Subspecialization in Cardiothoracic Surgery: What Trainees Need to Know

In this second special joint episode of Thinking Thoracic and the American Association for Bronchology and Interventional Pulmonology (AABIP), Dr. Erin Gillaspie is joined by interventional pulmonologist Dr. Sameer Avasarala of Case Western Reserve University and infectious disease specialist Dr. Renuga Vivekanandan of Creighton University to discuss the multidisciplinary management of pleural space infections. The conversation emphasizes early recognition, prompt source control, and seamless multidisciplinary collaboration. Following the clinical course, the panel discusses diagnosis, fluid sampling, targeted antimicrobials, drainage, intrapleural fibrinolytics, and risk stratification. They also explore when to pivot to surgical intervention, including VATS decortication, as well as the management of complex cases such as bronchopleural fistulas.

As cardiothoracic surgery becomes increasingly specialized, trainees have more choices to make about the direction of their careers. This article explores the evolving landscape of subspecialization, the continued role of generalist practice, and what additional training may mean as you consider the skills you want to develop and the career path you want to pursue.

What does the path to a career in cardiothoracic surgery look like today? Host Dr. Jane Yanagawa is joined by Dr. Varun Puri, Chief of Thoracic Surgery and CT Surgery Program Director at Washington University in St. Louis, to break down the evolving training pathways available to medical students and general surgery residents. They explore traditional 5+2/5+3 fellowships, fast-track 4+3 programs, and integrated I-6 tracks, highlighting key differences in clinical exposure, training timelines, board certification, and leadership development. The conversation also explores current match dynamics and common applicant misconceptions around applying to multiple tracks, while emphasizing the importance of early mentorship, scholarly research, and professional society resources such as TSMA, TSDA and TSRA in building a successful surgical career.

STS member Dr. Sean Jordan, chief of thoracic surgery and director of lung cancer screening at the University of Tennessee Medical Center, saw firsthand the barriers rural patients in East Tennessee faced in accessing lung cancer screening. In this episode, Jordan shares how a two-year effort—supported by collaboration, funding, and STS Advocacy—led to the creation of a 45-foot mobile CT lung cancer screening unit serving 21 counties. He'll discuss the challenges of bringing screening directly to underserved communities, the potential to detect lung cancer earlier and improve outcomes, and why thoracic surgeons have a unique opportunity to lead and advocate for stronger lung cancer screening programs nationwide.

In this episode of the STS Thinking Thoracic podcast, host Dr. Jane Yanagawa is joined by Dr. John Mitchell—Chief of Thoracic Surgery at the University of Colorado and incoming Chair of the American Board of Thoracic Surgery (ABTS)—to unpack critical updates from the board. Their discussion provides an inside look at how the ABTS operates, how surgeons can get involved, and key changes to initial and continuing certification pathways, including the recent transition from a 10-year to a 5-year certification cycle. Together, these updates are designed to help diplomates keep pace with modern clinical practice.

An STS Member blog by Dr. Jeffrey Shuhaiber, “Cardiothoracic Surgery at a Crossroads: Trust, Stability, and the Future of the Workforce,” explores the significant workforce challenges facing cardiothoracic surgery, from projected shortages and practice consolidation to evolving career pathways. Dr. Schuhaiber examines how systemic factors—not individual resilience alone—shape surgeon success and emphasizes the importance of psychological safety in supporting workforce well-being and patient care. He also considers the role of leadership in creating healthier practice environments and highlights the need to support, retain, and develop surgeons throughout their careers to build a stronger future for the specialty.

Host Dr. Melanie Edwards is joined by guest Dr. Andrea Wolf, director of the New York Mesothelioma Program, professor of thoracic surgery at the Icahn School of Medicine at Mount Sinai, chair of the American Association for Thoracic Surgery Wellness Committee, and an accomplished marathoner. Dr. Wolf explores how the mindset and discipline of distance running can strengthen resilience, performance, and career longevity in surgery. Drawing from her own experiences with running and injury, Dr. Wolf discusses the value of focusing on process over outcomes, prioritizing recovery and strength training, and building sustainable habits that support both surgeon well-being and patient care. She also shares insights on workplace ergonomics, mentorship, and challenging the culture of pushing through physical limitations.

In this episode of the STS Thinking Thoracic podcast, host Dr. Jeff Yang is joined by thoracic surgeons Dr. Seth Krantz and Dr. Christopher Seder, along with Harvard medical student Alexandra Potter, to discuss three landmark studies using the STS General Thoracic Surgery Database that are reshaping how lymph node evaluation is performed in lung cancer surgery. The panel explores current guidelines, quality standards, and how more comprehensive nodal evaluation can improve staging accuracy while maintaining patient safety. The discussion highlights national trends in surgical quality, the importance of surgeon-pathologist collaboration, and the future of personalized lymph node evaluation, including the potential role of emerging technologies such as radiomics, genomic markers, and AI.

Effective leadership requires the ability to bring together individuals with different backgrounds, experiences, and perspectives. In this blog post, Evan Alicuben, MD, of the University of Pittsburgh Medical Center, reflects on a recent STS Leadership Institute session on leading diverse teams and implicit bias, where case-based discussions with peers explored practical approaches to fostering inclusion and navigating challenging workplace situations. Dr. Alicuben writes, "Only by purposefully leading will we bring success to a diverse team." 

Jonathan Villena-Vargas, MD, sits down with Erin Gillaspie, MD, to examine key findings from the American Society of Clinical Oncology (ASCO) Annual Meeting, including advances in targeted therapy, dual-pathway immunotherapy, artificial intelligence, and adaptive treatment strategies that are reshaping thoracic oncology.