A thoracic surgery residency is where any aspiring surgeon learns how to do a lot by doing little. “Minimally invasive” is a word you’ll hear a lot when thoracic surgery comes up and it takes between three to six years to get to a level where you can perform complex, life-saving surgeries with precise incisions assisted by cameras, surgical lenses and robotic arms. There are two ways you can enter a thoracic surgery residency. One way is to do a first and then apply. But some programs are categorical and include a before you advance to the thoracic-specific modules. This article will go into detail about what’s involved in a thoracic surgery residency and how you can get into the various thoracic surgery residency programs available in the US and Canada.
According to the latest NRMP Match Data there were 138 applicants for 49 Thoracic Surgery Residency positions in the most recent match. There is a 100% match rate for this residency specialty – so all 49 spots were filled!
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Thoracic surgeries occur anywhere between your abdomen and the base of your neck, the area of your body known as the thorax. Since there are so many vital organs and body systems contained within the thorax, thoracic surgeons help treat a wide array of conditions dealing with the heart, lungs, esophagus, windpipe and diaphragm. Because thoracic surgeries are usually performed to treat heart conditions, the specialty is closely related to cardiology. Many of the programs listed here combine the two as cardiothoracic surgery.
Thoracic surgery is also closely tied to other types of surgery, such as vascular surgery. All these surgical specialties are interconnected and it may be hard to distinguish one from the other, but for this article we’ll only focus on what thoracic surgeons are most known for, although you should keep in mind that the lines between them are not so clear cut. Thoracic surgeons perform open heart surgeries and lung transplants, but so do vascular surgeons sometimes, depending on the patient and their particular case.
Thoracic surgeons can enter specific tracks in their residency programs to focus only one particular system or organ within the thorax whether it be the heart, lungs, or chest wall. But even with training in a specific sub-specialty, thoracic surgeons still rely on other surgeons, doctors, nurses and physician assistants to help address every patient’s unique history and condition.
As a thoracic surgeon, you’ll also rely heavily on technology, which is a distinction unique to the specialty. A skilled thoracic surgeon takes years to be able to coordinate with the various tools and implements used in modern thoracic surgeries, the most common of which is video-assisted thoracoscopic surgery (VATS). This type of surgery is for both diagnostic and therapeutic uses. But the scope of the thorax and all its inter-related systems means that you’ll also being using other technological means to heal various conditions from blocked arteries, lung cancer, heart disease and hernias.
There are between 34-36 different thoracic surgery residency programs throughout the United States. However, with only 46 positions spread out among them, a thoracic surgery residency is one of the to get into. Last year, close to 98% of all those positions were filled so they are highly sought after. The structure of thoracic surgery residency programs in the US is different for each host institution.
They each have specific tracks and a range of sub-specialties within thoracic surgery, which usually divides between:
- Cardiothoracic surgery
- Thoracic surgery
- Congenital heart surgery
There are a limited number of tracks, but the same does not apply to the length or pathways into these programs, as there are numerous options. Making things even more confusing is that there is little uniformity to any of them. For example, there are three distinct pathways you can take at the NYU Grossman School of Medicine, all with varying lengths. You can take either a:
- Traditional 5+3 pathway
- Integrated I-6 pathway
- General/thoracic surgery combined pathway
The traditional 5+3 pathway involves five years of a general surgery residency and three years in thoracic surgery specifically. The Integrated I-6 pathway is a categorical residency that includes three years of general surgery, and three years dedicated specifically to thoracic surgery; this is the most common format you’ll find among all the in the US. The final pathway is the school’s fast-track program that takes a total of seven years, with a 4/3 split between four years of general surgery and three of thoracic.
The Keck School of Medicine of USC also has an integrated, six-year thoracic surgery residency. The Thoracic Surgery Training Program at UC Davis has two pathways; an independent thoracic surgery residency that lasts two years, but requires completion of at least a general surgery residency beforehand; and an integrated six-year pathway.
Whatever pathway you chose, your ultimate goal is to be certified by the American Board of Thoracic Surgeons, which certifies all new thoracic surgeons after they complete their requisite residency training. As most of the programs on this list use the I-6 pathway, we’ll go more into more detail about the curriculum and clinical rotations for this specific pathway. If you enter any categorical residency, you usually spend the first two years rotating through general medicine departments such as family medicine or internal medicine.
However, there is a lot of variety between programs as to which rotations you’ll do in PGY-1 and PGY-2. A majority of programs emphasize rounds in cardiothoracic surgery, with additional surgical specialties as required rotations, such as plastic, vascular, otolaryngology, and minimally invasive general surgery. Some programs also divide time for clinical rotations with in-class instruction that teaches you about the various laparoscopic, endoscopic, and robotic approaches to thoracic surgery.
Depending on the program, you may be trained on specific procedures as well. The most common procedures done by thoracic surgeons are coronary artery bypass grafting (CABG) and lobectomies, which you can learn at various stage of your training program. Some introduce it in the beginning, while others leave it until the final years. But there are a range of other procedures crucial to thoracic surgery, such as robotic mitral valve repair, valve-sparing aortic root operations, and organ transplants (heart or lungs).
You will only have a few electives each year. Every thoracic surgery residency is based heavily on perfecting the skills of a thoracic surgeon through practice and repetition (see one, do one, teach one). This means you’ll spend more time developing the skill-set you need to be a thoracic surgeon rather than getting a wide-range of knowledge in off-service specialties such as family medicine or emergency medicine.
Every thoracic surgery residency program in the US participates in the service, so all your residency application materials have to be uploaded to the service. You will usually be asked to submit the following:
We’ve already talked about how competitive a thoracic surgery residency is, but thoracic surgery residency directors look for different things. You need to have the right clinical experiences or have published research within cardiac sciences to get noticed. In addition, having a proven record as a team player and someone who knows how to work with people will also stand out.
You should demonstrate your ability to learn new, complicated skills by excelling during your surgery rotations in medical school. You can also do this by taking electives in other surgical specialties, or learning more about the particular organ systems involved in thoracic surgery. This way you’ll be able to ask your instructors for letters of recommendation stating that you are fully capable of learning new skills quickly, and effectively.
In Canada, there are fewer thoracic surgery residency programs than in the US, which means they are even more competitive to get into. In Canada, thoracic surgery is known as cardiac surgery, although, as in the US, thoracic surgeons can perform any number of surgeries that are not associated with the heart. Regardless, a thoracic surgery residency in Canada lasts for six years, which is on par with the in the US.
All thoracic surgery residency programs in Canada are categorical. You begin with academic enrichment years that will expose you to the fundamentals of surgery. Then you will enter more focused training in vascular, general, thoracic and cardiac surgery. Many programs also require that you perform research in cardiac sciences, but you can also pursue research in related fields or sub-specialties. The time you spend in your off-service rotations depends on the program, but they range from 4-6 months in each.
Canadian residency training has also adopted a competency-based-education regimen. This means that you progress through a program by demonstrating competency in essential procedures that you would perform in the real-world. This type of training and education method is especially germane to thoracic or cardiac surgery, as you will be expected to have a wide knowledge of several different procedures and surgeries.
Cardiac or thoracic surgery in Canada is still a very niche specialty. There are only 9 positions throughout the country, which has decreased from 11 in previous years. Last year, there were only 17 applicants for these positions highlighting how hard it is and how stellar your application must be to get in.
Thoracic residency surgery directors in Canada look for the same things as their American counterparts. They want to see that you’ve pursued academic experiences within cardiology, pulmonology, even oncology, as removing tumors is part of being a thoracic surgeon. They also want to see that you have mastered, or have shown a desire to master, complicated technical skills that will make the difference when you are in training.
You’ll also stand out if you show a pointed interest and knowledge of technological or surgical innovations within thoracic surgery. This is where being a member of the Thoracic Surgery Medical Student Association can be helpful, as you will have access to the latest news and developments within thoracic surgery.
Every thoracic surgery residency in Canada lasts six years, but the exact curriculum requirements and schedule differs for each of them. Some leave their “academic year” - where you learn from faculty through in-person classes or have the time to pursue research interests – to the second or third year, while others leave it to the fourth or fifth year. Depending on the program, you might also be given time to complete graduate degrees, such as the Master of Science in Surgical Research offered by McGill.
A majority of programs start with training in surgical foundations. So, you’ll go through several surgery-related specialties such vascular and thoracic surgery in your first years. But, as in the US, you’ll also train on specific skills such as bypass and reconstructive procedures or even laser and video-assisted surgeries. In the later years of your program, you rotate through other specialties, such as anesthesiology, cardiology, or pediatric cardiac surgery.
You can also rise to the role of in your final years, depending on the program. But the focus in your final years will be on perfecting and repeating the skills necessary to be a competent thoracic surgery. You can either complete a full 12 or 18 months performing a variety of adult or pediatric thoracic surgeries or rotate through off-service specialties, such as the cardio-vascular intensive care unit, congenital cardiac surgery, or presenting research at conferences.
Take Surgery or Cardiac-Related Electives
Any residency program looks for whether you’ve taken the initiative to pursue further knowledge or training in that specific specialty, and that is doubly true with a thoracic surgery residency. Given it is such a small, narrow specialty, you can easily impress thoracic surgery residency directors by doing more than the required rotations in surgical specialties in medical school. General surgery is a required rotation, but going deeper into surgical specialties such as vascular, plastic or neurosurgery will help expand your knowledge. A lot of residency programs highlight the centrality of the heart, but other diseases, such as lung disease and other respiratory problems fall within the purview of thoracic surgeons, so you can take that route as well. You can also focus on other systems of the body within the thoracic region, such as the esophagus, trachea, chest wall and the lungs.
Pursue Research Experiences
Research and investigative pursuits may not seem relevant to thoracic surgery, but they are important to help expand your knowledge, while also demonstrating your passion for cardiac and pulmonary medicine. Doing research projects within these fields means that you wish to advance the knowledge of thoracic medicine, which is something that residency directors want to see on your application. You can do this research in your final years of medical school as a capstone project. You can also take a gap year before residency to do this research, which, because thoracic medicine is so diverse, can even include investigations into everything from esophageal or lung disease, heart arrythmias, heart or lung transplants to advanced valve and structural heart operations, and malignant pleural mesothelioma.
Join a Professional Association
There’s strength in numbers and joining a professional thoracic association for medical students or residents is one way to enter a community of like-minded, similarly ambitious individuals who share your goals. Professional associations not only provide you with an ever-growing network to help bounce ideas off for writing personal statements or sharpening your interview skills. It also gives you the chance to pursue professional development opportunities. Membership also gives you access to educational resources and potential mentors to help guide you through choosing the right residency program. There are two thoracic surgery associations in both the US and Canada, the American and Canadian Association of Thoracic Surgeons. You cannot join as a student, but if you are accepted into a residency, you can join then, as a resident. Your membership will also last for the rest of your career so you could evolve from being a junior member to a full-time member who gives advice and guidance to aspiring thoracic surgeons of the future.
Sharpen Those Interview Skills
Thoracic surgery residency programs in both the US and Canada hold interviews for all qualified candidates, but they neither use situational judgement tests such as CASPer nor during the interview process. This means you have to be able to demonstrate your communication and interpersonal skills while in the interview. The more at ease you are during the interview (relaxed body language, confident tone), the better you will be received, which is why can be so helpful. You can hire a professional academic consultant or use the resources provided through your school or the thoracic professional association to practice your delivery. But more important is writing out and refining answers to questions about your future career goals, your greatest achievements (or failures), and what you hope to contribute to the program. Interviews in Canada are usually panel interviews consisting of two or more senior or chief residents, so a lot depends on your ability to stay calm in front of pressure and be amiable with others, which are also important skills to have as a surgeon.
1. Is a thoracic surgery residency competitive?
Yes, getting into a thoracic surgery residency is ultra-competitive in both the US and Canada. The dearth of positions in both countries means that there are only so many positions to be filled, and they are always filled.
2. How can I get into a thoracic surgery residency?
Getting into a thoracic surgery residency requires a lot of preparation. You have to submit the usual, in terms of personal statements, letters of recommendation and transcripts, but your extracurriculars, research interests and publications also matter. An interview is also essential, and the perfect venue to demonstrate your communication, leadership, and interpersonal skills.
3. What are the requirements to get into a thoracic surgery residency?
Depending on the thoracic surgery residency program you want to enter, you typically need to have completed either a transitional year residency. But many programs are categorical so you do not need to have completed training previous. However, select programs in the US require a minimum USMLE Score (220 for most programs). As an international medical graduate, you’ll have to get your before applying.
4. How much are the starting salaries for thoracic surgery residents?
Many programs in the US have starting salaries for their PGY-1 thoracic surgeon residents at $75,000. It can raise to as much as $96,000 in PGY-6. In Canada, resident salaries are different in every province, so depending on where you study, you can start with a salary such as $67,000 in your first year, which can get up to $95,190 in your final year.
5. How long does a thoracic surgery residency last?
In the US, program lengths can vary with each institution, but categorical residencies, which are the most common in both the US and Canada last six years.
6. Is there a good work-life balance for thoracic surgeons?
In general, surgeons have a harder time achieving an acceptable work-life balance than most other doctors and the same applies to thoracic surgeons. However, many surveys among both US and Canadian thoracic surgeons report high levels (over 80%) of job satisfaction.
7. How can I match to thoracic surgery residency?
We mentioned the steps you can take to get into a thoracic surgery residency, but to reiterate, you should join a professional association, score high on the USMLE, pursue research projects, and take as many surgery electives as you can in medical school.
8. Which thoracic surgery residency program is the best?
Given the paucity of thoracic surgery residency programs in the US and Canada it is not hard to narrow down which ones consistently rank high as the best thoracic surgery residency programs. Columbia, UPenn, and Stanford are among the best in the US, while the University of Toronto and McMaster University are often cited as the best in Canada.