Physician Salary by Specialty: Cardiothoracic Surgery Guide

Understanding Physician Salary by Specialty in Cardiothoracic Surgery

Cardiothoracic surgery sits at the intersection of some of the most demanding clinical work and some of the most competitive compensation in medicine. For medical students and residents planning a cardiothoracic surgery residency, it’s essential to understand how physician salary by specialty works within this field, how training pathway and subspecialization influence income, and what tradeoffs come with pursuing one of the highest paid specialties in medicine.

This guide focuses specifically on cardiothoracic surgery, but also frames it within the broader context of surgical and non-surgical specialties so you can make informed career decisions before and during residency.

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1. Where Cardiothoracic Surgery Fits in the Physician Salary Landscape

When you look at any doctor salary by specialty report (e.g., Medscape, Doximity, MGMA, AAMC surveys), cardiothoracic surgery (CTS) almost always appears near the very top.

1.1 National Income Ranges for Cardiothoracic Surgeons

Specific numbers vary by survey, region, and practice model, but representative figures (attending level, full-time practice in the U.S.) are typically in this range:

• General Cardiothoracic Surgeon (adult, mixed practice)

  • Early career (0–3 years in practice): $600,000–$800,000
  • Mid-career (5–15 years): $800,000–$1,100,000+
  • Late career / partner / high-volume: $1,000,000–$1,500,000+ in some markets

• Cardiac Surgery–dominant practice (adult cardiac)

  • Early: $650,000–$900,000
  • Established: $900,000–$1,300,000+

• Thoracic Surgery–dominant practice (lung, esophagus, mediastinum)

  • Early: $550,000–$750,000
  • Established: $700,000–$1,000,000+ (varies widely by case mix and cancer center affiliation)

• Congenital/Pediatric Cardiothoracic Surgery

  • Early: $500,000–$750,000
  • Established: $700,000–$1,000,000+ with substantial variation based on case complexity and academic vs. private models

These ballparks are drawn from composite national survey data available through 2024; individual offers may sit below or far above these ranges depending on geography, call burden, and RVU expectations.

1.2 How Cardiothoracic Compares to Other High-Earning Specialties

To understand physician salary by specialty in context, compare median incomes:

• Neurosurgery: Often $800,000–$1,200,000+
• Orthopedic Surgery (esp. spine, joints): Often $600,000–$1,000,000+
• Cardiology (invasive/interventional): Commonly $550,000–$800,000+
• Gastroenterology: Often $500,000–$700,000+
• Radiology (interventional high end): $500,000–$800,000+

Cardiothoracic surgery is consistently grouped among these highest paid specialties, typically in the top 5–10 by compensation. Like these fields, it also demands:

• Longer training pathways
• High call burden and night/weekend coverage
• Intense procedural workload
• High medico-legal exposure
• Substantial physical and cognitive demands

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2. Training Pathways and How They Influence Future Salary

Before you reach attending-level heart surgery training compensation, you’ll spend many years in residency and fellowship. Understanding the pathway helps you see when and how the income curve actually begins to rise.

2.1 Traditional Pathway vs. Integrated Programs

There are two main routes in the U.S.:

1. Traditional Pathway

   • 5 years: General Surgery Residency
   • 2–3 years: Cardiothoracic Surgery Fellowship
   • Total: 7–8 postgraduate years (often plus research)

2. Integrated Pathway (I-6)

   • 6 years: Integrated Cardiothoracic Surgery Residency (from PGY-1)
   • Often includes built-in research or specialized tracks
   • Total: 6 years postgraduate (plus optional additional fellowship)

From a pure income-timeline standpoint, the integrated pathway gets you to attending salary sooner. That said, both paths typically place you in your early to mid-30s before your first true attending paycheck.

2.2 Resident and Fellow Salaries in Cardiothoracic Training

While you’re in cardiothoracic surgery residency or fellowship, your income is modest and relatively standardized:

• PGY-1: ~$60,000–$70,000 base
• PGY-2–3: ~$64,000–$75,000
• PGY-4–5: ~$68,000–$80,000
• PGY-6–8: ~$72,000–$85,000+

Expect:

• Small incremental raises per year
• Overtime not usually directly compensated, though some programs pay extra for moonlighting or additional call
• Health, dental, malpractice coverage, and sometimes housing or meal stipends

Given the length of heart surgery training, many CTS trainees graduate with significant educational debt and limited ability to pay it down until attending status.

2.3 The Income “Jump” After Training

Once you complete training, the income jump is dramatic:

• From ~$80,000 as a final-year fellow
• To $600,000+ as a first-year attending in some markets

However, this jump comes with:

• Substantially increased responsibility
• Higher work hours and call intensity, especially in smaller groups
• Pressure to build a referral base and meet productivity targets
• Leadership and program-development expectations, especially in small or growing hospitals

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3. Subspecialization Within Cardiothoracic Surgery and Its Impact on Salary

Even within cardiothoracic surgery, physician salary by specialty varies by case focus, practice type, and procedural mix.

3.1 Adult Cardiac Surgery

Scope: CABG, valve surgery, aortic surgery, LVADs, ECMO cannulation, sometimes TAVR in collaboration with cardiology.

Income drivers:

• High RVU-generating procedures
• Urgent and emergent cases, increasing call value
• Large referral dependence on cardiology groups and health systems
• Opportunities for leadership roles (cardiac surgery director, structural heart program leadership)

Typical characteristics:

• Generally among the highest earning within cardiothoracic surgery
• Compensation often heavily tied to OR volume and complex cases
• Call-intensive – nights, weekends, and urgent reoperations are routine

3.2 Thoracic Surgery (Non-Cardiac)

Scope: Lung resections, esophagectomy, mediastinal masses, pleural disease, some benign foregut, advanced minimally invasive and robotic thoracic procedures.

Income considerations:

• High case complexity in oncology-focused centers
• Robust demand in cancer centers and tertiary academic hospitals
• Growing emphasis on robotic and minimally invasive approaches, which can support higher productivity and outpatient volumes

Compared to adult cardiac:

• Some markets pay slightly less, but:
  • More predictable elective scheduling in many practices
  • Fewer emergent middle-of-the-night cases
  • More integration with oncology and multidisciplinary clinics

3.3 Congenital and Pediatric Cardiothoracic Surgery

Scope: Neonatal and pediatric repair of congenital heart disease, multi-stage operations, ECMO management, transplant participation in some centers.

Salary features:

• Compensation ranges can be slightly lower than adult cardiac but still very high
• Case complexity and emotional weight are extreme; surgeries may last 8–12+ hours
• Usually in major academic children’s hospitals or large tertiary centers
• Income may be partially supported by institutional subsidies more than pure RVU

Many congenital surgeons report high professional fulfillment, but the demands on time, stamina, and emotional resilience are considerable.

3.4 Niche and Hybrid Practice Roles

Some cardiothoracic surgeons integrate:

• Transplant and Mechanical Circulatory Support (e.g., LVAD, ECMO)
• Structural Heart / TAVR Programs (collaborative or co-managed with interventional cardiology)
• ECMO / Critical Care oversight roles
• Hybrid OR procedures (endovascular and open combined strategies)

These often come with:

• Additional stipends for program directorships
• Complex call schedules (particularly for ECMO and transplant)
• Academic and research expectations in university-based centers

Such niche roles can place you at the very high end of doctor salary by specialty, especially when combined with leadership or directorship contracts.

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4. Academic vs Private Practice vs Employed Models

Once training is complete, where you practice affects your income as much as what you do.

4.1 Academic Cardiothoracic Surgery

Setting: University hospitals, major teaching institutions, NCI-designated cancer centers, large children’s hospitals.

Income profile:

• Typically lower base salary than high-octane private groups, but still competitive (e.g., $450,000–$900,000+, depending on rank and niche)
• Potential income augmentation via:
  • RVU/productivity bonuses
  • Administrative stipends (program director, division chief)
  • Research grants (often more for protected time than direct personal income)

Non-monetary benefits:

• Protected academic time for research, teaching, education
• More stable compensation model (less volatile than pure RVU)
• Stronger institutional support for high-risk cases and complex programs
• Opportunities for national prominence, trial leadership, and guideline development

Tradeoff: Lower ceiling on personal earning potential in exchange for academic career, prestige, and program-building opportunities.

4.2 Private Practice Cardiothoracic Surgery

Setting: Independent or semi-independent cardiothoracic groups, large multispecialty surgical groups, regional heart centers.

Income profile often includes:

• Higher potential total compensation (frequently $800,000–$1,500,000+ in busy practices)
• RVU-based or collections-based models, with:
  • Lower base salary (e.g., $400,000–$600,000) plus productivity bonuses
  • Partnership tracks where income increases significantly after buy-in

Key considerations:

• You assume more financial risk tied to volume and payer mix
• Income can fluctuate by year and by market competition
• Business responsibilities (marketing, referral cultivation, negotiations, group governance) become important

4.3 Hospital-Employed / Health System Employed Models

Many cardiothoracic surgeons now work as employed physicians within large health systems.

Features:

• Guaranteed base salary with tiered RVU thresholds
• Often competitive with or slightly below private practice but more stable
• Robust benefits (retirement contributions, CME funds, malpractice coverage, health insurance, relocation)
• Less direct involvement in billing/collections; more standardized contracts

This model balances:

• Security and predictability
• Moderate-to-high earning potential
• Less direct control over OR block time, staffing, and strategic decisions

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5. Key Factors That Drive Cardiothoracic Surgeon Salary

Whether you end up near the lower or upper end of CTS compensation bands depends on a number of variables beyond just “specialty choice.”

5.1 Geographic Location and Market Demand

Compensation is heavily influenced by:

• Region:
  • Rural or underserved areas and certain southern or midwestern states often pay more to attract specialists.
  • Coastal urban academic centers may pay less but offer prestige and research opportunities.
• Competition:
  • Markets with few CTS surgeons and high cardiac volumes can offer lucrative contracts.
  • Areas saturated with large academic programs or multiple groups may dampen salaries.

As a resident, look at:

• State-level and regional CTS workforce reports
• Local cardiac surgery volume (CABG, valve, TAVR, ECMO, transplant)
• Hospital financial health and long-term service line strategy

5.2 Practice Volume and Case Mix

As a procedural specialty, CTS income is very volume-sensitive:

• Higher case volume → higher RVUs → higher bonus potential
• Complex procedures (aortic, redo sternotomies, LVADs, transplant) generate more RVUs but also increase stress and risk
• Efficient use of OR time, well-managed clinics, and optimized scheduling affect total throughput

Many contracts will outline:

• Expected annual case volumes
• RVU targets and corresponding bonus thresholds
• Support structures (PAs, NPs, clinic staff, call-sharing arrangements)

5.3 Call Coverage and Workload

Call is a major component of both compensation and lifestyle:

• 24/7 call for acute aortic syndromes, post-op complications, and emergent cases is the norm
• Small groups may require q2–q3 call, with additional financial compensation (call stipends, bonus pools)
• Large academic centers often share call across more surgeons but with higher case complexity

Compensation may include:

• Separate on-call stipends
• Additional shift pay for ECMO or transplant call
• Higher base offers for heavier call responsibilities

5.4 Leadership, Directorship, and Administrative Roles

As you progress in your career, you may take on:

• Division chief, section head, or department chair roles
• Cardiac or thoracic surgery program director positions
• Structural heart, ECMO, transplant, or VAD program directorships

These roles typically yield additional income via:

• Annual administrative stipends
• Protected time (which can reduce clinical RVUs but maintain total compensation)
• Contract renegotiations with higher base salary

Leadership roles can be substantial income boosters for mid- and late-career surgeons.

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6. Practical Advice for Residents Considering Cardiothoracic Surgery

For medical students and residents on the fence about heart surgery training, thinking only about the physician salary by specialty is incomplete. Use these steps to make a grounded decision.

6.1 Honestly Evaluate Your Fit for the Field

Ask yourself:

• Do you enjoy long, technically complex operations?
• Are you comfortable with high acuity, critically ill patients, and frequent life-or-death decisions?
• Can you tolerate irregular hours and prolonged periods on your feet?
• Are you resilient in the face of complications, bad outcomes, and medico-legal risk?

The income can be extraordinarily high, but the demands are unmatched in intensity.

6.2 Understand the Long-Term Financial Trajectory

Recognize the global picture:

• Long training (6–8+ postgraduate years)
• Relatively low earnings throughout your 20s and early 30s
• Delayed ability to pay off debt and save aggressively
• Then, a steep income ramp once you hit attending level

Actionable steps during training:

• Avoid lifestyle inflation with debt-funded “attending-level” living during residency
• Seek financial literacy early (budgeting, disability insurance basics, retirement principles)
• Understand Public Service Loan Forgiveness (PSLF) if you pursue academic or nonprofit employment

6.3 Learn to Evaluate Contracts and Negotiations

As you near the end of training:

• Request multiple offers from different settings (academic, private, employed)
• Pay attention to:
  • Base salary vs. bonus structure
  • RVU or collections targets and realistic volume estimates
  • Non-compete clauses and geographic restrictions
  • Call expectations and how they’re compensated
  • Support staff and resources (PAs, perfusionists, ICU coverage)

Consider using:

• A physician contract review service
• Mentors (senior cardiothoracic surgeons) to interpret “normal” vs “red flag” terms

6.4 Non-Financial Priorities That Matter

Even in one of the highest paid specialties, non-salary factors often determine satisfaction:

• Quality of OR team, anesthesia collaboration, perfusion, and ICU care
• Collegiality with cardiology, pulmonology, oncology, and ICU services
• Institutional support for your subspecialty interests (e.g., robotic thoracic, TAVR, ECMO)
• Availability of mentorship and opportunities to shape your niche over time

Many surgeons ultimately trade some income to gain a sustainable, fulfilling long-term practice.

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FAQs: Physician Salary by Specialty in Cardiothoracic Surgery

1. Is cardiothoracic surgery really among the highest paid specialties?

Yes. Most national compensation surveys place cardiothoracic surgery alongside neurosurgery and orthopedic surgery at or near the top of doctor salary by specialty rankings. Within that group, adult cardiac surgeons in high-volume, complex practices often reach the very upper tiers of physician income. However, this comes with very high workloads, intense call, and years of extensive training.

2. How much does a cardiothoracic surgeon make right after residency or fellowship?

A new attending cardiothoracic surgeon in the U.S. can commonly expect a starting total compensation package in the $600,000–$900,000 range, depending on region, practice type, and case mix. Academic positions may start somewhat lower; high-volume private or hospital-employed roles may start higher, often with signing bonuses and relocation assistance. Early years may also include “income guarantees” as you build your volume.

3. Do cardiothoracic surgeons in academics earn significantly less than in private practice?

On average, yes—academic cardiothoracic surgeons usually have lower peak earnings than their private practice counterparts. However, academic roles still offer very competitive salaries for physicians and often add value through job stability, protected time, research opportunities, and institutional support. Some hybrid and high-volume academic programs also offer substantial RVU-based bonuses that narrow the income gap with private practice.

4. Does subspecializing (e.g., congenital, thoracic, transplant) change salary a lot?

Subspecialization can shift your income but not always dramatically. Adult cardiac surgeons in busy practices often sit at the higher end of the pay spectrum due to volume and RVUs. Congenital/pediatric surgeons and thoracic oncologic surgeons may earn somewhat less on average, though still in the very high physician income tier. Niche expertise—like advanced aortic surgery, LVAD/ECMO, transplant, or structural heart—can command higher compensation in centers that need those skills and are building programs around them.

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Understanding the nuances of physician salary by specialty in cardiothoracic surgery helps you align expectations with reality as you pursue cardiothoracic surgery residency and beyond. If you are drawn deeply to the operating room, complex cardiopulmonary physiology, and high-stakes decision-making, this field offers both exceptional professional challenges and some of the most robust earning potential in medicine.