To become a cardiothoracic surgeon in the United States, you earn a bachelor’s degree, finish four years of MD or DO school, then complete either a six-year integrated thoracic surgery residency (I-6) or a five-year general surgery residency plus a two- or three-year thoracic surgery fellowship, and pass the American Board of Thoracic Surgery exams.
Counted from the first day of college, that is 14 to 16 years of education and training, and 16 to 18 if you add a congenital cardiac surgery fellowship to operate on children. For how medical school itself fits into the sequence, IMA’s step-by-step guide to becoming a doctor in the United States covers college, the MCAT and licensing.
Cardiothoracic Surgeon Training Paths at a Glance
The American Board of Thoracic Surgery (ABTS) recognizes several routes to the same certificate. The three that most U.S. medical students choose between are below, with lengths taken from the 2026 ACGME program requirements.
| Path | Structure | Training after medical school | Total from first year of college |
|---|---|---|---|
| Integrated thoracic surgery (I-6) | One six-year residency entered straight from medical school | 72 months | About 14 years |
| Traditional (general surgery + independent fellowship) | Five-year general surgery residency, then a separate thoracic fellowship | 60 + 24 months (or 60 + 36) | About 15 to 16 years |
| Joint 4+3 program | Four years of general surgery and three of thoracic surgery at one institution | 84 months | About 15 years |
| Congenital cardiac surgery (add-on) | Fellowship after any thoracic surgery program | 24 more months | About 16 to 18 years |
Many residents also take one or more research years during general surgery, which adds time to the traditional route. The rest of this guide explains each step in order.
Step 1: College and Medical School
There is no required major. You need the prerequisite science courses medical schools ask for, a competitive MCAT score, and real clinical experience before you apply. Medical school then takes four years and ends with an MD or DO degree.
During medical school, students interested in the heart and chest should look for a cardiothoracic surgery rotation or sub-internship in the third and fourth years. Program directors want to see that an applicant has spent time in the operating room and the cardiac surgery intensive care unit and knows what the daily work involves.
Which Path Should You Choose Before Residency Applications?
The decision comes in the fourth year of medical school, when you apply through ERAS and the National Resident Matching Program (NRMP). You either rank integrated thoracic surgery programs, rank general surgery programs and plan to apply for a thoracic fellowship later, or do both. IMA’s ERAS residency application guide walks through the timeline and documents.
Step 2A: The Integrated I-6 Thoracic Surgery Residency
The ACGME requirements for integrated thoracic surgery set the program at 72 months, completed at one institution unless the ABTS approves otherwise, starting right after the MD or DO. The last year must be a chief resident year on the thoracic surgery service.
The six years split into two phases:
- Core surgical years: at least 24 and at most 36 months of fundamental surgical care, with recommended rotations in general, vascular, trauma, pediatric, plastic and transplant surgery, surgical oncology and critical care.
- Cardiothoracic years: the rest of the program covers thoracic surgery and adult and congenital cardiac surgery.
- Case minimums: 375 procedures across PGY-1 to PGY-3, of which 125 must be cardiothoracic, then at least 125 major cardiothoracic procedures in each of PGY-4 to PGY-6, for 375 major cases.
How Competitive Is the Integrated Thoracic Surgery Match?
It is one of the smallest specialties in the Main Residency Match. In the 2026 NRMP Main Match results, 39 integrated thoracic surgery programs offered 56 positions and filled all of them. A total of 110 applicants ranked at least one program, including 88 U.S. MD seniors, and U.S. MD seniors took 52 of the 56 spots (92.9 percent). The number of positions has grown from 47 in 2022.
Because so few spots exist, most applicants also rank general surgery programs as a backup. A general surgery residency still leads to the same ABTS certificate through the traditional path. IMA’s list of the most competitive medical specialties shows where surgical fields rank.
Step 2B: General Surgery Residency, Then an Independent Fellowship
The traditional route starts with general surgery. The ACGME general surgery requirements set that residency at 60 months. IMA’s guide on how to become a general surgeon covers those five years in detail.
After general surgery comes the independent thoracic surgery fellowship. Under the ACGME independent thoracic surgery requirements, the fellowship lasts 24 months, or 36 months where the Review Committee approves a longer curriculum. Entry requires a completed residency in surgery, vascular surgery, cardiac surgery or thoracic surgery.
- Two-year fellowships: at least 125 major cardiothoracic procedures each year, 250 in total.
- Three-year fellowships: at least 125 each year, 375 in total.
- Joint 4+3 programs: 84 months at one institution, with 125 major cardiothoracic procedures in each of the last two years.
Independent thoracic fellowships fill through a separate NRMP fellowship match. IMA’s explainer on what a medical fellowship is covers how fellowship matching works after residency.
Do You Need General Surgery Board Certification First?
No. The ABTS pathways to certification state that for residents who began thoracic surgery training in July 2003 or later, certification by the American Board of Surgery is optional rather than mandatory. Many traditional-path surgeons still earn it because it allows them to practice general surgery as well.
The ABTS lists four pathways: a five-year ACGME general surgery residency (or a 4+3 program) followed by thoracic surgery training; a five-year Canadian residency in general, cardiac or vascular surgery followed by ACGME thoracic training; a six-year integrated residency; and an ACGME vascular surgery residency followed by thoracic training.
Integrated vs Traditional: How the Two Paths Compare
| Factor | Integrated I-6 | General surgery + fellowship |
|---|---|---|
| When you commit | Fourth year of medical school | During general surgery residency |
| Total residency and fellowship time | 6 years | 7 to 8 years, often more with research years |
| Number of positions | 56 in the 2026 Main Match | 1,807 categorical general surgery positions in 2026, then a fellowship match |
| Second board option | Thoracic certification only | Can also certify in general surgery |
| Best fit | Students already sure about the heart and chest | Students who want broad surgical training first or decide later |
Neither path is ranked higher by the board. Both lead to one ABTS certificate.
Step 3: Congenital Cardiac Surgery for Pediatric Heart Surgeons
Surgeons who want to operate on babies and children with heart defects complete one more fellowship. The ACGME congenital cardiac surgery requirements define the field as the diagnosis and treatment of congenital defects of the heart and great vessels and set the fellowship at 24 months, after completing a thoracic surgery program.
The ABTS congenital cardiac surgery subspecialty page adds that residents starting on or after July 1, 2023 must complete two consecutive years in a single program and 150 major cases, with at least 50 in the first year. Candidates are eligible for the subspecialty exam during the first two years after finishing congenital training.
Step 4: Licensing and ABTS Board Certification
To sit for the ABTS exams, you need a full and unrestricted state medical license, along with a completed ACGME-accredited thoracic surgery program. ABTS residency rules require at least 24 months of thoracic and cardiovascular surgery training, including 12 months of continuous senior-level responsibility in the final year.
The ABTS examination sequence works like this:
1. Apply within one year of finishing thoracic surgery residency. For 2026, applications run June 15 to August 12. 2. Pass Part I, the written exam, within three years of application approval. The 2026 written exam runs December 7 to 11 at Pearson testing centers. 3. Pass Part II, the oral exam, within three years of passing the written exam. The 2026 oral exam was held June 5 and 6 in Dallas. 4. Finish within seven years of completing residency. Each part allows three attempts in three years before more training is required.
Certified surgeons receive a certificate that is not time-limited, with a Milestone requirement every five years to keep it active.
What Operative Experience Does the Board Require?
The ABTS operative requirements call for an annual average of 125 major operations, plus index cases in which the resident is the primary surgeon. Residents meet those index cases through one of three pathways (cardiothoracic, general thoracic or cardiac), but only one certificate is issued regardless of pathway.
What Cardiothoracic Surgeons Do
The ACGME defines thoracic surgery as the operative, pre-operative, post-operative and surgical critical care of patients with acquired and congenital conditions within the chest. In practice, that work falls into three areas:
- Adult cardiac surgery: operations on the coronary arteries, heart valves, heart muscle, pericardium, great vessels and the thoracic aorta.
- General thoracic surgery: operations on the lungs, trachea and bronchi, esophagus, chest wall, mediastinum and diaphragm, including operations for lung cancer, airway management and chest injuries.
- Congenital heart surgery: repair of heart defects in newborns, children and adults born with them.
Cardiothoracic surgeons work closely with cardiologists, who diagnose and manage heart disease and refer patients for surgery. If you are weighing the medical side of heart care, compare this path with IMA’s guide on how to become a cardiologist.
The Society of Thoracic Surgeons (STS), founded in 1964, is the largest cardiothoracic surgery organization in the world, with more than 8,000 members in 102 countries. Its STS National Database holds data on nearly 10 million procedures from more than 4,300 surgeons, including 95 percent of adult cardiac surgery procedures, and surgeons use its risk models to compare outcomes.
What Is the Schedule Like?
Long operations, overnight call and critically ill patients are standard. During training, ACGME limits clinical and educational work to no more than 80 hours per week, averaged over four weeks. After training, emergency heart, aortic and chest injury cases still bring night and weekend work.
Cardiothoracic Surgeon Salary and Job Outlook
The Bureau of Labor Statistics does not publish a separate wage line for cardiothoracic surgeons. They fall under the broader “surgeons, all other” group. According to the BLS Occupational Outlook Handbook, surgeons, all other earned a median annual wage of $414,010 in May 2025, compared with a median of $275,930 for all physicians and surgeons.
| BLS measure (May 2025 wages, 2025-2035 projections) | Figure |
|---|---|
| Median annual wage, surgeons, all other | $414,010 |
| Median annual wage, all physicians and surgeons | $275,930 |
| Physicians and surgeons jobs in 2025 | About 862,800 |
| Projected employment growth, 2025 to 2035 | 4 percent |
| Average openings per year | About 22,100 |
For pay across every surgical specialty, see IMA’s breakdown of how much surgeons make.
How Pre-Meds Can Start Building Toward Cardiothoracic Surgery
Long before residency, the best preparation is clinical time that shows you understand patient care. IMA’s pre-med internships abroad place students in hospitals and clinics where, under the supervision of licensed clinicians, they take part in direct patient care such as vital signs, patient intake and triage, and basic patient interviews, along with ward rounds and community outreach. How those hours count on AMCAS is each medical school’s decision.
Cardiothoracic Surgeon Timeline Checklist
- Years 1 to 4: bachelor’s degree, prerequisites, MCAT, clinical experience, apply to medical school.
- Years 5 to 8: medical school, cardiothoracic rotations, Match into I-6 or general surgery.
- Years 9 to 14: I-6 residency, or general surgery residency with possible research years.
- Years 15 to 16: independent thoracic fellowship for the traditional path.
- After training: ABTS written and oral exams within seven years, congenital fellowship if chosen.
For a stage-by-stage comparison with other specialties, IMA’s timeline for becoming a doctor lays out training length by field.
Frequently Asked Questions
How many years does it take to become a cardiothoracic surgeon?
About 14 to 16 years after high school: four years of college, four of medical school, then six years in an integrated I-6 residency or seven to eight years of general surgery plus a thoracic fellowship. A congenital cardiac surgery fellowship adds 24 months.
What is an I-6 thoracic surgery residency?
An I-6 is an integrated thoracic surgery residency that starts right after medical school and lasts 72 months under the ACGME requirements. It combines 24 to 36 months of core surgical training with cardiothoracic training and ends with a chief resident year on the thoracic service.
Is a cardiothoracic surgeon the same as a heart surgeon?
A heart surgeon is one kind of cardiothoracic surgeon. Cardiothoracic surgeons are trained in both heart surgery and general thoracic surgery on the lungs, esophagus and chest wall, and the ABTS lets them meet their case requirements through a cardiothoracic, general thoracic or cardiac pathway.
Do cardiothoracic surgeons have to finish general surgery residency?
Not always. The integrated I-6 residency skips a separate general surgery residency, and the ABTS has made American Board of Surgery certification optional for residents who began thoracic training in July 2003 or later. The traditional path still requires a completed five-year general surgery residency first.
How much does a cardiothoracic surgeon make?
BLS does not list cardiothoracic surgeons separately. They are counted under surgeons, all other, a group with a median annual wage of $414,010 in May 2025, compared with $275,930 for all physicians and surgeons.
How hard is it to match into integrated thoracic surgery?
Positions are scarce. In the 2026 NRMP Main Match, 56 integrated thoracic surgery positions at 39 programs were all filled, with 110 applicants ranking at least one program. Most applicants also rank general surgery as a second route to the same board certificate.
What exams do cardiothoracic surgeons take for board certification?
The American Board of Thoracic Surgery gives a Part I written exam and a Part II oral exam. Candidates apply within a year of finishing residency, pass the written exam within three years and the oral exam within the next three, and must finish within seven years.
