Cardiac Anesthesia Fellowship 2020

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I would say unless you have an excess of free time and a love of analytics, there is not much to gain from this.
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Ketafol1:5 said:
Average number of ranked programs for matched vs unmatched applicants. Basically as a guide for the number of interviews I would go on.
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Apply to them all. I know some very strong applicants who didn’t....and didn’t match. Now kicking themselves. They were overconfident despite a really good application.
Seems like there’s a lot of connection based matching happening in cardiac, so stats and a great interview may not be enough at some programs that you’d think you would be a shoe in for.
 
Man o War said:
Apply to them all. I know some very strong applicants who didn’t....and didn’t match. Now kicking themselves. They were overconfident despite a really good application.
Seems like there’s a lot of connection based matching happening in cardiac, so stats and a great interview may not be enough at some programs that you’d think you would be a shoe in for.
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This is highly understated. Cardiac program directors talk to each other a lot. Also, academic Cardiac Anesthesia is a small world. I have seen mediocre applicants match to great programs because of the LOR from their Cardiac chair and a well place phone call by that person
 
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sethco said:
This is highly understated. Cardiac program directors talk to each other a lot. Also, academic Cardiac Anesthesia is a small world. I have seen mediocre applicants match to great programs because of the LOR from their Cardiac chair and a well place phone call by that person
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VERY true, for good or bad. Go to the SCA meeting and you’ll see all the “clicks” that happen. Who you know matters, especially for high level programs if you’re a typical applicant.

Also, there is a LOT of inbreeding with programs taking their own residents as fellows. At my residency, I think only 2 or 3 out of maybe 12 total were from other programs - I don’t view that as a positive, personally, but it is what it is. This wasn’t the case with our other fellowships (and I opted to leave to get a different perspective, which was personally and professionally very rewarding and absolutely the right move). Always assume at least 1 or 2 spots will go to home residents at just about every program with 2+ fellows.
 
Hi all, what are some important things to ask about on the interview? What in your opinion sets the excellent programs apart from the mediocre ones?
 
sandwiches9 said:
Hi all, what are some important things to ask about on the interview? What in your opinion sets the excellent programs apart from the mediocre ones?
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In no specific order

Case variety. Personalities of the attendings. Location. Reputation. Amount of supervising vs doing own cases. Academics if you're into that stuff. Echo teaching. Where people get jobs.
 
sandwiches9 said:
Hi all, what are some important things to ask about on the interview? What in your opinion sets the excellent programs apart from the mediocre ones?
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Yeah, I agree about case variety. I was very surprised on the interview trail that a couple of places I went didn’t do LVADs or lung transplants. In my opinion, those aren’t cases you really want to be doing for the first time as an attending. There are some more esoteric cases like PTEs that are done in only a handful of centers with any frequency.

Other things like supervising vs own cases or academic opportunities will really be more up to your interests and will vary in importance from applicant to applicant. Definitely important to ask, though!
 
It's definitely a lot more fickle of a process than residency match was. Also, another problem is that it is not uncommon for programs to completely fill from within, especially smaller ones. Some won't offer interviews if they know this in advance, but others will, especially if they have candidates who are undecided.
 
There is a not insignificant amount of programs that offer fellowships that do few to no heart or lung transplants and instead have an affiliate that you'll get some at, same for LVADs. So definitely ask about case variety and average numbers (this can also be looked up via UNOS but it is not simple). It's useful to see where the current fellows are from as many places have geographic trends. Call schedule is important. Educational stipend is useful because you will be paying for your Advanced PTE exam as well as your oral boards. Getting an idea for numbers is useful too. There are some programs that barely make echo numbers and instead rely on excessive reviewing of old exams to get you your numbers. These programs are typically 1-2 spots and often fill from within.

Another aspect is to consider supervisory vs. "hands on" fellowships. The majority of fellowships fall into one of these two categories where >70% of the time you are either supervising or you are hands on. There are a few that are entirely supervisory so you somewhat fudge your hands on numbers and there are a few that are 100% hands on and you basically function as a resident who only does cardiac. This has both life style and learning implications so figure out which best fits you. Programs are generally very open about the supervisory vs. hands on mix and are usually proud of whatever ratio they landed on.

Another important point, although increasingly less relevant, is to try to figure out who does the TEE exams for what, and if there is any oversight. There were a few programs where the TEE done by the anesthesiologist was essentially for fun, and the surgeon insisted on a cardiologist for the interpretation they cared about. I think this is a practice that is largely going by the wayside as neither cardiologist nor anesthesiologist seem to enjoy this arrangement. Related to this though is structural heart. Most institutions have a cardiologist doing or interpreting the TEE for things like TAVRs, Mitraclips, and LAA occlusion devices. There are a few programs where the Anesthesiologist does it, so if you want to be involved in structural heart it is important you go somewhere where you will receive this training as the 3D and integration is somewhat nuanced.
 
Question - if offered 2 fellowships which would you choose?

1 - Smaller program but still in a Level 1 trauma centre. No transplant. Still does some vads and dissections. Great salary. Great teaching. Shorter days

2 - Massive program with lots of transplant/vads lots of call, long days (echo teams do the TEE - you are part of that team for a portion of the year). Great teaching also. Much Lower salary
 
Bleeding edge is structural heart. Go into a department that is realigning and pushing boundaries into cath lab. TAVR, LAAO, mitral clip, EP, Rescue TEE.

BI now has a 6 month structural training for this exact purpose. Although I'm not a fan of added training for indentured service but we need to keep redefining what anesthesiologists do and leave the RNs behind.

https://www.bidmc.org/-/media/files...tion.ashx?la=en&hash=ACC1B940DE312B506DC8E454
 
Newtwo said:
Question - if offered 2 fellowships which would you choose?

1 - Smaller program but still in a Level 1 trauma centre. No transplant. Still does some vads and dissections. Great salary. Great teaching. Shorter days

2 - Massive program with lots of transplant/vads lots of call, long days (echo teams do the TEE - you are part of that team for a portion of the year). Great teaching also. Much Lower salary
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I think it depends on what kind of job you want in the future. Personally, I chose 1.
 
I second that it mostly depends on what you want for a job and where you want to practice. The majority of complex cases you do during fellowship are quickly teachable to someone with good fundamentals if you’re doing them for the first time as an attending.

The more refined echo skills are difficult to learn without a guide, but if you get a job where you don’t use them they tend to go away extremely quickly.

In the end pursue what you think will make you happy with the caveat that it’s often easier to get a job in the general region of the country where you did fellowship (and you may be more informed about the pros and cons of jobs in the region).

The main benefit of the latter is that there are people who will say, for better or worse, “oh you went to X? You can do anything then.”
 
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Yeah that exactly what im thinking re future work...
Place 2 seems to be staffed by researchers and the fellows do a lot of the clinical work. I like research a bit but im not that guy...

Place 1 still does about 1500 pump cases a year so its not small
 
Received very polite rejection emails from UCSF and Stanford :-(
 
This month is the main invite month from my somewhat outdated experience and that of some residents I’ve worked with.
 
Ketafol1:5 said:
Received very polite rejection emails from UCSF and Stanford :-(
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UCSF only has one fellowship position also, so I didn't even apply there figured it would fill internally. I mean they do have a pretty good residency also. So I wouldn't feel too bad about that one.
 
When are the Boston programs going to sent invites?
 
Do the fellowship programs considers the Ca-2 ITE scores?
 
Q why do so many ppl want cardiac? Does it pay better than regular anesthesia? Is there a shortage?
 
Newtwo said:
Q why do so many ppl want cardiac? Does it pay better than regular anesthesia? Is there a shortage?
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Cardiac cases are fun, and it's increasingly difficult to get credentialed to do them without the fellowship. Pay can be better in some places, or it may just get one out of the general/OB call pool.
 
I will definitely say the skills I picked up and refined and overall confidence I gained in the cardiac year eclipsed what I got from close to 2 years of residency. It made my transition to being an away way easier than I ever expected.
 
T-burglar said:
Interest In subspecialties is cyclical probably.

The better question is why WOULDNT everyone want to do cardiac?
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Agree and need to keep pushing boundry with skills set. Referring to the the ridiculous other thread about nurse providers ... If you define Anesthesiologists so far out of reach then these sort of shenanigans would never occur. Unfortunately we do have those amongst ourselves who are anesthesiologists in "as a provider" disguise.
 
SDF1 said:
I know BI sent out interviews, have not heard from MGH or BW. Anyone else?
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I have heard from a BWH resident that they have sent out invites to their internal applicants, however I am not sure how many spots are going to be available for them 2/2 their dual fellowship applicants last year...... Needless to say, I am eagerly awaiting to hear back as well....
 
Suggamadex2.0 said:
I have heard from a BWH resident that they have sent out invites to their internal applicants, however I am not sure how many spots are going to be available for them 2/2 their dual fellowship applicants last year...... Needless to say, I am eagerly awaiting to hear back as well....
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Got a dual from BWH around a week ago.
Any idea if Cleveland is done sending invites?
 
Suggamadex2.0 said:
I have heard from a BWH resident that they have sent out invites to their internal applicants, however I am not sure how many spots are going to be available for them 2/2 their dual fellowship applicants last year...... Needless to say, I am eagerly awaiting to hear back as well....
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You have PMs blocked
 
T-burglar said:
Interest In subspecialties is cyclical probably.

The better question is why WOULDNT everyone want to do cardiac?
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Because not everybody enjoys TEEs or central lines every day. Because it can be friggin' boring, especially when one is just the surgeon's glorified nurse anesthetist.

But mostly just because they have to work with cardiac surgeons. That's also the reason why I don't do CVICU.
 
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A very interesting article that my CV anesthesia attending sent to everyone in my program. I think this will be helpful for those who are interested in CV anesthesia fellowship.
 

Attachments

Tried to research previous posts but any one have any more current information on the Mayo and MGH fellowships? Relative to places that get talked about alot like duke, texas, BWH? Mayo seems like a really small program for the amount of volume they have. Would appreciate any insight.
 
Drwine said:
Because with the exception of complicated pediatric cases, you will be able to comfortably do any case that is done in your hospital. Better job security and opportunities during your career.
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Being near the end of my career I can definitely echo that sentiment. The only caveat I would mention is that the time management skills and judgment necessary to do a dozen small cases a day in a freestanding ASC or remote location in the hospital has to come from somewhere else. I would also add that many of my cardiac colleagues are not comfortable on a busy labor wing. Being able to be given any assignment on the daily schedule is an asset but it is sometimes a curse. If it were not for my wife's friends requesting me I would never get assigned any simple routine gyn cases. 😉
 
So looks like interview season has finished. Hope everyone does well! Any thoughts on the process?
 
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