Cardiothoracic anesthesia fellowship 2024

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PushinPropofol said:
How many interviews does everyone have? Seems like no more are going to get sent out, and I only have 5 so I'm a little worried.
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6 total for me.
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jhandy24 said:
I took 13 interviews. Maybe offered 15?
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I hope you are canceling some that you are not considering actually going. Professional to the programs and helps out the rest of applicants. Historically, ranking 7 programs guarantees matching, and most get their top 3. The programs are worried after last match because of the new landscape of remote interview removes the barrier to entry. On one hand, I expect more interview offers/spot by programs. However, I wonder if programs will settle by other means (i.e. exceptions).
 
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DrN2O said:
I hope you are canceling some that you are not considering actually going. Professional to the programs and helps out the rest of applicants. Historically, ranking 7 programs guarantees matching, and most get their top 3. The programs are worried after last match because of the new landscape of remote interview removes the barrier to entry. On one hand, I expect more interview offers/spot by programs. However, I wonder if programs will settle by other means (i.e. exceptions).
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Ranking 7 programs NEARLY guarantees matching.
 
Are you guys sending an updated complete CV to programs? Or just a word document with new updates like accepted publications, leadership responsibilities, etc?
 
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I just sent an update email with my ITE results, but if I had any other news, changes, or updates, I'd definitely send it out around this time.
 
I am wondering if we are going to hear back before Match day, like rank to match stuff
 
Is it worth sending ITE results if we did better? Or do programs do not care anymore especially if they already gave you an interview?
 
DrN2O said:
I hope you are canceling some that you are not considering actually going. Professional to the programs and helps out the rest of applicants. Historically, ranking 7 programs guarantees matching, and most get their top 3. The programs are worried after last match because of the new landscape of remote interview removes the barrier to entry. On one hand, I expect more interview offers/spot by programs. However, I wonder if programs will settle by other means (i.e. exceptions).
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Ya I cancelled or refused any program I knew I didn’t really want to go to after I got about 8-10. But that was only a few. How am I supposed to know if want to go there or not without interviewing? My understanding was 7 was safe before virtual interviews. Now with virtual interviews I’m not sure how it has changed. Better safe than sorry.
 
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jhandy24 said:
Ya I cancelled or refused any program I knew I didn’t really want to go to after I got about 8-10. But that was only a few. How am I supposed to know if want to go there or not without interviewing? My understanding was 7 was safe before virtual interviews. Now with virtual interviews I’m not sure how it has changed. Better safe than sorry.
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If you know you won’t go there, by all means cancel. But you are absolutely right that you don’t know what the program offers until you interview with them.

There is no “absolute” safe number of interviews. 7-8 is what has been said around but things are different with virtual interviews, and it does not guarantee a match. It just means you have very high chance of matching, and the more interviews you go on, the higher the chance of matching.

I know someone who cancelled interviews thinking he/she is safe and went unmatched, and I also know another person who went on 13 interviews and matched at #13.

You can guess who regretted their decision.

Yes, in an ideal world, you only go on 7-8, turn down other interviews, and those interview spots go to other people with fewer interviews, and everyone wins.

But if you go unmatched, you are the one living the consequences of the decision, and I guantantee you that no one else will care.

You earned those interviews. Go to those interviews if you are genuinely interested in learning more about those programs. Don’t cancel bc people are saying “you are going on too many.”
 
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I was hopeful, on one of the interviews they said this year has less applicants than last year
 
vector2 said:
It sounds like a pretty tough year this year. I wouldn't feel great about stopping at 7.
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Yeah I mean I applied in 2020 to 12-15 programs, got invited to 8 (could only make 7 work in my schedule). Great scores. Great letters. Reasonably strong app. Reputable program. Good reputation for being a hard-worker with a positive attitude. Halfway through the interview season, COVID caused the rest of interviews to be over Zoom (4/7 for me). Whole world went crazy at that time.

Ended up unmatched. That royally sucked to have done everything "right" and still not made it. I was wrecked. Still don't really know what happened overall. I am not under the impression that I come off as a giant D-bag in interviews. But maybe! Can't rule it out I guess.

I do know that things went crazy with COVID that year and I was told a lot of programs just kept their home people. Who knows. All that matters is that I'm in now and will finish my fellowship in 3 months!

I'm not envious of the all electronic interviews.
 
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abolt18 said:
Yeah I mean I applied in 2020 to 12-15 programs, got invited to 8 (could only make 7 work in my schedule). Great scores. Great letters. Reasonably strong app. Reputable program. Good reputation for being a hard-worker with a positive attitude. Halfway through the interview season, COVID caused the rest of interviews to be over Zoom (4/7 for me). Whole world went crazy at that time.

Ended up unmatched. That royally sucked to have done everything "right" and still not made it. I was wrecked. Still don't really know what happened overall. I am not under the impression that I come off as a giant D-bag in interviews. But maybe! Can't rule it out I guess.

I do know that things went crazy with COVID that year and I was told a lot of programs just kept their home people. Who knows. All that matters is that I'm in now and will finish my fellowship in 3 months!

I'm not envious of the all electronic interviews.
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Yeah, some of my CT trained classmates at academic places told me they're still heavily weighting their home applicants due in part to interviews being on zoom. However looks like there was a decent expansion of slots in 2022 plus a bunch of programs probably thought they didn't have to rank as many applicants as they should've and went unfilled, so that may help applicants this year. The flipside of that is anesthesia compensation absolutely exploded over the last year, especially for cardiac/cardiac locums, and the regular anesthesiology match was hella competitive this year so maybe the ACTA match will follow suit.


Screenshot 2023-03-21 at 7.23.30 PM.png



In either case, if an applicant doesn't at least have a couple interviews with lesser known, newer programs as backups then I'd feel a lot better with 8-10 interviews vs 6-7.
 
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Do you all expect a response when sending a thank you letter after an interview?
 
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I sent thank u email. But no all the program answered back. :( like 40% of the emails I sent. I wish we could have like a discord or excel where we can post post-interviews communication.
 
Gilgamesh. said:
I sent thank u email. But no all the program answered back. :( like 40% of the emails I sent. I wish we could have like a discord or excel where we can post post-interviews communication.
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A response is reassuring, especially if it’s a program you really like. That’s why I was wondering if others got many responses. I have on some but not others,
 
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Thank you letter or the response to the thank you letters make zero difference. Do it because it is a nice thing to do, not because you think it will get your extra points or think it will be a confirmation on how much they liked you.
 
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Was there a field for "ABA Basic Exam" in Licenses/Examinations when everyone submitted their supplemental form? I don't remember one being there, but I see one now (blank and unable to change) looking over my application again.
 
Guapicana said:
Was there a field for "ABA Basic Exam" in Licenses/Examinations when everyone submitted their supplemental form? I don't remember one being there, but I see one now (blank and unable to change) looking over my application again.
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There was, and for the score i just put "pass"
 
Any II’s lately? Seems like it’s getting to be end of season for invites and interviews themselves.
 
Question for interviewees. Have programs mentioned the new cardiothoracic boards at all as far as pushing it for y'all to take after fellowship?
 
Email from anesthesiallc

The Evolving Importance of Cardiovascular Anesthesia​
​
Summary​
Heart cases involve lots of base units and lots of time units, but how much value do they really bring to an anesthesia practice? Today’s article examines the current volume and relative value of cardiac anesthesia cases.​
​
April 10, 2023
There was a time, not too long ago, when cardiovascular anesthesiologists were the most respected members of anesthesia practices. Their specialized training and complexity of cases distinguished them both in terms of clinical skills and compensation. It was not uncommon for the cardiovascular surgeons to only allow certain members of the anesthesia practice into the heart room. Although these anesthesiologists rarely performed the greatest number of cases, the acuity of care inherent within their casework was often intense as most patients had advanced stages of coronary artery disease.
One of the hallmarks of these cases was the introduction of invasive monitoring, such as arterial lines, CVPs, Swan-Ganz catheters and, more recently, transesophageal echocardiography (TEE). As so often happens, though, the significance of the cardiovascular anesthesia team, while still a necessity, has diminished significantly.
A Review of Volume
A review of surgical activity for a sample of large anesthesia practices indicates that cardiac cases (ASA codes 00560 to 00580) now represent only about one percent of all surgical cases, and this has been fairly constant for the past five years. Because of the nature of cardiovascular disease, the number of heart cases—typically CABGs and valves—was not significantly impacted by the pandemic. Coronary artery disease was not a condition for which treatment could be deferred, especially if the patient had experienced a heart attack.​
​
041023Chart1.162919.png
The Relative Value
While cardiac care involves high acuity patients with compromised cardiac function, the cases are not only long (often lasting more than four hours) but complex. A typical CABG would result in about 40 base and time units, as well as separate charges for the invasive monitoring. (The arterial line, the CVP, the Swan-Ganz catheter and TEE are paid from a surgical fee schedule, not ASA units.) The problem, of course, was that, because these patients are often covered by Medicare, the effective net yield per billed unit is well below the group average. In other words, a practice that generates an average $40 per unit might only generate $30 or less for the cardiovascular cases.
Paradoxically, then, while it may look as though hearts should provide an above-average yield per case, the net yield per hour is not significant once you divide the total payment by the length of the case. The chart below shows the changes in the yield per cardiac case over the last five years.​
​
041023Chart2.162929.png
As a result of the relative undervaluing of cardiac cases, cardiovascular anesthesia has come to epitomize the challenge of today’s medicine: providers who are being asked to assume cases of greater complexity in an era of an aging population for less compensation per hour of work. As most hospitals continue to invest in their cath labs, the cardiovascular anesthesia time continues to be critical; it has simply become somewhat of a loss leader. For most practices, cardiovascular anesthesia is now the least profitable line of business.
Continuing Challenges
Coverage and call requirements for cardiac anesthesia can be especially problematic. Typically, only cardiac certified anesthesiologists can cover this call, which means that a cardiac specialist must be available every night when cardiac cases are performed. Historically, this has required an additional stipend from the facility.
Another problem that continues to challenge many practices is the need for cardiovascular specialists for unproductive heart programs. A group may go to great lengths to hire a cardiovascular anesthesiologist only to learn that the heart program is being phased out due to a lack of sufficient volume of cases. This can have a very disruptive impact on a practice.
If you have any questions, please reach out to your account executive.
With best wishes,
Rita Astani,
President, Anesthesia​
 
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Good summary Nimbus, not something I understood during any point in training. Some silver linings are that our presence in EP lab and to a much larger degree in structural heart cases like TAVRs are sought after. Also interesting in your chart that 2022 represents a significant rise in reimbursement, hopefully a start of a trend.
 
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nimbus said:
Email from anesthesiallc

The Evolving Importance of Cardiovascular Anesthesia​
​
Summary​
Heart cases involve lots of base units and lots of time units, but how much value do they really bring to an anesthesia practice? Today’s article examines the current volume and relative value of cardiac anesthesia cases.​
​
April 10, 2023
There was a time, not too long ago, when cardiovascular anesthesiologists were the most respected members of anesthesia practices. Their specialized training and complexity of cases distinguished them both in terms of clinical skills and compensation. It was not uncommon for the cardiovascular surgeons to only allow certain members of the anesthesia practice into the heart room. Although these anesthesiologists rarely performed the greatest number of cases, the acuity of care inherent within their casework was often intense as most patients had advanced stages of coronary artery disease.
One of the hallmarks of these cases was the introduction of invasive monitoring, such as arterial lines, CVPs, Swan-Ganz catheters and, more recently, transesophageal echocardiography (TEE). As so often happens, though, the significance of the cardiovascular anesthesia team, while still a necessity, has diminished significantly.
A Review of Volume
A review of surgical activity for a sample of large anesthesia practices indicates that cardiac cases (ASA codes 00560 to 00580) now represent only about one percent of all surgical cases, and this has been fairly constant for the past five years. Because of the nature of cardiovascular disease, the number of heart cases—typically CABGs and valves—was not significantly impacted by the pandemic. Coronary artery disease was not a condition for which treatment could be deferred, especially if the patient had experienced a heart attack.​
​
041023Chart1.162919.png
The Relative Value
While cardiac care involves high acuity patients with compromised cardiac function, the cases are not only long (often lasting more than four hours) but complex. A typical CABG would result in about 40 base and time units, as well as separate charges for the invasive monitoring. (The arterial line, the CVP, the Swan-Ganz catheter and TEE are paid from a surgical fee schedule, not ASA units.) The problem, of course, was that, because these patients are often covered by Medicare, the effective net yield per billed unit is well below the group average. In other words, a practice that generates an average $40 per unit might only generate $30 or less for the cardiovascular cases.
Paradoxically, then, while it may look as though hearts should provide an above-average yield per case, the net yield per hour is not significant once you divide the total payment by the length of the case. The chart below shows the changes in the yield per cardiac case over the last five years.​
​
041023Chart2.162929.png
As a result of the relative undervaluing of cardiac cases, cardiovascular anesthesia has come to epitomize the challenge of today’s medicine: providers who are being asked to assume cases of greater complexity in an era of an aging population for less compensation per hour of work. As most hospitals continue to invest in their cath labs, the cardiovascular anesthesia time continues to be critical; it has simply become somewhat of a loss leader. For most practices, cardiovascular anesthesia is now the least profitable line of business.
Continuing Challenges
Coverage and call requirements for cardiac anesthesia can be especially problematic. Typically, only cardiac certified anesthesiologists can cover this call, which means that a cardiac specialist must be available every night when cardiac cases are performed. Historically, this has required an additional stipend from the facility.
Another problem that continues to challenge many practices is the need for cardiovascular specialists for unproductive heart programs. A group may go to great lengths to hire a cardiovascular anesthesiologist only to learn that the heart program is being phased out due to a lack of sufficient volume of cases. This can have a very disruptive impact on a practice.
If you have any questions, please reach out to your account executive.
With best wishes,
Rita Astani,
President, Anesthesia​
Click to expand...

Spot on. The narrative needs to change so that a subsidy for cardiac anesthesia from the massive hospital charges / facility fee brought in by cardiac surgery is a given. Problem is that AMCs couldn't care less and will gladly staff up a pump case with an anesthesiologist and then give him two or three other rooms anyway to supervise. And by supervise I mean let the CRNA do the case by themselves (including inducing / emerging solo many places).
 
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vector2 said:
Spot on. The narrative needs to change so that a subsidy for cardiac anesthesia from the massive hospital charges / facility fee brought in by cardiac surgery is a given. Problem is that AMCs couldn't care less and will gladly staff up a pump case with an anesthesiologist and then give him two or three other rooms anyway to supervise. And by supervise I mean let the CRNA do the case by themselves (including inducing / emerging solo many places).
Click to expand...


Agree. Bad payor mix (large proportion of Medicare) has always been the bane of cardiac anesthesia. Our practice has always internally subsidized cardiac cases because they are reimbursed at the same $$/unit as all other cases even though the average $$/unit collected for cardiac cases is much lower than the groupwide $$/unit for all cases.


A local hospital is staffed by an AMC and the AMC is paying through the nose to get cardiac anesthesia coverage for a low volume (10 pump cases/month) program. The hospital was supposed to be reimbursing the AMC but the hospital claims they cannot come up with the cash. So they are on a “payment plan”. So far the AMC is honoring the contract they signed with the anesthesiologists so the anesthesiologists are still doing their own hearts and they are still getting paid.
 
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Have you guys gotten any thank you/gift packages before or after interviews? I heard it may be a thing
 
Graduates should take the following picture to heart when they get told their portion of a pump case is a mere 20-25 units + time units

1681153858194.png
 
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TexBlazer2106 said:
Good summary Nimbus, not something I understood during any point in training. Some silver linings are that our presence in EP lab and to a much larger degree in structural heart cases like TAVRs are sought after. Also interesting in your chart that 2022 represents a significant rise in reimbursement, hopefully a start of a trend.
Click to expand...
Don’t worry because the demand exceeds the supply. The actual anesthesia collections (Medicare) from cases are low,even structural heart cases, but the hospitals need you. That means large stipends for those that can do TEE for Mitral clips and other complicated cases. The hourly rate for cardiac as a locums is higher as well.

The bottom line is that hospitals make a ton of money from structural heart cases and that means they must share the revenue with you. Collections are a small piece of the puzzle.
 
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How would you guys rank Boston programs? How about New York programs?

Are there any that are on the rise?
 
Same here, I checked previous post and they said BWH >MGH> BI
 
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Gilgamesh. said:
Same here, I checked previous post and they said BWH >MGH> BI
Can someone post the list of the top 10 ACTA fellowship? I am not asking personal ranking list i am asking national wise!! Thank you
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No such thing as far as I know.
 
Gilgamesh. said:
Same here, I checked previous post and they said BWH >MGH> BI
Can someone post the list of the top 10 ACTA fellowship? I am not asking personal ranking list i am asking national wise!! Thank you
Click to expand...
There is no such thing because a fellowship rank list depends on what you want to get out of it. Different people will value different things.

There is academic reputation, academic productivity of fellows, maximal TEE exposure/training, maximal hands on vs supervising multiple rooms, lots of didactics vs self-directed, regional connections for job placement, job perks, nice place to spend a year, close to family, etc., etc.

I would advise that you get out of the mindset of “how do I win by impressing others,” and focus on “how do I win by accomplishing my personal goals.”
 
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Nervous here as well. Think it's a competitive year, anyone happen to hear how many people applied to cardiac this year?
 
Why do you say it is a competitive year? The job market is booming so more people not applying to fellowship, programs are expanding fellowship, so more number of spots. This year should be less competitive than the previous years.
 
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JiPo said:
Why do you say it is a competitive year? The job market is booming so more people not applying to fellowship, programs are expanding fellowship, so more number of spots. This year should be less competitive than the previous years.
Click to expand...
I know my program has had a decreasing applicant pool each of the last 2 years. I suspect for that exact reason.
 
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