Are there any integrated programs where you can complete general cardiology + interventional + structural with peripheral training in 4 years total?

[sallyhasanidea]

It seems many programs have 2 years interventional + structural + peripheral super fellowship, but I was wondering if any programs provided adequate training in coronary intervention + structural by some means, whether it be incorporating into general fellowship or otherwise?

From some of my own research, it seems as though Texas Heart Institute provides this training with structural + coronary + peripheral integrated into 4 year total fellowship training Curriculum | Texas Heart Institute Cardiovascular Disease Fellowship

Can anybody comment on whether this is true at texas heart or if any other institutions offer something similar?

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[littlecow]

Why can't they finish integrating residency and fellowship into a 5-year path too like all those surgical subspecialties did

 

[Cardiology4eva]

Why can't they finish integrating residency and fellowship into a 5-year path too like all those surgical subspecialties did

Seriously. They need to. 2 yr IM, 2 yr gen card, 1 yr interventional. 7 years is too long. Medicine is changing and antiquated residency / fellowship system needs to change.

 

[Limvostov]

So, there are some that offer enough numbers and difficulty of procedures to get the numbers you need in 7 years. However, to be truly proficient in that many procedures an 8th year is often necessary. In my program I had plenty of coronaries, a number of CTO and Impella assisted procedures, over 50 watchmans, 30 carotids, and about 130 peripheral interventions with venous stenting, iliac, SFA, below the knee interventions, mesenteric, renal, subclavian, pulmonary/DVT thrombectomy, ect. I feel confident in my peripheral skills and watchman skills in addition to lower complexity CTO and typical coronary work. That being said, you will need to find a place that will let you perform all these procedures when you get done. Some will already have more senior operators, vascular surgery, or IR will have a claim to them and you will not get credentialed. During my training I think I could have had more TAVR, EVAR, ECMO, and more MitraClip experience, but honestly there is only so much time in a day and I had to look at what I could get good at without diluting my experience. To be fully certified in structural the 8th year is a good plan and getting an 8th year spot often means going to a program that has one associated with it's interventional program as they often choose an internal candidate.

As for unnecessary years in IM and general cardiology... Well you need to get your ECHO, nuclear, cath, TEE numbers which might be hard to get in two years alone for cards. The IM training could be cut down, but no program is going to give a third year resident away. You're far too valuable at that point.

 

[cscswimmer227]

Texas Heart Institute is probably the closest you will get. Most fellows get 400-700 caths before their third year. Third year (before your interventional fellowship year) is a dedicated interventional year with peripheral interventions. Then your interventional year is only one year and you're routinely getting to be primary on TAVR, EVAR.

 

[timpview]

So, there are some that offer enough numbers and difficulty of procedures to get the numbers you need in 7 years. However, to be truly proficient in that many procedures an 8th year is often necessary. In my program I had plenty of coronaries, a number of CTO and Impella assisted procedures, over 50 watchmans, 30 carotids, and about 130 peripheral interventions with venous stenting, iliac, SFA, below the knee interventions, mesenteric, renal, subclavian, pulmonary/DVT thrombectomy, ect. I feel confident in my peripheral skills and watchman skills in addition to lower complexity CTO and typical coronary work. That being said, you will need to find a place that will let you perform all these procedures when you get done. Some will already have more senior operators, vascular surgery, or IR will have a claim to them and you will not get credentialed. During my training I think I could have had more TAVR, EVAR, ECMO, and more MitraClip experience, but honestly there is only so much time in a day and I had to look at what I could get good at without diluting my experience. To be fully certified in structural the 8th year is a good plan and getting an 8th year spot often means going to a program that has one associated with it's interventional program as they often choose an internal candidate.

As for unnecessary years in IM and general cardiology... Well you need to get your ECHO, nuclear, cath, TEE numbers which might be hard to get in two years alone for cards. The IM training could be cut down, but no program is going to give a third year resident away. You're far too valuable at that point.

If you can FIND a job where you can do all that and be able to KEEP a job where you are doing all that, than you sir deserve a tip of the cap. But that’s walking through a minefield in today’s day and age. But super impressive training and skill set. It’s a shame that such interventionalists aren’t celebrated in today’s world.

 

[AequaMD]

It's practically meaningless to train in all and hope to be able to perform these 3 during your practice (coronary + peripheral + structural). You simply won't be hired at any major center for that purpose where these interventions are routinely performed in high volume just because you can't be the 'expert' in all 3 at the same time. If you practice at a relatively smaller center, you might be allowed to do it all but why take liability for something you'll do a few times in a year? It's a big professional and financial risk imho. The best you can hope is to pick and choose one (peripheral or structural) on top of your coronary training and do enough to sustain full practice. This is my experience in actual practice in the last 6 years.

 

[sallyhasanidea]

If you can FIND a job where you can do all that and be able to KEEP a job where you are doing all that, than you sir deserve a tip of the cap. But that’s walking through a minefield in today’s day and age. But super impressive training and skill set. It’s a shame that such interventionalists aren’t celebrated in today’s world.

Can you elaborate on how this is walking through a minefield?

Also, why is it that broadly trained (in many procedures) interventionalists are not celebrated today? Is it not a good thing to have a broad skill set?

 

[turica]

UChicago does this as well. You basically taylor your third and fourth year for peripheral, coronary and structural.

 

[aafisahar]

Can you elaborate on how this is walking through a minefield?

Also, why is it that broadly trained (in many procedures) interventionalists are not celebrated today? Is it not a good thing to have a broad skill set?

When it's your name on the chart, you own all the liability. So if you aren't 100% confident in your skills, you shouldn't be doing those procedures. Moreover, peripheral and structural pay well and you'll have lots of competition in most hospital systems. Peripheral may have IR, vascular, and senior cardiologists take first crack before cases trickle down to you. So you may go years before actually doing a peripheral case, assuming they let you get credentialed. Likewise, doing structural work is hard especially if you want to do it right. It takes a good team to select the right patient for clips, tavrs, pfos, watchman etc. Again, these pay well and will go to the most experienced guys first before it trickles down to you. You may have to wait 5 years before an opening pops up.

Most places want an interventionalist to share stemi call. It'll take you 3-5 years to build a patient base up to let you have consistent lab time. Most places only guarantee 1 day in the lab and you have to earn the rest.