Choosing between reputation vs procedural volume

[turica]

I thought getting some other perspectives on this issue could help.

Trying to choose between Royal Oak Beaumont (RO) vs Henry Ford (HF) vs University of Michigan (UM) for cardiology fellowship.

I know that I would want to go into either interventional cardiology or remain as general cards. Very small thought of pursuing advanced imaging.

PCI #: 1600 RO vs 1200 HF vs 500 UM

Downside of RO is they do not have strong heart failure program and are not a transplant center (not many LVADs). However, their IC and imaging program is debateably the strongest in the state.

Knowing that I want to pursue IC, how important is it to be exposed to the heart failure population if I am interested in likely pursuing private practice in the future. UM has it all, however downside is it only has a 10 bed CICU and PCI # are not too high. I am still waiting on Henry Ford interview so not too sure what their program is like.

At the same time, I wonder how many caths or PCIs is enough? For example going to UM and graduating with 300 PCI vs going to RO and finishing 700 PCI --> I mean at what point is enough PCIs considered enough to feel comfortable in most situations? Are all PCIs the same after 400 or something or how does it work lol

Any thoughts/guidance is very welcome please!

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[qmcat]

Just my opinion, but I think that if you're set on pursuing a certain subspecialty within cardiology, like IC, I would be more interested in whether the program has an IC fellowship and do they usually take their own internal candidates, how is the mentorship for fellows wanting to do IC, are the IC faculty well-known or prolific. As a general fellow, if you are at a program that has IC fellows, you may not get to do many PCI. At least, at some places the general fellow will do the diagnostic cath, but then the IC fellow takes over and does the PCI portion. On the other hand, if you're at a program that doesn't have IC fellows, you may get to do a lot depending on the comfort level of your attendings. So, ymmv. Numbers is probably more important when you're applying for IC fellowship, but as a general fellow, I think it's more important that you have the opportunity to get enough experience to be comfortable doing your own diagnostic caths and to reach COCATS II in the things that you want to. Having a heart failure program can help if that gives you the opportunity to learn to do mechanical circ support like IABP and Impella and learn to manage those. In all, you're likely to get all the procedural experience you would need in IC fellowship, so I would focus more on mentorship and how well you get exposed to the other aspects of cardiology for general fellowship, since you'll likely have to do both cards and IC once you get out and not just IC alone.

 

[timpview]

I wouldn’t touch Michigan with a 20 ft pole if i wasn’t 100% sure I was doing academics.. probably one of the worst places in the country to train if you’re looking for a well-rounded private cardiology practice..

If I’m certain I’m doing academics I would probably lean towards Michigan. It’s still a world of incest in academics and I woukd want the name program

 

[shouldigomd]

I had some of the same concerns as you when I was applying but ended up choosing a high PCI volume / "less academic" spot and am happy with the decision. I knew I wanted IC however.

If general cardiology is still in the running than a more balanced program may be a better option than my approach. As a clinical IC you will not need advanced CHF or imaging. You simply do not have time for that and it is a waste of your skillset. Also there is no such thing as "too many cath's" while training. It takes thousands and thousands and thousands. However ... 100 caths does not always = 100 caths as some programs allow a lot more independence than others.

 

[deleted980918]

Being in a Tx center is very important and often overlooked, pt waiting for transplant/MCS is the sickest of the sickest. Taking care of them really make u a better and well rounded cardiologist, even if u are set on PP, having that kind of skill set is important.

Volume matters but it’s also important to learn to do things correctly when u first start out. Learning the hemodynamics, pt selection, physiologic assessment, imaging assessment are often overlooked at high volume centers because they slow the operators down and emphasizes more at academic centers. You have to be good first before you can be fast.

and lastly, always keep the door open, u may not want to do PP or IC or your life priorities may change during fellowship.

Anything can happen.

 

[cards67]

Numbers aren't everything. Consider how much of that volume you actually get exposed to, the quality of that volume, autonomy you actually get, other skillsets you'll learn, etc. If they have their own IC program and take internal candidates. How sure you want to do IC? What if you want to switch to EP? I'd say maybe half of fellows I know switched subspecialties. Most programs will prepare you fine for gen cards PP career. Tx/lvad for IC probably doesn't matter too much, maybe not ideal but you'll likely manage. It seems many trainees/attendings, IC and general, don't take HF too seriously unfortunately. As to volume vs proficiency, some of that is individual and some of that is the factors above. A high volume of routine caths, or routine anything, isn't the most helpful. Assuming the programs check the boxes for you, I'd go with whichever felt best fit, which is probably hard with zoom. But it's still 3-4yr of your life you'll be spending around the program and it's people, and in the end you career won't likely be all that different.