Becoming a cardiothoracic surgeon through the traditional general surgery pathway usually requires four years of college, four years of medical school, five years of general surgery residency, and another two to three years of thoracic surgery residency. For someone who moves directly from one stage to the next, the complete journey generally takes approximately 15 to 16 years after graduating from high school, although research years, gap years, additional degrees, parental leave, and other personal or professional circumstances may make the timeline longer.

Cardiothoracic surgeons diagnose and surgically treat conditions involving the heart, lungs, esophagus, major blood vessels within the chest, mediastinum, chest wall, and other structures inside the thoracic cavity. Depending on the surgeon’s training and eventual clinical focus, the work may include coronary artery bypass surgery, heart valve repair, removal of lung cancer, esophageal surgery, treatment of thoracic aortic disease, mechanical circulatory support, heart or lung transplantation, and critical care after complex operations.

The specialty is broad enough that two cardiothoracic surgeons working at the same hospital may have very different practices. One may spend most of the week performing heart operations, while another focuses on lung cancer and minimally invasive chest surgery, and a third may build a practice around aortic disease, heart failure, transplantation, or congenital heart conditions.

The traditional pathway begins with the broad surgical foundation explained in my guide on how to become a general surgeon, although cardiothoracic surgery is somewhat different from many of the other specialties in this series because students can also enter an integrated six-year thoracic surgery residency directly after medical school. The general-surgery-first route remains an established and important pathway, so this article will explain that sequence in the greatest detail while also helping you understand the integrated and joint training options you may encounter.

The Path to Becoming a Cardiothoracic Surgeon

The traditional pathway includes four years of college, four years of medical school, five years of categorical general surgery residency, and two to three years of independent thoracic surgery residency.

Current ACGME requirements establish the traditional independent thoracic surgery program as 24 months following completion of the required prior residency, although programs may offer a 36-month curriculum or another approved educational format when they have received advance approval from the Review Committee. The Thoracic Surgery Directors Association therefore describes the traditional pathway as five years of general surgery followed by two to three years of cardiothoracic surgery training.

This creates a traditional post-high-school timeline of approximately:

• Four years of college
• Four years of medical school
• Five years of general surgery residency
• Two to three years of thoracic surgery residency

A student who graduates from high school at 18 and progresses continuously through the two-year traditional pathway might complete training at approximately 33 years old, while someone entering a three-year program might finish around 34. Several years of research during general surgery residency or a gap between college and medical school can extend that timeline further.

Seeing 15 or 16 years written out at once can understandably make the career feel distant, particularly when you are still thinking about prerequisite courses or the MCAT. It may feel more manageable to remember that you are not making every decision during college, because your first task is determining whether medicine feels right, your later experiences will help you decide whether surgery fits you, and general surgery residency will give you several years to explore whether operating inside the chest is where you hope to focus the rest of your career.

What Is a Cardiothoracic Surgeon?

A cardiothoracic surgeon is a physician with advanced training in the surgical treatment of diseases affecting structures inside the chest, particularly the heart, lungs, esophagus, thoracic aorta, airways, pleura, mediastinum, diaphragm, and chest wall.

The formal specialty name used by the ACGME and American Board of Thoracic Surgery is thoracic surgery, even though many patients, students, hospitals, and physicians commonly use the term cardiothoracic surgery.

The word cardio refers to the heart and cardiovascular structures, while thoracic refers more broadly to the chest. The combined term reflects that accredited thoracic surgeons receive education in both cardiac and general thoracic disease, even when their eventual practices become concentrated more heavily in one area.

The American Board of Thoracic Surgery offers cardiac, general thoracic, and cardiothoracic operative pathways during training, but successful surgeons receive one primary certificate in thoracic surgery rather than three completely separate board certificates.

That structure explains why a physician who primarily removes lung tumors and a physician who primarily performs heart valve operations may both be board-certified thoracic surgeons, even though their daily work looks very different.

What Does a Cardiothoracic Surgeon Do?

Cardiothoracic surgeons evaluate patients with diseases of the heart and chest, determine whether surgery is appropriate, perform operations, manage patients through recovery, and continue treating complications or long-term conditions after the procedure.

Their work may include:

• Reviewing imaging and diagnostic testing
• Evaluating whether a patient can tolerate surgery
• Discussing surgical and nonsurgical treatment options
• Performing heart, lung, esophageal, aortic, or chest operations
• Managing patients in cardiothoracic intensive care units
• Responding to postoperative complications
• Participating in cancer tumor boards
• Working within structural heart and heart-failure teams
• Evaluating patients for heart or lung transplantation
• Following patients after surgery
• Teaching residents, fellows, and medical students
• Conducting research and quality-improvement work

The operation may be the most visible part of the career, but a cardiothoracic surgeon’s decisions begin long before the patient enters the operating room.

A patient with heart valve disease, for example, may have several possible treatments, including continued observation, medication, open surgery, a minimally invasive operation, or a catheter-based procedure. The surgeon works with cardiologists, imaging specialists, anesthesiologists, and other physicians to determine which option is most likely to provide meaningful benefit.

Similarly, a patient with lung cancer may need additional imaging, pulmonary-function testing, biopsy, lymph-node staging, chemotherapy, immunotherapy, or radiation before surgery is recommended. The surgeon must understand the disease, the available alternatives, and the patient’s goals rather than viewing the operation as an isolated technical event.

What Conditions Do Cardiothoracic Surgeons Treat?

The complete scope of thoracic surgery includes adult cardiac disease, congenital heart disease, general thoracic disease, cardiothoracic critical care, mechanical circulatory support, and selected forms of transplantation.

The American Board of Thoracic Surgery’s certification examinations cover both cardiac and general thoracic surgery, including acquired heart disease, congenital conditions, lung disease, esophageal disease, pleural disease, mediastinal disease, chest-wall conditions, critical care, and transplantation.

Coronary artery disease

The coronary arteries supply blood and oxygen to the heart muscle. When these arteries become severely narrowed or blocked, some patients may need coronary artery bypass grafting, commonly called CABG or bypass surgery.

During CABG, the surgeon uses blood vessels from another part of the body to create new routes for blood to travel around blocked coronary arteries.

Not every patient with coronary artery disease needs bypass surgery. Many people are treated with medications, lifestyle changes, or catheter-based procedures such as stent placement, while others have patterns of disease for which surgery may offer a better long-term result.

The treatment decision is often made through collaboration among cardiologists, interventional cardiologists, cardiac surgeons, imaging specialists, and the patient rather than by one physician working alone.

Heart valve disease

The heart contains valves that direct blood through its chambers and into the circulation. When a valve becomes narrowed, leaks substantially, or develops another serious abnormality, surgery may be considered.

Cardiothoracic surgeons perform operations involving the:

• Aortic valve
• Mitral valve
• Tricuspid valve
• Pulmonary valve

Depending on the disease, the surgeon may repair the patient’s existing valve or replace it with a mechanical or tissue valve.

Valve repair can be particularly attractive when it restores normal function while preserving the patient’s own tissue, although repair is not possible or appropriate in every situation. The decision depends on the specific valve, anatomy, cause of disease, severity, symptoms, age, other medical conditions, and the experience of the surgical team.

Cardiac surgeons increasingly work within structural heart programs in which surgeons and interventional cardiologists jointly evaluate patients for open surgery, minimally invasive surgery, transcatheter valve treatment, or continued medical care.

Thoracic aortic disease

The aorta is the largest artery in the body, and its thoracic portion carries blood from the heart through the chest.

Cardiothoracic surgeons may treat aneurysms, dissections, genetic aortic disorders, infections, traumatic injuries, and other diseases involving the aortic root, ascending aorta, arch, or portions of the descending thoracic aorta.

Aortic operations can involve replacing part of the artery, repairing or replacing the aortic valve, reconnecting branches that supply the brain, or coordinating treatment with vascular surgeons and interventional specialists.

Some aortic conditions develop gradually and can be followed through imaging before an operation becomes necessary, while an acute aortic dissection may become a life-threatening emergency requiring immediate surgery.

Heart failure and mechanical circulatory support

Patients with advanced heart failure may eventually need surgical treatment when medications and other therapies can no longer provide adequate support.

Cardiac surgeons may implant ventricular assist devices, commonly called VADs, that help the heart pump blood. A device may support a patient while waiting for a heart transplant, allow the heart time to recover, or serve as long-term therapy when transplantation is not available or appropriate.

Surgeons in this area must understand mechanical circulatory support, heart-failure physiology, anticoagulation, infection, device complications, intensive care, and transplant candidacy.

Cardiothoracic training includes experience with circulatory-support technologies such as ventricular assist devices, extracorporeal membrane oxygenation, and other methods of supporting the heart and lungs. Current ABTS operative requirements also include experience with circulatory assistance and cardiothoracic critical care.

Lung cancer and pulmonary tumors

General thoracic surgeons commonly diagnose, stage, and surgically treat lung cancer.

Possible operations include:

• Wedge resection
• Segmentectomy
• Lobectomy
• Pneumonectomy
• Lymph-node sampling or dissection
• Sleeve resection
• Airway reconstruction

Many lung operations can be performed through minimally invasive approaches, including video-assisted thoracoscopic surgery, commonly called VATS, or robotic surgery. Other patients still require an open thoracotomy because of the tumor’s location, size, complexity, or surrounding anatomy.

Surgery may occur before or after chemotherapy, immunotherapy, or radiation, depending on the cancer’s stage and biology. Cardiothoracic surgeons therefore work closely with medical oncologists, radiation oncologists, pulmonologists, radiologists, and pathologists.

The cancer-related side of this work overlaps with the multidisciplinary principles discussed in my guide on how to become a surgical oncologist, although thoracic surgeons follow a different advanced training pathway and concentrate on diseases within the chest.

Esophageal disease

Thoracic surgeons may treat both cancerous and noncancerous diseases of the esophagus, including:

• Esophageal cancer
• Achalasia
• Esophageal perforation
• Diverticula
• Severe reflux-related disease
• Hiatal or paraesophageal hernias
• Motility disorders
• Complications after prior esophageal surgery

Esophageal operations can be particularly complex because the esophagus travels through the neck, chest, and upper abdomen before reaching the stomach.

Treatment may require collaboration with gastroenterologists, surgical oncologists, abdominal surgeons, medical oncologists, radiation oncologists, nutrition specialists, and speech or swallowing professionals.

Patients undergoing esophagectomy may need reconstruction using the stomach or another part of the gastrointestinal tract, and recovery can involve significant changes in eating, nutrition, swallowing, and daily routines.

Pleural, mediastinal, airway, and chest-wall disease

The specialty also includes conditions involving structures that may receive less attention when students first imagine cardiothoracic surgery.

Thoracic surgeons may treat:

• Pleural infections and empyema
• Pneumothorax
• Pleural tumors
• Mediastinal masses
• Thymic tumors
• Tracheal and bronchial disease
• Chest-wall tumors
• Rib and sternal abnormalities
• Diaphragm disorders
• Hyperhidrosis in selected patients

Training requirements include experience with the lungs, pleura, mediastinum, airway, esophagus, chest wall, diaphragm, bronchoscopy, upper gastrointestinal endoscopy, and multidisciplinary patient management.

Heart and lung transplantation

Some cardiothoracic surgeons pursue practices involving heart transplantation, lung transplantation, or both.

These surgeons participate in recipient selection, donor-organ recovery, transplantation, mechanical support, postoperative critical care, immunosuppression, rejection management, and long-term follow-up alongside transplant cardiologists, pulmonologists, infectious disease physicians, pharmacists, nurses, coordinators, and many other specialists.

Heart and lung transplant surgeons follow cardiothoracic training rather than the abdominal transplant pathway described in my guide on how to become a transplant surgeon, which focuses on kidney, liver, pancreas, intestine, and other abdominal organs.

The fields share many principles involving organ donation, allocation, rejection, immunosuppression, and multidisciplinary care, but their foundational anatomy and surgical pathways differ.

Cardiac Surgery and General Thoracic Surgery

Cardiothoracic surgery is often divided into two major clinical branches: cardiac surgery and general thoracic surgery.

Cardiac surgery

Cardiac surgeons focus primarily on the heart and major vessels near it, including the coronary arteries, valves, aorta, heart chambers, and mechanical circulatory-support systems.

Their practices may include:

• Coronary artery bypass grafting
• Valve repair and replacement
• Aortic surgery
• Surgery for heart tumors
• Arrhythmia surgery
• Ventricular assist devices
• ECMO
• Heart transplantation
• Adult congenital heart surgery
• Structural heart procedures

General thoracic surgery

General thoracic surgeons focus primarily on noncardiac structures in the chest, including the lungs, esophagus, pleura, mediastinum, trachea, diaphragm, and chest wall.

Their practices may include:

• Lung cancer surgery
• Esophageal surgery
• Airway reconstruction
• Pleural surgery
• Mediastinal tumor removal
• Chest-wall surgery
• Lung transplantation
• Minimally invasive thoracic procedures
• Bronchoscopy and endoscopy

Some surgeons maintain broad cardiothoracic practices, particularly in certain community settings, while many surgeons at large academic centers become more concentrated in either adult cardiac or general thoracic surgery.

The American Board of Thoracic Surgery allows trainees to satisfy operative requirements through cardiothoracic, general thoracic, or cardiac pathways, although the primary certification remains one thoracic surgery certificate.

Is Cardiothoracic Surgery a Fellowship or a Residency?

Students will often hear the traditional post-general-surgery program called a cardiothoracic fellowship, and that language remains common in everyday conversation.

Officially, however, the ACGME and American Board of Thoracic Surgery generally refer to the advanced training as a thoracic surgery residency, while physicians completing the traditional independent program may be described as fellows within ACGME documents.

The standard traditional sequence is:

College → medical school → general surgery residency → independent thoracic surgery residency

The terminology matters less than understanding that the physician has completed a full general surgery residency before entering another accredited program devoted to cardiothoracic surgery.

Because other pathways now allow students to begin cardiothoracic training directly after medical school, it is important not to assume that every cardiothoracic surgeon first completed all five years of general surgery.

The Three Main Cardiothoracic Surgery Training Pathways

There are currently three major pathways into cardiothoracic surgery in the United States.

The traditional independent pathway

The independent pathway includes five years of general surgery followed by two or three years of thoracic surgery training.

The American Board of Thoracic Surgery recognizes successful completion of a full five-year ACGME-accredited general surgery residency followed by an ACGME-accredited thoracic surgery residency as one of its formal certification pathways.

This is the pathway emphasized throughout this article because it fits within the broader series of careers available after general surgery residency.

A major advantage of this route is that students do not need to commit to cardiothoracic surgery while still in medical school. General surgery residency provides several years of operative growth and exposure before the physician applies for advanced thoracic training.

The tradeoff is that the total training time is generally longer than an integrated six-year residency.

The integrated six-year pathway

The integrated pathway, commonly called the I-6 pathway, allows medical students to match directly into a six-year thoracic surgery residency after medical school.

Current ACGME requirements specify 72 months of integrated thoracic surgery education, with the curriculum combining foundational surgical training and progressive cardiothoracic experience under the direction of the thoracic surgery program.

The integrated curriculum includes core surgical education along with oncology, transplantation, laparoscopy, critical care, trauma, general thoracic surgery, adult cardiac surgery, and congenital cardiac surgery.

For a student who is confident about cardiothoracic surgery during medical school, the I-6 route offers a more direct pathway and may reduce the post-medical-school training period from seven or eight years to six.

However, integrated positions are limited, and students applying directly must demonstrate a well-developed understanding of the specialty much earlier than someone choosing the traditional pathway during general surgery residency.

The joint 4+3 pathway

The joint surgery and thoracic surgery pathway includes four years of general surgery education followed by three years of thoracic surgery, with all seven years completed at the same institution.

Current ACGME requirements describe this as an 84-month program, while the ABTS recognizes successful completion of an approved 4+3 joint pathway as satisfying its certification requirements.

This pathway integrates the two specialties more closely than the traditional route while preserving a substantial general surgery foundation.

Because the joint program must be completed within one institution and is not offered everywhere, most students will encounter either the independent pathway or the integrated six-year pathway more frequently.

Which Cardiothoracic Training Pathway Is Best?

There is no single pathway that is best for every future cardiothoracic surgeon.

The integrated route can be appealing to a medical student who has already gained meaningful cardiothoracic exposure, understands the realities of the specialty, and feels confident enough to begin focused training directly after graduation.

The traditional route may be more appropriate for someone who wants the complete experience and certification foundation of general surgery, discovers cardiothoracic surgery during residency, or values having more time before making such a specialized commitment.

The joint pathway can provide an integrated experience at an institution where a resident is able to enter and remain within the approved training structure.

All recognized pathways can lead to American Board of Thoracic Surgery certification when the physician meets the applicable training, operative, licensing, and examination requirements. The eventual quality of the surgeon depends on the depth of training, operative experience, mentorship, judgment, technical development, and continued learning rather than the pathway name alone.

Step 1: Complete College and the Premed Requirements

The journey begins with earning a bachelor’s degree and completing the prerequisite courses required by the medical schools where you plan to apply.

There is no required undergraduate major for becoming a cardiothoracic surgeon. Students may major in biology, chemistry, engineering, physics, neuroscience, psychology, business, public health, history, English, or nearly any other field as long as they complete the required science courses and prepare adequately for the MCAT.

Engineering and physics may seem naturally connected to a specialty involving blood flow, pressure, mechanical valves, pumps, and circulatory-support devices, but choosing one of those majors is not necessary. A student who genuinely enjoys history or psychology can still build an excellent academic foundation while completing medical school prerequisites separately.

During college, your experiences may include clinical work or volunteering, physician shadowing, service, research, leadership, teaching, mentoring, and involvement in activities that matter to you personally.

You do not need to shape your entire application around heart or lung surgery. Medical schools are selecting future physicians rather than future cardiothoracic surgeons, and many students will not encounter the specialty meaningfully until medical school.

A cardiothoracic shadowing experience or research project may help you explore the field when those opportunities are available, although meaningful clinical work in an outpatient clinic, hospital, nursing facility, hospice, rehabilitation program, or another setting can still teach you how illness affects patients and families.

My premed guides and application resources can help you organize your courses, clinical experience, extracurricular activities, MCAT preparation, and application timeline without feeling as though every part of the journey has to happen at once.

Step 2: Take the MCAT and Apply to Medical School

Most students take the MCAT before applying to medical school, and admissions committees consider the score alongside your GPA, clinical experience, service, research, leadership, essays, letters of recommendation, and interviews.

An interest in cardiac disease, lung cancer, surgery, medical technology, or another related area may naturally become part of your application story. However, you do not need to declare that cardiothoracic surgery is the only career you will ever consider, particularly when you have not yet experienced the specialty’s operating rooms, intensive care units, outpatient clinics, training pathways, and call responsibilities.

Students who eventually apply directly to integrated thoracic surgery residency will need to develop a clearer specialty commitment during medical school, but that does not mean a premed student must present themselves as already certain.

The more immediate question is why you want to become a physician and what your experiences have taught you about caring for other people, while medical school can provide the exposure needed to determine whether the surgical treatment of heart and chest disease becomes your eventual direction.

For MCAT planners, application checklists, tracking spreadsheets, and other downloads, you can explore my free premed and MCAT resources.

Step 3: Complete Medical School

Future cardiothoracic surgeons earn either an M.D. or D.O. degree, with medical school traditionally lasting four years.

During the earlier portion of the curriculum, students study anatomy, physiology, pathology, pharmacology, microbiology, immunology, clinical reasoning, and the major organ systems.

Cardiovascular and pulmonary physiology become particularly important because cardiothoracic surgeons must understand how the heart and lungs work together, how surgery affects circulation and oxygen delivery, and how devices such as cardiopulmonary bypass, ECMO, and ventricular assist systems temporarily support or replace normal function.

During the clinical years, students rotate through general surgery, internal medicine, pediatrics, family medicine, psychiatry, obstetrics and gynecology, neurology, emergency medicine, and other specialties.

A cardiothoracic surgery elective can show you the operations, but rotations in cardiology, pulmonology, oncology, anesthesiology, radiology, intensive care, and pathology can provide equally valuable insight into the patients and decisions surrounding those procedures.

A student may initially be impressed by the technical complexity of a valve replacement or lung resection, but the broader career also includes evaluating whether surgery is appropriate, discussing substantial risks, managing long recoveries, and responding when a complication develops despite careful planning.

Step 4: Explore Cardiothoracic Surgery During Medical School

Students interested in cardiothoracic surgery may explore the field through:

• Cardiothoracic surgery electives
• Cardiac or thoracic surgery research
• General surgery rotations
• Cardiology and pulmonary medicine
• Medical and radiation oncology
• Cardiothoracic anesthesia
• Surgical intensive care
• Echocardiography and cardiac imaging
• Lung cancer tumor boards
• Structural heart conferences
• Mentorship with cardiothoracic surgeons

The Society of Thoracic Surgeons offers medical-student mentorship and career-development opportunities, including programs designed to connect students with residents, fellows, and practicing surgeons who can help them understand training pathways and the application process.

If you are considering an integrated six-year residency, early specialty exposure becomes especially helpful because you will be applying directly from medical school rather than using general surgery residency to make the decision later.

Research is common among integrated applicants, although the most useful projects are those that help you understand the clinical question and contribute meaningfully rather than simply adding another title to your application.

When observing the specialty, try to see more than the operation. Outpatient evaluations, multidisciplinary conferences, postoperative rounds, intensive care, and conversations with families provide a more complete view of the surgeon’s responsibilities than standing in the operating room for one memorable case.

Step 5: Choose Between Integrated Thoracic Surgery and General Surgery

Students who become interested in cardiothoracic surgery during medical school face an important decision that does not arise in quite the same way for every specialty in this series.

You may apply directly to integrated thoracic surgery residency, or you may first complete general surgery residency and later apply to an independent thoracic surgery program.

The integrated route may feel appropriate when you have gained enough exposure to understand both cardiac and general thoracic surgery, have strong mentorship, and feel ready to commit to the field at the end of medical school.

The traditional general surgery route provides a broader foundation and more time before specialization, which may be reassuring for students who enjoy cardiothoracic surgery but are not yet certain or who want the option to pursue another general surgery fellowship later.

Neither choice should be reduced only to the number of training years. Program culture, operative development, mentorship, research support, geographic considerations, career goals, and the type of surgeon you hope to become all deserve attention.

Step 6: Apply to General Surgery Residency

For the traditional pathway, medical students apply to categorical general surgery residency programs through ERAS and participate in the residency match.

General surgery programs may consider clinical performance, clerkship evaluations, examination results, letters of recommendation, research, leadership, service, professionalism, written materials, and interview performance.

Cardiothoracic research is not required to match into general surgery. Meaningful work in surgery, cardiovascular disease, oncology, physiology, engineering, outcomes, education, public health, or another area can still help you develop valuable skills.

Students who already have a strong interest in cardiothoracic surgery may consider whether a general surgery program offers:

• Cardiothoracic rotations
• Cardiac and general thoracic faculty mentors
• Strong vascular and critical care exposure
• An independent thoracic surgery program
• Cardiothoracic research
• A history of fellowship placement
• Experience with complex abdominal and vascular surgery
• Opportunities for dedicated research years
• Supportive resident culture
• Progressive operative autonomy

These opportunities can make it easier to explore and prepare for thoracic surgery, although the overall quality of general surgery training should remain central to the decision.

Step 7: Complete Five Years of General Surgery Residency

The traditional pathway requires completion of a five-year general surgery residency before entering independent thoracic surgery training. The American Board of Thoracic Surgery lists successful completion of a full five-year ACGME-accredited general surgery residency followed by an approved thoracic surgery residency as one of its formal pathways to certification.

During general surgery residency, future cardiothoracic surgeons develop broad experience in:

• Operative technique
• Critical care
• Vascular exposure
• Trauma
• Abdominal surgery
• Surgical oncology
• Emergency surgery
• Postoperative management
• Nutrition
• Infection
• Complication recognition
• Team leadership

Residents may rotate through cardiac surgery, general thoracic surgery, vascular surgery, cardiothoracic intensive care, or transplant surgery depending on the institution.

A thoracic surgery rotation may include lung resections, coronary bypass surgery, valve operations, bronchoscopy, esophageal surgery, chest-tube management, postoperative rounds, and critical care.

General surgery residents interested in the field may also complete research involving cardiac outcomes, lung or esophageal cancer, aortic disease, mechanical support, transplantation, surgical technology, or quality improvement.

The breadth of general surgery remains valuable even when your eventual practice becomes highly specialized. Cardiothoracic patients can develop bleeding, infection, abdominal complications, nutritional problems, vascular emergencies, shock, and critical illness, all of which require judgment that extends beyond one organ or operation.

Do Future Cardiothoracic Surgeons Complete Research Years?

Some general surgery residents complete one or more dedicated research years before applying to thoracic surgery residency, particularly when they hope to pursue academic careers or enter research-intensive programs.

Possible research areas include:

• Coronary artery disease
• Heart valve surgery
• Aortic disease
• Heart failure
• Mechanical circulatory support
• ECMO
• Lung cancer
• Esophageal cancer
• Transplantation
• Minimally invasive surgery
• Robotic surgery
• Surgical education
• Outcomes and quality improvement
• Artificial intelligence and imaging
• Tissue engineering
• Health disparities

Research can provide mentorship, presentations, publications, technical-development opportunities, and a better understanding of how new evidence changes surgical practice.

The specialty continues to evolve through transcatheter procedures, robotic platforms, improved imaging, new cancer treatments, organ-preservation technology, and mechanical support, which makes lifelong engagement with evidence especially important.

Dedicated research years are not an automatic requirement for every applicant, and extending training is worthwhile only when the opportunity supports your academic, clinical, or professional goals.

Step 8: Apply to Independent Thoracic Surgery Residency

General surgery residents usually apply to independent thoracic surgery programs during the later portion of residency.

Programs may evaluate:

• General surgery residency performance
• Operative development
• Letters of recommendation
• Cardiothoracic exposure
• Research and scholarly work
• Professionalism
• Teaching and leadership
• Career goals
• Understanding of both cardiac and thoracic surgery
• Interview performance

Applicants may find that programs differ substantially in clinical emphasis. One program may provide particularly strong adult cardiac and aortic surgery, while another may be known for general thoracic oncology, esophageal surgery, transplantation, congenital surgery, or mechanical circulatory support.

Even though the ABTS issues one thoracic surgery certificate, the operative experience and culture of a program can shape the type of practice a graduate feels best prepared to enter.

Applicants may therefore consider cardiac and general thoracic case volume, resident autonomy, transplant experience, critical care, structural heart exposure, minimally invasive surgery, research, faculty mentorship, call responsibilities, and graduate career placement.

Step 9: Complete Two to Three Years of Thoracic Surgery Training

The traditional independent program usually lasts two years, although approved three-year curricula also exist. Current ACGME requirements identify 24 months as the standard traditional format and allow 36-month programs when an approved educational rationale is in place.

During training, residents or fellows receive experience in:

• Adult cardiac surgery
• General thoracic surgery
• Congenital cardiac surgery
• Cardiothoracic critical care
• Mechanical circulatory support
• Heart and lung transplantation
• Aortic surgery
• Minimally invasive and robotic procedures
• Bronchoscopy and endoscopy
• Multidisciplinary patient management

The ABTS provides three operative pathways: cardiothoracic, general thoracic, and cardiac. Trainees choose one pathway for meeting the required distribution of operative cases, although their education and certification examinations still cover the breadth of the specialty.

A resident following the cardiac pathway may perform more valve, coronary, aortic, mechanical-support, and other heart operations, while a general thoracic trainee may accumulate greater experience with lung, esophageal, airway, pleural, mediastinal, and chest-wall procedures.

The cardiothoracic pathway maintains a more balanced distribution between the two areas.

Current ABTS operative requirements include hundreds of major cases, additional minor procedures, multidisciplinary conferences, consultation experience, imaging interpretation, simulation, and cardiothoracic critical care management.

The numerical requirements provide structure, but readiness for independent practice also depends on judgment, technical development, communication, professionalism, and the ability to manage complications.

Cardiopulmonary Bypass and Cardiothoracic Critical Care

Many cardiac operations require cardiopulmonary bypass, during which a heart-lung machine temporarily circulates and oxygenates the patient’s blood while the surgeon operates on the heart.

The cardiac surgeon needs to understand:

• Cannulation
• Blood flow and oxygenation
• Temperature management
• Anticoagulation
• Myocardial protection
• Weaning from bypass
• Bleeding and coagulation
• Mechanical support
• Postoperative hemodynamics

Perfusionists manage the bypass machine in close collaboration with the surgical and anesthesia teams, while cardiac anesthesiologists monitor the patient and use advanced imaging such as transesophageal echocardiography.

Cardiothoracic residents also develop substantial critical care experience because patients may require mechanical ventilation, vasopressors, invasive monitoring, dialysis, ECMO, ventricular assist devices, or treatment for bleeding and organ failure after surgery.

The ABTS requires documented cardiothoracic critical care management across several areas, including ventilation, hemodynamic instability, bleeding, organ dysfunction, dysrhythmias, invasive monitoring, and nutrition.

This intensive-care responsibility overlaps with concepts discussed in my guide on how to become a surgical critical care physician, although cardiothoracic critical care is specifically centered on patients with heart and chest disease, cardiopulmonary bypass, mechanical circulatory support, and postoperative cardiothoracic complications.

Step 10: Obtain Medical Licensure and Board Certification

Cardiothoracic surgeons must hold an appropriate medical license and satisfy the credentialing requirements of the hospitals or healthcare systems where they practice.

Physicians who complete an approved pathway can apply for certification through the American Board of Thoracic Surgery.

The initial certification process includes:

1. The Part I written examination
2. The Part II oral examination

The written examination covers the full breadth of thoracic surgery, including adult cardiac, congenital cardiac, general thoracic, transplantation, and cardiothoracic critical care. The oral examination evaluates knowledge, judgment, and clinical decision-making across cardiac and general thoracic scenarios.

ABTS candidates are generally expected to apply for certification within one year of completing an approved thoracic surgery residency. After application approval, they must complete the written and oral examination sequence within the board’s specified eligibility periods.

Medical licensure and board certification are related but separate. Licensure gives a physician legal authority to practice medicine, while board certification demonstrates completion of specialty-specific education, operative experience, and examinations.

Can Cardiothoracic Surgeons Pursue Additional Fellowship Training?

Cardiothoracic surgeons may pursue additional focused training after completing thoracic surgery residency, although another formal fellowship is not necessary for every career.

Possible areas of additional focus include:

• Congenital cardiac surgery
• Advanced aortic surgery
• Heart and lung transplantation
• Mechanical circulatory support
• Minimally invasive cardiac surgery
• Structural heart procedures
• Advanced thoracic oncology
• Esophageal surgery
• Robotic thoracic surgery

Congenital cardiac surgery has a formal ACGME-accredited fellowship and ABTS subspecialty certification pathway. Candidates beginning the current pathway are required to complete two consecutive years of accredited congenital cardiac surgery training and satisfy the applicable operative requirements.

Other focus areas may be developed through institution-specific fellowships, advanced training positions, mentorship, and concentrated clinical practice rather than a separate ABMS subspecialty certificate.

How Long Does It Take to Become a Cardiothoracic Surgeon?

The traditional general surgery pathway takes approximately:

• Four years of college
• Four years of medical school
• Five years of general surgery residency
• Two to three years of thoracic surgery residency

This creates a total of approximately 15 to 16 years after high school.

The integrated pathway includes four years of college, four years of medical school, and six years of thoracic surgery residency, producing a total of approximately 14 years after high school.

The joint 4+3 pathway includes seven years of post-medical-school surgical training and therefore generally takes approximately 15 years after high school.

These totals may become longer when a student takes gap years, earns an additional degree, participates in dedicated research, takes leave, or follows a less traditional route.

There is no required age by which someone must finish. The length deserves honest consideration, but you do not need to decide the entire pathway while you are still completing college prerequisites, because each stage will provide far more information about whether the next one remains worthwhile.

Can a General Surgeon Perform Cardiothoracic Surgery Without Additional Training?

General surgeons receive some exposure to chest surgery during residency and may perform procedures such as chest-tube placement, emergency thoracotomy in selected circumstances, tracheostomy, or treatment of certain chest injuries.

However, independent practice involving coronary bypass surgery, heart valves, lung resection, esophagectomy, thoracic aortic surgery, transplantation, and other major cardiothoracic operations generally requires completion of accredited thoracic surgery training, the appropriate hospital privileges, and specialty-specific expertise.

General surgery provides the broad foundation, while thoracic surgery residency develops the advanced knowledge, technical skill, and operative experience required for independent cardiothoracic practice.

How Is a Cardiothoracic Surgeon Different From a Cardiologist?

A cardiologist is a physician who completes internal medicine residency followed by cardiovascular disease fellowship and evaluates and treats heart disease primarily through medication, imaging, diagnostic testing, and catheter-based procedures.

A cardiothoracic or cardiac surgeon completes surgical training and performs operations involving the heart, valves, coronary arteries, aorta, and related structures.

Interventional cardiologists perform catheter-based treatments such as coronary stenting and many structural heart procedures, while electrophysiologists focus on abnormal heart rhythms and related devices.

These physicians frequently care for the same patients. Someone with severe valve disease may be evaluated by a cardiologist, interventional cardiologist, cardiac imaging specialist, anesthesiologist, and surgeon before the team recommends open surgery, a transcatheter procedure, or continued medical treatment.

How Is a Cardiothoracic Surgeon Different From a Thoracic Surgeon?

The terms overlap substantially.

Thoracic surgery is the formal name of the board-certified specialty, while cardiothoracic surgery is a common broader term emphasizing that the field includes both heart and chest surgery.

In practice, someone described as a general thoracic surgeon usually focuses on noncardiac structures such as the lungs, esophagus, pleura, mediastinum, airway, diaphragm, and chest wall.

Someone described as a cardiac surgeon primarily operates on the heart, valves, coronary arteries, aorta, and mechanical-support systems.

A cardiothoracic surgeon may maintain experience across both areas or may use the broad specialty title despite having a more concentrated practice.

How Is a Cardiothoracic Surgeon Different From a Vascular Surgeon?

Cardiothoracic and vascular surgeons may both operate on major blood vessels, particularly the aorta.

Cardiothoracic surgeons commonly treat the aortic root, ascending aorta, and aortic arch because these structures are closely connected to the heart and may require cardiopulmonary bypass.

Vascular surgeons generally focus on arteries and veins throughout the rest of the body, including the carotid arteries, abdominal aorta, lower-extremity vessels, dialysis access, and peripheral vascular disease.

The specialties often collaborate when a patient has complex thoracoabdominal aortic disease extending from the chest into the abdomen.

How Is Cardiothoracic Surgery Related to Surgical Oncology?

General thoracic surgeons treat several cancers involving the lungs, esophagus, mediastinum, chest wall, and pleura.

They work with medical oncologists, radiation oncologists, pathologists, radiologists, pulmonologists, and gastroenterologists to determine whether surgery should be part of the treatment plan.

A complex general surgical oncologist follows a general surgery and surgical oncology pathway covering several abdominal, breast, endocrine, melanoma, and soft-tissue cancers, while a thoracic surgeon receives advanced training focused specifically on cardiac and chest disease.

Both may call themselves cancer surgeons in the appropriate clinical setting, but their residency and fellowship pathways are different.

Where Do Cardiothoracic Surgeons Work?

Cardiothoracic surgeons commonly work in:

• Academic medical centers
• University hospitals
• Regional heart and vascular centers
• Cancer centers
• Transplant hospitals
• Children’s hospitals
• Community hospitals
• Veterans Affairs medical centers
• Large multispecialty practices
• Private surgical groups

Academic surgeons may divide their time among operating, clinic, inpatient care, research, teaching, multidisciplinary conferences, and administrative leadership.

A surgeon at a major referral center may develop a highly focused practice involving only thoracic aortic disease, mitral valve repair, lung cancer, esophageal surgery, transplantation, or another complex area.

Community cardiothoracic surgeons may maintain broader practices and provide several types of heart or chest surgery depending on the hospital and local needs.

What Is a Cardiothoracic Surgeon’s Schedule Like?

A cardiothoracic surgeon’s schedule depends heavily on the clinical focus, practice size, call structure, hospital resources, and academic responsibilities.

A typical week may include:

• Scheduled operating days
• Outpatient clinic
• Inpatient rounds
• Intensive care
• Emergency consultations
• Tumor board or heart-team meetings
• Research and teaching
• Administrative responsibilities

Many heart, lung, and esophageal operations are planned in advance, but emergencies still occur. An acute aortic dissection, transplant-organ offer, postoperative bleeding, cardiac surgical complication, airway emergency, or esophageal perforation may require care overnight or during a weekend.

The schedule of an elective general thoracic surgeon may differ substantially from that of a transplant or aortic surgeon, while a large group may distribute call differently from a small regional practice.

The most realistic understanding often comes from speaking with surgeons in several practice models and asking how their groups divide operating time, call, clinic, intensive care, post-call recovery, and time away from the hospital.

How Can Premed Students Explore Cardiothoracic Surgery?

Premed students may explore the field through general surgeon shadowing, cardiothoracic surgery observation when available, hospital volunteering or employment, cardiac or cancer research, engineering projects, organ-donation work, or conversations with physicians and patients.

Direct operating-room access may be difficult to arrange, and not observing open-heart surgery during college does not place you behind other applicants.

Learning about the patient journey can be equally useful. A student who volunteers in cardiac rehabilitation, oncology, a pulmonary clinic, hospice, or another clinical environment may gain insight into how major disease and surgery affect daily life long after the operation is over.

When you do have an opportunity to shadow, clinic, rounds, and multidisciplinary conferences may reveal aspects of the career that are less visible than the procedure itself, including patient selection, risk discussions, recovery, complications, and the relationships among surgeons and other specialists.

How Can Medical Students Prepare for Cardiothoracic Surgery?

Medical students interested in cardiothoracic surgery can gradually build exposure through surgical electives, research, mentorship, conferences, and related rotations in cardiology, pulmonology, oncology, anesthesiology, radiology, and intensive care.

Students considering integrated thoracic surgery residency benefit from seeking mentorship early enough to understand the application process and demonstrate an informed commitment to the field.

Those who prefer the traditional route can focus on becoming strong general surgery applicants while continuing to explore cardiothoracic surgery without feeling that every decision must be finalized during medical school.

Technical skill develops through supervised training, so medical students are not expected to enter residency knowing how to perform a bypass operation, repair a valve, or remove a lung tumor.

Reliability, preparation, curiosity, communication, teamwork, and willingness to accept feedback are much more important than trying to appear like a finished surgeon.

What Qualities May Fit Cardiothoracic Surgery?

Cardiothoracic surgery may appeal to someone who enjoys anatomy, physiology, technically complex operations, critical care, medical technology, teamwork, and the opportunity to treat serious diseases with an immediate intervention.

The field often rewards attention to detail because small technical decisions involving blood vessels, valves, airways, or anastomoses can have substantial consequences.

Patience is equally important, because major operations may last many hours and require sustained concentration even when the most exciting part of the procedure has passed.

Surgeons also need to communicate honestly with patients and families about substantial risks, uncertain outcomes, and difficult recoveries. Confidence helps a surgeon lead the operating room, but humility helps the same surgeon recognize when another specialist’s expertise or a nonsurgical treatment may serve the patient better.

Is Becoming a Cardiothoracic Surgeon Worth It?

Cardiothoracic surgery can be a deeply meaningful career for someone who enjoys complex surgery, cardiovascular and pulmonary physiology, technology, critical care, oncology, and multidisciplinary medicine.

The specialty allows surgeons to relieve blocked blood flow, repair failing valves, remove cancers, replace diseased organs, and treat conditions that may otherwise shorten or substantially limit a patient’s life.

The work can also be demanding. Training is long, operations may be lengthy, complications can become life-threatening, and certain practices involve significant night, weekend, or emergency call.

Patients may be older or medically complex, and an operation can be technically successful without producing the recovery everyone hoped for. Surgeons must be prepared to remain present when patients experience stroke, organ failure, infection, recurrent cancer, graft dysfunction, or another serious outcome.

Whether the career feels worthwhile depends on the work that gives you purpose and the responsibilities you are willing to carry. The clearest understanding usually develops gradually through exposure to surgery, intensive care, cardiology, oncology, outpatient evaluation, postoperative recovery, and the lives patients return to after leaving the hospital.

Frequently Asked Questions About Becoming a Cardiothoracic Surgeon

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

The traditional general surgery pathway takes approximately 15 to 16 years after high school, including four years of college, four years of medical school, five years of general surgery residency, and two to three years of thoracic surgery residency.

The integrated pathway generally takes approximately 14 years after high school because it includes a six-year thoracic surgery residency directly after medical school.

What residency do cardiothoracic surgeons complete?

Cardiothoracic surgeons may complete one of several pathways, including a five-year general surgery residency followed by an independent thoracic surgery residency, a six-year integrated thoracic surgery residency, or an approved 4+3 joint general and thoracic surgery pathway.

How long is cardiothoracic surgery training after general surgery?

The standard independent thoracic surgery program lasts 24 months, although approved 36-month programs also exist.

Is cardiothoracic surgery a fellowship?

The post-general-surgery pathway is often called a cardiothoracic fellowship in conversation, although official ACGME and ABTS materials generally refer to it as an independent thoracic surgery residency.

Can you become a cardiothoracic surgeon without completing general surgery residency?

Yes. The integrated six-year thoracic surgery pathway allows eligible medical students to match directly into cardiothoracic training after medical school.

What is an I-6 cardiothoracic surgery residency?

An I-6 program is a six-year integrated thoracic surgery residency entered directly after medical school. It combines foundational surgical education with progressive cardiac and general thoracic training.

What is the 4+3 cardiothoracic surgery pathway?

The joint 4+3 pathway includes four years of general surgery education and three years of thoracic surgery education, with all seven years completed at the same institution.

Are cardiothoracic surgeons board certified?

Eligible surgeons may become certified by the American Board of Thoracic Surgery after completing an approved training pathway and passing the Part I written and Part II oral examinations.

What is the difference between a cardiac surgeon and a cardiothoracic surgeon?

A cardiac surgeon focuses primarily on the heart, coronary arteries, valves, aorta, and mechanical circulatory support.

Cardiothoracic surgeon is a broader term that may include both cardiac and general thoracic surgery involving structures such as the lungs and esophagus.

What is the difference between a thoracic surgeon and a cardiothoracic surgeon?

Thoracic surgery is the formal board specialty, while cardiothoracic surgery is a common term emphasizing both the cardiac and chest portions of the field.

A physician described specifically as a general thoracic surgeon usually focuses on noncardiac structures in the chest.

Do cardiothoracic surgeons perform lung surgery?

Yes. General thoracic surgeons perform lung resections, lung cancer surgery, pleural procedures, airway operations, and, in selected practices, lung transplantation.

Do cardiothoracic surgeons perform heart transplants?

Some cardiothoracic surgeons specialize in heart failure, mechanical circulatory support, and heart transplantation.

Do cardiothoracic surgeons perform lung transplants?

Some surgeons develop focused expertise in lung transplantation after completing thoracic surgery training.

Do cardiothoracic surgeons treat cancer?

General thoracic surgeons treat cancers of the lung, esophagus, mediastinum, pleura, and chest wall while working with medical oncology, radiation oncology, pulmonology, radiology, and pathology teams.

Do cardiothoracic surgeons perform robotic surgery?

Many general thoracic surgeons use robotic and video-assisted approaches for lung, mediastinal, esophageal, and other chest procedures.

Some cardiac surgeons also perform minimally invasive or robotic heart operations, although availability depends on the surgeon, institution, and patient’s condition.

Do cardiothoracic surgeons work in the ICU?

Yes. Cardiothoracic surgeons care for patients in specialized intensive care units, and training includes management of ventilation, bleeding, hemodynamic instability, organ failure, dysrhythmias, invasive monitoring, and mechanical circulatory support.

Is cardiothoracic surgery competitive?

Integrated thoracic surgery residencies and many independent programs can be competitive, although the application landscape changes over time.

Clinical performance, operative development, mentorship, research, letters of recommendation, professionalism, and a well-informed commitment to the specialty may all influence an application.

Do I need research to become a cardiothoracic surgeon?

Research is not a universal requirement for every pathway, although it is common among applicants and can be particularly helpful for students or residents interested in academic programs.

Meaningful work in cardiac surgery, thoracic oncology, transplantation, outcomes, engineering, critical care, or another area may help you explore the specialty and build mentorship.

Can both M.D. and D.O. physicians become cardiothoracic surgeons?

Yes. Graduates of M.D. and D.O. medical schools can enter approved cardiothoracic surgery pathways when they satisfy the applicable residency, licensing, operative, and certification requirements.

What should I major in to become a cardiothoracic surgeon?

There is no required undergraduate major. Students may choose nearly any academic field as long as they complete the prerequisite courses required by the medical schools where they plan to apply.

Can cardiothoracic surgeons have a good work-life balance?

Work-life balance varies greatly by clinical focus and practice structure.

An elective general thoracic practice may have a different schedule from a heart-transplant or acute aortic practice, while call burden depends on group size, hospital coverage, emergency responsibilities, and academic expectations.

What should I read next?

The traditional pathway begins with the broader foundation explained in my guide on how to become a general surgeon, while the following guides can help you compare cardiothoracic surgery with related careers:

• How to Become a Transplant Surgeon
• How to Become a Surgical Oncologist
• How to Become a Surgical Critical Care Physician
• How to Become a Trauma Surgeon