Overview
Cardiothoracic surgery is coronary bypass, valve repair/replacement, aortic surgery, transplantation and mechanical support, plus thoracic surgery for lung cancer. The operating is as high-stakes as medicine gets, the physiology is beautiful, and the craft rewards obsessive standards.
Two hard truths define the pathway: the lowest selection success rate in SET (11.5% in 2023), and a consultant market so small that new fellows must plan for international fellowships, subspecialty differentiation, and possibly years of waiting. Go in with eyes open; those who love it find nothing else compares.
The pathway
- PGY1–2Cardiothoracic/ICU/cardiology terms; GSSE prep; research within a CTS unit (essential).
- Unaccredited CTS registrar (PGY3–6+)2–4 years standard; perfusion knowledge, ICU fluency, publications, national reputation-building.
- Board of CTS SET selectionGSSE + application → CV/referees/interview → single-digit national offers most years (9 for 2025).
- SET 1–6Six years across cardiac and thoracic units (interstate moves expected); fellowship exam late.
- FRACS (CTh) → fellowships → consultantInternational fellowship(s) near-mandatory; consultant appointment often the longest wait in surgery.
Formal requirements
- General (unconditional) AHPRA registration and Australian or NZ citizenship / permanent residency.
- Completion of PGY1 and PGY2 by the time training starts (most successful applicants are well beyond this).
- GSSE pass before applying: the Generic Surgical Sciences Examination is now an eligibility requirement at application for the SET specialties (confirm timing rules for your specialty in the current Guide to Surgical Selection).
- Registration for selection (fee) late in the prior year, then a formal application early in the selection year, strict documentation and verification rules; late or unverifiable CV items are struck out.
- Limits on attempts: most specialty boards cap the number of times you can apply (commonly 3–4 valid applications); check the specialty regulations before you 'burn' an early application.
- Substantial cardiothoracic experience and CTS consultant referees are effectively mandatory (multiple unaccredited years).
- Research output is expected at selection; many entrants hold or are completing higher degrees.
Selection and points
How selection works
| Component | What it involves |
|---|---|
| Structured CV | Scored against a published specialty matrix, research, higher degrees, presentations, courses, rural service and specialty experience. Every item must be verifiable. |
| Structured referee reports | Usually the heaviest single component. Referees are commonly drawn from ALL recent terms or from specialty consultants you nominate; scores are averaged and standardised. |
| Semi-structured interview | Scenario-based stations (judgement, communication, conflict, ethics), not primarily a knowledge test. Only shortlisted applicants are interviewed in most specialties. |
Points & scoring
- Standard SET structure with a strongly research-weighted CV matrix; referee reports from the small national community of cardiothoracic surgeons dominate in practice.
The unofficial view
- With ~10 places nationally, selection approximates a national audition conducted over years in unaccredited jobs, consistency, stamina and likeability under pressure are what referees actually report.
- A PhD or serious research program is close to standard among successful metro applicants.
- Thoracic-only interest is worth flagging, thoracic surgery has better job liquidity than cardiac in several states.
- Before committing, talk honestly to recent fellows about the job market; the training gate is not the last gate.
Competition & demographics
Competitiveness
- 2023 selection success: 11.5%, the lowest of all nine SET specialties (RACS, verified).
- 9 trainees appointed nationally for 2025 (verified); some years fewer.
- Median entry PGY5–8 after several unaccredited years and often multiple attempts.
Who's in the program
- Tiny cohorts; women remain a minority though recent intakes are more balanced.
- Training and jobs concentrate in a handful of metro units with pump programs.
Exams
| Exam | When | Format | Cost | Pass rate |
|---|---|---|---|---|
| GSSE (Generic Surgical Sciences Examination) Score matters in some specialties' shortlisting, not just the pass; check your specialty's rules. | Before applying to SET (sit PGY2–4 for most people) | MCQ papers covering anatomy, physiology and pathology, a large basic-sciences exam similar in scale to a college primary | ≈ $5,500 | Roughly 50–70% per sitting depending on cohort (indicative) |
| Fellowship Examination FRACS (CTh) | SET 5–6 | Written + vivas + clinicals | ≈ $10,500 | Variable (small cohorts) |
Fees and pass rates are indicative; check the college's current fee schedule and exam reports.
What training costs
- Selection registration + application fees ≈ $800–1,000 per attempt.
- GSSE ≈ $5,500 per sitting.
- Annual SET training fee ≈ $10,000–11,500 per year once on the program (the single most expensive training program in Australia).
- Mandatory RACS skills courses before/early in SET: ASSET, EMST (≈ $3,000–3,800 each), CCrISP and others per specialty.
- Fellowship examination ≈ $10,500, plus courses; most trainees also spend $5,000–20,000 on exam prep and interstate travel across training.
How to improve your chances at each stage
StageMedical student
- Attach to a cardiothoracic unit's research program immediately, the field expects an academic record.
- Spend real time in cardiac theatre and ICU; confirm you love the physiology and the temperament of the environment.
StageIntern (PGY1)
- CTS/ICU/cardiology terms; GSSE prep begins.
- Learn the ICU side cold. CTS juniors live or die by postoperative care competence.
StageResident (PGY2–3)
- Unaccredited CTS reg posts (be prepared to move interstate); start or continue a higher degree.
- Publish consistently; present at ANZSCTS meetings so the national community knows you.
StageRegistrar years & applications
- Build referees across at least two units; document operative/assisting logbooks meticulously.
- Have a live Plan B conversation with yourself annually, sunk-cost drift is this pathway's signature hazard.
StageIf you don't get on (or change your mind)
- Adjacent: cardiology (interventional/structural via BPT, where much volume has migrated), ICU, vascular surgery, thoracic-focused general surgery, or anaesthesia (cardiac).
See also the general strategy guide: universal CV, referee and interview advice that applies across specialties.
Job market & workforce outlook
Outlook: The tightest consultant market in surgery: units are few, TAVI has shifted volume to cardiology, and new fellows commonly need international fellowships and patience
- The bottleneck: consultant posts are few, turnover slow, and TAVI/structural cardiology has absorbed volume that once required sternotomy.
- Thoracic surgery demand (lung cancer resection) is comparatively healthier; transplant/mechanical support remains a small tertiary niche.
- Expect international fellowship(s) and geographic flexibility as prerequisites for a substantive post.
Income
- Established consultants sit in the top ATO 'surgeons' bracket ($500,000–1,000,000+ indicative), but the small job market gates access to those earnings.
- Long training + fellowship + waiting arc gives cardiothoracic one of the latest peak-earnings profiles in medicine.
Pre-tax, indicative, and highly variable with hours, setting and billing model. ATO figures are averages of taxable income by reported occupation.
Subspecialties & special interests
| Area | Notes |
|---|---|
| Adult cardiac | CABG/valves, core but TAVI-pressured |
| Thoracic | Lung cancer, better job liquidity |
| Transplant / mechanical support | Few quaternary centres |
| Congenital/paediatric cardiac | A handful of surgeons nationally |
International medical graduates
- Specialist IMGs apply through the RACS SIMG pathway for an assessment of comparability (substantially / partially / not comparable), then complete a period of oversight ± the Fellowship exam.
- Surgery is not yet on the expedited specialist pathway (as of early 2026), general surgery and ENT are flagged as priority candidates to be added next; check the Medical Board list for the current position.
Official links
Community: questions and perspectives
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