to CT surgery? Stereotypically, the gunners. After all, CT surgery is far from easy, and it comes with long hours. The bread and butter cases, such as CABG and lung resections, can last a long while. For these reasons, it attracts those who aren’t afraid of hard work. Particularly if you end up at an integrated CT surgery residency program, you’ll need to be at the top of your class with stellar board scores, research, letters of recommendation, and honors in your clinical rotations.

Steps To Become A Cardiothoracic Surgeon

1. Earn an undergraduate degree

You first must earn a bachelor’s degree and meet the prerequisite courses needed to apply to an accredited medical school. It’s best to pursue a degree in science with coursework focused on chemistry, biology and math. To prepare for medical school, students need to maintain an exceptional grade point average (GPA), usually above 3.5.

During your undergraduate years, you will need to take the Medical College Admission Test (MCAT). The score will be part of your admission application to medical school.

2. Volunteer at hospitals and clinics

Volunteering at hospitals and clinics helps you gain experience and determine whether you are passionate about the medical field. The work experience can be beneficial for your resume as well. To find volunteer opportunities, contact your local hospitals to see if they have any available positions.

3. Take the Medical College Admission Test (MCAT)

Passing the MCAT is a requirement for those who want to attend medical school. The MCAT covers four sections: Biological and Biochemical Foundations of Living Systems; Chemical and Physical Foundations of Biological Systems; Psychological, Social and Biological Foundations of Behavior and Critical Analysis and Reasoning Skills. The exam challenges your problem-solving skills, critical thinking, writing and scientific principle knowledge. To prepare for the MCAT, consider taking courses online or seeking a tutor.

4. Graduate medical school

Those interested in cardiothoracic surgery must earn a Doctor of Medicine (M.D.) degree. You need to complete four years of medical school to earn this degree. The first two years focus primarily on lectures and labs in a classroom setting and you may take an elective in surgery. The last two years include clinical practice so seek out surgery, cardiothoracic or other rotations that might be useful for a cardiothoracic career path.

When pursuing a career as a cardiothoracic surgeon, research medical schools that offer this specialization to better prepare you with the necessary knowledge.

5. Become a licensed physician

You must become a licensed physician before continuing your post-medical school education. The requirements for licensure vary by state but most require that you pass the U.S. Medical Licensing Examination (USMLE).

6. Complete a general surgery residency

A general surgery residency typically combines clinical experience, research opportunities, conferences and operating room experience. The program usually lasts five years. During the first two years, you might study various critical areas of surgery, such as cardiovascular surgery. The following years include assisting and performing surgeries and pursuing opportunities for rotations in specialized surgery. Residencies are typically organized through your medical school.

7. Complete a cardiothoracic surgery fellowship

A thoracic surgery fellowship provides advanced training and education through hospital experience. It helps you gain more specialized experience with cardiothoracic surgery and meet case requirements set by the American Board of Thoracic Surgery (ABTS) for certification. A thoracic surgery fellowship typically takes two to three years to complete, but some professionals choose to partake in a six-year integrated cardiothoracic surgery residency for more experience.

8. Obtain board certification

You may consider pursuing a certification in thoracic surgery through the ABTS to provide you with more job opportunities. To earn certification, most prospective cardiothoracic surgeons first earn a state medical license, complete general and thoracic surgery residencies and earn satisfactory scores on a board exam. Other requirements for the certification often include completing additional medical education hours, submitting letters of reference, providing case summaries and passing an exam every 10 years.

 

Sub- Specialties within Cardiothoracic Surgery

After completing CT surgery training, you can subspecialize even further with a 1 year fellowship.

Congenital Cardiac Surgery

Congenital cardiac surgery is for those who love precision and working on tiny objects. Many congenital cardiac operations must be done as soon as the neonate is born, which means working on a heart the size of a golf ball.

Congenital cardiac surgeons also operate on adults with congenital heart defects. If you’d like to work with a wide age range of patients, this may be a good fit.

Transplant Surgery

Transplant surgery is for the workaholics who love a rush. Transplants can occur at any moment, depending on when the donor passes, and this often translates to operations in the middle of the night. The glorious side of transplant surgery is that you’ll be riding in helicopters and private jets to harvest the organs.

Thoracic Aortic & Endovascular Surgery

Thoracic aortic and endovascular surgery includes extra training to master operating on the thoracic aorta, or the part of the aorta that is in the chest. You mostly treat patients with aortic aneurysms, or aortas with expanded and weak walls that are about to erupt! You can either perform open surgeries to replace the diseased segment of the aorta or perform an endovascular operation in which you snake a wire and a stent through the patient’s femoral artery in the leg. Once you work it up to the thoracic aorta, you can deploy the stent by expanding it to address the defect in the wall.

A Cardiothoracic Surgeon’s Earning Potential

Cardiothoracic surgery is not for the faint-of-heart. Long years of training, working, studying, and practical surgical experience require intense focus. A residency as well as years practicing as a cardiothoracic surgeon are required. That’s how you become the best surgeon you can be in this delicate specialty. Given the time and financial resources needed, you may be interested in knowing what the return could be on your investment.

According to the U.S. Bureau of Labor Statistics (BLS), as of 2016, physicians practicing primary care earned a total median annual compensation of $251,578. Physicians practicing in medical specialties received a total yearly median salary of $425,509. It is important to note that BLS figures may not include the income of doctors and surgeons in private practice.

Earning potential may increase with additional certifications. To become certified in cardiothoracic surgery you must complete a specialty residency and pass exams from the American Board of Thoracic Surgery (ABTS). The ABTS administers the same tests for all heart surgeons and thoracic surgeons, regardless of their scope of practice. If you wish, after achieving general certification, you can qualify as a subspecialist in congenital heart surgery through passing an additional exam.

Besides earnings, cardiothoracic surgeons often see some immediate and life-changing results of their work. When patients are able to return to most, if not all of their activities, the work becomes emotionally rewarding and filled with purpose.

 

What You’ll Love About Cardiothoracic Surgery

Cardiothoracic surgery is a pretty dope specialty. If you love big, epic operations, this is the field for you. Where else can you feel the heart beating in your hands, stop it, and then bring it back to life? CT surgery is also incredibly exciting with rapid innovation and new robotic and minimally invasive surgeries being developed regularly.

In terms of patients, you’ll be working with the sickest of the sick. Particularly with heart failure and heart attack patients, who are at death’s door, you’ll be saving lives. For this reason, it’s highly rewarding and CT surgeons build a strong bond with their patients. However, you should also be able to stomach when cases occasionally go bad.

If you love complex work with multiple moving parts and teamwork, CT surgery has you covered. Not only are you working with the nurses and anesthesiologists, but you’ll have the perfusionist manning the cardiopulmonary bypass machine and robot assistance for minimally invasive surgery. Additionally, these patients require close post-op monitoring and care, so you’ll be working with several other members of the healthcare team to ensure a safe recovery.

Lastly, money. CT surgeons are highly compensated for their work, with an average annual salary of $480,000.

What You Won’t Love About Cardiothoracic Surgery

While CT surgery is glamorous and exciting, it’s definitely not for everyone. This is a highly demanding specialty with a great deal of hard work. Surgeries are long, and patients are sick, often not having favorable outcomes. You will have more patients die than compared to other specialties.

And you won’t have a predictable schedule. In this line of work, emergency surgeries in the middle of the night are not uncommon. Get ready to pull all-nighters and still operate the next day. The usual “9 to 5”, 40 hours per week does not apply here.

Training is long and it will take a while to become a CT surgeon, and even longer if you want to specialize further. While other specialties have 3 to 5 years of training after medical school, be prepared to spend another decade for CT surgery. That’s 10 years of making $50 to $80k a year as a resident or fellow as well as 10 years of spending intense hours in training.

Frequently Asked Questions About Becoming A Cardiothoracic Surgeon 

Here are answers to common questions about the career:

1. What are the subspecialties within cardiothoracic surgery?

After completing cardiothoracic training, you can pursue subspecialties within the field, including:

• Congenital cardiac surgery
• Transplant surgery
• Thoracic aortic and endovascular surgery

Each requires additional education and training.

2. What might a cardiothoracic surgeon treat?

Coronary artery disease is one of the most common diseases treated by cardiothoracic surgeons. General thoracic surgeons typically treat lung cancer and diseases of the esophagus and chest wall. Congenital heart surgeons treat babies, children and adults with holes between their heart chambers or abnormal connections within the heart.

Other diseases and defects include:

• Abnormal enlargement or aneurysms of the large arteries in the chestAortic valve disease
• Atrial fibrillation
• Atrial septal defects
• Blockages of the arteries or heart valve
• Coarctation of the aorta
• Esophageal cancer
• Gastroesophageal reflux disease
• Heart failure
• Hiatal hernias
• Hypoplastic left or right heart syndrome
• Leaking heart valves
• Severe emphysema
• Swallowing disorders such as achalasia
• Transposition of the great arteries
• Ventricular septal defects

3. What is the salary and job outlook?

A cardiothoracic surgeon makes a national average salary of $281,038 per year. Salaries vary depending on experience, education, skills and location.

According to the U.S. Bureau of Labor and Statistics (BLS), the job outlook for surgeons should remain similar to its current level with a projected job increase of 4% through 2029.

4. What is the workplace environment?

Cardiothoracic surgeons often work in fast-paced environments. They typically work in hospital settings, medical schools or for the government. They perform both scheduled and emergency operations. Their presence may also be required at outpatient clinics, team meetings and ward rounds.

Shifts can be long and irregular, as they may be called into work whenever emergencies and the need for surgeries arise. Cardiothoracic surgeons may work 60 or more hours a week. They may perform two surgeries one day and five the next. A surgical procedure can take up to eight hours or more. This is a demanding career and knowing how to manage stress is extremely important.

5. What skills are helpful to become a cardiothoracic surgeon?

Here are some skills that may help a cardiothoracic surgeon perform their tasks effectively:

• Hand-eye coordination: Cardiothoracic surgeons typically require excellent hand-eye coordination to perform surgery properly.
• Ability to remain calm: Heart surgery is an incredibly delicate and intensive procedure, so having the ability to remain calm may help a surgeon operate well.
• Attention to detail: Attention to detail can help surgeons properly diagnose and resolve patient issues without errors or delays.
• Leadership and management: Cardiothoracic surgeons often work with teams during surgery, so being able to lead and guide others when overseeing operations is crucial.
• Physical stamina: Cardiothoracic surgeons often work in operating rooms for long periods and stand for the entire duration without a break.

 

Should You Become a Cardiothoracic Surgeon?

At the end of the day, how can you decide if CT surgery is a good fit for you? If you’re an adrenaline junkie who loves big cases, a fast-paced lifestyle but isn’t afraid of standing for hours doing longer surgeries in the middle of the night, then CT surgery may be a good fit.

If you also crave innovation and want to be on the cutting edge of surgery, CT seems to always have a new noteworthy technology every year and is one of the leading specialties in robotics utilization.

Finally, CT surgery is incredibly competitive, particularly if you want to get into an integrated residency or get into a strong general surgery residency to position you well for a CT fellowship.

And who better to learn from and be mentored by than CT surgeons themselves. Big shout out to the CT surgeons at Med School Insiders that helped me in the creation of this post. If you need help acing your MCAT, USMLE, or other exams, our tutors can maximize your test day performance. If you’re applying to medical school or cardiothoracic surgery residency, our CT surgeons can share the ins and outs of what it takes and how to navigate the highly competitive process most effectively. We’ve become the fastest growing company in the industry, and it’s no surprise. Our customers love us because we’re committed to delivering results, period.

How many years does it take to become a cardiothoracic surgeon?

All cardiac surgeons are required to complete extensive education and training programmes that last for at least 15 years.

Is it hard to be a heart surgeon?

The path to becoming a heart surgeon is not simple.

What major should I choose to be a cardiothoracic surgeon?

you should strongly think about majoring in a science like biology or chemistry.

What are the steps to become a cardiovascular surgeon?

Pre-medical four-year undergraduate degree with a focus on science. four-year medical programme. 5-year residency programme in general surgery. Cardiothoracic surgery experience of two to three years

How to become a cardiothoracic surgeon in the USA?

Obtain a bachelor’s degree. Volunteer at clinics and hospitals Take the Medical College Admission Test Complete medical school, obtain a license, then complete a residency in general surgery to become board certified.

Cardiothoracic surgeon salary

The typical base income for a cardiothoracic surgeon is $500,200, with salaries ranging from $400,900 to $627,000.

At what age do you become a cardiothoracic surgeon?

Till you are roughly 30 or 31, you must attend school. Another 10–13 years of training and experience may be necessary to become recognised as a heart surgeon.

How many years does it take to become a cardiothoracic surgeon?

A minimum of 15 years are required to become a cardiothoracic surgeon in total.

Cardiothoracic surgery fellowship

Includes in-depth, practical exposure to the fields of mechanical cardiac assist devices, lung transplantation, and heart transplantation.

Cardiothoracic surgeon education cost

The average expenditure of $483,000 a year was nearly twice what was anticipated.

Cardiothoracic surgery residency

For a total of seven years of residency training, residents in this fast-track course complete four years of general surgery and three years of cardiothoracic surgery residency.

How to become a cardiothoracic surgeon in the UK?

You will sign up for a paid two-year foundation programme after graduating from medical school, and then you can apply for paid speciality training to become a cardiothoracic surgeon.