Cardiothoracic Surgery Career Pros & Cons: Is It Right for You?

Are you considering a career as a cardiothoracic surgeon? With so many specialties to choose from, it’s one of the hardest choices medical students have to make.

This guide will cover the pros and cons of becoming a cardiothoracic surgeon, from the exciting, life-saving procedures and prestige to the challenging work-life balance.

There are so many different factors to account for when choosing a specialty, including how many years you’ll spend in residency, whether or not you want to focus on procedures, the level of patient interaction you’ll have, the setting you’ll practice in, the people you’ll work with, your work-life balance, your compensation, and more.

This series takes a deep dive into the career of a cardiothoracic surgeon from the perspective of Dr. Kevin Jubbal. He outlines the factors he considered and explains why he ultimately chose not to pursue cardiothoracic surgery as his specialty. That said, rest assured that this guide presents both sides of the story, outlining the pros and cons of pursuing a career in cardiothoracic surgery.

For a completely objective and unbiased look at cardiothoracic surgery, including more details into the daily life of a cardiothoracic surgeon and the exact steps to take to become one, also check out our guide to How to Become a Cardiothoracic Surgeon (So You Want to Be).

Cardiothoracic Surgery Pros — What I Liked

1 | Procedures

One of the most important distinctions is determining whether or not you want to be surgical. As they say, only pursue surgery if you can’t imagine yourself doing anything else because there are generally more sacrifices associated with a surgical subspecialty.

I knew I loved working with my hands since I was a kid. Still, it wasn’t until getting to medical school that I realized specific non-surgical procedural fields, like gastroenterology, didn’t provide the same level of depth and complexity to stimulate me in the way I wanted.

I loved that CT is one of the more elegant specialties out there, considering the nature of the procedures, and it requires a lot of technical skills to be in this field. After all, you’re literally performing surgery on an open, beating heart. How many people get to say that?

Some procedures include heart and lung transplants, valve replacements, CABG, aortic dissections, and much more, all of which are very impactful surgeries.

And while precision is a key requirement of every surgical specialty, it’s especially essential when you’re trying to repair a faulty heart valve or an aortic aneurysm.

A big reason I loved plastic surgery was the level of precision, detail, and meticulousness. While it differs in many ways from CT, I believe that CT can satisfy the same desire, perhaps not to the same extent or with the same frequency, but at least with certain types of procedures.

2 | Variety

One of the most compelling aspects of cardiothoracic surgery is the incredible variety of procedures you’ll encounter.

On the cardiac side, you’ll perform complex operations like coronary artery bypass surgeries, heart valve repairs, and aortic dissection repairs.

The thoracic component involves removing lung cancers, addressing esophageal cancers, and repairing certain hernias, among other procedures.

The technical approaches vary significantly as well. Some surgeries are traditional open procedures where you’ll open the chest and directly see the pumping heart and lungs. Others utilize minimally invasive techniques, requiring only small incisions and specialized instruments.

Many programs now feature cutting-edge technology, such as the Da Vinci robot, which medical students often have the opportunity to practice with during their training. This technological diversity keeps the field dynamic and intellectually stimulating.

3 | Procedural vs Medical Management

Cardiothoracic surgery typically employs a predominantly procedural and technical approach, rather than extensive medical management. While I initially felt that all the hard work of medical school would be wasted if I weren’t utilizing some of the medical management side, I’ve come to view this as a significant advantage. The focus allows you to master complex technical procedures rather than juggling multiple aspects of patient care.

This differs substantially from interventional cardiology, which offers more flexibility in practice patterns. Interventional cardiologists might work as general cardiologists, in the CCU, as diagnostic angiographers, or performing interventional procedures.

They typically split time between the cath lab, clinic, general cardiology duties, and reading echocardiograms. While this versatility provides career resilience, cardiothoracic surgery makes you a master of technical procedures and a surgeon first and foremost, capable of handling most surgical emergencies.

4 | Prestige

There’s undeniably high prestige associated with being a cardiothoracic surgeon, both within the medical community and among the general public. This recognition is well-deserved—you’re performing procedures that very few people can execute, literally operating on the organ that sustains life.

While prestige shouldn’t be the primary motivation for choosing any specialty, it’s important to honestly acknowledge all factors that influence our career satisfaction and professional identity.

Cardiothoraic Surgery Cons — What I Didn’t Like

1 | Procedures

While some cardiothoracic procedures are undeniably impressive, it’s crucial to consider the bread-and-butter cases you’ll encounter daily. Despite the variety available, the majority of patients are incredibly sick, and most surgeries you’ll perform are coronary artery bypass grafts (CABG) and valve repairs. These represent essential procedures, with nearly 400,000 CABG surgeries and over 150,000 valve surgeries performed annually in the United States.

However, CABG procedures typically require 3 to 6 hours to complete. The prospect of routinely spending this much time daily on these types of surgeries was a significant concern for me. While these operations are critically important and life-saving, the repetitive nature of the most common procedures may not appeal to everyone seeking variety in their surgical career.

The length of cardiothoracic surgeries presents a significant lifestyle consideration. This wasn’t something I fully appreciated during medical school, even when considering microsurgery within plastic surgery, which features some of the longest cases in medicine. However, as I’ve entered my early thirties and begun prioritizing lifestyle factors more seriously, I’ve recognized how prolonged surgeries can compromise the sustainability of a medical career.

The physical toll of spending hours in the operating room, often in challenging positions, accumulates over time. While these surgeries are vital and the physicians willing to dedicate these long hours deserve utmost respect, the physical demands represent a real consideration for long-term career satisfaction and health.

2 | Lifestyle

The stereotype of cardiothoracic surgeons having demanding lifestyles isn’t universal, but it’s common enough to warrant serious consideration. While surgical residency is challenging across all specialties, the attending lifestyle in cardiothoracic surgery presents ongoing difficulties that extend far beyond the training period.

Cardiothoracic surgeons manage extremely sick patients requiring urgent interventions. They regularly handle high-stress situations and, particularly at larger institutions, frequently perform complex cases that extend late into the night. While you won’t operate overnight as often as neurosurgeons, trauma surgeons, or orthopedic trauma specialists, when you’re called in, it’s typically for life-threatening emergencies like aortic dissections or coronary vessel perforations during catheterization. These scenarios often mean spending the entire night in the operating room.

Some colleagues suggest that while cardiothoracic surgery residency may not be as demanding as neurosurgery, the attending lifestyle can actually be more challenging. The constant pressure and demanding conditions can contribute to the occasionally worn-out demeanor that some residents and attendings may exhibit in the field.

It’s worth noting that focusing more on thoracic rather than cardiac procedures generally provides a better lifestyle. Thoracic cases typically occur during regular hours with fewer emergencies and overnight calls. However, this subspecialty is often considered less exciting, and the patient population differs from the dramatic cardiac cases that draw many to the field.

Despite the demanding lifestyle, cardiothoracic surgeons are well-compensated for their expertise and time investment. The median salary reaches approximately $515,000 annually, with some specialists earning much more, reflecting the specialized nature of their work and the extensive training required.

However, compensation alone shouldn’t drive specialty selection, especially when similar or slightly lower earnings are achievable in specialties with more manageable lifestyles.

3 | Job Security

During my medical school years, there was considerable discussion about cardiothoracic surgery being increasingly threatened by the advancement of interventional cardiology techniques. Interventional cardiology, a subspecialty that requires an internal medicine residency, a cardiology fellowship, and an interventional cardiology fellowship (totaling seven years), was positioning itself as the future of cardiac procedures through minimally invasive approaches.

The concern was that endovascular procedures performed through blood vessels would gradually replace traditional open-heart surgery, potentially making some cardiothoracic procedures obsolete. This perspective significantly influenced my view of the field’s prospects, as I was seeking a specialty that offered job security and longevity.

While it’s true that medical management continues to evolve and interventional cardiology advances may change cardiac care delivery, medicine constantly evolves across all specialties.

Cardiothoracic surgery will remain essential for the foreseeable future. Patients will continue needing CABG procedures and valve replacements. Emergency cases like aortic dissections will always require cardiothoracic surgical expertise, and congenital heart diseases will need surgical correction.

The real question isn’t whether cardiothoracic surgery will disappear, but whether technological developments might displace some procedures currently performed by cardiothoracic surgeons, potentially affecting supply and demand dynamics.

Coronary artery disease has evolved from primarily surgical to interventional to increasingly medical management. Transcatheter aortic valve replacement (TAVR) has been shown to be non-inferior to surgical aortic valve replacement (SAVR) in patients at intermediate risk. These trends deserve consideration when evaluating long-term career prospects.

Should You Choose Cardiothoracic Surgery?

So, should you become a cardiothoracic surgeon?

It depends on what you’re looking for and what you’re willing to sacrifice.

There are pros and cons to every specialty, and what’s important is figuring out what makes you want to jump out of bed in the morning and what challenges you’re willing to tolerate. What trade-offs are you prepared to accept, and what aspects of the work would make you genuinely excited about your career?

If you thrive on performing highly complex, life-saving procedures, appreciate significant professional prestige, enjoy technical mastery over medical management, and find fulfillment in operating on the organ that sustains life itself, cardiothoracic surgery could be an excellent fit.

However, you must be prepared for extremely long surgeries, a demanding lifestyle with frequent emergencies, predominantly very sick patients, and the physical toll of sustained OR time. The field also faces ongoing questions about job security as interventional techniques continue to advance, though the specialty will undoubtedly remain essential for the foreseeable future.

I have tremendous respect for our colleagues in cardiothoracic surgery and the incredible work they do. However, I could never see myself in that field, particularly because of how demanding the quality of life can be. It’s an absolutely essential specialty, and if you think you have a passion for it, you should definitely get exposure during your medical training to see if it resonates with you.

The decision ultimately comes down to your personal priorities and career goals. If you have an unwavering passion for cardiac and thoracic procedures and can’t imagine yourself doing anything else, then by all means pursue it – we need dedicated people like you in this critical field.

If you want to learn more about cardiothoracic surgery, check out So You Want to Be a Cardiothoracic Surgeon.