Vascular Surgery Residency: A Comprehensive Guide to Physician Salaries

Understanding how vascular surgery fits into the broader landscape of physician salary by specialty is critical when you’re planning a career or applying to an integrated vascular program. Compensation affects not only your financial future, but also your lifestyle, practice setting, and long‑term career satisfaction.

This guide walks you through where vascular surgery stands among the highest paid specialties, what drives income variation, how training pathway and practice type influence earnings, and what to realistically expect at each stage—from residency through late career.

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1. Where Vascular Surgery Fits in the Physician Salary Landscape

Vascular surgery is consistently ranked among the higher-earning surgical fields, though typically a step below ultra‑high earners like orthopedic surgery and certain procedural subspecialties. When you look at doctor salary by specialty, three big patterns emerge:

1. Procedural specialties (surgery, interventional radiology, cardiology, GI, etc.) tend to be among the highest paid specialties.
2. Cognitive/non‑procedural specialties (internal medicine, pediatrics, psychiatry) sit at the lower end of the income spectrum.
3. Hybrid procedural-cognitive fields (vascular surgery is a good example) usually land in the upper-middle to high tier.

While exact dollar figures change yearly and by source, this is the general hierarchy for full‑time U.S. physicians in clinical practice:

• Top tier (ultra‑high)
  Orthopedic Surgery, Plastic Surgery, Neurosurgery, Interventional Cardiology, Cardiac Surgery, some Ophthalmology subspecialties

• Upper-high tier
  Vascular Surgery, General Surgery (especially with subspecialty focus), Gastroenterology, Dermatology, Interventional Radiology, Radiology, Anesthesiology, Urology

• Middle tier
  Emergency Medicine, Hospitalist Medicine, Pulmonology/Critical Care, Oncology, Rheumatology, Neurology, OB/GYN

• Lower tier
  Internal Medicine (outpatient), Family Medicine, Pediatrics, Psychiatry, Infectious Disease, Endocrinology

Vascular surgery typically falls into the upper‑high tier, especially for surgeons working in busy, procedure-heavy practices with significant endovascular volume.

How Vascular Surgery Compares to Other Surgical Specialties

Broadly, vascular surgery compensation tends to align as follows:

• Below: Orthopedic surgery, neurosurgery, cardiac surgery, plastic surgery
• Comparable or slightly below: Interventional radiology, some high‑volume general surgeons, urology
• Above: Standard general surgery (without subspecialty focus), ENT (varies), most non‑surgical fields

This means that if your primary goal is to be at the very top of the physician salary by specialty rankings, vascular surgery won’t usually beat ortho or neurosurgery. However, it does combine strong compensation with a unique blend of open and endovascular work, long-term patient relationships, and broad pathology that many trainees find more appealing than income alone.

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2. Training Pathways and Early-Career Compensation

Your route into vascular surgery—traditional pathway vs. integrated vascular program—affects when you earn attending-level income, even if not the ultimate ceiling of your earnings.

2.1 Integrated Vascular Surgery Residency vs. Fellowship Pathway

There are two main paths:

1. Integrated Vascular Surgery Residency (0+5)

   • 5 years total after medical school
   • Combines core surgical training with early and progressive vascular exposure
   • Graduates proceed directly to vascular surgery practice as attendings

2. Traditional Pathway (5+2 or 5+3)

   • 5 years of general surgery residency
   • 2 additional years of vascular surgery fellowship (occasionally 3 in some settings)
   • 7–8 years post‑MD before starting as a vascular surgery attending

From a financial perspective:

• Integrated vascular program advantage:
  You complete training in 5 years instead of 7–8, so you start earning a full vascular surgeon salary 2–3 years earlier.
• Even if a general surgery + vascular fellowship background can sometimes command slightly higher initial offers in select markets (due to additional general surgery flexibility), the time value of those extra attending years usually favors the integrated pathway.

2.2 Resident and Fellow Salaries in Vascular Surgery Paths

Regardless of pathway, resident and fellow compensation is broadly similar at a given institution:

• PGY‑1–PGY‑5 (residents):
  Typically in the $60,000–$80,000 base salary range annually (varies by geography and institution)
• Fellows (PGY‑6–PGY‑7/8):
  Slightly higher, generally $70,000–$90,000

Factors affecting trainee pay:

• Cost‑of‑living adjustments (e.g., NYC or San Francisco vs. Midwest)
• Unionization or GME policies
• Night float and call frequency (impacting moonlighting opportunities, not base salary)

While trainee salaries are modest, the primary financial leverage points come when you transition to attending roles—where the difference between a low‑paid primary care specialty and a high‑paid vascular surgery role can be $150,000–$300,000+ per year.

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3. Attending Vascular Surgeon Salary: What to Expect

Once you complete training, your physician salary by specialty becomes much more dependent on practice type, workload, case mix, and geography than on training pathway. Still, some general patterns for vascular surgery stand out.

3.1 Typical Salary Ranges for Vascular Surgeons

While numbers vary year to year, full‑time U.S. vascular surgeons often see compensation in these approximate ranges (base + productivity-based pay, not counting fringe benefits):

• Academic Vascular Surgery

  • Early career: $300,000–$450,000
  • Mid‑career: $400,000–$600,000
  • Senior/high‑productivity: potentially more, with leadership roles and RVU incentives

• Private Practice / Community Hospital-Employed

  • Early career: $400,000–$600,000
  • Mid‑career: $500,000–$800,000+ (especially in high‑volume, call-heavy, or underserved markets)
  • Senior partners in high-volume groups may exceed this range when profit-sharing is robust

• Hybrid models (academic-private affiliates, large multispecialty groups)

  • Ranges typically fall between academic and private practice, often $375,000–$700,000+ depending on RVUs and call

In the broader landscape of doctor salary by specialty:

• Vascular surgery’s median and upper quartile incomes tend to exceed those of:
  • Internal medicine, family medicine, pediatrics, psychiatry, neurology, rheumatology, endocrinology, and most hospitalists
• Vascular surgery generally falls below:
  • Neurosurgery, orthopedic surgery, some plastic surgery, and certain interventional cardiology practices
• It is often similar to:
  • General surgery with subspecialization, interventional radiology, GI (depending on case mix), urology in some markets

3.2 Factors That Drive Vascular Surgery Compensation

Several variables explain why two vascular surgeons might have significantly different incomes despite similar training:

1. Case Mix: Open vs. Endovascular

   • High-volume endovascular practices (EVAR, TEVAR, complex peripheral interventions, dialysis access interventions) often generate more RVUs and procedural revenue.
   • Open aortic work can be highly reimbursed but may be less frequent at some sites where interventional cardiology, IR, or other services share the endovascular pie.

2. Practice Setting

   • Hospital-employed surgeons may have more stable base salaries with clear RVU thresholds and quality incentives.
   • Private practice partners share in practice profits, imaging, office-based labs (OBLs), and ancillaries, often increasing total compensation but also adding risk.

3. Geographic Location

   • Rural or underserved regions often offer higher salaries and stronger loan repayment packages to attract vascular surgeons.
   • High-cost urban academic centers may offer lower salary but superior academic resources, prestige, and opportunities for research.

4. Call Burden

   • Heavy call schedules (ruptured aneurysms, acute limb ischemia, trauma coverage) can drive higher compensation.
   • Some contracts offer separate call stipends, particularly for coverage of multiple hospitals.

5. Productivity and RVU Models

   • Compensation plans heavily tied to work RVUs (wRVUs) create strong incentives for high procedural volume and efficient practice patterns.
   • Surgeons who build robust referral networks and deliver efficient, high-quality care often see income gains over time.

6. Academic Roles and Leadership

   • Department chairs, program directors, and service line leaders may receive administrative stipends and higher base salaries.
   • However, pure academic time (research, teaching) often comes at some opportunity cost compared with maximal clinical productivity.

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4. How Vascular Surgery Compares to Other High-Paying Specialties

To understand physician salary by specialty in context, it helps to see how vascular surgery stacks up against some of the highest paid specialties.

4.1 Vascular Surgery vs. Other Surgical Specialties

Orthopedic Surgery and Neurosurgery

• Often at the top of doctor salary by specialty lists.
• Median earnings can be significantly higher than vascular surgery, especially in private groups (sometimes $800,000+ in certain subspecialties).
• Training is typically long (5–7 years), and the work is physically demanding but often less emergency-call‑intense than ruptured aneurysms and acute limb ischemia, depending on the specific practice.

Cardiothoracic Surgery

• Similarly high or higher compensation compared with vascular surgery, particularly in adult cardiac surgery.
• Higher proportion of OR-open cases vs. hybrid OR/endovascular work, though overlap exists.

General Surgery

• Standalone general surgeons generally earn less than most vascular surgeons, unless they have high-volume bariatrics, trauma/critical care plus a robust practice, or niche procedures.
• Vascular training adds complexity and extends training but tends to improve long-term earning potential.

4.2 Vascular Surgery vs. Interventional Fields

Interventional Radiology (IR)

• Often similar or somewhat higher in compensation than vascular surgery, especially in private groups with imaging and procedure-based revenue.
• IR and vascular surgery share many procedures (e.g., peripheral interventions, venous interventions), but workflow, autonomy, and call patterns differ.

Interventional Cardiology

• Among the highest paid specialties, often exceeding typical vascular surgery income.
• Strongly procedural with high RVU generation, though also high-stress, high-risk, and sometimes with similar lifestyle tradeoffs to vascular surgery.

4.3 Vascular Surgery vs. Non-Surgical Specialties

Compared with non-surgical specialties, vascular surgery:

• Almost always earns more than internal medicine, family medicine, pediatrics, psychiatry, and many internal medicine subspecialties such as endocrinology or infectious disease.
• Is often similar or somewhat higher than:
  • Emergency medicine
  • Pulmonology/critical care
  • Hematology/oncology (depending on practice)
• Typically lower only than the most lucrative cognitive-procedural fields (GI, interventional cardiology, some dermatology practices, especially cosmetic-heavy ones).

Bottom line: Vascular surgery reliably sits among the upper ranks of physician salary by specialty, though not at the absolute top. For applicants looking for a procedural, complex, longitudinal-care specialty with strong earnings, vascular surgery is an attractive option.

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5. Practical Financial Planning Across the Vascular Surgery Career Timeline

Maximizing the value of a vascular surgery career is about more than just gross physician salary by specialty. It also depends on debt management, cost of living, savings behavior, and career choices.

5.1 During Medical School and Early Residency

Key moves:

• Be intentional about debt.
  Vascular surgery training is long and demanding; high six-figure loans are common. Use income-driven repayment plans and understand Public Service Loan Forgiveness (PSLF) if you anticipate an academic or nonprofit hospital career.

• Choose training location with strategy, not just prestige.
  An integrated vascular program in a very high-cost city may increase living expenses without increasing resident salary. Consider housing and lifestyle costs.

• Build financial literacy early.
  Learn basics of budgeting, disability insurance, retirement accounts (401(k)/403(b)/457(b)), and compound interest. The earlier you start planning, the more of your future surgeon income you keep.

5.2 Mid-Residency to Fellowship / Senior Integrated Years

• Moonlight strategically (if allowed and safe).
  Occasional moonlighting can add several thousand dollars annually, but must not compromise training or patient care.

• Network for your ideal first job.
  Salary negotiation is easier when you have multiple offers. Use away rotations, conferences, and mentors in vascular surgery societies to explore markets and practice types.

• Clarify your priorities.
  Decide how you value:

  • Academic prestige vs. income vs. location vs. lifestyle
  • Call frequency vs. procedural variety
  • Research and teaching vs. maximal productivity

5.3 Transition to Attending: First 3–5 Years

This is typically the steepest income jump of your life. Key considerations:

• Understand your contract thoroughly.

  • Base salary and length of guarantee
  • RVU thresholds and conversion factor
  • Call pay, relocation assistance, signing bonus, loan repayment
  • Non-compete clauses and tail coverage for malpractice insurance

• Right-size your lifestyle growth.

  • Avoid immediately matching your spending to your new physician salary.
  • Early aggressive loan repayment and high savings rates can dramatically increase long-term financial security.

• Prioritize disability and life insurance.

  • As a proceduralist, your hands and health are essential.
  • Own-occupation disability insurance is particularly important for surgeons.

5.4 Mid- to Late Career

• Consider leadership roles cautiously.

  • Division chief, program director, or service line leadership can add income and influence, but also administrative burden.
  • Ensure the compensation for nonclinical time truly reflects your responsibilities.

• Diversify income streams if desired.

  • Office-based labs (OBLs), consulting, speaking, device trials, or equity in group-owned facilities can supplement standard compensation.
  • Ensure appropriate compliance with conflict-of-interest and regulatory rules.

• Plan for retirement deliberately.

  • Take advantage of tax-advantaged accounts, backdoor Roth IRAs, and, if applicable, defined benefit or cash balance plans.
  • Because vascular surgery is physically and cognitively demanding with unpredictable call, many surgeons aim for flexible or reduced-intensity practice in later years.

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6. Choosing Vascular Surgery with Eyes Wide Open

When evaluating physician salary by specialty, vascular surgery stands out as:

• Financially rewarding: Strong earnings potential, especially in high-volume, endovascular-heavy practices or underserved areas.
• Clinically rich: High acuity, broad pathology, mix of elective and emergent cases, and meaningful, long-term patient relationships.
• Demanding: Lengthy training, heavy call, high complication risk, and significant stress associated with limb- and life-saving interventions.

When comparing vascular surgery to other highest paid specialties, keep these questions in mind:

• Am I drawn to vascular pathology and complex circulation-based disease?
• Do I enjoy both OR and endovascular/hybrid procedures?
• Can I tolerate frequent emergencies, long cases, and high-stakes decision-making?
• Is the combination of strong income plus clinical interest more important to me than maximizing absolute salary?

If the answer is yes, vascular surgery offers an excellent balance of high physician salary, procedural excitement, and deep professional fulfillment.

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FAQs: Physician Salary and Vascular Surgery

1. Is vascular surgery one of the highest paid specialties?
Vascular surgery is consistently in the upper tier of physician compensation, particularly among surgical subspecialties. It typically earns more than general surgery alone, most primary care fields, and many internal medicine subspecialties. However, it usually earns less than ultra‑high‑income fields like orthopedic surgery, neurosurgery, and some interventional cardiology practices.

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2. Do integrated vascular surgery residents earn more after training than traditional pathway surgeons?
Over a full career, total earning potential is similar, but integrated vascular surgery residents start earning attending-level income 2–3 years earlier, which can translate into a significant long-term financial advantage. At a given level of experience, compensation is more influenced by practice type, productivity, and geography than by training pathway.

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3. How does vascular surgery salary compare to general surgery?
In most markets, vascular surgeons earn more than general surgeons, reflecting the additional subspecialty expertise and procedural complexity. General surgeons with high-volume niche practices (e.g., bariatrics) may approach or exceed some vascular surgeons’ income, but as a group, vascular surgery is typically better compensated than broad-based general surgery.

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4. Are academic vascular surgeons paid significantly less than private practice surgeons?
Academic vascular surgeons generally earn less in base and total clinical compensation than their private practice counterparts, but the difference can narrow with leadership roles, stipends, and RVU incentives. Academic positions offer tradeoffs: research time, teaching, a rich academic environment, and often more robust institutional support. Many surgeons choose academic careers for reasons beyond income alone.

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Understanding physician salary by specialty is an important part of planning your career, but no single data point should define your path. For vascular surgery, the combination of strong compensation, complex procedural work, and lives saved makes it a compelling—and demanding—choice for the right applicant.