To become a pediatric surgeon, you finish a bachelor’s degree and four years of medical school, complete a 60-month general surgery residency, then train for 24 months in an accredited pediatric surgery fellowship. You then earn American Board of Surgery certification in general surgery and in pediatric surgery. Counting from college, plan on at least 15 years.
Pediatric surgery is built on top of general surgery, so the first long stretch of training is the same as the path to becoming a general surgeon. The children’s focus, newborn care and the specialty board come after residency.
Pediatric Surgeon Training Path at a Glance
| Stage | Length | What happens | Rule set by |
|---|---|---|---|
| Bachelor’s degree | Usually 4 years | Premed science courses, the MCAT, clinical experience | Medical schools |
| Medical school (MD or DO) | 4 years | Clinical rotations, USMLE Step 1 and Step 2 CK | Schools, USMLE |
| General surgery residency | 60 months | At least 850 major operations, including pediatric cases | ACGME (2026) |
| Pediatric surgery fellowship | 24 months | At least 800 major pediatric operations as surgeon | ACGME (2026) |
| General surgery boards | Within 7 years of residency | Qualifying exam, then a virtual oral exam | American Board of Surgery |
| Pediatric surgery boards | Within 7 years of fellowship | Qualifying exam, then a five-session virtual oral exam | American Board of Surgery |
The Bureau of Labor Statistics gives the general outline for all doctors: physicians and surgeons need a bachelor’s degree and medical school, then “3 to 9 years in internship and residency programs” depending on the specialty. With seven years of residency and fellowship combined, pediatric surgery sits near the long end of that range.
What Pediatric Surgeons Do
The American Board of Surgery defines pediatric surgery as “the diagnostic, operative, and postoperative surgical care for children with congenital and acquired anomalies and diseases, be they developmental, inflammatory, neoplastic or traumatic.” The ABS pediatric surgery page says the scope covers surgical problems in utero, infancy, childhood, adolescence and sometimes young adulthood, and that some patients stay with their pediatric surgeon into adulthood until they move to adult surgeons.
In practice, the work covers a wide range of the body. The ACGME fellowship rules list the conditions pediatric surgery fellows must learn to manage:
- Congenital, cancerous, infectious and other acquired conditions of the gastrointestinal tract and other abdominal organs.
- The diaphragm and chest, not including the heart.
- Endocrine glands, the head and neck, and the gonads and reproductive organs.
- The skin and soft tissues, and the blood and vascular system.
- Operative and nonoperative care of injured children.
- Critically ill newborns and children on ventilators and extracorporeal membrane oxygenation (ECMO).
Pediatric surgeons also work closely with neonatologists, pediatric intensivists and emergency teams. The ABS notes that its pediatric surgery certificate is not meant for surgeons who limit their work to the areas of other surgical boards, such as neurologic, orthopaedic, plastic, thoracic and urologic surgery. A child’s heart operation, for example, falls to thoracic surgeons who focus on congenital heart disease. IMA’s guide to every surgical specialty explained shows how these fields divide the work.
How Is a Pediatric Surgeon Different From a Pediatrician?
A pediatrician is a primary care or medical specialist who completes a pediatrics residency and treats children without operating. A pediatric surgeon trains in adult general surgery first and then operates on children. The two work together often: the pediatrician usually spots the problem and refers the child, and the surgeon decides whether an operation is needed. If you like children’s medicine but not the operating room, read how to become a pediatrician.
Step 1: College, the MCAT and Medical School
No college major is required. You need the premed science courses your target schools list, a strong MCAT score and real clinical experience. IMA’s guide on how to become a doctor in the United States covers admissions step by step.
Medical school takes four years. MD students take the United States Medical Licensing Examination, a three-Step exam for medical licensure; Step 3 comes after graduation. During your third and fourth years, a surgery clerkship and a pediatric surgery elective are the best ways to test the fit.
What Should Premed Students Do Now?
- Build steady hands-on patient experience, especially with children and families.
- Take anatomy, physiology and embryology seriously, since many pediatric surgical problems are birth defects.
- See an operating room early. Start with IMA’s advice on shadowing surgery in high school.
- Learn to talk with worried parents in plain language; it is a daily part of this job.
Clinical exposure before applying helps you test the fit. Through IMA’s pre-med internships abroad, students work under licensed clinicians on ward rounds and rotations and take part in supervised direct patient care such as vital signs, patient intake and triage, and basic patient interviews.
Step 2: Five Years of General Surgery Residency
Every pediatric surgeon starts as a general surgery resident. The ACGME general surgery requirements, effective July 1, 2026, state that the program “must be 60 months in length.” At least 54 of those months must be clinical assignments in surgery, with at least 42 months in essential content areas, and pediatric surgery is one of those areas.
| ACGME general surgery operative minimum (2026) | Number |
|---|---|
| Total major cases per resident | 850 |
| Operations before the PGY-3 year | At least 250 |
| Cases as a teaching assistant | 25 |
| Major cases during the chief resident experience | 200 |
The ACGME notes that some general surgeons go on to further training in fields such as pediatric surgery, and that programs may send residents to a children’s hospital for their pediatric rotation. Work hours are capped at 80 per week, averaged over four weeks. You apply to residency through the ERAS residency application and the Main Residency Match. Residents earn a salary throughout; see how much resident doctors make.
Is There a Combined Pathway?
The ACGME pediatric surgery requirements say its Review Committee will consider applications for a joint surgery and pediatric surgery program, “a pathway leading to certification in both general surgery and pediatric surgery.” Both programs should be run by the same sponsoring institution, or meet strict conditions if they are not. Most future pediatric surgeons instead apply to fellowship through the NRMP during residency.
Step 3: The Two-Year Pediatric Surgery Fellowship
The ACGME pediatric surgery requirements, effective July 1, 2026, set the fellowship at 24 months, with 48 weeks of clinical pediatric surgery in each of the two years. Before starting, fellows must have completed a general surgery residency. For a broader explainer on this stage, see what a medical fellowship is.
| ACGME pediatric surgery fellowship requirement (2026) | Minimum or limit |
|---|---|
| Major pediatric operations as surgeon | At least 800 |
| Teaching assistant cases | At least 50, at most 100 |
| Time in general pediatric surgery | At least 20 months |
| Related disciplines (critical care, other surgical fields, burns) | At most 4 months |
| Neonatal surgical patients cared for in critical care | At least 20 |
| Critically ill pediatric surgical patients | At least 10 |
| Neonatal intensive care unit | 1 month |
| Pediatric intensive care unit | 1 month |
| Outpatient clinic | At least one half-day weekly |
Fellows must hold current pediatric advanced life support training before critical care rotations, and they teach junior residents and medical students. They may not share primary responsibility for a patient with a general surgery chief resident, which protects the fellow’s operative experience.
How Competitive Is the Pediatric Surgery Fellowship Match?
Very. Pediatric surgery runs its own match through the NRMP Specialties Matching Service. The NRMP Results and Data for the 2026 appointment year show that the match opened February 5, 2025, and Match Day was April 30, 2025, for positions starting in 2026. That means you apply more than a year before fellowship begins.
| NRMP pediatric surgery match | 2022 | 2023 | 2024 | 2025 | 2026 |
|---|---|---|---|---|---|
| Positions offered | 43 | 49 | 44 | 49 | 47 |
| Applicants | 69 | 82 | 64 | 68 | 66 |
| Applicants matched | 43 | 49 | 44 | 49 | 47 |
| Applicants unmatched | 26 | 33 | 20 | 19 | 19 |
| Percent of applicants matched | 62.3% | 59.8% | 68.8% | 72.1% | 71.2% |
Years are NRMP appointment years. For 2026, all 47 positions at 46 programs filled, and U.S. MD graduates took 89.4% of them, the second highest share among fellowships with at least 30 positions. Across these five years, between 28% and 40% of applicants went unmatched each cycle. The American Pediatric Surgical Association notes on its fellowship positions page that unmatched candidates pursue subspecialty fellowships, such as pediatric surgical critical care, “to strengthen their applications” and begin pediatric surgery training. To compare with residency match odds, see IMA’s look at the most competitive medical specialties.
Step 4: Board Certification From the American Board of Surgery
Board certification comes in two layers. First you earn ABS general surgery certification, which has its own qualifying exam and virtual oral exam. The ABS states that primary certification in surgery is required for pediatric surgery certification and “highly” recommends finishing it before the end of fellowship.
| ABS pediatric surgery exam | Format | Limits |
|---|---|---|
| Pediatric Surgery Qualifying Exam (PSQE) | About 200 multiple-choice questions over about five hours, in three 90-minute sessions | Once a year; up to four tries in four years |
| Pediatric Surgery Certifying Exam (PSCE) | Virtual oral exam: five 30-minute sessions, each with two examiners | Once a year; up to three tries in three years |
The Pediatric Surgery Qualifying Exam tests cognitive knowledge of pediatric surgery. To apply, you need a completed ACGME- or RCPSC-accredited fellowship, 48 weeks of full-time clinical activity in each fellowship year, a PALS certificate and an operative log from fellowship that meets ABS minimums, including 120 abdominal, 50 thoracic, 25 oncology and 30 endoscopy cases. A full and unrestricted U.S. or Canadian medical license is required to register; temporary or training licenses are not accepted.
The Pediatric Surgery Certifying Exam is the last step. Its five sessions cover oncology; trauma and critical care; GI, hepatobiliary and abdomen; head and neck, endocrine and GU; and thoracic, airway and chest wall. The ABS lists the next one for February 2 to 4, 2027. You have no more than seven academic years after fellowship to pass both exams. BLS adds that all states require physicians and surgeons to be licensed, with requirements that vary by state.
Pediatric Surgeon Salary From BLS
Unlike many specialties, BLS publishes a separate occupation for pediatric surgeons. Its May 2025 occupational wage profiles for surgeons show these national figures.
| Pediatric surgeons (BLS, May 2025) | Annual wage |
|---|---|
| 10th percentile | $215,410 annual wage |
| 25th percentile | $336,380 annual wage |
| Median | $559,030 annual wage |
| Mean | $502,050 annual wage |
| 75th percentile | $583,200 annual wage |
| 90th percentile | $726,660 annual wage |
BLS counted 1,190 pediatric surgeon jobs in May 2025, with a mean hourly wage of $241.37. For comparison, the median annual wage for all physicians and surgeons was $275,930 in May 2025. The small count reflects how few fellowship positions open each year. For pay in other surgical fields, see how much surgeons make by specialty.
Job Outlook for Pediatric Surgeons
BLS projects employment of physicians and surgeons to grow 4 percent from 2025 to 2035, about as fast as the average for all occupations, with about 22,100 openings each year on average. BLS does not publish a separate projection for pediatric surgeons. With fewer than 50 fellowship spots a year, the specialty stays small, and the ACGME training model ties the work to hospitals with neonatal and pediatric intensive care units. The American Pediatric Surgical Association, founded in 1970, describes itself as the nation’s largest professional organization for the specialty.
What Is the Work Schedule Like?
Newborns with surgical emergencies and injured children arrive at all hours, so call is part of the job. BLS notes that many physicians and surgeons work long shifts, which may include irregular and overnight hours or being on call. During fellowship, the ACGME limit of 80 hours per week, averaged over four weeks, still applies.
Sample Timeline From College to Independent Practice
| Age (example, no gap years) | Stage |
|---|---|
| 18 to 22 | Bachelor’s degree and MCAT |
| 22 to 26 | Medical school and USMLE Steps 1 and 2 |
| 26 to 31 | General surgery residency (PGY-1 to PGY-5) |
| About 29 to 30 | Apply and match to pediatric surgery fellowship |
| 31 to 33 | Pediatric surgery fellowship |
| 31 to 35 | ABS general surgery and pediatric surgery exams |
Research years during residency, a year in a subspecialty fellowship after an unmatched cycle, or gap years before medical school push these ages later. Most pediatric surgeons reach independent practice in their early to mid 30s at the earliest.
Frequently Asked Questions
How long does it take to become a pediatric surgeon?
At least 15 years after high school: four years of college, four years of medical school, a 60-month general surgery residency and a 24-month pediatric surgery fellowship. Research years or an extra fellowship year add more time.
Do you have to do general surgery residency to become a pediatric surgeon?
Yes. The ACGME requires fellows to complete a general surgery residency before entering a pediatric surgery fellowship, and the American Board of Surgery requires general surgery certification before it certifies a surgeon in pediatric surgery.
How many pediatric surgery fellowship spots are there?
For the 2026 appointment year, the NRMP reported 47 positions at 46 programs, with 66 applicants. All positions filled and 19 applicants did not match.
How much does a pediatric surgeon make?
BLS reports a median annual wage of $559,030 and a mean annual wage of $502,050 for pediatric surgeons in May 2025. The 10th percentile annual wage was $215,410 and the 90th percentile annual wage was $726,660.
What conditions do pediatric surgeons treat?
Congenital and acquired problems in fetuses, newborns, children and teens, including abdominal, intestinal, chest, head and neck, endocrine and reproductive conditions, childhood tumors and injuries. Heart, spine and other organ-specific operations usually belong to other surgical specialties.
Is pediatric surgery board certification separate from general surgery?
Yes. The American Board of Surgery awards a separate pediatric surgery certificate after a qualifying exam and a five-session virtual oral exam, and you must already hold general surgery certification. See the ABS pediatric surgery requirements.
Can a pediatrician become a pediatric surgeon?
Not directly. A pediatrics residency does not lead to surgical training credit. A pediatrician would need to match into and complete a five-year general surgery residency and then a pediatric surgery fellowship.
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