Vascular Surgery — Specialty Profile

Exploratory, not prescriptive. This profile blends hard data (pay, match rates, burnout, demographics — each sourced and dated) with generalizations and synthesized online opinion about culture and "who fits." It's here to help you get curious and go find out for yourself — not to tell you who to become. Numbers marked ⟳ verify change every year; check the linked source before you quote one. Last reviewed: 2026-07-25.

Also called: vascular, VS. Enterable straight from medical school through the integrated (0+5) residency, or after general surgery through a fellowship (5+2). Organ system: the arteries, veins, and lymphatics of the whole body except the heart and brain, the plumbing that keeps every other organ alive.

The 30-second version

Vascular surgery is the specialty of the body's blood vessels, the one field where the same surgeon opens a chest or belly to sew a graft by hand and threads catheters and stents through a groin puncture under live X-ray. You repair aneurysms before they burst, restore blood flow to a leg the body is trying to lose, build dialysis access for kidney-failure patients, clean out carotid arteries to prevent strokes, and get called at 3 a.m. for a ruptured aorta or an acutely cold, pulseless limb that will die within hours. The patients are old, sick, and comorbid, with diabetes, smoking, kidney failure, and prior strokes, and you often follow them for years ("a vascular patient is always a vascular patient"). That hybrid open-plus-endovascular identity, paired with the sickest patients and among the heaviest call in surgery, is the whole personality of the field.

Quick dashboard (details and sources below)
Training after med school 5 years (integrated 0+5) or 7 years (general surgery 5 + vascular fellowship 2)
Total from college start ~13 years via 0+5 (4 undergrad + 4 med school + 5 residency); ~15 years via 5+2
Competitiveness High — small field, fills at ~99–100%, US-MD-dominated ⟳
Typical full-time pay ~$576,000 average total comp, ~9th of all specialties (Doximity 2025, 2024 earnings) ⟳
Pay range (structure) No published percentile ladder. SVS members' median total comp: $576,000 men, $475,500 women; only 20% get separate call pay ⟳
Lifestyle Heavy, unpredictable call (~2.7 nights/week); ~55–60+ hr weeks
Burnout Among the worst in surgery — 2nd-highest of 14 surgical specialties (SVS) ⟳
% women ~15% of practicing workforce; 39.7% of integrated residents and 34.9% of fellows ⟳
DO / IMG accessibility Among the least open fields. 2026 integrated match: 7.3% DO and 6.4% IMG; the DO share has run 1.2% to 8.0% across the five cycles to 2026 ⟳

What they actually do

Vascular surgeons treat diseases of the arteries, veins, and lymphatics everywhere except the heart and brain, a whole-body physiology problem rather than a single organ. Their bread and butter: aortic aneurysms (elective repair before rupture, and emergent repair after), peripheral arterial disease and limb ischemia (restoring flow to failing legs, limb salvage vs. amputation), carotid disease (stroke prevention), dialysis access for kidney-failure patients, venous disease, and traumatic or iatrogenic vascular injuries. The defining feature of the modern field is that it is a hybrid craft: the same surgeon does long, physical open reconstructions (bypasses, open aortic repair, endarterectomy) and image-guided endovascular work (EVAR/TEVAR stent grafts, angioplasty, atherectomy, stenting, embolization, thrombectomy), increasingly in a dedicated hybrid OR with fixed imaging.12

The work is procedure-rich, high-acuity, and continuity-heavy at the same time, an unusual combination. You manage chronic vascular disease in clinic over years while also being the person the hospital calls when something catastrophic and time-critical happens to a blood vessel. Vascular surgeons are frequently the "surgeon's surgeon," the ones other specialties call for uncontrollable bleeding or a vascular injury they can't manage.3

Representative procedures: open abdominal/thoracic aortic aneurysm repair · endovascular aneurysm repair (EVAR/TEVAR, including fenestrated grafts) · lower-extremity bypass · carotid endarterectomy and stenting · peripheral angioplasty, atherectomy, and stenting for PAD · thrombectomy/embolectomy for acute limb ischemia · dialysis-access creation and maintenance (AV fistulas/grafts, fistulograms) · venous ablation · diagnostic angiography · vascular trauma repair.1

A day in the life: In a stable practice, a typical week is ~5 days with roughly 2 OR days and 1–2 clinic days, plus rounding, imaging review, and consults, commonly 55–60+ hours of which ~20 are in the OR.4 But call reshapes everything. When you're on, the pager owns your schedule: a ruptured AAA, an acutely ischemic limb, a bleeding dialysis access, or a vascular trauma can arrive at any hour and cannot wait for morning. Group size is the single biggest determinant of quality of life: a large partner group with real cross-coverage is livable; being one of two surgeons covering a whole region can mean brutal, near-continuous call.4

The training path & time to completion

There are two main pathways into vascular surgery, plus one hybrid, all ACGME-accredited and all leading to a primary certificate in Vascular Surgery from the American Board of Surgery (ABS). This is one of the most important things a premed should understand about the field, because the newer route is genuinely faster.15

Pathway 1, Integrated "0+5": straight from medical school. A 5-year residency you match into directly from med school via the NRMP Main Match. Structure: roughly 3 years dedicated to vascular surgery and ~2 years of core surgical training (distributed across the early years). It leads to certification in vascular surgery only, so you do not also become a general surgeon. This pathway was deliberately created to expand and accelerate the workforce pipeline.16

Pathway 2, Traditional or Independent "5+2": fellowship after general surgery. A full 5-year general surgery residency followed by a 2-year independent vascular surgery fellowship (applied for through the NRMP Specialties Matching Service). Total 7 years after med school. It results in certification in both general surgery and vascular surgery, a broader board profile at the cost of two extra years.1

Pathway 3, the Early Specialization Program (4+2 ESP), hybrid. For residents in ESP-accredited programs: enter vascular after 3 years of general surgery, with the GS chief year counting as the first year of vascular training. Yields dual certification.1

  • Same destination, same scope. Both major pathways train the full open + endovascular skill set; the difference is length (5 vs. 7 years) and whether you also hold general surgery certification, rather than case mix or pay in practice.2
  • Case & certification requirements (identical across pathways): ≥250 major vascular reconstructions and ≥40 surgical critical care cases, verified by the program director; then a two-exam sequence of the Vascular Surgery Qualifying Exam (VSQE) followed by the Vascular Surgery Certifying Exam (VSCE).5
  • Total from the start of college: ~13 years via 0+5 (4 + 4 + 5); ~15 years via 5+2 (4 + 4 + 5 + 2).

How competitive is it?

Integrated vascular surgery is a small, highly competitive surgical subspecialty that fills at or near 100% and is dominated by US MD seniors. It is not a huge match, at roughly 100 positions a year nationally, so every seat is contested.78

  • 2026 Main Match, the current cycle: 110 positions offered and 110 filled (100.0%): 92 US MD seniors (83.6%), 3 US MD graduates, 8 US DO seniors (7.3%), 3 US IMGs and 4 non-US IMGs (6.4% combined).9 ⟳
  • 2025 Main Match: 102 positions offered and 102 filled (100.0%): 84 US MD seniors (~82%), 2 US DO seniors (~2%), 2 US IMGs, 9 non-US IMGs; 172 applicants ranked the specialty (applicant-to-position ratio ~1.69).8 ⟳
  • 2024 Main Match: 100 offered and 99 filled (99.0%): 77 US MD seniors (~78%), 8 US DO seniors (~8%), 3 US IMGs, 8 non-US IMGs; 163 applicants (ratio ~1.63).7 ⟳
  • Matched applicant profile: mean USMLE Step 2 CK ≈ 250–253 for matched US MD seniors (Step 1 is now Pass/Fail), with substantial research output (~4.7 research experiences and ~10.5 abstracts/publications/presentations on average, per a secondary summary of NRMP Charting Outcomes).10 ⟳
  • A growing but still-small field. Integrated positions have run 84, 93, 100, 102, 110 across the five cycles to 2026, up 31%, and programs have expanded over the past decade specifically to address the projected shortage, but the field is still small enough that mentorship and early exposure matter enormously.7869
  • Read the DO share as volatile rather than as a trend. On a base of about 100 seats, two matched DO applicants move the number two points, and the published five-year series runs 1.2%, 4.3%, 8.0%, 2.0%, 7.3%. It is noise around roughly 5% rather than a direction.9 ⟳

The honest read: vascular is reachable for a strong US MD applicant and, unusually, offers a 5-year route to a shortage-protected, top-10-paying career straight from medical school, but it is genuinely competitive and DO- and IMG-unfriendly relative to most fields (see demographics), and under-exposed in medical school, so you have to seek it out deliberately.

Compensation — the robust version

Vascular surgery is one of the better-documented surgical fields, and two sources carry it: a national survey and the specialty's own society study. They land within a few hundred dollars of each other, which almost never happens.

National number. Doximity's 2025 report puts vascular surgery at $576,452 average total compensation on 2024 earnings, roughly 9th of all specialties.11 ⟳ Medscape's 29-specialty list does not include vascular surgery, so there is no second national survey to weigh it against.

The society study is the better guide to structure, and it is specific to this field. The Society for Vascular Surgery partnered with Phairify to survey its membership, collecting responses from 708 of 3,200 invited surgeons (22%) between May and December 2023, and published the results in the Journal of Vascular Surgery in 2025. Median total compensation was $576,000 for men and $475,500 for women. The men's figure sits within $500 of Doximity's average for the whole field, from a different instrument in a different year.12 ⟳

What that study found moves pay, and what it found does not. Higher compensation tracked with years in practice, with non-academic practice settings, and with being male. It did not track with hours worked, and it did not differ across racial groups.12 Those are reported as associations rather than as dollar gaps, so this page prints no private-versus-academic delta: nothing published for vascular surgery supports one. What the study does quantify is call. 93% of respondents take first call and 64% are on call one night or weekend in four, and only 20% receive any separate call pay. For a field whose defining burden is call, that is the most useful compensation fact anyone has published about it.12

There is no percentile ladder for vascular surgery, and you will find several online. MGMA's per-specialty percentile tables are paywalled, and the 25th-through-90th ladders circulating under MGMA's name on physician-salary aggregator sites cannot be traced back to MGMA. One of them stood on this page until 2026-08-13 and has been deleted rather than re-sourced. A reader negotiating a first contract needs to know whether a number was measured or assembled, and those ladders were assembled.

Office-Based Labs (OBLs) and office endovascular suites are the ownership lever, and they are vascular's signature compensation quirk. An OBL is a physician-owned outpatient endovascular suite where the surgeon performs procedures (diagnostic angiography, PAD interventions, atherectomy, stenting, dialysis-access maintenance/fistulograms, venous ablation, embolization) outside the hospital, and captures both the professional fee and the facility/technical margin that would otherwise go to the hospital. That captured margin is the mechanism behind vascular's high end. How much it adds is not published anywhere this site will quote, and the SVS study's finding that non-academic settings pay more is the closest thing to a measurement of it.1213

  • Vascular dominates OBL volume: peripheral vascular intervention was 36.84% of all OBL revenue in 2024, the largest single segment. The US OBL market was ~$13.9B (2024), projected to reach ~$35.2B (2033) at an 11.16% CAGR.13
  • For high-volume endovascular/dialysis-access practices, the technical/ancillary income can rival or exceed professional-fee income, and payers have shifted reimbursement to favor the lower-cost office setting; office-based interventional labs saw a reimbursement boost in 2026, though the trade reporting on it does not quantify the size.13 ⟳
  • Risk to name: OBL economics are highly sensitive to CMS reimbursement changes (past cuts to atherectomy/PAD codes compressed margins), payer site-of-service policy, capital cost of the angio suite, and utilization scrutiny. The income is real but reimbursement-policy-dependent and volume-driven.13

Call pay is the number to ask about in an offer, because most surgeons do not get it. Vascular procedures carry high work-RVU values, so a high-volume operator beats base salary on productivity. But the pager is what the field's own members name as its hardest feature, and four in five of them are paid for it only through whatever their base salary already assumed.12 No published benchmark sets a per-shift rate for vascular call, so this page gives none.

Geography shows the shortage-and-desirability inversion. As in many high-need fields, pay runs higher in lower-cost, lower-supply, non-coastal markets and lower in saturated coastal metros, the opposite of cost-of-living intuition, because underserved markets pay premiums to recruit. The SVS study collected geography and reports its respondents distributed evenly across US regions without publishing a regional pay table.12 BLS's highest-average-wage states for surgeons (May 2025) are North Dakota $526,650, New Jersey $503,070, Iowa $488,900, Minnesota $487,710 and Ohio $482,910. Four of those five read as a rural and low-supply premium rather than big-metro concentration, and New Jersey, the exception, carries by far the widest sampling error in the group.14

Urban vs. rural shows a shortage premium: direction clear, dollar delta not published. Only ~6% of US vascular surgeons practice rurally (2017 SVS survey), a severe maldistribution that drives strong rural recruitment premiums: above-median guarantees, signing bonuses, loan repayment, and call stipends. No benchmark survey publishes a quantified rural-vs-urban dollar premium for vascular, so the direction is well supported and the size is not.13 ⟳

The gender gap is measured here, and it is large. $475,500 against $576,000 is a 17% difference in median total compensation, found in a study that also found no relationship between pay and hours worked.12 An earlier analysis in the same journal put the gap near 20%.15 ⟳

The trend that colors all of it. Vascular has the most severe demand-supply mismatch of any specialty (see Wellbeing/FLI): 31% projected demand growth against a pipeline that has grown but not fast enough, with training positions up 56% against 42% applicant growth in the cited workforce reporting, driving 100+ job offers for >50% of new graduates, bidding wars, and continued upward pay pressure into the late 2020s. The bottleneck is recruitment rather than capacity, which is the same shape as the shortage on trauma surgery, and the NRMP series shows the capacity half independently: integrated positions rose 84 to 110 across five cycles. Vascular rose ~$556k → ~$576k across Doximity's 2023 and 2024 earnings years.11136 ⟳

Lifestyle & the call bargain

The single most-cited pro of vascular is the work itself: an unmatched hybrid of open craftsmanship and catheter-based intervention, genuine emergencies you can fix with your hands, and deep longitudinal relationships with patients you manage for years. The variety is a major draw, since few specialties let one person both cut open an aorta and thread a stent.42

The single most-cited con, and it is the defining feature of the field: heavy, unpredictable call. SVS Wellness Task Force data pegs the average at roughly 2.7 nights of call per week, a heavy load by any measure, and vascular emergencies (ruptured aortas, acute limb ischemia, dialysis-access crises, vascular trauma, post-op bleeds) are genuinely time-critical and arrive at all hours. Call often comes in week-long blocks; in thinly-staffed or single-coverage settings it can degrade to every-other-night or worse (one widely-cited anecdote describes 17 consecutive on-call days).4

Elective OR and clinic can be planned, but the emergent, high-acuity caseload means schedule control is low-to-moderate when you're on. Practice setting matters enormously: SalaryDr's 54-physician panel shows private-practice balance satisfaction (~4.3/5) well above academic (~3.5) or hospital-employed (~3.2). And the endovascular half of the job carries a physical cost of its own: radiation exposure from fluoroscopy and years of wearing lead aprons during long cases.4

Lifestyle rating: 2/5. High schedule predictability for elective work, but low control once the pager is yours, and a call burden among the heaviest in surgery.

Wellbeing — the part to take seriously

Burnout: among the worst in surgery. The SVS Wellness Task Force report found vascular surgeons report the second-highest burnout rate of 14 surgical specialties, with nearly one-third screening positive for depression. In that same dataset vascular surgeons reported the lowest career satisfaction of the surgical specialties, ranked first in saying they might choose a different career, and first in saying they would steer their own children away from medicine, and the report flagged high suicidal ideation among surgical colleagues. Trainees are hit early: surgical training pipelines report burnout in the high-60s percent range, with ergonomic strain/workplace pain and mistreatment identified as risk factors.1617 ⟳

The satisfaction paradox, minus the number that used to carry it. This page reported that ~92% would choose the specialty again, from a crowdsourced panel — sitting directly beneath SVS data in which vascular surgeons had the lowest career satisfaction of fourteen surgical specialties and ranked first in saying they might choose a different career. Nobody has published a would-choose-again rate by specialty since about 2019, so there is no figure to give here and none is asserted., and a figure that contradicts the survey printed above it is not the exception that proves a paradox. What is real, and what surgeons in this field say consistently, is that the work itself, saving limbs, fixing catastrophic problems by hand, and decades-long patient relationships, is deeply meaningful, while the system around it (call, EHR, volume, understaffing) is what grinds people down.416

Career longevity and emotional load are the real crux. The patient population is old, sick, and comorbid (diabetes, PAD, renal failure, prior strokes, heavy smoking), and outcomes are often poor despite excellent surgery, and patients lose limbs or die from disease that was too advanced by the time it reached the OR. Surgeons carry the emotional weight of amputations and mortality, sometimes on patients they've followed for years. On top of that, the physical toll of lead aprons, long cases, and cumulative radiation is a genuine longevity question over a full career.416

Who's in the field (demographics)

  • Women: roughly 15% of the practicing vascular workforce and ~14% of board-certified vascular surgeons (2022), but 39.7% of integrated (0+5) residents and 34.9% of independent (5+2) fellows in AY2024-25. The two training routes are five points apart, and the integrated pathway being the higher of them is the mechanism people usually name for the rise. The gap between trainees and workforce is the well-documented "leaky pipeline." (For context, general surgery overall is ~24% women, all specialties ~38%.)181920 ⟳
  • DO: small, at ~8% of integrated matches in 2024 and ~2% in 2025 (8 of 99; 2 of 102). Vascular is among the least DO-friendly fields.7821 ⟳
  • IMG: ~11% of integrated matches in both 2024 and 2025 (mostly non-US IMGs; US IMG numbers are too small for NRMP to chart). Non-US IMGs who preferred integrated vascular matched at ~30.8% (8 of 26) in 2024.78 ⟳
  • URiM: specialty-specific URiM percentages are not reported in NRMP Match Results; the literature notes vascular is among the less racially/ethnically diverse surgical specialties, but no precise current URiM percentage is published.9 ⟳

Culture, personality & the online stereotypes

Who gravitates here: surgeons who genuinely want both open technical craftsmanship and catheter or endovascular skill, people who'd be bored by a single modality. It draws those who like the sickest, most complex patients and don't flinch at high-stakes 3 a.m. emergencies; who find satisfaction in millimeter-precise anastomoses and durable reconstructions; who value longitudinal relationships managing chronic vascular disease rather than one-and-done operating; and systemic thinkers who see vascular disease as a whole-body problem (hemodynamics, pharmacology, imaging, surgery together). As always, plenty of people in the field do not fit any single mold.22

The stereotypes. Community caricatures rather than facts, each with an unfair edge:

  • "Hardest lifestyle in surgery, and underrated pay for it." Kernel of truth, since call and acuity are genuinely among the toughest, but "underrated pay" undersells a top-10 earning specialty with shortage-driven leverage. Unfair edge: it flattens huge variation between a well-staffed group and solo regional coverage.
  • "Sickest patients, highest mortality, you can't win." The population is genuinely comorbid and outcomes can be poor, but framing the field as futile discounts the limb salvage and aneurysm repairs that save lives and function every day.
  • "Turf war with IR and cardiology over endovascular cases." A real dynamic: interventional radiology and interventional cardiology compete for catheter-based peripheral and some aortic work, and there's genuine friction over scope and referrals, but the "war" framing obscures that vascular surgeons are the only specialists who can offer the full menu (open, endovascular, and medical management).

What people say online (synthesized and paraphrased, not quotes): Across trainee and physician forums the picture is consistent. Vascular is widely regarded as one of the most punishing lifestyles in surgery, and the recurring theme is that the cases are loved but the call is what breaks people, and threads repeatedly warn applicants to scrutinize group size and call structure before signing anywhere. The IR/cardiology dynamic comes up constantly, with the prevailing take that vascular surgeons "own the complications" (they get called to bail out endovascular cases that go wrong regardless of who started them), which fuels resentment but underscores that vascular is the definitive backstop for arterial disease. There's strong consensus that the specialty is chronically under-exposed in med school, so many people back into it with limited firsthand understanding, and that early shadowing is essential. A recurring sentiment holds that vascular is "underrated": respected by other surgeons, invisible to the public, and financially solid but not glamorous, and there's frequent acknowledgment of the emotional weight of amputations and dying-vessel disease as a distinct hardship.

Voices from the field. Paraphrased from public writing, with links to the originals:

  • Dr. Ayman Ahmed, in an AMA specialty profile, frames the appeal as breadth, combining very fine open technique with minimally invasive endovascular skill and medical and imaging knowledge, plus the lifelong patient relationships ("a vascular patient is always a vascular patient"); he credits his own low burnout to a supportive partner group and good documentation tools, and names week-long call as the real challenge.23
  • Dr. William D. Jordan Jr., writing in Doximity's Op-Med, argues the workforce cannot keep up with an aging, vascular-disease-riddled population (~20% of people over 70 have PAD) while vascular surgeons are only ~10% of the surgical workforce, a structural gap that pushes patients toward less comprehensive providers.24
  • Dr. Jeffrey Hsu, also in Op-Med, argues that the endovascular revolution has differentiated vascular from general surgery enough to warrant a fully independent specialty board, capturing the field's ongoing identity/scope struggle.25
  • The SVS Wellness Task Force's "Tackling Burnout" report documents the second-highest burnout of surgical specialties and frames wellness as a specialty-level priority, not an individual failing.16

Why people choose it / why people leave

Why choose it: an unmatched hybrid of open surgery, endovascular intervention, and medical management under one specialty · you fix genuine emergencies and save limbs and lives · deep, longitudinal relationships with patients you follow for years · a severe national shortage that means outstanding job security, 100+ offers per graduate, and real negotiating leverage · strong top-10 compensation with an ownership/OBL path into the top decile · intellectually demanding whole-body physiology and constant technological evolution · a 5-year integrated route to all of it straight from medical school.

Why leave or avoid it: the highest-tier burnout and lowest career satisfaction figures in surgery are not an accident: call is heavy (~2.7 nights a week) and unpredictable · the patient population is sick with often-poor outcomes despite good surgery · the emotional load of amputation and mortality is real · cumulative physical and radiation toll · turf friction with IR/cardiology · long training and a compensation level some feel is modest relative to the grind.

Best fit if: you love both open surgery and catheter work and refuse to give up either · you're energized rather than crushed by 3 a.m. emergencies · you want to manage chronic disease over years, not just operate and discharge · you think systemically about physiology · you can protect your wellbeing well enough to survive heavy call.

Not for you if: you need predictable hours and reliable schedule control · you want a mostly elective, low-acuity practice · you're demoralized by patients who do poorly despite good surgery · you dislike radiation exposure or long, physically taxing cases · you have caregiving/family duties that a q-week (or worse) call structure would repeatedly collide with.

The FLI angle — Vascular Surgery for first-gen, low-income & immigrant students

Where vascular fits FLI realities well:

  • Demand and job security are exceptional. A documented, worsening national shortage means near-guaranteed employment, strong offers, and real leverage, genuinely valuable when you can't fall back on family financial cushioning. This is arguably vascular's single strongest FLI selling point.626
  • Strong, stable compensation. An average around $576,000, with an ownership path higher, provides serious income to support family, repay debt, and build the kind of generational stability that is often the whole point of the journey. Read the gender gap alongside it: the society's own study puts women's median $100,500 below men's, and it is the number a woman entering this field should walk into a negotiation already knowing.1112
  • A faster entry via the integrated 5-year pathway, which is a real access plus. Matching directly into vascular from med school shaves roughly two years off the traditional route, so you reach attending income sooner, which matters a lot when every year of trainee salary against loan interest counts, and when family may be depending on you to start earning.1

Risks to name honestly:

  • The call/caregiving collision is the central FLI tension. Heavy, unpredictable call (~2.7 nights/week, sometimes week-long blocks or worse) and the highest burnout in surgery are especially hard if you carry caregiving duties, whether children, aging parents, or being a family breadwinner. A q-week or worse call structure repeatedly collides with family obligations, and you may not have paid help to absorb the gap. The demand/security upside and the caregiving toll pull in opposite directions, and this is the trade-off to sit with most honestly.416
  • Access is genuinely harder here. Vascular is among the least DO- and IMG-friendly fields, at 7.3% DO and 6.4% IMG of the integrated positions filled in 2026, with the DO share bouncing between 1.2% and 8.0% across five cycles, it's competitive, and it's under-exposed in medical school, so FLI students without insider networks or a nearby vascular program have to be deliberate about early shadowing, research, and mentorship to be a strong applicant.7821
  • Long training and cumulative toll mean deferred earnings plus real physical, radiation, and emotional wear over a career, so go in with eyes open.

Bottom line: Vascular offers something rare: a shortage-protected, top-10-paying surgical career you can enter in 5 years straight from medical school, with job security and leverage that are especially meaningful when you have no financial safety net. But that security is bundled with among the heaviest call and highest burnout in all of surgery, and with the sickest patients in medicine, a toll that lands hardest on students with caregiving obligations. Shadow a vascular surgeon through a real call week, not just an elective OR day, before you commit.

Subspecialties & fellowships (the areas of focus within vascular)

Vascular surgery is itself a subspecialty, entered via the integrated 0+5 residency or a 2-year fellowship after general surgery, and no further formal fellowship is required to practice after either pathway. Within vascular, deeper focus tends to develop by practice emphasis rather than additional boarded fellowships:26

  • Complex aortic / advanced endovascular. EVAR/TEVAR, fenestrated and branched grafts, complex aortic reconstruction.
  • Limb salvage & peripheral intervention. PAD, critical limb ischemia, atherectomy/angioplasty/stenting; the core of most OBL-heavy practices.
  • Dialysis access. AV fistula/graft creation and maintenance, fistulograms; a high-volume, endovascular-friendly niche.
  • Venous disease. Ablation, thrombosis/venous reconstruction, often office-based.
  • Vascular trauma & critical care. The emergent, hospital-based, high-acuity end of the field.

Academic and high-volume centers enable deeper subspecialization; community practice usually stays broad. The 0+5 vs. 5+2 distinction affects training length and board scope, not the focus areas available afterward.226

Fun facts

  • Vascular is one of the few surgical fields where the same surgeon routinely both cuts open and threads catheters, a true hybrid often working in a dedicated hybrid OR with fixed imaging.2
  • It has its own integrated 5-year residency you can match into straight out of med school (the "0+5" pathway), a two-year time-saver versus the traditional 5+2 route.1
  • ~20% of people over age 70 have peripheral arterial disease, yet vascular surgeons make up only ~10% of the surgical workforce, a demand-and-supply mismatch projected to worsen.24
  • Vascular surgeons are frequently the "surgeon's surgeon," the ones other specialties call when there's catastrophic bleeding or a vascular injury they can't control.3
  • The push for full specialty independence is long-running: 91% of vascular surgeons backed an independent board in a 1997 survey, but the motion was defeated in 2005, and the debate is still alive.25
  • The field's public invisibility is a running joke internally: patients rarely know the specialty exists until they urgently need it.3

Sources

Footnotes

  1. Vascular surgery training pathways (integrated 0+5, traditional 5+2, ESP 4+2) and structure. Society for Vascular Surgery, "Vascular Surgery Training Pathways" (accessed 2026) (https://vascular.org/trainees-students/training/vascular-surgery-training-pathways); ABS, "Vascular Surgery Training Requirements" (accessed 2026) (https://www.absurgery.org/get-certified/vascular-surgery/training-requirements/). ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7 ↩8

  2. Hybrid open + endovascular identity, hybrid OR, and case mix. AMA specialty profile of Dr. Ahmed (see 23); SVS Training Pathways (https://vascular.org/trainees-students/training/vascular-surgery-training-pathways). ↩ ↩2 ↩3 ↩4 ↩5

  3. "Surgeon's surgeon" role, public invisibility, and the backstop-for-arterial-disease framing. Synthesized community sentiment (r/surgery, r/medicalschool, SDN — paraphrased) and MedSchoolInsiders (https://medschoolinsiders.com/medical-student/vascular-surgery-career-pros-cons/). ↩ ↩2 ↩3

  4. Lifestyle, hours (~55–60+), call (~2.7 nights/week per SVS Wellness Task Force), schedule control, radiation/lead, and setting-based balance satisfaction. SalaryDr, "Vascular Surgery Work-Life Balance" (https://www.salarydr.com/specialty-lifestyle/vascular-surgery); MedSchoolInsiders, "Vascular Surgery Career Pros & Cons" (https://medschoolinsiders.com/medical-student/vascular-surgery-career-pros-cons/); SVS Wellness Task Force reporting (see 16). SalaryDr panel size: n=54. A self-selected physician panel; the n is disclosed here because it is what the figure rests on. ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7 ↩8

  5. ABS board certification — case minimums (≥250 major vascular reconstructions, ≥40 surgical critical care cases) and the VSQE → VSCE exam sequence. ABS, "Vascular Surgery Training Requirements" (https://www.absurgery.org/get-certified/vascular-surgery/training-requirements/) and "Vascular Surgery Certification" (https://www.absurgery.org/get-certified/vascular-surgery/), accessed 2026. ↩ ↩2

  6. Workforce shortage and pipeline. Vascular News, "Vascular disease management struggles expected as demands on workforce grow" — 31% projected demand growth (highest of any specialty), need for +1,833 surgeons by 2030, projected supply ~3,333 by 2030, 56% training-position increase vs. 42% applicant growth. Corrected 2026-08-17: the compensation section described the mismatch as "31% projected demand growth against a roughly flat pipeline," which contradicts this source's own 56% training-position increase and the competitiveness section above it. The mismatch itself is well sourced and stands; the mechanism stated was wrong. Positions grew faster than applicants, so the bottleneck is recruitment rather than capacity. (https://vascularnews.com/vascular-disease-management-struggles-expected-demands-workforce/); An Updated Physician Workforce Model, Annals of Vascular Surgery (2020) (https://pubmed.ncbi.nlm.nih.gov/32027989/); JVS 2025 workforce forecast (full figures paywalled) (https://www.ovid.com/journals/jvsu/abstract/10.1016/j.jvs.2025.04.071~trends-in-supply-demand-and-workforce-adequacy-in-vascular?redirectionsource=fulltextview). ↩ ↩2 ↩3 ↩4

  7. NRMP, Results and Data: 2024 Main Residency Match (June 2024): integrated vascular 100 offered / 99 filled (99.0%); 77 US MD, 8 US DO, 3 US IMG, 8 non-US IMG; 163 applicants. https://www.nrmp.org/wp-content/uploads/2024/06/2024-Main-Match-Results-and-Data-Final.pdf ↩ ↩2 ↩3 ↩4 ↩5 ↩6

  8. NRMP, Results and Data: 2025 Main Residency Match (May 2025): integrated vascular 102 offered / 102 filled (100.0%); 84 US MD, 2 US DO, 2 US IMG, 9 non-US IMG; 172 applicants. https://www.nrmp.org/wp-content/uploads/2025/05/Main_Match_Results_and_Data_20250529_FINAL.pdf ↩ ↩2 ↩3 ↩4 ↩5 ↩6

  9. URiM diversity (qualitative — no precise per-specialty % reported). "Diversity, Equity, and Inclusivity in Vascular Surgical Education," J Surg Educ (2025) (https://www.sciencedirect.com/science/article/abs/pii/S0895796725000250). ↩ ↩2 ↩3 ↩4

  10. Matched applicant profile — mean Step 2 CK ~250–253 and research productivity. The Match Guy compilation of NRMP Charting Outcomes 2024 (https://thematchguy.com/usmle-step-1-step-2-ck-scores-by-specialty/); ProspectiveDoctor, "How Competitive is a Vascular Surgery Residency" (updated 2025) (https://www.prospectivedoctor.com/how-competitive-is-a-vascular-surgery-residency/). ↩

  11. The one national survey that carries vascular surgery. Doximity, 2025 Physician Compensation Report (2024 earnings, ~37,000 US physicians) — vascular surgery $576,452 average total compensation, ~9th of all specialties, against $556k in the prior edition's 2023 earnings. Openable directly: https://www.doximity.com/reports/physician-compensation-report/2025. Medscape's Physician Compensation Report 2026 covers 29 specialties and vascular surgery is not one of them, so no second national survey exists for this field. Corrected 2026-08-13: this page previously gave a "$560,000–$680,000 typical" range and a "$615k–$620k median" built on figures attributed to MGMA 2025 and to a physician-salary aggregator panel, neither of which could be traced to the survey named. Both are removed; see the compensation section. ⟳ ↩ ↩2 ↩3

  12. The specialty's own compensation study, and the best source on this page. Calligaro KD, Lombardi JV, Aulivola B, et al., "Society for Vascular Surgery Compensation Study of Vascular Surgeons in the United States," J Vasc Surg 2025 May;81(5):1208–1220, doi 10.1016/j.jvs.2024.11.042 (https://pubmed.ncbi.nlm.nih.gov/39800122/). SVS partnered with Phairify on a vascular-specific instrument developed January–May 2023, collecting responses May 1 to December 21, 2023; 708 of 3,200 invited active and early-active members responded (22%). Median total compensation $475,500 for women against $576,000 for men (P < .001). Male gender, years in practice and non-academic practice setting were associated with higher compensation; hours worked were not, and there was no difference across racial groups. 85% work more than 50 hours a week and 13% more than 80; 93% take first call and 64% are on call one in four nights or weekends; only 20% receive separate call pay. Respondents were 80% men, 57% White, 41% academically affiliated, and evenly distributed across US regions. The study reports associations rather than dollar deltas by setting or region, so this page prints none. ⟳ ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7 ↩8

  13. Office-based-lab / endovascular ancillary economics and the rural premium. Grand View Research, "Office-Based Labs (OBL) Market" (2024) — OBL market $13.9B (2024) → $35.2B (2033), CAGR 11.16%; peripheral vascular intervention 36.84% of OBL revenue (https://www.grandviewresearch.com/industry-analysis/office-based-labs-obl-market); Cardiovascular Business, "Office-based interventional labs see boost in pay for 2026" (2026) (https://cardiovascularbusiness.com/topics/healthcare-management/healthcare-policy/office-based-interventional-labs-see-boost-pay-2026); Vascular.org national shortage report (https://vascular.org/news-advocacy/articles-press-releases/national-shortage-vascular-surgeons); rural ~6% (2017 SVS) via Vascular News (https://vascularnews.com/vascular-disease-management-struggles-expected-demands-workforce/). None of these publishes a dollar figure for what an OBL adds to a surgeon's income, a per-shift call rate, a rural-vs-urban premium, or the size of the 2026 OBL reimbursement change. Corrected 2026-08-13: median work-RVU production, a $65–$80/wRVU conversion rate and $1,000–$2,500 per-24-hour call stipends previously appeared here, sourced to a physician-salary aggregator. All are removed. ↩ ↩2 ↩3 ↩4 ↩5 ↩6

  14. Government floor reference. BLS Occupational Employment and Wage Statistics, "Surgeons, All Other" (SOC 29-1249), May 2025 mean annual wage $373,930 ($179.78/hr) on employment of 25,140, with a median of $414,010 and a 90th percentile of $655,320. US Bureau of Labor Statistics, Occupational Employment and Wages — May 2025, Table 1 (https://www.bls.gov/news.release/archives/ocwage_05152026.htm). The top-paying-states list comes from the state half of the same release (state file at https://www.bls.gov/oes/special-requests/oesm25st.zip), which publishes a mean for 36 states in this occupation. New Jersey's $503,070 rests on a relative standard error of 24.3%, against 5% for North Dakota and 4.2% for Ohio, so read the ordering ahead of the dollar figures. This is a W-2 wage series covering a broad surgical bucket rather than vascular surgery specifically, so it runs well below either survey above and is useful as a floor and for state ordering. Updated 2026-08-18: this note carried the May 2024 mean of $371,280 and an unpriced state ordering of Alabama, Delaware, Idaho, Kansas and Missouri, given without dollar figures because that release stopped publishing a value at the top of a state distribution. The May 2025 release, published 2026-05-15, publishes those values, and none of those five states is in the top group under it. ↩

  15. Gender pay gap ~20% in vascular surgery. "Equal pay for equal work: Disparities in compensation in vascular surgery," J Vasc Surg 2021 (https://www.sciencedirect.com/science/article/pii/S0741521421006492); all-specialty gap ~26% per Doximity 2025 (https://www.doximity.com/reports/physician-compensation-report/2025). ↩

  16. Burnout and wellbeing. SVS Wellness Task Force / "Tackling Burnout: A Special Report (Part 1)" — 2nd-highest burnout of 14 surgical specialties, ~1/3 screening positive for depression, lowest career satisfaction, first in considering an alternate career and steering children from medicine (https://vascular.org/news-advocacy/articles-press-releases/tackling-burnout-special-report-part-1); SVS Wellness Task Force report, J Vasc Surg 2020/2021 (https://pubmed.ncbi.nlm.nih.gov/33248123/). ↩ ↩2 ↩3 ↩4 ↩5 ↩6

  17. Trainee burnout risk factors. "Prevalence and Risk Factors for Burnout in U.S. Vascular Surgery Trainees," J Vasc Surg / PMC (https://pmc.ncbi.nlm.nih.gov/articles/PMC8712370/). ↩

  18. Women in vascular — ~14–15% of the practicing and board-certified workforce ("leaky pipeline"), with the integrated pathway driving the trainee rise. Endovascular Today, "Increasing Representation of Women Entering Vascular Specialties" (Jan 2022) (https://evtoday.com/articles/2022-jan/increasing-representation-of-women-entering-vascular-specialties). Trainee shares for academic year 2024-25, 39.7% of integrated residents and 34.9% of independent fellows: ACGME, Data Resource Book, Academic Year 2024-2025, Table C.21 (https://www.acgme.org/globalassets/pfassets/publicationsbooks/2024-2025_acgme_databook_document.pdf). Correction 2026-08-13: this page previously carried "~33% of trainees" as a single number covering both routes, in the Quick dashboard and in Who's in the field. The two routes report separately and both run above 33%. ↩

  19. Integrated residency associated with increased women among vascular trainees. Smith et al., J Vasc Surg (2019) (https://pubmed.ncbi.nlm.nih.gov/31176639/). Current share of women among active integrated residents, 39.7% in academic year 2024-25: ACGME, Data Resource Book, Academic Year 2024-2025, Table C.21 (https://www.acgme.org/globalassets/pfassets/publicationsbooks/2024-2025_acgme_databook_document.pdf). ↩

  20. Cross-specialty context — general surgery ~24% women, all specialties ~38% women (active physicians). AAMC Physician Specialty Data Report (2021/2022 data) (https://web.archive.org/web/20250112142220/https://www.aamc.org/data-reports/workforce/data/active-physicians-sex-specialty-2021). ↩

  21. DO-friendliness — vascular surgery among the least DO-friendly fields (~8% of PGY-1 positions filled by DOs, 2024). NRMP 2024 Results and Data (https://www.nrmp.org/wp-content/uploads/2024/06/2024-Main-Match-Results-and-Data-Final.pdf), cross-referenced in the cross-specialty DO dataset. ↩ ↩2

  22. Who gravitates to vascular / personality. Synthesized from AMA specialty profile (see 23) and MedSchoolInsiders (https://medschoolinsiders.com/medical-student/vascular-surgery-career-pros-cons/). ↩

  23. Dr. Ayman Ahmed — AMA, "What it's like to specialize in vascular surgery: Shadowing Dr. Ahmed" (2023). https://www.ama-assn.org/medical-students/preparing-residency/what-its-specialize-vascular-surgery-shadowing-dr-ahmed ↩ ↩2 ↩3

  24. Dr. William D. Jordan Jr. — Doximity Op-Med, "So Many Patients, So Little Time: The Challenge for Vascular Surgeons." https://opmed.doximity.com/articles/so-many-patients-so-little-time-the-challenge-for-vascular-surgeons-1970e52f-6683-4fbc-8d31-524c4119a81e ↩ ↩2

  25. Dr. Jeffrey Hsu — Doximity Op-Med, "A Call for Independence in Vascular Surgery" (independent-board debate; 91% support in 1997 survey, defeated 2005). https://opmed.doximity.com/articles/a-call-for-independence-in-vascular-surgery ↩ ↩2

  26. Areas of focus within vascular (no additional formal fellowship required) and FLI framing. SVS Training Pathways (https://vascular.org/trainees-students/training/vascular-surgery-training-pathways); Vascular.org national shortage report (https://vascular.org/news-advocacy/articles-press-releases/national-shortage-vascular-surgeons). ↩ ↩2 ↩3

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