Picking a Cardiology fellowship: clinical numbers / experience vs traditional academic programs

[shouldigomd]

I am looking for some advice after this interview season thoroughly confused me. I interviewed mainly at mid tier programs. My goal is non academic interventional cardiology. I have realized that the differences in most of the programs are relatively minute and most would leave you a solid general cardiologist.

How do you compare your more traditional "larger" cardiology programs with 4+ fellows per year, subspecialty fellows, crystalized didactics and structure with the smaller programs (2 fellows). These smaller programs often lack the very robust / structured didactics and push for research but have much more autonomy in the cath lab and potential to get ahead in terms of procedural skill. Many fellows at these programs are doing a fair number of stents during 3rd year and overall have significantly higher procedural numbers. One argument is that having an in house interventional fellowship is a plus but honestly after asking many people landing interventional fellowship isn't that hard. At the end of the day getting an interventional fellowship depends on procedural numbers and program rep / vouch it seems.

Pros vs Cons?

Opinions appreciated...

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[NYknicks44]

I would recommend going to more traditional programs. They are better in terms of didactics and teaching. Smaller programs often don’t have faculty, and often operate like private practice where fellows do a lot of scut work.

Regarding your point about getting autonomy and procedural skills without interventional fellowship. Don’t worry about falling behind in skills, everyone catches up during their interventional year.

I would very strongly recommend that you go to a program with in house fellowship as they take internal candidates. You are only competing against your co-fellows that want to do interventional for the in house spots while for outside spots, you are competing against the entire applicant pool.

 

[cardsguy2017]

Being able to stent as a 3rd year doesn't really matter, that's what your interventional year is for. You have to ask what kind of experience these small programs give their fellows, even if they have autonomy. Are they being taught properly? Potentially they're seeing less complex patients/cases. A bigger hospital may see more complex cases. One could argue being second operator on complex cases is more beneficial than primary on straightforward cases. Same thing for consults, echo, etc., more complexity, more volume, variety, etc. Volume gets people excited, but I want to know the quality of that volume. Moreover, it's general cardiology fellowship not interventional, and you may even change your mind about doing interventional, many do.

Also, if a program basically guarantees their own fellows a spot as a 4th yr, that's a big perk as it can suck going through the application process.

 

[IMreshopeful]

I am looking for some advice after this interview season thoroughly confused me. I interviewed mainly at mid tier programs. My goal is non academic interventional cardiology. I have realized that the differences in most of the programs are relatively minute and most would leave you a solid general cardiologist.

How do you compare your more traditional "larger" cardiology programs with 4+ fellows per year, subspecialty fellows, crystalized didactics and structure with the smaller programs (2 fellows). These smaller programs often lack the very robust / structured didactics and push for research but have much more autonomy in the cath lab and potential to get ahead in terms of procedural skill. Many fellows at these programs are doing a fair number of stents during 3rd year and overall have significantly higher procedural numbers. One argument is that having an in house interventional fellowship is a plus but honestly after asking many people landing interventional fellowship isn't that hard. At the end of the day getting an interventional fellowship depends on procedural numbers and program rep / vouch it seems.

Pros vs Cons?

Opinions appreciated...

I’m not sure who you talked to but IC fellowship is extremely competitive. It is not easy to land after applying out because it isn’t a match, for one thing.

Secondly it doesn’t really matter how many stents you do as a third year. They don’t count towards your PCI numbers and it has zero bearing on matching IC fellowship. I’m not sure where you’re getting your information but it’s pretty misguided. Doing a few PCIs or being the second operator as a third year may be helpful in just knowing the basics of what stents, balloons, and wires feel like but that’s about it.

In general if you want to do IC, you should go to a program that has an in house fellowship. These are much easier to get spots in - when meeting fellows around the country, majority just stayed with their own program. This isn’t always possible- for example in my class we had three folks doing IC and one internal spot. Also, program reputation matters - some programs will basically look at where you’re doing fellowship to choose interview candidates first and foremost. Research also is probably pretty helpful. And remember that as an IC doc you have to know good general cardiology or else you’re doing your patients a disservice.

You will do fine in terms of your PCI skills at many of these programs. Focus on getting into a good cardiology program first.

 

[shouldigomd]

I’m not sure who you talked to but IC fellowship is extremely competitive. It is not easy to land after applying out because it isn’t a match, for one thing.

Secondly it doesn’t really matter how many stents you do as a third year. They don’t count towards your PCI numbers and it has zero bearing on matching IC fellowship. I’m not sure where you’re getting your information but it’s pretty misguided. Doing a few PCIs or being the second operator as a third year may be helpful in just knowing the basics of what stents, balloons, and wires feel like but that’s about it.

In general if you want to do IC, you should go to a program that has an in house fellowship. These are much easier to get spots in - when meeting fellows around the country, majority just stayed with their own program. This isn’t always possible- for example in my class we had three folks doing IC and one internal spot. Also, program reputation matters - some programs will basically look at where you’re doing fellowship to choose interview candidates first and foremost. Research also is probably pretty helpful. And remember that as an IC doc you have to know good general cardiology or else you’re doing your patients a disservice.

You will do fine in terms of your PCI skills at many of these programs. Focus on getting into a good cardiology program first.

Thank you for the responses.

So I made the comment of IC competitiveness based on my experience on the interview trail which obviously is very limited. It may be hard to access competitiveness when you match ... but out of all the programs I interviewed at I did not see anyone who wanted IC fail to match or express difficulty in the process. Then going back and looking at prior alumni the same holds true...

I think I was not clear in my initial post. I am not talking about obviously dumpy programs vs high quality academic programs but rather private practice driven programs (like many off campus university programs) with quality interventionalists (many of whom trained at your cleveland clinic's / etc). I am sure they transfer some patients but there are plenty non "major academic university" interventional attendings performing abundant complex PCIs...

A lot of these private practice programs are smaller with 2 fellows per year. If you compare it to your larger traditional academic programs with 4-6 fellows and maybe 1-2 interventional spots. In the end there are probably just as many graduates applying to IC outside their own programs...

I interviewed at several lower quality university programs that have in house fellowships so would that be worth ranking over a better program without that?

I think the convention is to idealize these "big name programs" but I know that (at least for medicine) that doesn't equate to a better doctor and in fact is the opposite. I could be wrong which is why I am asking but common sense would tell you that the best program should be the one that gives you access to the most experience from quality teachers.