Thoracic Surgeon Salary Guide 2026: Lobectomy, Esophagectomy, VATS, and Income Breakdown

Thoracic surgeon salary overview 2026

Thoracic surgery encompasses surgical care of the chest — lungs, esophagus, mediastinum, pleura, chest wall, and diaphragm. Modern thoracic surgeons train through one of two pathways: the traditional cardiothoracic surgery residency (graduates both cardiac and general thoracic surgeons) or the Integrated Thoracic Surgery (6-year) residency focused on general thoracic without cardiac. "Pure thoracic" surgeons (general thoracic without cardiac) and cardiac surgeons who also perform thoracic cases represent different income profiles. Mean total compensation in 2026 ranges from $400,000–$650,000 in academic settings and $450,000–$700,000 in employed health system and private group positions. Thoracic surgery is predominantly employed or academic — the hospital infrastructure required for thoracic anesthesia, single-lung ventilation, and post-thoracotomy ICU management precludes most private practice models outside of highly selected outpatient endoscopic procedures.

Income by practice setting and emphasis

• Academic general thoracic surgery: $400,000–$620,000; complex lung resection (pneumonectomy, sleeve), esophageal cancer surgery, mediastinal tumors, tracheal reconstruction; STS and ESTS research activity; thoracic surgery database (STS National Database) quality reporting; robotics and VATS innovation; NIH NCI grant funding for lung cancer surgical outcomes; fellowship training program
• Employed health system general thoracic: $450,000–$680,000; lung cancer surgery (lobectomy, segmentectomy, wedge), lung volume reduction surgery, pleural disease (mesothelioma, effusion, empyema), esophageal disease (GERD, achalasia, cancer), mediastinal surgery; call coverage for thoracic emergencies (hemothorax, tension pneumothorax, tracheal injury); wRVU production bonus structure
• Cardiothoracic combined program: $550,000–$850,000; both cardiac surgery (CABG, valve) and general thoracic (lobectomy, esophagectomy) scope; higher income due to cardiac procedural volume; more common at community hospitals without separate cardiac and thoracic specialists; higher call burden and operative scope
• Minimally invasive thoracic surgery / robotic thoracics specialist: $500,000–$720,000; VATS and robotic lobectomy leadership; lung cancer resection in early-stage disease; mediastinal thymectomy by VATS/robotic; innovation in uniportal VATS; academic and community programs building robotic thoracics programs recruit these specialists specifically

Procedure-level billing: lung

• VATS lobectomy: CPT 32663; professional fee $3,500–$6,000; video-assisted thoracoscopic anatomic lung resection; standard of care for early-stage NSCLC in operable patients; 4–5 small incisions; 3–5 day hospital stay vs. 5–7 days for open; volume of VATS lobectomy strongly predicts outcome — high-volume centers (>50/year per surgeon) have superior perioperative results
• Robotic-assisted lobectomy: CPT 32663 (same code, approach-specific modifier may apply); professional fee $4,000–$6,500; da Vinci robotic VATS lobectomy; superior visualization of hilar anatomy; growing adoption nationally; hospitals with robotic thoracics programs see increased referral volume from thoracic oncology
• Open lobectomy (thoracotomy): CPT 32480; professional fee $3,000–$5,500; required for centrally located tumors, complex hilar anatomy, or converted VATS cases; posterolateral thoracotomy with muscle division; higher RVU due to increased complexity modifier in appropriate cases
• Segmentectomy (anatomic lung-sparing resection): CPT 32484 (open) / 32669 (VATS) / 32670 (robotic); professional fee $3,000–$5,500; sublobar anatomic resection for early-stage lung cancer (T1a, ≤2 cm); JCOG0802 and LCSG 821 trials supporting segmentectomy equivalence to lobectomy for select tumors; growing rapidly in thoracic practice
• Wedge resection (non-anatomic): CPT 32657 (VATS) / 32510 (open); professional fee $2,000–$4,000; non-anatomic parenchyma-sparing resection for benign nodules, metastasectomy, and biopsy; high-volume procedure in thoracic practices managing pulmonary nodule surveillance
• Pneumonectomy: CPT 32440 (simple) / 32442 (sleeve pneumonectomy) / 32445 (extrapleural); professional fee $5,000–$10,000; entire lung removal for centrally located or extensive tumors; highest-risk thoracic procedure; sleeve pneumonectomy (carinal sleeve) is the highest-RVU lung surgery code; concentrated at major thoracic programs
• VATS decortication (pleural peel): CPT 32651; professional fee $2,500–$4,500; organized empyema or trapped lung; multiloculated pleural effusion after failed tube drainage; significant procedural complexity in fibrothorax cases
• EBUS (Endobronchial Ultrasound-guided transbronchial needle aspiration): CPT 31652 (single station) / 31653 (2–3 stations) / 31654 (4+ stations); professional fee $1,500–$3,000; mediastinal lymph node staging for lung cancer; replaces mediastinoscopy in most centers for N2/N3 node sampling; EBUS-guided sampling also applicable to central airway masses; thoracic surgeons performing EBUS in their own bronchoscopy suite capture professional fee without OR
• Robotic/VATS thymectomy: CPT 60271 (thorascopic) / 60270 (open); professional fee $3,000–$6,000; thymectomy for myasthenia gravis (autoimmune thymoma) and anterior mediastinal mass; VATS and robotic approaches (transcervical, subxiphoid, or lateral thoracoscopic); MIST trial evidence supporting minimally invasive thymectomy equivalence to open in MG
• Esophageal myotomy (Heller): CPT 43330 (open) / 43279 (laparoscopic Heller) / 43281 (robotic Heller); professional fee $2,500–$4,500; achalasia treatment by LES myotomy; typically combined with partial fundoplication (CPT 43280) to prevent GERD; POEM (per-oral endoscopic myotomy, CPT 43284) is increasingly performed by endoscopists rather than surgeons but some thoracic surgeons perform both

Procedure-level billing: esophagus

• Transhiatal esophagectomy (THE): CPT 43107; professional fee $6,000–$10,000; abdominal and cervical approach without thoracotomy; esophageal cancer and high-grade Barrett's; lower pulmonary complication rate than transthoracic approach; anastomosis in the neck
• Ivor Lewis esophagectomy: CPT 43117; professional fee $7,000–$12,000; abdominal + right thoracotomy approach; intrathoracic anastomosis; most common approach for mid-esophageal tumors; highest technical complexity of the 3 major esophagectomy approaches; highest RVU esophageal procedure
• Minimally invasive esophagectomy (MIE): CPT 43117 with minimally invasive approach; professional fee $7,000–$12,000; laparoscopic abdominal + thoracoscopic chest phases; TIME trial validated MIE vs. open for reducing pulmonary complications; robotic MIE growing at high-volume centers; highest-complexity thoracic surgery procedure category
• Esophageal diverticulectomy: CPT 43130 (cervical) / 43135 (thoracic); professional fee $2,500–$4,500; Zenker's diverticulum (most common), thoracic diverticulum; surgical approach vs. endoscopic diverticulotomy debate for Zenker's — thoracic surgeons perform both

Geographic variation in thoracic surgeon compensation

• Major NCI cancer centers and academic thoracic programs: $420,000–$660,000; highest lung cancer surgery volume nationally; VATS and robotic lobectomy innovation leadership; esophageal cancer complex reconstruction; STS database participation and quality leadership; NIAID and NCI grant funding for lung cancer outcomes research
• Regional thoracic surgery programs (community hospitals, 500–800 bed): $460,000–$680,000; employed model; full-scope general thoracic; lung cancer surgery and pleural disease dominant; cardiothoracic combined programs at community hospitals expand scope to cardiac; highest employed income range
• Sun Belt markets (FL, TX, AZ, NC): $480,000–$700,000; large lung cancer burden driven by aging, former-smoker populations; NSCLC surgical volume high; robotic thoracics programs expanding; strong market for experienced VATS/robotic thoracic surgeons
• Rural and underserved markets: $460,000–$650,000; significant shortage of thoracic surgery access in rural areas; locum thoracic coverage at community hospitals; NHSC loan repayment available; thoracic emergency coverage requires transfer to Level I/II trauma center in most rural markets

What we see at Ava Health

Thoracic surgery is experiencing a technical transition — the shift from open thoracotomy to VATS and now robotic-assisted thoracoscopic surgery is accelerating, and programs without robotic thoracics capability are increasingly at a competitive disadvantage for complex lung cancer and esophageal referrals. The thoracic surgeons in our network who are most in demand are those with high VATS/robotic lobectomy volume (100+ cases/year) and esophagectomy experience at minimally invasive techniques. For hospitals recruiting thoracic surgeons, the key infrastructure question is whether the program can support the volume a thoracic surgeon needs to maintain competency — isolated thoracic surgery programs performing fewer than 30 major lung resections per year are not competitive with major regional thoracic programs for candidate recruitment, and volume transparency during the recruitment process matters to sophisticated candidates.

Related: Cardiac Surgeon Salary Guide, Pulmonologist Salary Guide, Intensivist Salary Guide, Vascular Surgeon Salary Guide.