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Cardiothoracic surgery encompasses the operative management of acquired and congenital cardiac disease, thoracic malignancies and benign thoracic conditions, esophageal disease, and diseases of the great vessels and mediastinum. Core procedural domains include coronary revascularization, structural heart surgery including valve repair and replacement and septal defect closure, aortic root and ascending aorta surgery, lung resection for malignancy and benign disease, minimally invasive thoracic surgery, esophagectomy, and heart and lung transplantation.

The specialty has evolved with the widespread adoption of minimally invasive and robotic approaches to both cardiac and thoracic procedures, transcatheter structural heart interventions requiring surgical collaboration, and expanding indications for mechanical circulatory support as a bridge to transplantation or destination therapy. The scope of practice varies by subspecialty focus, with many programs differentiating cardiac surgery from general thoracic surgery training and practice.

Career paths in cardiothoracic surgery are well-suited to surgeons who are drawn to the technical demands of chest surgery, the high-stakes perioperative environment of cardiac critical care, and the opportunity to deliver life-saving and life-changing surgical outcomes.

Opportunities include:

• Cardiac Surgeon: Performing coronary artery bypass grafting, valve repair and replacement, aortic surgery, and structural heart procedures, including collaboration with interventional cardiology on hybrid and transcatheter structural heart programs.
• General Thoracic Surgeon: Managing thoracic malignancies including lung cancer, esophageal cancer, mediastinal tumors, and pleural disease, using minimally invasive video-assisted and robotic thoracoscopic approaches alongside open techniques.
• Congenital Heart Surgeon: Operating on infants, children, and adults with congenital cardiac anomalies, including septal defects, conotruncal anomalies, hypoplastic left heart syndrome, and complex single-ventricle physiology, typically within dedicated congenital heart surgery programs at children's hospitals and academic cardiac centers.
• Heart and Lung Transplant Surgeon: Performing heart and lung transplantation and serving as a core surgical member of advanced heart failure and transplant programs, including mechanical circulatory support implantation and management.
• Minimally Invasive and Robotic Cardiac Surgeon: Specializing in minimally invasive approaches to valve surgery, coronary revascularization, and atrial fibrillation surgery, using robotic and endoscopic platforms that may reduce surgical trauma and recovery time in appropriately selected patients.
• Academic, Research, and Leadership Roles: Cardiothoracic surgeons with interests beyond clinical practice can pursue faculty appointments at academic cardiac and thoracic surgery programs, lead research in structural heart surgery outcomes, robotic thoracic surgery, mechanical circulatory support, and lung transplantation, and serve in leadership roles as division chiefs, cardiac surgery program directors, or surgical directors of heart failure and transplant programs.

Whether pursuing cardiothoracic surgery jobs at academic quaternary care centers, high-volume community cardiac programs, or comprehensive thoracic oncology programs, the specialty supports a range of professional goals and practice environments.

Coronary Artery Surgery: On-pump and off-pump coronary artery bypass grafting, including arterial revascularization strategies and hybrid coronary revascularization in collaboration with interventional cardiology.

Valve Surgery: Mitral, aortic, and tricuspid valve surgery, along with participation in multidisciplinary structural heart programs involving procedures such as TAVR and transcatheter mitral edge-to-edge repair (TEER).

Aortic Surgery: Open and endovascular management of aortic root aneurysm, ascending aorta disease, aortic dissection, and thoracoabdominal aortic pathology in collaboration with vascular surgery.

Thoracic Oncology Surgery: Anatomic and sublobar lung resection for primary and metastatic lung malignancy, esophagectomy for esophageal cancer, thymectomy, and surgical management of mediastinal and pleural tumors.

Minimally Invasive and Robotic Thoracic Surgery: Video-assisted thoracoscopic surgery and robotic-assisted thoracic surgery for lung resection, mediastinal procedures, and esophageal surgery.

Congenital Heart Surgery: Surgical repair of congenital cardiac anomalies across the full spectrum of complexity, from simple septal defects to complex single-ventricle palliation, in pediatric and adult congenital heart disease programs.

Heart and Lung Transplantation: Donor procurement, recipient transplant surgery, and perioperative management of heart and lung transplant patients in collaboration with advanced heart failure and pulmonology teams.

Mechanical Circulatory Support: LVAD implantation, perioperative VAD management, and surgical involvement in cardiogenic shock and bridge-to-transplant programs.

Demand for cardiothoracic surgeons is expected to remain strong amid an aging population, substantial cardiovascular and thoracic disease burden, and projected national shortages in the thoracic surgery workforce. Cardiothoracic surgery jobs are available at academic medical centers, high-volume community cardiac surgery programs, comprehensive cancer centers, and heart and lung transplant programs.

Compensation in cardiothoracic surgery reflects the technical complexity and training demands of the specialty, with variation based on subspecialty focus, procedural volume, practice setting, geographic location, and program structure. To review physician compensation data specific to cardiothoracic surgery and related surgical specialties, request your copy of our Annual Physician Compensation and Placement Summary.

Tangible Benefits:

• Comprehensive health, dental, and vision insurance
• Retirement plans with contribution matching
• Paid time off and holidays
• Sign-on bonuses, student loan repayment, and relocation assistance in high-demand areas
• Support for continuing education, CME stipends, and subspecialty training
• Accommodations for an inclusive and accessible workplace

Intangible Benefits:

• Performing technically elite surgical procedures that directly save and extend lives
• Practicing at the forefront of surgical innovation in structural heart surgery, robotic thoracic surgery, and transplantation
• Access to advanced surgical platforms, hybrid operating room environments, and mechanical circulatory support programs
• Opportunities for high-impact research, structural heart program leadership, and national contributions to cardiac and thoracic surgery
• Commitment to nondiscrimination and employee rights

Hard Skills: Coronary artery bypass grafting, cardiac valve repair and replacement, aortic surgery, lung resection including minimally invasive and robotic approaches, esophagectomy, cardiopulmonary bypass management, LVAD implantation, heart and lung transplant surgery.

Soft Skills: Precise communication with patients, families, and cardiac and thoracic care teams regarding complex surgical decisions and perioperative expectations, collaborative engagement within multidisciplinary cardiac surgery, cardiology, and oncology programs, composure and decisive judgment in high-stakes operative and perioperative environments, adaptability to rapidly evolving surgical technologies and structural heart program development.

Cardiothoracic surgeons practice in a variety of settings, including:

• Academic medical centers and quaternary care cardiac surgery programs
• High-volume community hospital cardiac surgery programs
• Comprehensive cancer centers and thoracic oncology surgery programs
• Heart and lung transplant programs and advanced heart failure centers
• Children's hospitals and congenital heart surgery programs
• Veterans Affairs medical centers and military cardiothoracic programs
• Hybrid operating room environments supporting structural heart and endovascular programs

Cardiothoracic surgery involves significant operative and perioperative demands, including cardiac ICU management responsibilities and on-call coverage that varies by program size and team structure. The specialty is well suited to surgeons committed to the highest level of technical surgical practice and the perioperative intensity of cardiac and thoracic care.

The pathway to a career in cardiothoracic surgery includes:

• Bachelor's degree (pre-medical focus)
• Medical school (MD or DO)
• General surgery residency (typically 5 years) followed by cardiothoracic surgery fellowship (typically 2 to 3 years), or integrated cardiothoracic surgery residency (typically 6 years)
• Board certification by the American Board of Thoracic Surgery (ABTS)
• Optional advanced subspecialty training may include a two-year ACGME-accredited congenital cardiac surgery fellowship or institution-specific advanced training in areas such as thoracic oncology or cardiothoracic transplantation
• Ongoing participation in ABTS Continuing Certification requirements, including continuing medical education, professional standing, and periodic knowledge assessment