Training pathway and early career trajectories in cardiothoracic surgery: A national cohort study

The study objective was to compare educational outcomes and early career practice patterns of cardiothoracic surgery graduates by training pathway: direct entry through the integrated thoracic surgery residency and the independent fellowship pathways comprising fast-track entry and the 2- and 3-year fellowship programs.

We assembled a national cohort of graduates from Accreditation Council for Graduate Medical Education-accredited integrated thoracic surgery residencies and independent cardiothoracic surgery fellowships between 2013 and 2023. Graduates were identified using institutional alumni resources and self-identification in the Doximity Residency Navigator. Demographic, educational, and professional characteristics were abstracted from institutional websites, advertised professional profiles, and state and national provider databases.

Women were most represented among integrated thoracic surgery residency and fast-track graduates, whereas international medical graduates and osteopathic physicians were more common among 2- and 3-year independent graduates. Independent graduates had higher odds of thoracic subspecialization, but lower odds of adult cardiac subspecialization compared with integrated thoracic surgery residency graduates. Fast-track and 3-year independent graduates had similar odds of congenital cardiac subspecialization compared with integrated thoracic surgery graduates, whereas 2-year independent graduates had lower odds. Among adult subspecialists, only 3-year independent graduates had lower odds of superfellowship completion compared with integrated thoracic surgery residency graduates. Integrated thoracic surgery residency graduates completed fewer postgraduate training years than all independent-pathway groups regardless of subspecialization. Within subspecialties, integrated thoracic surgery and independent graduates had similar odds of entering academic practice.

Integrated thoracic surgery residency and independent pathways have attracted trainees with distinct demographic, educational, and subspecialization patterns. After accounting for subspecialization, graduates achieve comparable early career outcomes. Maintaining multiple entry pathways broadens access to cardiothoracic surgery and supports workforce diversity.