A cardiothoracic surgeon is a specialist who operates on the heart, lungs, oesophagus and other thoracic (chest) organs. As well as performing surgery, they also diagnose and treat diseases of these organs.
This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.
Nature of the work
Cardiothoracic surgery is one of the most challenging and demanding areas of surgery. It is also highly competitive with a relatively small number of jobs. But it is also extremely rewarding, since diseases of the chest are a major cause of ill-health and death throughout the world.
As a cardiothoracic surgeon you will see the immediate and often life-changing results of your work. Since the end of the Second World War cardiothoracic surgery has seen rapid growth, coupled with fast-paced technological changes. The specialty is relatively young and is still evolving.
Highly specialised heart and lung transplant surgery is performed in eight specialist centres in the UK. These units have international reputations and are centres of excellence for clinical work and research.
The main areas of cardiothoracic surgery are:
- adult cardiac surgery
- general thoracic surgery
- congenital cardiac surgery
- heart and lung transplant surgery
Monitoring patients in intensive care is a vital part of the work. Although cardiothoracic surgery is very safe, complications can occur, including arrhythmias (heart-beat irregularity), post-operative bleeding, stroke, pleural effusion (fluid around the lungs), wound infection or thrombosis.
As well as performing surgery, cardiothoracic surgeons are involved in the treatment and management of many different conditions within their specialty. This involves attendance at outpatient clinics, multi-disciplinary team meetings and ward rounds.
Cardiac surgeons perform various kinds of surgery including:
- coronary artery bypass surgery – restores blood flow to the heart by adding a bypass graft to the blocked area
- heart valve surgery – repairing and replacing heart valves
- aortic surgery – repairing aneurysms and other conditions
Thoracic surgeons perform a wide range of surgery including:
- key hole thoracic surgery (video assisted thoracoscopic surgery (VATS))
- chest-wall deformities (pectus surgery)
- surgery for lung cancer, tumours and cysts and oesophageal cancer
Congenital cardiac surgeons treat babies and children with heart diseases that have been present from birth. They perform surgery to treat:
- septal defects (a hole between two of the heart’s chambers)
- aortic and pulmonary valve stenosis (where the valve is narrower than normal)
- transposition of the arteries and single ventricle surgery
Most surgeons specialise in one of the areas listed above, although a minority have a mixed practice to include thoracic and adult cardiac.
"When I’m in theatre I just can’t believe how fortunate I am as I love my job! I really enjoy being part of such a close-knit inspirational team, which is like an extended family. We all appreciate one another’s individual roles."
Want to learn more?
Find out about:
- the working life of a cardiothoracic surgeon
- the entry requirements and training and development needed
- Pay and conditions Expand / Collapse
This section provides useful information about the pay for junior doctors (doctors in training), SAS doctors (specialty doctors and associate specialists) and consultants.
NHS employers provides useful advice and guidance on all NHS pay, contracts terms and conditions.
Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.
- Where the role can lead Expand / Collapse
Read about consultant and non-consultant roles in cardiothoracic surgery, flexible working and about wider opportunities.
Managerial opportunities for consultants include:
- clinical lead - lead NHS consultant for the team
- clinical director - lead NHS consultant for the department
- medical director - lead NHS consultant for the Trust
- Most NHS consultants will be involved with clinical and educational supervision of junior doctors.
Here are some examples of education and training opportunities:
- director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
- training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors e.g. foundation training programme director. This role will be working within the LETB/deanery
- associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will also be working within the LETB/deanery
SAS doctor roles
SAS surgeons (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for SAS roles.
The role of an SAS surgeon can vary greatly. Depending on your experience you might work on complex surgery or relatively minor diagnostic and outpatients work. SAS doctors will frequently participate in routine and elective surgery rather than emergency work. They may also train other staff.
Some surgeons are attracted to the SAS role as the hours are more regular than those of the consultant, and you’re paid for on-call work and overtime beyond 7am-7pm.
Other non-training grade roles
These roles include:
- trust grade
- clinical fellows
If you have trained on an academic surgery pathway or are interested in research there are opportunities in academic medicine.
For those with a particular interest in research, you may wish to consider an academic career in cardiothoracic surgery. Whilst not essential, some doctors start their career with an Academic Foundation post. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.
Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) and may progress to a Clinical Lectureship (CL). Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.
Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC).
There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine.
The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.
There are good career opportunities for ambitious and hard-working doctors within cardiothoracic surgery. The slight decrease in the number of cardiac operations has been balanced with an increased need for thoracic surgery.
As their careers progress cardiothoracic surgeons often become increasingly involved in a wide range of other activities including research, audit, teaching, writing and committee work.
- Job market and vacancies Expand / Collapse
This section provides useful information about the availability of jobs, how to find vacancies and sources of further information.
Job market information
In 2016 the competition ratio for CT1/ST1 cardiothoracic surgical training was10.17, and for ST3 cardiothoracic surgery it was 6.75 (NHS specialty training 2016). Cardiothoracic trainees can also apply through national recruitment for Core Surgical Training programmes (the Core Surgical Training was 2.53 in 2016).
The demand for cardiothoracic surgeons is declining slightly overall and by 2020 the cardiothoracic surgery workforce is forecast to decrease by about 9%. However although the need for cardiac surgery has decreased, there is an increased need for thoracic surgeons. Cardiothoracic surgery had 363 consultant posts and 385 medical registrars in England (NHS Digital, 2016)
The largest numbers of consultants work in London (27.3%) and the north-west of England (15.4%). Women are under-represented in this specialty at present. The opportunities for part-time working and less than full-time training (LTFT) have been limited in the past but the core and specialty surgery training programmes are now open to those who want to train less than full time (LTFT) or job-share.
In this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.
Where to look for vacancies
Applications for core surgery training are made via the Core Surgery National Recruitment Office. Further details including closing dates can be found on the Surgery Recruitment website.
London and the South East (LaSE) nationally coordinates the recruitment into Core Surgery Training round one (CT1) on behalf of England, Wales and Scotland. This training programme is open to those who may want to train flexibly on a less than full-time basis (LTFT). You can request and apply for this after you have been offered the job. Restrictions apply.
Health Education Wessex is coordinating the national process for recruiting trainees into Cardiothoracic Surgery ST posts.
Registration and application for core surgery and specialist training is online via Oriel. Further details, person specifications and application deadlines are also available on the Oriel website.
Northern Ireland has its own recruitment process. For further details please visit the Northern Ireland Medical and Dental Training Agency website.
Generally all cardiothoracic surgery posts are advertised on NHS jobs.
- Further information Expand / Collapse