Getting into cards fellowship

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I'm almost positive I want to do cards and i'm currently an intern. I want to make sure I do all the right things to build my application before I apply. So my question is how much and what type of research do strong applicants for cards have? I know they look at recommendations and evals during residency. How important is step 3? Any guidance on the research front would be appreciated as I'm not sure where I have to go with this Thanks in advance...

anyone?

I'm not talking about what will actually make you a good cardiologist (which I would say is to be a good medicine doc first...), however...
1) suck up to program director
2) suck up to cardiology division director and/or any full professors of cardiology
3) suck up to associate professors of cardiology
4) try to do research with #2. Any research will do, though if it produces a publication that is better.
5) repeat #1-4 PRN
It also matters where you do residency, and to an extent where you went to med school. USMLE scores may or may not have any importance at all, depending on where you apply...many programs don't even ask for them to be sent. I think it was about 50/50 for the places I applied to. Your medicine program director may make reference to your academic performance, including your in service exam scores, but he can't quote your in service exam scores exactly. If a 60th %ile is awesome @your program, for example, he may write that you are a top resident, but if that is just average @your program, he may pan you for the same scores. Therefore, try to at least do OK on your in service exams.

Someone please explain this to me -- I've heard that cardiology is very competitive, but the following data from the AAMC seem to tell a completely different story (I pulled all this data from Careers in Medicine).


Fellowships Participating in the NRMP Match 2008 2009 2010
Number of Active Positions Offered: 712 718 729
Number of U.S. Graduates Applying: 495 542 497
Number of Total Applicants: 1156 1184 1119
Positions Per U.S. Graduate: 1.4 1.3 1.5
Positions Per Total Applicants: 0.6 0.6 0.7
Number of Positions Filled by US Graduates (%): 421 450 425
Number of Positions Filled, Total Applicants (%): 702 713 719
Number of Unfilled Positions: 10 5 10

Based on 2010 numbers, 425/497 US grads got into card programs --- more than 85% of card applicants got into a program. That seems very high for a "competitive" specialty. Moreover, with only 425 slots filled by US grads, that left 300 to be filled by IMGs (and others in addition to IMGs; just not sure who those others are -- the data are for US grads and total applicants, of which I'm guessing a lot are IMGs, but I don't really know). So what the hell is going on here? Do potential applicants only apply if they know they're going to get in, or what's the story? Thanks in advance for shedding some light on this subject.

Originally Posted by treeknowledge

Someone please explain this to me -- I've heard that cardiology is very competitive, but the following data from the AAMC seem to tell a completely different story (I pulled all this data from Careers in Medicine).


Fellowships Participating in the NRMP Match 2008 2009 2010
Number of Active Positions Offered: 712 718 729
Number of U.S. Graduates Applying: 495 542 497
Number of Total Applicants: 1156 1184 1119
Positions Per U.S. Graduate: 1.4 1.3 1.5
Positions Per Total Applicants: 0.6 0.6 0.7
Number of Positions Filled by US Graduates (%): 421 450 425
Number of Positions Filled, Total Applicants (%): 702 713 719
Number of Unfilled Positions: 10 5 10

Based on 2010 numbers, 425/497 US grads got into card programs --- more than 85% of card applicants got into a program. That seems very high for a "competitive" specialty. Moreover, with only 425 slots filled by US grads, that left 300 to be filled by IMGs (and others in addition to IMGs; just not sure who those others are -- the data are for US grads and total applicants, of which I'm guessing a lot are IMGs, but I don't really know). So what the hell is going on here? Do potential applicants only apply if they know they're going to get in, or what's the story? Thanks in advance for shedding some light on this subject.

There is a huge selection bias in cards applications. Just like in med school, people who just aren't going to get into derm don't bother applying, same with IM --> Cards. There are outliers of course but in general this is true.

Originally Posted by gutonc

There is a huge selection bias in cards applications. Just like in med school, people who just aren't going to get into derm don't bother applying, same with IM --> Cards. There are outliers of course but in general this is true.

Thanks for explaining. That makes a lot more sense now. On a related note, the AAMC has data for most IM subspecialties. Of those specialties, Heme/Onc and Nephro seem even easier to get into than cards, e.g. for Heme/Onc, 238/296 US grads matched and there were a total of 458 slots. This means that nearly half of the slots were filled by non-US grads. For Nephro it's even worse -- only 97 US grads applied for 380 slots So, my question is basically the same thing -- do these specialties have a huge selection bias as well?

It's not super hard in general to get a cardiology slot if you are a US grad. However, there is self-selection that goes on. If someone is told they didn't do that well in residency they won't be able to get LOR's and they won't be able to apply. Most US grads will be able to get in somewhere, but not everyone gets to go where they want, or even to one of their top few choices. Usually people who get 6 or 7 interviews will match somewhere (especially if you are a US grad). I'm surprised the match rate was 85%...if that is so, then it is going up.

Nephro is not competitive any more, a fact that I think actually is pretty upsetting to some nephrology faculty. I think they even made a task force to try to figure out why US grads aren't applying for nephrology.

Hem/onc is competitive at certain places, but not so much at others.

As far as who is filling those "other" spots in the cardiology match, I'm assuming that there are some DO's doing the allopathic cardiology match too.

Thanks for the response Dragonfly. Much appreciated.

Originally Posted by dragonfly99

I'm not talking about what will actually make you a good cardiologist (which I would say is to be a good medicine doc first...), however...
1) suck up to program director
2) suck up to cardiology division director and/or any full professors of cardiology
3) suck up to associate professors of cardiology
4) try to do research with #2. Any research will do, though if it produces a publication that is better.
5) repeat #1-4 PRN
It also matters where you do residency, and to an extent where you went to med school. USMLE scores may or may not have any importance at all, depending on where you apply...many programs don't even ask for them to be sent. I think it was about 50/50 for the places I applied to. Your medicine program director may make reference to your academic performance, including your in service exam scores, but he can't quote your in service exam scores exactly. If a 60th %ile is awesome @your program, for example, he may write that you are a top resident, but if that is just average @your program, he may pan you for the same scores. Therefore, try to at least do OK on your in service exams.

Hopefully this is good advice.....

1. Sorta Done
2. Done
3. Done
4. Research with Chief of Cardiology (probably will get published), Chief of EP (NIH study), & faculty member

Going to do another research project with the chief of EP.....really nice guy

Also doing a month with the chief of cardio & EP

get good recs, do enough research to at least have something to talk about at interviews, be yourself. i think fellowship programs look for more of a person that they want to work with than just a smart person.

This is a general fellowship question. Everywhere I interviewed mentioned that they did not want interns to participate in research projects. With the fellowship match being pushed to third year. Do you guys recommend just focusing on being an intern PGY-1 year then really hit our research projects second year?

I feel like if I can get in a ACP abstract during intern year that is productive enough lol.

Originally Posted by dragonfly99

I'm not talking about what will actually make you a good cardiologist (which I would say is to be a good medicine doc first...), however...
1) suck up to program director
2) suck up to cardiology division director and/or any full professors of cardiology
3) suck up to associate professors of cardiology
4) try to do research with #2. Any research will do, though if it produces a publication that is better.
5) repeat #1-4 PRN
It also matters where you do residency, and to an extent where you went to med school. USMLE scores may or may not have any importance at all, depending on where you apply...many programs don't even ask for them to be sent. I think it was about 50/50 for the places I applied to. Your medicine program director may make reference to your academic performance, including your in service exam scores, but he can't quote your in service exam scores exactly. If a 60th %ile is awesome @your program, for example, he may write that you are a top resident, but if that is just average @your program, he may pan you for the same scores. Therefore, try to at least do OK on your in service exams.

Dragonfly, thank you for the information. I was also wondering - is only cardiology research looked at favorably, or does other (past) clinical research help as well?

Also, are there any other determinants for self-selection that take place besides residents being told that they did not perform well (board exam scores, unofficial residency "ranking", etc.). I understand how self-selection bias takes place when applying to residencies (grades, board scores, class rank, etc.), but not quite sure how it applies at the fellowship level, at least to a significant degree (other than being at a university based program vs. a community based program). Thank you.

Bump.

i think the tougher thing about cardiology is that it is more subjective than med school and residency. Objective things i.e. step scores, med school performance play less of a role than how you are perceived. For example, a top applicant from a less known academic program or a community program may actually get less interviews than lets say an average at a huge well known top tier academic program. I think also the regional bias is there for cardiology. I'm from a decent program in the south and most my interviews ended up being in the south, despite my mix of applications being even geographically. I think what medicine16 mentioned is actually very important and not mentioned as often. We all hear be in the good graces of your program director, your cardiology program director, but your ability to work well with others and fit in with the culture of the program seems to be an important factor as I was interviewing.

That is a really interesting point made above. What do you think about doing away rotations to further expand the network and get to know people on a more personal level?

The 2012 match data shows 43 DOs matched cards compared to 300 something carib/FMGs. So in your guys opinion who stands a better chance a DO resident or carib/IMGs when it comes to a cards fellowship?

I only ask as I will be a DO resident starting in a mid tier university program possibly interested in a cardiology fellowship...

Originally Posted by desijigga

The 2012 match data shows 43 DOs matched cards compared to 300 something carib/FMGs. So in your guys opinion who stands a better chance a DO resident or carib/IMGs when it comes to a cards fellowship?

I only ask as I will be a DO resident starting in a mid tier university program possibly interested in a cardiology fellowship...

As with all of these types of questions and statistics, these numbers are more or less useless in answering your question. You only have the numerator, not the denominator, so you have no idea what the number really means. Were there 50 DO applicants? 500? 5000? I think you get the point.

Also, isn't it a bit late to be worrying about this now? You're a DO, you want to do cards. Do it...or not.

there is also a selection bias towards "known candidates". If your home hospital has a cards fellowship, you can increase your odds. I matched at my home hospital.

Originally Posted by taurus70

there is also a selection bias towards "known candidates". If your home hospital has a cards fellowship, you can increase your odds. I matched at my home hospital.

yes, i've heard this to be true at most places. out of 6 positions at my university hospital, the cardiology program director told me himself that they usually pick 3, on average, from the same program.

Originally Posted by dragonfly99

I'm not talking about what will actually make you a good cardiologist (which I would say is to be a good medicine doc first...), however...
1) suck up to program director
2) suck up to cardiology division director and/or any full professors of cardiology
3) suck up to associate professors of cardiology
4) try to do research with #2. Any research will do, though if it produces a publication that is better.
5) repeat #1-4 PRN
It also matters where you do residency, and to an extent where you went to med school. USMLE scores may or may not have any importance at all, depending on where you apply...many programs don't even ask for them to be sent. I think it was about 50/50 for the places I applied to. Your medicine program director may make reference to your academic performance, including your in service exam scores, but he can't quote your in service exam scores exactly. If a 60th %ile is awesome @your program, for example, he may write that you are a top resident, but if that is just average @your program, he may pan you for the same scores. Therefore, try to at least do OK on your in service exams.

wow, this seems intense. luckily, i had the opportunity to work with my program director during my cardiac icu block. i worked with him for a week and he agreed to write a letter. i also have a paper in press. i hope that's enough!

Question...what is the impact of an International Elective(in an underserved part of the world) on the application for a cardiology fellowship? Does it count for something?

It's a talking point on interviews. I had a handful of interviewers ask me about my international elective. Interesting talking points are always a plus; it allows the interviewer to assess our ability to engage in conversation.

On the other hand, while an international elective may draw some attention on a resume/application, I'm doubtful it wins any extra interviews.

Originally Posted by ROBINHO

Question...what is the impact of an International Elective(in an underserved part of the world) on the application for a cardiology fellowship? Does it count for something?

I don't think doing international work will have much effect on the application to most cardiology fellowships. It won't hurt but it probably won't help much.
Letters of recommendation from cardiologists, especially if they have high rank/power, plus having published research would help more.
p.s. I got into cardiology fellowship and I didn't have a ton of research or LOR's from very high-up people, so don't despair if you don't have these things, but I still think my advice is good and I wouldn't change it. I think I would have had an easier time had I been able to do all the things on my list...LOL.

.

Originally Posted by dragonfly99

I don't think doing international work will have much effect on the application to most cardiology fellowships. It won't hurt but it probably won't help much.
Letters of recommendation from cardiologists, especially if they have high rank/power, plus having published research would help more.
p.s. I got into cardiology fellowship and I didn't have a ton of research or LOR's from very high-up people, so don't despair if you don't have these things, but I still think my advice is good and I wouldn't change it. I think I would have had an easier time had I been able to do all the things on my list...LOL.

Maybe if you did what you wrote/advised up there you would have gotten into a better program than the one you are in now ? .. who knows sometimes it is not just about getting into a program or not.

Originally Posted by Crazy Diamond

Maybe if you did what you wrote/advised up there you would have gotten into a better program than the one you are in now ? .. who knows sometimes it is not just about getting into a program or not.

Yikes, you might be a tad harsh on Dragonfly. My experience with the process (I'm a current cards fellow now) is that cardiology faculty are very narrow in their focus. Right or wrong, they care about cardiology experience, cardiology letters, cardiology research, etc. Things like non-cardiology research, community service (both of which I had on my CV), mattered less. I was never asked about these experiences, nor about medical school performance, board scores etc (besides, at this point you can't change those things anyway). At my program, they didn't even care about your overall performance as a resident (I'm serious about this), only your performance on cards rotations. While Dragonfly's comments are a little tongue-in-cheek, it's actually good advice.

Peace.

Crazydiamond,
I don't see the reason for the hate...actually my fellowship program is "good", in terms of clinical training, and so/so for research and "prestige" (if you care a lot about that).
I might have gotten into a more famous/well known fellowship program if I'd done more of things on my list - that's true. I'm not sure I would have necessarily gotten more clinical training...perhaps better in certain areas and worse in others. Some of those "famous" academic places have pretty crappy cath lab training, from what I've heard and observed. Most fellowships, just like most applicants, have weak areas and strong areas. Some places have great imaging but little invasive/cath experience. Some places are too busy clinically with not enough didactics/teaching. Some places don't have a cardiac transplant program, while others do. There are a lot of variables that would go into defining a "good" fellowship (for your needs).

Actually with the way my residency was there wasn't much opportunity to do research, and definitely not during intern year, which was when it would have been necessary (back then @that time when app. process was different) to get it on one's application. I don't know any intern in my class of 30+ people who managed to do research during intern year, except 1 who did a GI poster. We worked >30 hrs and Q3-Q4 11 months of the year with no night float...there was barely time to sleep much less do research.

And I don't really have the personality type that is super gregarious or likes to spend a lot of time sucking up to people, even if they are important. I honestly wasn't too impressed with some other residents who spent a lot of time sucking up to faculty and not enough taking care of patients and their families, but to each his own. You just have to decide what is important to you and then go for it, and be ready to take the consequences of your actions...but people above were asking what is the best thing to do to get a cardiology fellowship, and I told them what I thought.

well said...people on this forum need to relax.