Surgery on newborns, infants and children. Fifteen years of training for one of the smallest and hardest specialties in medicine.
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Pay, the path, pros and cons and the facts on one printable page. Good for a wall or a guidance counsellor.
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What you earn and what it costs to get there.
Typical
$559,030
Junior academic
$215,410
Senior or high volume
$726,660
The national median is $559,030 a year, with the bottom tenth near $215,410. This is among the highest paid occupations the federal survey publishes. It counts employed surgeons, and nearly every pediatric surgeon is employed by a children's hospital or a university, so the figure is a fair picture here.
$65,000 to $90,000
Resident and fellow salary across 7 years after medical school
Seven years of paid hospital work at a fraction of the eventual salary, while roughly $200,000 of medical school debt sits there collecting interest.
15 years of training
Longer than almost any other path on this site
You reach full pay in your late thirties. A general surgeon finishes 2 years sooner, and plenty of specialties finish 5 years sooner and earn comparable money.
Tuition, fees, exams and kit. Not rent, food or travel
The low end is a cheap undergraduate route into a public medical school at in state rates, with the admission test, applications and the full set of board exams added. The high end is four years of public university tuition then a private medical school at around sixty five thousand dollars a year, plus general surgery certification followed by the separate pediatric surgery qualifying and certifying exam fees. Residency and the pediatric surgery fellowship are paid positions, so the six or seven training years after medical school add exam fees but no tuition. The real hidden cost is time, roughly fifteen years of it, while people who left school earlier are already earning.
Medical graduates who borrow typically owe around $200,000. Children's hospitals are usually nonprofits, so most pediatric surgeons qualify for Public Service Loan Forgiveness after 10 years of payments, which often lands right as training ends.
Malpractice insurance paid
Always covered by the hospital, and in this specialty it is expensive coverage.
Academic appointment
Most jobs come with a faculty title, protected research time and residents to teach.
Signing bonuses and relocation
There are few pediatric surgeons and few centers, so recruiting is competitive.
Sabbatical and conference funding
University centers fund travel to national meetings and research leave.
The exact path from high school to qualified.
You become a general surgeon first. Pediatric surgery is a fellowship on top of that.
High school
Grades 11 and 12
Biology, chemistry, physics and math, with the grades for a college where you can hold a very high grade point average.
Bachelor's degree
4 years
Any major, as long as you finish the pre-medical science courses and sit the Medical College Admission Test (MCAT).
Medical school
4 years
Classroom science then hospital rotations, ending in a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO).
General surgery residency
5 years
Five years of operating, on call, across trauma, cancer, vascular and everything else. Many trainees add research years on top.
Pediatric surgery fellowship
2 years
Two more years in an accredited program. It is one of the most competitive fellowships in American medicine.
Board certification
During and after fellowship
The American Board of Surgery requires certification in general surgery first, then a pediatric surgery qualifying exam and a certifying exam.
Biology
Development, anatomy and physiology. In this specialty the anatomy is still forming.
Chemistry
Required everywhere for pre-medical study and heavily tested at admission.
Physics
Pressure, flow and mechanics turn up in ventilators, drains and fluid management.
Public speaking or debate
You will explain terrifying things to parents, and later teach residents.
Physicians are licensed state by state through each state's medical board, and you hold a full unrestricted license in every state where you operate. The exams are national: the United States Medical Licensing Examination (USMLE) sequence through medical school and residency, then the American Board of Surgery. That board requires general surgery certification before pediatric surgery certification, an accredited pediatric surgery residency, and passing both the pediatric surgery qualifying exam and the certifying exam within seven academic years of finishing training.
Things you don't need, but that help.
Neonatal surgery
Operating on babies born with defects of the gut, lung or diaphragm, sometimes within hours of birth.
Pediatric surgical oncology
Childhood tumors, done alongside chemotherapy teams. Long relationships with families.
Fetal surgery
Operating before birth. A handful of American centers do it, and getting in is extremely competitive.
Trauma and burns
Children's hospitals are the regional trauma centers, and the surgeon on call takes whatever arrives.
Research years during residency
Close to expected for this fellowship. Most successful applicants have publications.
Tolerance for the worst days
Some children die. This specialty asks you to keep operating the next morning.
Mobility
There are a limited number of children's hospitals. You will move to where the job is, more than once.
Teaching ability
Almost every job is at a teaching hospital with residents and medical students attached to you.
There are only a few dozen accredited pediatric surgery fellowship positions in the country each year, and jobs cluster at the children's hospitals that exist in maybe one or two cities per state. That means real leverage on pay and very little choice about geography. It also means a tight professional community, where the national association is small enough that people know each other by name.
Day to day, pros and cons, where you'd work.
In by 6am for rounds in the neonatal intensive care unit and on the surgical floor, checking overnight changes with the residents. Then the operating room: maybe an appendix, a hernia repair, a feeding tube, and one long case on a newborn. Between cases you talk to parents, some of whom heard their child's diagnosis this morning. Clinic in the afternoon, then charts. On call nights you come back in for trauma and for babies who cannot wait until morning.
The good
The hard parts
Things people don't tell you.
The American Board of Surgery will not certify a pediatric surgeon who is not already certified in general surgery. Pediatric surgery is built on top of the full adult training, not instead of it.
Premature newborns can be operated on at well under a kilogram. Instruments, sutures and blood volumes are all scaled down accordingly, and there is no margin for a slip.
Fetal surgery, where the operation happens while the baby is still in the womb, is done at only a small number of American centers. It grew directly out of pediatric surgery.
After finishing fellowship you have no more than seven academic years to complete certification. Miss that window and you have to repeat parts of the process.
Last checked September 2026. Pay figures are typical full-time annual amounts in United States dollars, based on Bureau of Labor Statistics wage data and published pay scales. They vary by state, employer and experience. Tuition is for in-state students at public schools unless the card says otherwise.