Alternate Pathway Qualification Checklist
Please take this brief quiz to see if you meet the minimum requirements for the Alternate Pathway to Certification.

Application Process
The 2023 application process is now closed. The next application cycle will occur in the summer of 2024. 

Alternate Pathway leading to certification by the American Board of Thoracic Surgery
An alternate pathway into the American Board of Thoracic Surgery (ABTS) Certification process has been created for truly exceptional cardiothoracic surgeons who are International Medical Graduates (IMG).  IMG is defined as completion of training programs in Thoracic Surgery outside of the United States and its territories not approved by the Accreditation Council for Graduate Medical Education (ACGME) or Royal College of Physicians and Surgeons of Canada (RCPSC).

This pathway is intended for candidates who have and will continue to contribute to the specialty through scholarship, education and research. The ABTS considers this situation extraordinary, and the Credentials Committee of the ABTS approves or disapproves entrance into this alternate pathway on a case-by-case basis. 

The Chair of the Department of Surgery (or equivalent such as the Chair of the Department of Thoracic and Cardiovascular Surgery if separate and independent from the Department of Surgery), and the Thoracic Surgery residency Program Director, and if applicable, the subspecialty Congenital Cardiac Surgery Program Director at the institution where the candidate holds a current fulltime faculty appointment, must propose the candidate.

Requirements for the 2024 application process are below.  ALL requirements must be met at the time of application. No exceptions will be made. 

The applicant must:  

1. Possess a current and unrestricted US medical license in the state of practice for a minimum of 3 years.
2. Must have a minimum of 10 years of clinical experience in thoracic surgery as an attending surgeon in the United States after completing all training.
3.  Have a clinical appointment of an Associate Professor of Surgery or higher.
4. Have unrestricted clinical privileges at a licensed medical center certified by Centers for Medicare and Medicaid Services (CMS) – Approved Accrediting Organization (e.g. the Joint Commission;
5. Have a minimum of 3 continuous years of clinical activity at the current institution, employed as a full-time teaching faculty member at a Liaison Committee on Medical Education (LCME) accredited medical school and at an institution with an ACGME-accredited Thoracic Surgery residency program.  
6. Document extraordinary scholarship and evidence for continued contributions, and national recognition, in one or more of the following areas: Research, Education, Clinical Care, Program Development, or Service. These include: 1) Appointment as Associate Professor (or higher) at an institution with an ACGME-accredited Thoracic Surgery residency training program and 2) Evidence of continuous graduate medical education responsibilities as a full-time teaching faculty with an ACGME-accredited Thoracic Surgery residency training program for a minimum of 3 continuous years. 
7. Have completed medical training at an Educational Commission for Foreign Medical Graduates (ECFMG) recognized medical school and possess an ECFMG certificate.
8. Have completed an equivalently structured and accredited international residency education and training program in Thoracic Surgery, in comparison to the current ACGME-approved Thoracic Surgery residency education and training program, including a signed attestation by the Program Director and the Designated Institutional Official (DIO).
9. Have achieved board certification in Thoracic Surgery by the national organization responsible for setting training and practice standards in the country where Thoracic Surgery training was completed. This certification will be reviewed and approved on a case by case basis. If original documents are in a language other than English, a notarized English translation must accompany them.
10. Document current experience through submission of most recent 36 months of operative logs and clinical outcomes. Must have a minimum 150 major cases as the primary surgeon  over three years.  
11. Applicants must provide a sponsorship letter from the Chief of the Medical Staff documenting participation in local quality, patient safety, and outcomes programs. 
12. Three additional reference letters from peers at the nominating institution and three letters of reference from referring physicians which attest to the applicant’s performance, ethics and professionalism.
13. Three additional reference letters from peers from the country where the applicant trained. 
14. Current Curriculum Vitae signed by the applicant and validated by the Chair of the Department of Surgery (or equivalent) of the nominating institution.  If original documents are in a language other than English, a notarized English translation must accompany them.

The ABTS Credentials Committee will review all documents and letters of endorsement; if acceptable, the candidate will be approved to take the Qualifying Examination to initiate the certification process.  

Fee for application
An application fee of $1,500.00 is due upon submission.  A portion of the fee ($850) will be refunded if not admitted into the certification process. Any additional fees will be line with current fee schedules for examinations.

Requirements for the certification process
Qualifying Process 
Applicants meeting these criteria will be eligible to enter the ABTS certification process and must remain in practice at the same institution/location while completing the certification and examination process. Upon application approval, the individual will be granted three opportunities within three years to pass an admissible secure examination of approximately 250 multiple-choice questions.  The examination process covers the entire specialty (Adult Cardiac, General Thoracic, Congenital Cardiac and Cardiothoracic Critical Care).  The examination is NOT specialty specific.

Certifying Exam
Upon successful completion of the Qualifying Exam, the individual will be granted three opportunities to pass the Certifying (Oral) Exam.  This requirement is effective for applicants starting in 2024.

Non-discrimination.  ABTS retains the privilege of review and consideration of eligibility on a case by case basis, and allows appeals in the event of non-favorable decisions.

Pilot Program
The ABTS considers the Alternate Pathway to Certification to be a pilot program.  The ABTS will evaluate this pathway in the future to determine its value to the specialty and the public.

Congenital Cardiac Surgery Alternate Pathway Plans
The ABTS has no plans to offer an Alternate Pathway to Subspecialty Certification in Congenital Cardiac Surgery.