Abstract
Cardiothoracic surgery requires prolonged training and offers among the highest compensation in medicine. However, the long-term financial implications across cardiothoracic subspecialties remain incompletely characterized. This study evaluated the lifetime net present value (NPV) of earnings for cardiothoracic surgeons, accounting for variation by subspecialty, training pathway, income percentile, and career trajectory.
We developed an NPV model using salary data from the 2024 Society of Thoracic Surgeons Cardiothoracic Surgery Compensation Report, stratified by years of post-training experience. Integrated and traditional training pathways were modeled for thoracic surgery, adult cardiac surgery, and congenital heart surgery across income percentiles. Scenario analyses evaluated leadership roles, career length, and discount rate sensitivity. A Monte Carlo simulation incorporated uncertainty across key model parameters.
Modeled lifetime NPV ranked among the highest in medicine, with estimates of $19.3 million for adult cardiac surgeons, $19.1 million for congenital heart surgeons, and $14.1 million for thoracic surgeons at the 50th income percentile. Thoracic surgeons demonstrated consistently lower earnings across scenarios. Congenital heart surgeons exhibited greater variability, reflecting delayed entry into the workforce and the potential for substantially higher compensation later in their careers. At the 90th income percentile with prolonged careers and leadership roles, discounted lifetime earnings for congenital heart surgeons exceeded $40 million.
Despite prolonged training and delayed earnings, cardiothoracic surgeons achieve substantial lifetime income. Thoracic surgeons earn less than their peers, whereas adult cardiac and congenital heart surgeons achieve higher lifetime NPV, with congenital heart surgery exhibiting the greatest variability and potential upside.