Academic Cardiology Fellowship Match Competitiveness

[Anonymous Lurker]

Hello all,

I am a fourth year medical student (USMD) who is interested in pursuing a cardiology fellowship. I fell down my rank list and will be attending a mid tier (~T50) academic internal medicine residency program with a reasonably strong in-house fellowship program. My goal for my career is to remain in academics and conduct research while practicing (or at the very least I want to keep that option open). As such I am interested in completing a cardiology fellowship at an academic institution with a lot of research opportunities preferably, at a larger city in the south (ie Emory, UAB, UTSW, Vanderbilt, etc). My step 2 score was ~255 and I will have 1 ACC abstract and 1 cardiology manuscript prior to starting residency.

Given what I've shared, do you think that this a realistic goal, and if so, what can I do to hit the ground running? I have heard that the reputation of your residency program is the most important factor that determines where you end up doing fellowship and I'm wondering if I should be tempering my expectations in light of my match results. Thanks in advance!

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[1713938018]

It really depends on the program you're at. You should have a match list of where people matched from your program. Pay attention to where your upper level residents interview-this should help get an idea of what might be realistic. Fellowship programs do already have a bias on im programs- and that's unfortunately unlikely to change very much even if you have a competitive application coming from a smaller place.

The programs you listed may be hard to get to. They are selective. The cardiology match is very competitive.

To best position yourself, you'll need to crush it as a im resident and intern with no red flags. It's quite important to get glowing reviews thru residency. If you dropped down your rank list, you need to evaluate why that might be (ie application, scores, personality, extracurriculars, red flags?).

Research during residency will be necessary as is making contacts in your own department that might be able to reach out to larger programs if you ultimately want to leave.

Position yourself perfectly and the rest falls into place. You can only control so many things. Might as well aim as high as possible and see. There are a lot of good cards programs out in the south besides the ones you named.

 

[Anonymous Lurker]

It really depends on the program you're at. You should have a match list of where people matched from your program. Pay attention to where your upper level residents interview-this should help get an idea of what might be realistic. Fellowship programs do already have a bias on im programs- and that's unfortunately unlikely to change very much even if you have a competitive application coming from a smaller place.

The programs you listed may be hard to get to. They are selective. The cardiology match is very competitive.

To best position yourself, you'll need to crush it as a im resident and intern with no red flags. It's quite important to get glowing reviews thru residency. If you dropped down your rank list, you need to evaluate why that might be (ie application, scores, personality, extracurriculars, red flags?).

Research during residency will be necessary as is making contacts in your own department that might be able to reach out to larger programs if you ultimately want to leave.

Position yourself perfectly and the rest falls into place. You can only control so many things. Might as well aim as high as possible and see. There are a lot of good cards programs out in the south besides the ones you named.

Thank you so much for taking the time to answer!

 

[cards67]

Your career goals are doable coming from pretty much any fellowship program and there are great programs all over the country. For now, keep building that resume and be an excellent resident. When the time comes, apply broadly and see what happens. You should have no problem matching somewhere based on your current stats.

 

[NewYorkDoctors]

not a cardiologist but have seen plenty of residents AMG and IMG match and fail to match

your baseline stats are very solid and as an AMG you have a very good chance
but it's not automatic
also "connections with cardiology faculty are not automatic"

be active. be proactive. be a good IM resident but don't go out of your way to be a "superb internist." Dont waste your time and effort trying to "master MKSAP or the opthalmologic exam because some old internist said it's a dying art," doing IM stuff like quality improvements, schmoozing the nurse managers, or those IM things.
Just do a good job for the hospitalists and on CCU and get the impression of a good team member who gets the job done for the attendings.
You need to dedicate your time and energy to the cards faculty.

Don't "go home early." "stay late after school" and meet the cardiology faculty.
if no early CCU or cards rotations ask your IM PD or other IM staff to get you a meeting with whichever cards faculty has research. they always have things going on with fellows and attendings. offer to do any and all scholarly activity
get the cards faculty PubMed citations (even if a lowly case manuscript to start). that is the academic currency you want to get for them
be proactive and get after it
A competitive cards fellowship will not make its way to you (short of nepotism and connections)

 

[fightthatebola]

If you are able to do a chief year at that academic program, that is looked upon quite favorably in the fellowship match process. In order to be selected as a chief, you need to demonstrate you are a great intern and the first 6 months of PGY2 are critical in how you lead the teams in the MICU and on the wards. In the meantime, you should try to crush the research as well and go to a national cards conference or two esp during PGY2 year.

 

[shouldigomd]

not a cardiologist but have seen plenty of residents AMG and IMG match and fail to match

your baseline stats are very solid and as an AMG you have a very good chance
but it's not automatic
also "connections with cardiology faculty are not automatic"

be active. be proactive. be a good IM resident but don't go out of your way to be a "superb internist." Dont waste your time and effort trying to "master MKSAP or the opthalmologic exam because some old internist said it's a dying art," doing IM stuff like quality improvements, schmoozing the nurse managers, or those IM things.
Just do a good job for the hospitalists and on CCU and get the impression of a good team member who gets the job done for the attendings.
You need to dedicate your time and energy to the cards faculty.

Don't "go home early." "stay late after school" and meet the cardiology faculty.
if no early CCU or cards rotations ask your IM PD or other IM staff to get you a meeting with whichever cards faculty has research. they always have things going on with fellows and attendings. offer to do any and all scholarly activity
get the cards faculty PubMed citations (even if a lowly case manuscript to start). that is the academic currency you want to get for them
be proactive and get after it
A competitive cards fellowship will not make its way to you (short of nepotism and connections)

You are going to scare the OP haha. The American medical system is terrible without any way to truly gauge the quality of trainee you are. You are painting the picture of what I had to do a a carib IMG. As an AMG MD with those scores and absence of red flags it would be very unusual to not land a mid tier academic fellowship with minimal research / effort. With modest effort you have a good chance at a solid mid to high tier program. If you want to ensure that top tier spot you obviously you need to do everything you can. There is no magic Goldie Locks amount.

Shining as a IM resident means little unless you get an award or someone makes a call for you. There is no gauge to the actual quality of resident you are when it comes to fellowship app's as long as you aren't messing up. The only exception to this is if you are a star it will usually help a lot at staying at your home institution as this will be seen by the cards program.

My opinion regarding pubs is nothing matters as much as the amount of pubs you can generate. Quantity > quality. 99% of medical research done is BS.

Letters mean little as long as nothing negative is said. The most important parts of the letter are giving a subject to talk about during interview day and the person who wrote it. It is a small world, especially in cardiology.

 

[Doctor_Strange]

You are going to scare the OP haha. The American medical system is terrible without any way to truly gauge the quality of trainee you are. You are painting the picture of what I had to do a a carib IMG. As an AMG MD with those scores and absence of red flags it would be very unusual to not land a mid tier academic fellowship with minimal research / effort. With modest effort you have a good chance at a solid mid to high tier program. If you want to ensure that top tier spot you obviously you need to do everything you can. There is no magic Goldie Locks amount.

Shining as a IM resident means little unless you get an award or someone makes a call for you. There is no gauge to the actual quality of resident you are when it comes to fellowship app's as long as you aren't messing up. The only exception to this is if you are a star it will usually help a lot at staying at your home institution as this will be seen by the cards program.

My opinion regarding pubs is nothing matters as much as the amount of pubs you can generate. Quantity > quality. 99% of medical research done is BS.

Letters mean little as long as nothing negative is said. The most important parts of the letter are giving a subject to talk about during interview day and the person who wrote it. It is a small world, especially in cardiology.

Yeah, sadly, I think this is the case. I have about >30 abstracts and a few manuscripts like 2 or so. There are folks with literally >90 abstracts, manuscripts, and other publications. It feels impossible to ever catch up with that rate.

I wish I had known how difficult it was to match and how much research #s matters. I may not have gone into IM and pursued anesthesiology instead. Regarding research, it seems it's just how you know that can put your name on their pub and you return the favor. The saying PDs don't know how to read, but they know how to count rings true.

I have a life outside of medicine, but to match into the fellowship it seems one has to literally leave the hospital, go home, shower, and then do research every second of my free time. My wife would have divorced me yesterday if I approached my life that way.

Anyways, end of my rant.

 

[shouldigomd]

Something is clearly not right here, the bigger thing for cards fellowship is your letters and reputation of program, being at an academic program(especially mid tier and higher) gives you a huge boost, I know people with FAR fewer research projects than that who have had no issues matching. Also how you interview matters a lot. 30 abstracts just seems ridiculous to me, especially if they are all from residency, it might make a Cardiology PD do a double take, HOW did this resident get that much time? (that is word for word what my home Cards PD told me), like was the program too lax clinically that a resident had the time to do that much research? Keep in mind a lot of IMG's who have crazy research numbers have a lot of that from before residency as well. You definitely need research, need to be involved in a few projects and have a few abstracts/cases presented to a few conferences but no on expects a resident to have 30 abstracts or pubs in less than 3 years(more like 2 years) to match Cards. Being at a community program does make it more of an uphill battle but after a certain amount there is a diminishing returns on research, like 30 vs 15 vs 10 abstracts isn't going to make a massive impact on your app, other things such as the strength of your letters, your residency reputation, extra-cirricullars and your board scores(Step scores are still used for screening) matter as well, cumulatively just as much as your research output.

I disagree. Perhaps the "huge boost" applies to the top 10% elite programs but Academic vs Community isn't black and white.... especially when it comes to the middle 70% of programs. The majority of programs are ... mid tier... I wish I had known this when I was applying to IM programs as I valued academic university programs way too much. Many "academic" programs have inferior education and research while many community programs churn out more research, offer superior education and have better fellowship match placements.

 

[Doctor_Strange]

know people with FAR fewer research projects than that who have had no issues matching.

Were they AMGs? Because, nowadays it seems you need a s**t-ton of research even to be considered for an interview.

HOW did this resident get that much time? (that is word for word what my home Cards PD told me), like was the program too lax clinically that a resident had the time to do that much research?

Some residents remotely collaborate on research with friends/colleagues at other institutions, and they swap authorships to increase their overall #s. As the saying goes, PDs cannot read but can count. I figure there is some truth in that.

Being at a community program does make it more of an uphill battle but after a certain amount there is a diminishing returns on research, like 30 vs 15 vs 10 abstracts isn't going to make a massive impact on your app, other things such as the strength of your letters, your residency reputation, extra-cirricullars and your board scores(Step scores are still used for screening) matter as well, cumulatively just as much as your research output.

I generally agree. I think community IM programs are, overall, weaker regarding didactics and autonomy to residents. I come from a university-affiliated county program and would stack up my experience with anyone else's (not that I am biased). I think IMGs from community programs have no other option but to publish like crazy to maybe get consideration. It is kind of crazy to consider that some of these folks have 50-90 abstracts and a dozen or so manuscripts, and despite hundreds of hours of work, accumulate about 5 interviews or so.

This is my second time applying, now as a Chief. If I do not match, I may go be an academic hospitalist and thus I can parlay any ongoing research into my job duties. However, as I get further away from training, time is money and I am not getting any younger. I need to save for a family. A decently nice house. Retirement. Getting paid s**t is simply not sustainable.

 

[Doctor_Strange]

I disagree. Perhaps the "huge boost" applies to the top 10% elite programs but Academic vs Community isn't black and white.... especially when it comes to the middle 70% of programs. The majority of programs are ... mid tier... I wish I had known this when I was applying to IM programs as I valued academic university programs way too much. Many "academic" programs have inferior education and research while many community programs churn out more research, offer superior education and have better fellowship match placements.

Yes. I went to an "academic" program (let's call it mid-tier) with little to no support for research. Massive regret. I hope residency reputation matters for something, but I fear that is not the case.

 

[Doctor_Strange]

Did you go to a university program or a university affiliated one? There’s a huge difference. The people at my program who matched cards the last few years all had some research but no where near what you have and had no issues matching. They were USMD and DO’s and one IMG.

I think on FREIDA it is listed as a university-affiliated but we are de facto a university program with multiple fellowships, "university" in the program name, a county hospital, and a college of medicine affiliation as a core site. To my surprise, the only reason we are not a "university program" is because the 3rd-year med students rotate half the year at our site and not the whole year, but that is changing in the next year or so.

At least last year, on the few interviews I had, PDs grouped us with the "main campus". But to your point, it's no Yale or Emory where I trained.

 

[MaxPlancker]

Unfortunately, playing the numbers game is the wrong move that resulted from the wrong takeaway. A high ratio of abstracts to publications signals a poor rate of taking projects to completion. Programs don't want fellows starting things and not finishing things (e.g. leaving it at the abstract stage). I really do think the obsession with numbers is unhealthy and actually part of what is hurting your app. My 2 cents.

 

[Doctor_Strange]

Unfortunately, playing the numbers game is the wrong move that resulted from the wrong takeaway. A high ratio of abstracts to publications signals a poor rate of taking projects to completion. Programs don't want fellows starting things and not finishing things (e.g. leaving it at the abstract stage). I really do think the obsession with numbers is unhealthy and actually part of what is hurting your app. My 2 cents.

What if the abstract is a case report?

 

[MaxPlancker]

What if the abstract is a case report?

It really depends on your story. If you're trying to sell yourself as the researcher, then case reports aren't actually research and institutions aren't going to want fellows who are professional case report writers. They want fellows who have skills in study design, data mining, statistics, and so forth. Think about it from the faculty standpoint.

On the other hand, if you're selling yourself as an educator, then perhaps the case reports fit better.

And yes, it is always better to be honest and sell yourself as who you really are. It is glaringly obvious if someone says they want to do research but the rest of the app doesn't show it. Numbers do not mean as much as people think, it is actually the LOR followed by quality of work that matters. Everyone knows right place right time is huge for publications as trainees.

 

[shouldigomd]

I disagree the majority of programs aren’t mid tier.. a community affiliated university program isn’t mid tier, there’s def also low tier university programs but they are usually still better regarded than a community program. The pd survey from 2016 is pretty clear, residency reputation is rated higher than research.

The majority of programs are mid tier because thats what mid tier means. PD surveys would be something I would place little value in. Like a halftime interview of a sports coach..... They aren't going to discuss the ugly truths, politics and bias' that goes on. Every program is different and the values that each program places on its fellowship positions are unique and complex/manipulated. I couldn't disagree more on the university vs community opinion you have. I don't want to label programs but there are many great community programs and so many sub par university programs. After voting for cards candidates, watching my colleagues match and talking to my own PD over the past 4 years of my cards training maybe I am just a little jaded.

 

[shouldigomd]

Unfortunately, playing the numbers game is the wrong move that resulted from the wrong takeaway. A high ratio of abstracts to publications signals a poor rate of taking projects to completion. Programs don't want fellows starting things and not finishing things (e.g. leaving it at the abstract stage). I really do think the obsession with numbers is unhealthy and actually part of what is hurting your app. My 2 cents.

Abstracts can be published or unpublished just like case reports. Doing a research project and not writing it into a manuscript is not "leaving something unfinished."

 

[MaxPlancker]

Abstracts can be published or unpublished just like case reports. Doing a research project and not writing it into a manuscript is not "leaving something unfinished."

Unfortunately this is just plain incorrect. Who starts a research project with the goal of not taking it to completion? In what cases do you start research with the intent not to publish?

 

[Doctor_Strange]

Are they abstracts that were published or presented at a conference?

Yeah. I was told by one cardiologist not to try and submit those as case reports, "not worth it". I still did for a few of them, but not all.

 

[Doctor_Strange]

It really depends on your story. If you're trying to sell yourself as the researcher, then case reports aren't actually research and institutions aren't going to want fellows who are professional case report writers. They want fellows who have skills in study design, data mining, statistics, and so forth. Think about it from the faculty standpoint.

On the other hand, if you're selling yourself as an educator, then perhaps the case reports fit better.

And yes, it is always better to be honest and sell yourself as who you really are. It is glaringly obvious if someone says they want to do research but the rest of the app doesn't show it. Numbers do not mean as much as people think, it is actually the LOR followed by quality of work that matters. Everyone knows right place right time is huge for publications as trainees.

For me, I want to be an educator. Research is fine, but I do not want a career in academics like that. I was motivated to pursue cardiology not due to research but bedside teaching and empathetic care by my mentors.

Outside of publishing in JGME, I feel like that is hard to convey via research alone :/

 

[Doctor_Strange]

Unfortunately this is just plain incorrect. Who starts a research project with the goal of not taking it to completion? In what cases do you start research with the intent not to publish?

I suppose my counter is that the time it takes to see a project to completion can be pretty long. The basis of my personal statement, for example, is the creation of an IRB-approved project during the fall of my PGY-2 year. Nearly 2 years later, I am only now complete and only now presenting at a national conference (have not even started the manuscript writing yet). Part of that is because my residency had virtually no support for research. But that's only one project. In that time, one could argue, I could have submitted another 6 abstracts of "meh" quality.

 

[shouldigomd]

There is no evidence to the fact that majority of programs are mid tier??, the match list of a place like UT Houston/VCU/ USF-Tampa etc (solidly mid tier places) is no where in the same realm as say LSU-Lafayette or NCH healthcare or a Wellstar hospital in suburban Atlanta. No PD would consider these programs similar in terms of name recognition, training or match outcomes. The argument your trying to make is a place like Houston Methodist or Oschner Clinic which are community programs are great and give good training, yes these programs are pretty much on par with academic programs and have that reputation and would be considered similarly to other academic programs, and yes they might have superior training to a low tier academic program say a University of Nebraska or South Alabama etc. There absolutely are tiers to IM residency training and it 100% plays a role in fellowship matching. Generally speaking there are High/Mid/Low tier among academic programs and most truly flagship programs find themselves somewhere in this spectrum, some true community are considered mid tier, like the ones i mentioned, but the vary vast majority of community programs are low tier, hence if you look at their match lists you will see far fewer Card/GI/Heme onc/pulm crit matches, and those who match from those programs are superstars and usually have a stupendous amount of research.

https://www.doximity.com/residency/...rainingEnvironmentKey=&intendedFellowshipKey=

The doximity rankings based on reputation give you an idea of how the residencies are ranked. Generally speaking an academic program puts you at an advantage for matching fellowships. I will agree that within the tiers, the rankings and reputations don't matter much and is like splitting hairs, for example:
Top tier- MGH vs Hopkins vs USCF- you would be spitting hairs between these
Upper Mid- CCF, Emory, U Chicago, UAB, UPMC
Solid Mid-UNC, BCM, Rush, UT Houston, USF-Tampa, U Miami, UT San Antonio Georgetown, Tulane, U Rochester, Wake Forest,IU, can also put community programs such as Methodist Houston, Oschner Clinic, Scripps etc here- would be splitting hairs between these for example
Lower tier- UMMC, Nebraska, UT Memphis, MCG, LSU-NO etc
After lower tier academic programs would be the vast majority of community programs/community University affiliated programs - these are all lumped in together. My general point is that you cannot argue that the vast majority of community programs are similar to upper mid/solid mid tier or even lower tier academic programs. There's like 600? IM programs in the country. The match outcomes aren't at all similar.

If you generalize, yes I agree with your point that most academic > community. My point is that there are good community programs out there with good track records outside of the obvious ones you listed. I once shared your stance on programs and was obsessed with ranking and tiers (which I am not saying is unimportant) but having gone through the system my opinions changed.

 

[shouldigomd]

Unfortunately this is just plain incorrect. Who starts a research project with the goal of not taking it to completion? In what cases do you start research with the intent not to publish?

What part of my statement is incorrect?

 

[Doctor_Strange]

The majority of programs are mid tier because thats what mid tier means. PD surveys would be something I would place little value in. Like a halftime interview of a sports coach..... They aren't going to discuss the ugly truths, politics and bias' that goes on. Every program is different and the values that each program places on its fellowship positions are unique and complex/manipulated. I couldn't disagree more on the university vs community opinion you have. I don't want to label programs but there are many great community programs and so many sub par university programs. After voting for cards candidates, watching my colleagues match and talking to my own PD over the past 4 years of my cards training maybe I am just a little jaded.

Looking at match lists, I think this confirms a lot of what I have been seeing and hearing.

 

[Doctor_Strange]

Ok I am bit confused but what’s the difference between presenting an abstract and a case poster at a conference? Poster presentation according to ERAS counts as a “publication” but I believe an abstract does not? Does the abstract even need to be presented? Or can someone just put abstracts regarding cases or a research project that they have been working on eventhough it’s not presented at a local or regional conference? Like hey I saw a bunch of cool cases during residency and have like 10 abstracts from them, eventhough they haven’t been presented?

I think part of this confusion lies within how ERAS is structured. One category is “Peer Review Journal Articles / Abstracts”, which many will say you can list an abstract presented to ACC no matter if the abstract is a meta-analysis or a simple case report. Others will say that’s not right and will simply list the ACC abstract under “Poster Presentations”.

For my money, an abstract accepted to a state chapter of ACC that is not published in a supplemental of journal should be a poster whereas something accepted to the national ACC or any national conference could reasonably be listed under “Peer Review Journal Articles / Abstracts”. To that end, not all abstracts have a DOI which I think also can be used to judge the appropriateness. Ultimately, one thing it comes down to is folks will “double-dip” and list in multiple categories. I did that last year and I think it hurt me. This year, unless I turned an abstract into a publication in a journal, I list it only once.

 

[MaxPlancker]

As someone who has trained at the "top" institutions for all my medical training, I don't think there's any significant difference in quality of training until you get to fellowship. There are significant differences, of course, but not in training. On the other hand, training in fellowship can be vastly different and change the course of your career trajectory. For fellowship, the names can be very misleading. For example, Hopkins/UCSF have great layperson name recognition but from a clinical cardiology perspective, are markedly weaker, with nuanced exceptions, than many other programs with less lay person brand. Their reputation within the world of cardiology is also not as glamorous as you may imagine. You can see some trends - Hopkins (one of the "best" IM residencies) has some degree in difficulty retaining Hopkins residents for cards fellowship. A huge slew of them head off to places like CCF. The reason one would go to a place like Hopkins is to do serious research work. If that isn't your goal, beyond family and other personal obligations, you're just shooting yourself in the foot.

tldr; For fellowship, tiers are a useless term and organization. Truly explore what an institution offers, don't go by the name; fit is queen/king at this stage. For training before fellowship, it's all more or less the same, you can blindly pick a place with branding if that's what you want, and you'll come out fine.

 

[shouldigomd]

Ok I am bit confused but what’s the difference between presenting an abstract and a case poster at a conference? Poster presentation according to ERAS counts as a “publication” but I believe an abstract does not? Does the abstract even need to be presented? Or can someone just put abstracts regarding cases or a research project that they have been working on eventhough it’s not presented at a local or regional conference? Like hey I saw a bunch of cool cases during residency and have like 10 abstracts from them, eventhough they haven’t been presented?

I don't think that is correct but ERAS is definitely confusing in how they organize / word things. Only something that gets published counts as a "publication." A case report, abstract or manuscript can be presented and/or published.

 

[shouldigomd]

As someone who has trained at the "top" institutions for all my medical training, I don't think there's any significant difference in quality of training until you get to fellowship. There are significant differences, of course, but not in training. On the other hand, training in fellowship can be vastly different and change the course of your career trajectory. For fellowship, the names can be very misleading. For example, Hopkins/UCSF have great layperson name recognition but from a clinical cardiology perspective, are markedly weaker, with nuanced exceptions, than many other programs with less lay person brand. Their reputation within the world of cardiology is also not as glamorous as you may imagine. You can see some trends - Hopkins (one of the "best" IM residencies) has some degree in difficulty retaining Hopkins residents for cards fellowship. A huge slew of them head off to places like CCF. The reason one would go to a place like Hopkins is to do serious research work. If that isn't your goal, beyond family and other personal obligations, you're just shooting yourself in the foot.

tldr; For fellowship, tiers are a useless term and organization. Truly explore what an institution offers, don't go by the name; fit is queen/king at this stage. For training before fellowship, it's all more or less the same, you can blindly pick a place with branding if that's what you want, and you'll come out fine.

Agree. I went to a solid IM program and had a hard time accepting the fact that the fellowship program calling to me was not on the same "prestige level." Turned out to be the best decision I made and gave me exactly what I wanted.