Choosing Between Academic and Private Practice for DO Cardiothoracic Surgeons

Understanding Your Options as a DO Cardiothoracic Surgeon

For a DO graduate completing cardiothoracic surgery residency or fellowship, the transition into practice is both exciting and daunting. After years focused on the osteopathic residency match, heart surgery training, board exams, and case minimums, you’re now facing a very different question: What type of career do you want in cardiothoracic surgery—and in what environment do you want to build it?

The central decision for many DO graduates is whether to pursue:

• Academic medicine (university or teaching hospital setting), or
• Private practice (independent group, hospital-employed, or large corporate practice)

Each pathway offers distinct trade-offs in:

• Case mix and clinical autonomy
• Compensation and income growth
• Lifestyle and schedule predictability
• Teaching and research opportunities
• Long-term academic medicine career development

This article will walk you through the key differences, with specific focus on the realities for a DO graduate in cardiothoracic surgery, including how your osteopathic background may influence opportunities, and how to strategically choose—and pivot between—academic vs private practice over time.

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Core Differences: Academic vs Private Practice in Cardiothoracic Surgery

At a high level, the difference between academic and private practice for cardiothoracic surgeons can be summarized by the 3 T’s:

• Trainees – How much you teach and supervise
• Trial/Translational work – Involvement in research and innovation
• Throughput – Volume, efficiency, and financial focus of clinical work

Academic Cardiothoracic Surgery: Key Features

Academic practice is built around clinical work + teaching + research in varying proportions.

Common characteristics:

• Practice environment

  • University hospital, academic medical center, or major teaching hospital
  • Presence of residents and fellows, often including DO trainees
  • Complex referrals (advanced heart failure, redo sternotomies, lung transplant, ECMO, congenital or adult congenital cases depending on your niche)

• Primary roles

  • Clinical care (often 60–80% of time)
  • Teaching residents, fellows, and medical students
  • Participating in research (clinical trials, outcomes research, basic science, device development)
  • Administrative roles (committee work, program development, quality initiatives)

• Compensation

  • Typically lower starting salary than high-volume private practice
  • Often RVU-based with academic supplements or stipends
  • May include incentives for research productivity, leadership roles, or program building
  • Retirement, CME, and benefits are often strong and stable

• Metrics of success

  • Publications, grants, presentations
  • Teaching evaluations, mentorship
  • Clinical outcomes and program growth
  • Academic promotion (Assistant → Associate → Full Professor)

• Lifestyle

  • Case load may be high, but some departments protect academic time
  • Call often shared among more surgeons, but complexity and intensity may be higher
  • Evening/weekend time may be used for charting, writing manuscripts, or preparing talks

Private Practice Cardiothoracic Surgery: Key Features

Private practice focuses more heavily on clinical productivity and revenue generation.

Common characteristics:

• Practice environment

  • Independent cardiothoracic group, hospital-employed group, or large multispecialty group
  • Less or no involvement with residents/fellows (unless affiliated with a teaching hospital)
  • Case mix may be more bread-and-butter: CABG, valves, thoracic resections, aortic disease depending on region

• Primary roles

  • High-volume clinical care and surgery
  • Practice management and business decisions (in independent groups)
  • Outreach to referring cardiologists, pulmonologists, oncologists
  • Limited or no formal research obligations

• Compensation

  • Typically higher earning potential, especially after early years
  • Strong link between productivity (cases/RVUs) and income
  • Partnership track in some independent groups with additional profit sharing
  • Hospital-employed models may have more stable salaries with RVU bonuses

• Metrics of success

  • Surgical volume and efficiency
  • Financial performance of the practice
  • Relationships with referring physicians
  • Patient satisfaction and quality metrics

• Lifestyle

  • Schedule centered on OR days, clinic days, and call
  • Evening/weekend time may be consumed by call, emergencies, or practice management
  • Less academic “after-hours” work (papers, grants), but more administrative and business responsibilities in some settings

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How Your DO Background Fits Into Each Path

As a DO graduate, you’ve already navigated unique considerations in the osteopathic residency match and in securing cardiothoracic surgery residency or fellowship positions. That context continues into your post-residency and job market decisions.

Academic Medicine as a DO Cardiothoracic Surgeon

Opportunities:

• Many academic programs have become increasingly accepting of DO graduates, especially given the single accreditation system.
• Your background in holistic, patient-centered care and strong clinical communication can be a significant asset in:
  • Teaching residents and students
  • Leading multidisciplinary teams
  • Patient counseling for complex cardiothoracic decisions

Challenges you might encounter:

• Some historically conservative academic departments may still preferentially recruit MDs, especially for heavily research-focused or high-prestige positions.
• Certain elite programs may expect:
  • Robust research portfolio (first-author publications, multi-center studies)
  • Strong letters from academic leaders at recognized CT surgery institutions
  • Fellowship or advanced training at “name-brand” academic centers

How to strengthen your academic profile as a DO:

• During residency/fellowship:
  • Prioritize research productivity—even if not basic science, robust clinical outcomes/quality projects matter.
  • Present at national meetings (STS, AATS, WTS, etc.).
  • Seek mentorship from established academic CT surgeons who will advocate for you and introduce you to department chairs.
• When job hunting:
  • Apply broadly, including mid-sized academic centers that may be especially receptive to DOs.
  • Emphasize your interest in resident education, curriculum development, or quality improvement.
  • Highlight strengths such as communication, empathy, and patient-centered care—areas where osteopathic training often shines.

Private Practice as a DO Cardiothoracic Surgeon

In private practice, clinical skill, efficiency, and collegiality matter far more than your degree letters.

• Most groups focus on:

  • Your operative volume and outcomes
  • Your ability to build strong relationships with referring cardiologists and pulmonologists
  • Your reputation among patients and staff

• Your DO background can be an asset:

  • Many patients respond well to osteopathic training’s holistic philosophy.
  • In certain regions, community hospitals may have a strong DO presence, easing cultural fit.

Bottom line:
Your DO degree is unlikely to limit you in private practice. The main differentiators will be your training reputation, references, and ability to generate and manage a high-volume, high-quality cardiothoracic practice.

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Comparing Academic vs Private Practice: Key Domains

1. Clinical Work and Case Mix

Academic:

• More likely to involve:
  • Complex redo sternotomies, mechanical circulatory support, transplant (if at a transplant center)
  • Cutting-edge techniques (TAVR, minimally invasive cardiac surgery, robotic thoracic procedures, hybrid ORs)
  • Multidisciplinary clinics (heart failure, valve centers, structural heart disease, thoracic oncology boards)
• Trainees are involved in every case:
  • You must be comfortable operating through others and supervising close-graded autonomy.
  • Case flow may be less “efficient” in terms of pure RVUs due to teaching.

Private Practice:

• More likely to emphasize:
  • High-volume CABG, valve surgery, lung resections, occasionally esophagectomies or aortic work depending on your niche and region.
  • Rapid OR turnover and efficiency.
• Less teaching (unless affiliated with a teaching hospital), so:
  • You often do more of the technical work yourself.
  • Case times may be shorter, fewer intraoperative teaching pauses.

For a DO graduate:
If you value complex pathology, innovation, and teaching, academic practice may be more aligned. If you are driven by high-volume surgery, self-directed operative work, and efficiency, private practice may be more satisfying.

2. Research and Innovation

Academic:

• Expectations can range from minimal (a few projects per year) to intense (NIH-funded lab, multiple protocols).
• Opportunities:
  • Clinical trials (e.g., new valve prostheses, device trials)
  • Outcomes and quality improvement research
  • Translational science in collaboration with basic scientists or engineers
• Protected time may be:
  • Formal (e.g., 1–2 days/week) in research-heavy roles
  • Informal (expected to be done around clinical schedule) in more clinically oriented jobs

Private Practice:

• Research is not typically required, but can still be possible:
  • Participation in industry-sponsored device trials
  • Practice-based registries and quality initiatives
• If research is important to you, target:
  • Hospital-employed groups with strong cardiac programs
  • Large systems that foster some clinical research

DO-specific angle:
If you aspire to build a recognizable academic medicine career in cardiothoracic surgery—publishing regularly, speaking nationally, leading guidelines—academic practice is usually the more supportive environment, especially early on.

3. Teaching and Mentorship

Academic:

• Teaching is a core job function:
  • Intraoperative teaching of residents/fellows
  • Didactic sessions, boot camps, simulation
  • Mentoring students (including DO students) interested in cardiothoracic surgery
• You may help shape:
  • CT surgery curricula
  • Osteopathic/MD integration in training
  • Early exposure programs for DO students

Private Practice:

• Teaching opportunities vary:
  • Some community hospitals have surgery residents or advanced practice provider students.
  • Occasionally, medical students rotate through.
• Teaching is less formal and less tied to promotion or compensation.

For many DO graduates who benefitted from mentorship themselves, academic careers allow you to “pay it forward” and serve as a role model for future generations of DO surgeons.

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Income, Lifestyle, and Job Stability: Realistic Expectations

Compensation: Academic vs Private Practice

While specifics vary dramatically by region, institution, and subspecialty focus, some general patterns hold:

Academic Cardiothoracic Surgery

• Starting salary: Often lower than private practice for similar workload.
• Total compensation:
  • Base salary + potential RVU bonus
  • Academic stipends (program directorship, leadership, committees)
  • Occasionally research/administrative buyout
• Growth trajectory:
  • More gradual income growth over time.
  • May include longevity bonuses or raises with academic rank.
• Non-monetary benefits:
  • More robust retirement plans (university pensions, 403(b) matching)
  • Tuition discounts (for children or spouse at the university)
  • Support for conferences, professional development, and protected time.

Private Practice Cardiothoracic Surgery

• Starting salary:
  • Often higher, especially in non-coastal or high-demand regions.
  • Sign-on bonuses may be substantial.
• Long-term potential:
  • Partnership in independent groups can significantly increase income.
  • High producers in stable markets can out-earn typical academic salaries by a wide margin.
• Hospital-employed models:
  • Salary-based with RVU tiers.
  • Can be very competitive but may cap at certain levels.
• Risk-reward balance:
  • Independent practices carry more business risk but also more upside.
  • Ability to negotiate contracts with hospitals, manage ancillaries (e.g., imaging, programs).

For a DO graduate often carrying significant educational debt, short-term income may push you toward private practice, but it’s critical to weigh that against your long-term goals in research, leadership, and teaching.

Lifestyle: Hours, Call, and Control

Both academic and private practice cardiothoracic surgeons work long, intense hours. That said, the shape of your week may differ.

Academic Practice

• More variability due to:
  • Teaching duties
  • Academic meetings, conferences
  • Research commitments
• Call:
  • Often shared among a larger group (in bigger academic centers).
  • Night/weekend cases may be more complex.
• Autonomy over schedule:
  • Some ability to carve out academic/clinic/OR days as you gain seniority.
  • Institutional expectations can limit how much flexibility you have.

Private Practice

• Schedule generally driven by:
  • OR block time and clinic volume
  • Practice coverage agreements with hospitals
• Call:
  • In smaller markets or smaller groups, call burden may be high.
  • Urgent and emergent cardiothoracic call (dissections, ruptured aneurysms, etc.) can be demanding.
• Workload:
  • Direct link between taking more cases and higher income.
  • Efficiency pressures may be more intense.

In both settings, cardiothoracic surgery is rarely a “lifestyle specialty.” However, some DO graduates find slightly better control over nonclinical time in academic careers, while others value the direct link between effort and compensation in private practice.

Job Stability and Mobility

Academic jobs:

• Often more stable during economic downturns due to institutional support.
• Tenure or long-term contracts may exist in some systems.
• However, changes in leadership, funding priorities, or program direction can impact your role.

Private practice jobs:

• Dependent on:
  • Local referral patterns
  • Hospital contracts
  • Group dynamics and partnership agreements
• Market changes (hospital acquisitions, system consolidation) can significantly affect income and autonomy.

Mobility considerations:

• Academic CT surgeons often build national reputations, making moves to other academic centers easier, especially with a strong publication record.
• Private practice surgeons move based on:
  • Volume data, outcomes, and references
  • Personal relationships with cardiology and cardiology groups

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How to Choose Your Path (and Keep Options Open)

Step 1: Clarify Your Core Priorities

Ask yourself:

1. How important is research and innovation to me?

   • Do I enjoy designing studies, analyzing data, and writing papers?
   • Do I want to be known for advancing the field or developing new techniques?

2. Do I derive energy from teaching and mentoring?

   • Am I excited by the idea of shaping the next generation of CT surgeons?
   • Do I enjoy explaining concepts, giving feedback, and supervising?

3. How do I think about compensation vs autonomy?

   • Do I prioritize higher earning potential in the near-to-mid term?
   • Am I comfortable with the business side of medicine?

4. What kind of clinical practice do I want?

   • Complex, niche, referral-based practice vs high-volume, broad CT surgery.
   • Interest in transplant, MCS, structural heart, or congenital work that may be concentrated in academic centers.

5. Where do I want to live and what lifestyle do I envision?

   • Academic centers often cluster in larger metros.
   • Private practice opportunities may be more varied geographically (suburban, rural, regional hubs).

Step 2: Understand That Your First Job Is Not Your Final Destination

One of the biggest misconceptions for DO graduates is that you must choose once, forever. In reality:

• Many surgeons start in academic practice to:
  • Build their CV
  • Gain experience in complex cases
  • Develop a niche (e.g., aortic, minimally invasive valve surgery)
• Later, some transition to private practice seeking:
  • Higher income
  • Different pace or location
  • Less academic pressure

Others do the reverse:

• Begin in private practice, then:
  • Develop strong operative volumes and outcomes
  • Get involved in local or regional research/quality initiatives
  • Transition to academic roles bringing a wealth of clinical experience

The best long-term strategy is to keep both doors open:

• Maintain some involvement in:
  • Quality improvement projects
  • Teaching (students, APPs, or community educational talks)
  • Regional/national societies (STS, AATS, etc.)
• Build a portfolio that demonstrates:
  • Clinical excellence
  • Teamwork and communication
  • Either academic productivity or strong practice-building skills (ideally both, at least to some extent)

Step 3: Evaluate Specific Job Offers Rigorously

When comparing academic vs private practice jobs, consider:

• Clinical scope:

  • What procedures will you actually be doing?
  • Will you be able to grow your preferred niche?

• Support structure:

  • Are there enough APPs, perfusionists, ICU resources?
  • How is the OR staffed? How often will you have trainees?

• Compensation transparency:

  • In private practice, get clear on partnership track, buy-in, and historical income data.
  • In academics, understand promotion criteria, RVU expectations, and any caps or tiers.

• Culture and fit:

  • How do colleagues speak to each other?
  • Is there visible DO representation or at least genuine respect for osteopathic training?
  • Are you treated as a future partner/leader or just a “workhorse”?

• Long-term trajectory:

  • Is there a path to leadership—division chief, program director, practice partner?
  • Will this job open or close future doors you care about?

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FAQs: Academic vs Private Practice for DO Cardiothoracic Surgeons

1. As a DO, is it harder to get an academic cardiothoracic surgery job?

It can be somewhat more challenging at a small number of highly traditional or prestige-focused institutions, especially if your research portfolio is limited. However, many academic centers now actively recruit DO graduates who have strong clinical training, solid references, and demonstrable interest in teaching or research. Your competitiveness is far more dictated by your training program reputation, case log, and academic output than by your degree alone.

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2. Will choosing private practice limit my ability to move into academics later?

Not necessarily, but it depends on how you structure your early career. If you want the option to transition into academics:

• Maintain an outcomes database and participate in quality initiatives.
• Stay engaged with professional societies and present if possible.
• Collaborate with academic colleagues on occasional projects.

If you spend many years in purely production-focused private practice with no academic or leadership footprint, transitioning to a research-driven academic role later may be more difficult—but teaching-focused academic roles may still be feasible.

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3. Which path pays more: academic cardiothoracic surgery or private practice?

Across most markets, private practice (especially independent or high-RVU hospital-employed models) tends to offer higher earning potential, particularly after the first several years. Academic jobs may start lower and grow more slowly but can be competitive when factoring in benefits, retirement, stability, and non-monetary rewards like research and teaching. Ultimately, you should evaluate each offer individually rather than relying on averages.

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4. If I am undecided, should I default to academic or private practice?

If you are genuinely undecided:

• Consider starting in academics if you:

  • Have a strong interest in research/teaching.
  • Trained in a major academic center and want to build on that foundation.
  • Prefer more complex or niche cases.

• Consider starting in private practice if you:

  • Feel more passionate about high-volume clinical work.
  • Are highly motivated by financial goals in the near term.
  • Trained in a strong community or hybrid program and see yourself thriving in that environment.

Either way, focus on a first job that offers strong mentorship, a healthy culture, and good support, rather than fixating solely on “academic vs private” as a binary. For a DO graduate in cardiothoracic surgery, the best career path in medicine is the one that aligns with your values, leverages your strengths, and supports sustainable excellence over decades—not just your first few years out of training.