Applying for two fellowship

[malikgh]

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Hey guys

I am a PGY-2 thinking about applying for two fellowship next cycle. I am interested in critical care and cardiology and will pursue both fellowships eventually anyways. What are your thoughts on applying to both at the same time?

Thanks

 

[Redpancreas]

Very overwhelming. My first question would be why apply to both? The main possibilities I can think of are 1.) You are undecided 2.) You want a back up to Cardiology and don't want to waste a year. I personally don't think either is a great reason. While the two have overlaps, they are fundamentally different careers in that one remains a generalist albeit one for critically ill patients while one is a specialist. I would recommend you think more carefully about what it is you truly want as this will be what you're practicing for the next 30 or so years.

 

[blue.jay]

There are very few people who have done both. Especially in bigger centers where they have exclusive interest in working in cardiac ICU managing balloon pump, LVADS and Impella. I know few people who have done cardiology -> crit -> interventional cardiology. These are mostly in academic settings.

Favorable path for you is cardiology followed by 1 yr CCM. Instead of 2 yr CCM followed by 3 yr cardiology.

You should be aware that by doing both fellowships you end up losing upto 1 million of lost income potential. Ideally I recommend that you chose one and stick to the plan.

 

[malikgh]

Very overwhelming. My first question would be why apply to both? The main possibilities I can think of are 1.) You are undecided 2.) You want a back up to Cardiology and don't want to waste a year. I personally don't think either is a great reason. While the two have overlaps, they are fundamentally different careers in that one remains a generalist albeit one for critically ill patients while one is a specialist. I would recommend you think more carefully about what it is you truly want as this will be what you're practicing for the next 30 or so year

Very overwhelming. My first question would be why apply to both? The main possibilities I can think of are 1.) You are undecided 2.) You want a back up to Cardiology and don't want to waste a year. I personally don't think either is a great reason. While the two have overlaps, they are fundamentally different careers in that one remains a generalist albeit one for critically ill patients while one is a specialist. I would recommend you think more carefully about what it is you truly want as this will be what you're practicing for the next 30 or so years.

The reason is I love both, I think I might pursue CIVCU career in the future, it is easier for me to match now in critical care than in cardiology, but I do want to take the chances of applying to both, I will prefer to start with matching in cardiology but the problem is my chances are lower than they're with critical care.

 

[malikgh]

There are very few people who have done both. Especially in bigger centers where they have exclusive interest in working in cardiac ICU managing balloon pump, LVADS and Impella. I know few people who have done cardiology -> crit -> interventional cardiology. These are mostly in academic settings.

Favorable path for you is cardiology followed by 1 yr CCM. Instead of 2 yr CCM followed by 3 yr cardiology.

You should be aware that by doing both fellowships you end up losing upto 1 million of lost income potential. Ideally I recommend that you chose one and stick to the plan.

how would I loose 1 million? by wasting couple of years in training?

 

[Redpancreas]

The reason is I love both, I think I might pursue CIVCU career in the future, it is easier for me to match now in critical care than in cardiology, but I do want to take the chances of applying to both, I will prefer to start with matching in cardiology but the problem is my chances are lower than they're with critical care.

If you match Pulm/Crit would you be happy just doing that (seeing resuscitated MICU patients who're delirious with trachs who needed close monitoring without cardiac issues)? If so, go ahead and dual apply. Keep in mind you may not be able to find the Cards ICU niche or there may be limitations with it if you go the PCCM route. From my limited residency experience with CICU, Cardiology seems to be a much a better vantage point than Pulm/Crit to staff the unit and would think employers would feel the same way. Therefore, I extrapolate that PCCM-staffed CICUs is more of an academic center thing where you find all sorts of people with various training.

So again, while Cards/ICU are similar in that both often deal with shock and critical conditions, they are fundamentally different paths even though PCCM allows a shot at doing Cards-related stuff later. If you're satisfied with either, dual apply but if you see yourself as a specialist I would consider just applying cards next cycle and doing a clinical year. One year is NOT the end of the world if it means doing what you love for the next 30. You can also prolong the decision by dual applying just to see your yield for Cards and then if you get a few interviews, you know you're perhaps competitive and then just rank the Cardiology programs and hope for a match, but if you get 0 Cards interviews, reason that maybe you're not going to be successful with an extra year and just rank the PCCM places and move on.

 

[greatnt249]

how would I loose 1 million? by wasting couple of years in training?

"Up to" 1 million on the idea that if you do critical care then cardiology that you would be potentially missing out on 2 years of cardiology attending salary than if you had just done cardiology alone.

 

[NotAProgDirector]

Plain CCM is not in the match. So your plan would be to apply to cards in the match. If you match in cards, you can add a year of CCM if your institution has both and is willing to support it. If you don't match cards, then you could look for a CCM spot. Some of them fill before the fellowship match, so your options may be limited. In that case, CCM is 2 years and then you still do the full 3 years of cards. If you're not competitive for cards now, a CCM fellowship may not help.

Unless you're considerring P/CCM. Then that's 3 years. And that will definitely not make you more competitive for Cards. But you could apply to the match for both.

I don't recommend this plan to my residents. When it rarely happens, I'll only write one letter -- so I am vague and just say "malikgh is applying for a fellowship in your program". It greatly limits what I can say -- if I'm supporting you for a single field, I can talk about why you would be good in that field.

 

[aafisahar]

you get enough critical care exposure in cardiology. If you want that ICU itch, do advanced heart failure. Cards/CCM is an academic niche and pays accordingly.

There's so much freedom in being a specialist that it's difficult to appreciate from the other side.

 

[CCM-MD]

Agree with above. CCM followed by cardiology is a bad plan. That’s 5 years and you will probably end up practicing one or the other. If you’re interested in having that niche in academia, then do cardiology first followed by CCM so you’re done in 4 years. You will be managing hemodynamics, shock, drips, doing point of care echo on a daily basis as an intensivist. ECMO depending on where you work. You could work full time in a community CVICU, I have a few friends that do this.

Bottom line: pick one.

 

[Redpancreas]

And to drive it home @malikgh I don't think anyone is telling you NOT to dual apply but merely pointing out the lack of viability of the cards/crit niche in your position. Like I said earlier, you could prolong the decision by dual applying cards and pccm and see how competitive of a cards candidate you are now, roll the dice if you get cards interviews and only rank cards, and do a research year if you strike out (vs. settling for PCCM if you strike out with cards completely because if you don't get even a single interview in cards now, what will change in a year to get you more)? Keep in mind @NotAProgDirector's point about how your IM PD will not be able to as fully support you for a specific fellowship as well.

Also do not underestimate case reports/small observational studies you can get done from now to fellowship application time. Talk to your fellowship program director (not IM PD) and see if there is something he/she can get you on STAT in cardiology.

 

[mszzeta]

Very overwhelming. My first question would be why apply to both? The main possibilities I can think of are 1.) You are undecided 2.) You want a back up to Cardiology and don't want to waste a year. I personally don't think either is a great reason. While the two have overlaps, they are fundamentally different careers in that one remains a generalist albeit one for critically ill patients while one is a specialist. I would recommend you think more carefully about what it is you truly want as this will be what you're practicing for the next 30 or so years.

The "sub-specialization" of cardiology, namely interventional, advanced heart failure, EP, takes extra years in addition to a 3-year cardiology fellowship. Most CCM program would take one more year in addition to another fellowship. So this may not be as overwhelming as you may think.

I do know a faculty in my residency who did cardiology + interventional + CCM and now works in CCU while also do PCIs.

 

[Redpancreas]

The "sub-specialization" of cardiology, namely interventional, advanced heart failure, EP, takes extra years in addition to a 3-year cardiology fellowship. Most CCM program would take one more year in addition to another fellowship. So this may not be as overwhelming as you may think.

I do know a faculty in my residency who did cardiology + interventional + CCM and now works in CCU while also do PCIs.

My point was re: overwhelming was PCCM/Cardiology dual applying, not anything about paths after Cardiology which are extremely versatile. Entering cardiology itself is like entering medicine again. For non-proceduralists who want to develop relationships in a specific area, there's a HF niche. For those interested in primarily clinic, there's a preventative option and sports cardiology. There's obviously interventional and EP as well. There's also imaging specializations for those who prefer that.

Also as residents, we need to be wary that what we see our attendings do isn't representative of what's out there unless we stay in the world of academia.

 

[mszzeta]

Also, my point re: overwhelming was PCCM/Cardiology dual applying, not anything about paths after Cardiology which are extremely versatile. Cardiology itself is like entering medicine. For non-proceduralists who want to develop relationships, there's a HF niche. For those interested in primarily clinic, there's a preventative option and sports cardiology. There's obviously interventional and EP as well.

Also as residents, we need to be wary that what we see our attendings do isn't representative of what's out there and available outside academia.

I agree. It can be totally a different story to apply for two fellowship in the same year, instead of one by one sequentially after done another. Applying two fellowship, in my opinion, may "dilute" the efforts and otherwise decrease the chances of matching. Though I have seen a few people doing so for back up, not for real interest

 

[Redpancreas]

I agree. It can be totally a different story to apply for two fellowship in the same year, instead of one by one sequentially after done another. Applying two fellowship, in my opinion, may "dilute" the efforts and otherwise decrease the chances of matching. Though I have seen a few people doing so for back up, not for real interest

Exactly, I suspect that's where OP's heart is at but they may be trying to rationalize it with this CICU niche when in reality, it's not as expansive as OP probably thinks.