The Role Of A Cardiothoracic Surgeon
A cardiothoracic surgeon is a doctor who performs surgery on the heart, lungs, and other thoracic structures. They may focus on a particular area of the chest, ie cardiac surgery, thoracic surgery, or congenital cardiac surgery, which is concerned with babies and children born with heart diseases and defects (1).
A wide variety of surgery is carried out by cardiothoracic surgeons, including (1):
Surgery for lung cancer, tumours, and cysts
Surgery on collapsed or infected lungs
Keyhole thoracic surgery (video-assisted thoracoscopic surgery)
Chest wall deformities (pectus surgery)
Congenital cardiac surgeons
Although cardiothoracic surgery work is relatively safe, complications do occur, such as bleeding, infections, stroke, and death; consequently, monitoring patients in intensive care units is an integral part of cardiothoracic surgery. Their responsibilities also include a mix of medical and imaging work, ie diagnosing, managing, and treating numerous diseases affecting the organs of the chest. This involves attending outpatient clinics and ward rounds. They work within a close-knit multidisciplinary team, both within the operating theatre (eg anaesthetists, theatre nurses, other surgeons, clinical perfusion scientists) and outside (eg cardiologists, respiratory physicians, oncologists, intensivists, physiotherapists, administrative staff). Consultants lead and manage their own team (1).
Apart from the necessary skills employed by all doctors, aspiring cardiothoracic surgeons should exhibit certain qualities and traits. In addition to a high degree of manual dexterity and excellent visuo-spatial awareness, a high aptitude for problem-solving and the ability to think and plan in three dimensions are vital. You will also need to demonstrate physical stamina and emotional resilience to cope with the demands of surgery, as well as the ability to remain calm and level-headed in stressful situations. Cardiothoracic surgery is very fast-paced and you should have the capacity to continuously monitor developing situations and anticipate issues.
Teamwork and leadership ability are crucial to effectively manage and lead your team. Despite being one of the most challenging fields of surgery, cardiothoracic surgeons find their job incredibly rewarding since they often see immediate and life-changing results of their work (1).
Cardiothoracic surgery is a relatively new and rapidly evolving specialty. Tremendous scientific breakthroughs have been made over the past decades, thus allowing significant improvements in existing surgical procedures, as well as providing new cutting-edge technologies. As a result, cardiothoracic surgeons are expected to conduct research and do lots of reading to stay up-to-date with new developments (1).
However, as with surgery in general, this specialty is notorious for being male-dominated, with female cardiothoracic surgeons constituting less than 10% of the workforce. The Women in Surgery initiative, nonetheless, is dedicated to encouraging and enabling women to pursue their surgical career ambitions (2).
A Typical Week
Only part of your working week is spent operating – usually two or three days – with the remaining days spent attending outpatient clinics, ward rounds, and monitoring patients in intensive care. A day in the theatre may comprise one or several operations and potentially take up to 12 hours, sometimes even at night. Despite most surgeries being pre-booked and non-emergency, cardiothoracic surgeons are required to be on-call out-of-hours and on weekends. Owing to the nature of work, on-call commitment is higher in cardiothoracic surgery compared to other surgical specialties; being on-call every third week, including weekends, is common (1).
Cardiothoracic surgeons are expected to be involved in research, allocating at least a day a week to research and academic meetings. Moreover, many surgeons give lectures to students and colleagues, as well as write articles and books. Some time must be invested in clinical management and governance.
The Route To Becoming A Cardiothoracic Surgeon
Interested undergraduate medical students can join the surgical society at their university and attend conferences for an opportunity to explore the specialty and network with potential future colleagues. You may also want to consider joining associated societies, institutes or professional bodies such as the Royal College of Surgeon of England (RCSEng) and The Society of Cardiothoracic Surgeons in Great Britain and Ireland (SCTS) (1).
During your foundation years, get in touch with cardiothoracic surgeons at hospitals and try to help in any way possible, be it research or audits. Attend courses offered by the RCSEng and SCTS (1).
If you are certain you want to pursue a career in cardiothoracic surgery, you can apply for a specialty training run-through programme starting at ST1 and finishing after eight years at ST8 (1,3). This, however, is incredibly competitive; in 2019, there were 8.42 applications per ST1 post (4).
Alternatively, if you are uncertain, you can first complete core surgical training lasting two years (CT1-2) and then apply for an ST3 post (1,3); this may be less competitive than ST1, but there is still a high degree of competition with 5.00 applications per post (4). Due to this, it is essential for you to develop your practical skills and interest in cardiothoracic surgery as early as possible, and you will find referring to the person specifications extremely useful.
Regardless of whether you complete CT1-2 or ST1-2, six months should be in cardiothoracic surgery. You must also sit and pass the examination to obtain full Membership of the Royal College of Surgeons (MRCS) prior to ST3 (1).
Be ready to move to a different location as certain hospitals – such as the University Hospital Southampton in Hampshire – are renowned for their excellence in this specialty and would prove beneficial to your career prospects (5). Throughout specialty training you will be required to take further examinations leading to specialty fellowship of the RCS. At the end of training, you will be awarded the certificate of completion of training (CCT) to go on to work as a consultant cardiothoracic surgeon.
Nevertheless, many complete a senior fellowship position before assuming a permanent consultant position (1). Since cardiothoracic surgery is a highly academic specialty, the majority of consultant cardiothoracic surgeons will additionally have acquired a research qualification, eg an MD (2-3 years) or a PhD (3-4 years) before or during specialty training (6).
Although most cardiothoracic surgeons perform a broad range of surgeries, some develop special interests and complete additional training in more complex areas, such as (3):
Congenital cardiac surgery in adults/children
Transplantation and heart failure surgery
Robotic thoracic surgery
Advanced lung cancer resections
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
Consultant cardiothoracic surgeons may also wish to run private practices to supplement their salary. On average, cardiothoracic surgeons can make a profit of an additional 57% of their NHS salary by working in the private sector. This is higher than many other specialties, e.g. oral and maxillofacial surgery (47%) or neurology (50%), placing cardiothoracic surgery in the top 15 specialties for private earning potential (7).
For more information on doctor's salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
If you are interested in deepening your knowledge in cardiothoracic surgery, you may find it useful to consult relevant journals, such as the ones listed below:
Journal of Cardiothoracic Surgery
The European Journal of Cardio-Thoracic Surgery
Journal of Thoracic and Cardiovascular Surgery
Annals of Cardiothoracic Surgery
The following societies and institutes offer a wealth of information on conferences, podcasts, essay prizes, research, tutorials, courses, and learning resources relevant to cardiothoracic surgery:
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Other Complete Guides By BMJ Careers
1. Cardiothoracic Surgery [Internet]. Healthcareer | NHS. [cited 2020 Jul 19]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/cardiothoracic-surgery
2. Women in Surgery [Internet]. Royal College of Surgeons of England. [cited 2020 Jul 19]. Available from: https://www.rcseng.ac.uk/careers-in-surgery/women-in-surgery/
3. Cardiothoracic Surgery Curriculum [Internet]. General Medical Council. 2015 [cited 2020 Jul 19]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/curricula/cardiothoracic-surgery-curriculum
4. Specialty Recruitment Competition Ratios [Internet]. Specialty Training | NHS. 2019. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition Ratios 2019_1.pdf
5. Cardiac Surgery [Internet]. University Hospital Southampton. [cited 2020 Jul 19]. Available from: https://www.uhs.nhs.uk/OurServices/Bloodandcirculation/CardiacSurgery/CardiacSurgery.aspx
6. UK Cardiothoracic Surgery Workforce report [Internet]. The Society of Cardiothoracic Surgeons in Great Britain and Ireland. 2019 [cited 2020 Jul 19]. Available from: https://scts.org/wp-content/uploads/2019/01/SCTS-workforce-report-2019.pdf
7. Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D, et al. Analysis of consultants’ NHS and private incomes in England in 2003/4. J R Soc Med [Internet]. 2008 Jul;101(7):372–80. Available from: http://journals.sagepub.com/doi/10.1258/jrsm.2008.080004