Cardiac Fellowship 2021

[JiPo]

What do you guys think of Columbia's program? I know it doesn't have the name Duke, CCF, Cedar-Sinai do, but in regards to training does it fall far behind the top places?

I replied to the post, but somehow, it wasn't posted, so here it goes again.

It is interesting that you mentioned Cedar-Sinai along with Duke and CCF. I didn't apply to any west coast programs, but if you are looking for programs that make you sit your own stool, top names commonly thrown around are Duke, CCF, and THI. I've never heard of Cedar-sinai grouped on par with these three.

Anyways, I liked Columbia when I interviewed. Solid clinical experience. Maybe slightly worse clinical experience compared to Duke and CCF, but I don't think it is a significant difference. If you are looking to stay around the tri-state area afterwards, Columbia would be a solid choice. They are increasing the class size to 9 for our year, so the call burden would be much lighter.

---

Members don't see this ad.

 

[dchz]

I replied to the post, but somehow, it wasn't posted, so here it goes again.

It is interesting that you mentioned Cedar-Sinai along with Duke and CCF. I didn't apply to any west coast programs, but if you are looking for programs that make you sit your own stool, top names commonly thrown around are Duke, CCF, and THI. I've never heard of Cedar-sinai grouped on par with these three.

Anyways, I liked Columbia when I interviewed. Solid clinical experience. Maybe slightly worse clinical experience compared to Duke and CCF, but I don't think it is a significant difference. If you are looking to stay around the tri-state area afterwards, Columbia would be a solid choice. They are increasing the class size to 9 for our year, so the call burden would be much lighter.

Yeah Cedar-Sinai has its perks: it's essentially private practice so the fellows gets to go to all the conferences. You also see a lot of hollywood celebrities there. California weather is MUCH better than NY weather. Although cost of living is expensive, it's still better than bang for your buck than Manhattan. But it's not on par with Columbia Duke or CCF. I think UCLA would be more on par with Columbia or Duke in Southern California.

I would consider Columbia and Duke to be top tier programs. However, did duke tell you that the pre and post TEEs count as separate TEEs in order to meet their numbers? Columbia might have to ramp down again if a second wave hits NYC. Still both are good training with an academic focus.

CCF is more on par with Mount Sinai - good clinical training, but definitely heavy workhorse.

THI got a great name and extensive networking. But their fellows aren't doing very many LVADs or Transplants due to recent results of the previous transplant surgeon. (i'm working with primary sources that are a year old, so it might be back to full force by the time you get there.)

In essence, the difference between mid tier and top tier is a lot closer than one thinks - it's not like the difference between harvard and a community college, more like the difference between a regional private school and a good state school. It's good for the soon to be CT fellows to understand at this point in your life the location might matter more than the difference between top and mid tier. If you want to be in Houston, THI is slightly lower tier than Columbia but it's certainly easier to get a CT job in Houston if you went to THI, and the cost of living is way lower. However, I would absolutely move across the country to avoid a truly horrible fellowship - think no advanced heart failure, barely meeting the numbers, no name or good training.

Hope this helps. Best of luck to you all.

 

[Nivens]

However, did duke tell you that the pre and post TEEs count as separate TEEs in order to meet their numbers?

This is true. My program (not Duke- often also mentioned in top lists) interprets this as two fellows can get credit for each echo (one for the pre and one for the post). We typically will all do the echos for our cases, and then will float around to the different rooms to check out the other pathology and increase our numbers. We never count a pre and a post as two exams for one fellow- if there isn’t another fellow around to take the “second” spot, it gets “wasted”. We weren’t super aggressive about doubling up in the beginning, but post-COVID have been making a bigger effort.

Definitely a perk of a 50-50 solo/supervisory split.

 

[vector2]

This is true. My program (not Duke- often also mentioned in top lists) interprets this as two fellows can get credit for each echo (one for the pre and one for the post). We typically will all do the echos for our cases, and then will float around to the different rooms to check out the other pathology and increase our numbers. We never count a pre and a post as two exams for one fellow- if there isn’t another fellow around to take the “second” spot, it gets “wasted”. We weren’t super aggressive about doubling up in the beginning, but post-COVID have been making a bigger effort.

Definitely a perk of a 50-50 solo/supervisory split.

I think letting fellows float around to another room to do an exam on another pt to see more pathology totally counts as a new exam. However, having the same fellow on the same case count the pre and post as two exams sounds a bit fraudulent and is almost certainly not in the spirit of what NBE meant with 300 read, at least 150 of those performed by the applicant. But I guess NBE must not mind since they're receiving logs that must have a gazillion double entries on them

 

[Nivens]

I think letting fellows float around to another room to do an exam on another pt to see more pathology totally counts as a new exam. However, having the same fellow on the same case count the pre and post as two exams sounds a bit fraudulent and is almost certainly not in the spirit of what NBE meant with 300 read, at least 150 of those performed by the applicant. But I guess NBE must not mind since they're receiving logs that must have a gazillion double entries on them

Totally agree. In the COVID “are we done with elective cardiac cases for the year?” panic we asked our PD about counting pre and post separately for a single fellow. We were promptly shot down. Luckily we’ve ramped back up and it’s a non-issue.

 

[CoxMD]

What's the current consensus on Brigham? They often seem to get added to the "top program" groups with the likes of Duke and CCF. That said, not much actual discussion on the program itself.

 

[abolt18]

I personally really liked UT Houston. Seemed to be excellent. I also really loved U of Michigan, but those 2 programs were total opposites in that Houston you do all your own cases and Michigan you do none of your own cases (except minimum acgme requirement) and supervise the whole year.

Yeah Cedar-Sinai has its perks: it's essentially private practice so the fellows gets to go to all the conferences. You also see a lot of hollywood celebrities there. California weather is MUCH better than NY weather. Although cost of living is expensive, it's still better than bang for your buck than Manhattan. But it's not on par with Columbia Duke or CCF. I think UCLA would be more on par with Columbia or Duke in Southern California.

I would consider Columbia and Duke to be top tier programs. However, did duke tell you that the pre and post TEEs count as separate TEEs in order to meet their numbers? Columbia might have to ramp down again if a second wave hits NYC. Still both are good training with an academic focus.

CCF is more on par with Mount Sinai - good clinical training, but definitely heavy workhorse.

THI got a great name and extensive networking. But their fellows aren't doing very many LVADs or Transplants due to recent results of the previous transplant surgeon. (i'm working with primary sources that are a year old, so it might be back to full force by the time you get there.)

In essence, the difference between mid tier and top tier is a lot closer than one thinks - it's not like the difference between harvard and a community college, more like the difference between a regional private school and a good state school. It's good for the soon to be CT fellows to understand at this point in your life the location might matter more than the difference between top and mid tier. If you want to be in Houston, THI is slightly lower tier than Columbia but it's certainly easier to get a CT job in Houston if you went to THI, and the cost of living is way lower. However, I would absolutely move across the country to avoid a truly horrible fellowship - think no advanced heart failure, barely meeting the numbers, no name or good training.

Hope this helps. Best of luck to you all.

 

[dchz]

I personally really liked UT Houston. Seemed to be excellent.

Well, everyone in that department is new except for like 2 faculty. I don't know what happened, perhaps @rishk789 could comment.

 

[abolt18]

Oh dang! That was definitely not communicated to me.

Well, everyone in that department is new except for like 2 faculty. I don't know what happened, perhaps @rishk789 could comment.

 

[Crash44]

Thanks for the responses everyone!

 

[RK.md]

Well, everyone in that department is new except for like 2 faculty. I don't know what happened, perhaps @rishk789 could comment.

Yes, several faculty transitioned from Hermann to Methodist before I joined the Hermann HVI group late last year, but as CV fellows, these are the two hospitals you'll work at anyways. You'll be working with anesthesiologists with a YEARS of experience. Specifically at Hermann HVI, we have (more than two) faculty with 10+ years of experience, those with roughly 5, and then the me as the greenest member with only 8 months.

I can also tell you that between the two institutions, our fellows are doing a crazy number of transplant cases, advanced heart failure cases, thoracoabdominal aneurysms, and the like not only from the patient base in the Texas Medical Center but those brought in from surrounding cities/states.

 

[abolt18]

Anyone know about the details of this match day? I only just realized you have to log into the SF match website to get the results (had just assumed we would get an email out something). Any idea on an approximate time of day so I don't spend all of June 15 sitting at my computer pressing F5?

 

[JiPo]

Anyone know about the details of this match day? I only just realized you have to log into the SF match website to get the results (had just assumed we would get an email out something). Any idea on an approximate time of day so I don't spend all of June 15 sitting at my computer pressing F5?

Rank list was due at 12pm PST, so i was going to check around that time on 6/15. I think last year, it came out much earlier. Just keep yourself busy in the OR. Your day will be over before you know it, and the results will be available.

 

[AdmiralChz]

I seem to remember getting an email to check. But that was some time ago...

Went live at 11 or 12.

 

[JiPo]

I seem to remember getting an email to check. But that was some time ago...

Went live at 11 or 12.

11am PST? EST?

 

[Nivens]

Haha @JiPo it’s gonna be fine dude.

 

[abolt18]

I'll be on vacation so lots of free time... Haha

Rank list was due at 12pm PST, so i was going to check around that time on 6/15. I think last year, it came out much earlier. Just keep yourself busy in the OR. Your day will be over before you know it, and the results will be available.

 

[CoxMD]

Thought I'd seen somewhere that it was 9am PST, but now I can't find that anywhere on the SF Match site

 

[CoxMD]

emailed SF Match. Released 9am PST or Noon EST.

Found this "source" in last year's Cardiac thread.

 

[dchz]

Yep, it's earlier in the day. 9PST 12 Eastern.

Congrats to those that matched, here is a good thread from last year for those that don't.

Didn't Match into Cardiac Fellowship.....Thoughts and Advice?

Hi All, New CA-3, Applied for Cardiac last year, Got 5 interviews at excellent programs, sent love letters. And didn't match. Been applying to private practice/academic jobs and have had a good response. Just trying to focus on getting a job now. But I know that after a few yers the cardiac...

forums.studentdoctor.net

 

[abolt18]

Yep, it's earlier in the day. 9PST 12 Eastern.

Congrats to those that matched, here is a good thread from last year for those that don't.

Didn't Match into Cardiac Fellowship.....Thoughts and Advice?

Hi All, New CA-3, Applied for Cardiac last year, Got 5 interviews at excellent programs, sent love letters. And didn't match. Been applying to private practice/academic jobs and have had a good response. Just trying to focus on getting a job now. But I know that after a few yers the cardiac...

forums.studentdoctor.net

T - 7 days

 

[dchz]

T - 7 days

Meant to say congrats to those that WILL* match.

 

[dchz]

Get your application ready for forwarding the applications to any spot that might be unfilled.

Also as @AdmiralChz says, there will be an non-insignificant amount of spots that open up during the year. Keep proactive - call the places you interviewed and let them know you're still interested, have it on your calendar to check the SFmatch website every week to check on vacancies.

But again, this might be a blessing in disguise.

 

[Man o War]

Get your application ready for forwarding the applications to any spot that might be unfilled.

Also as @AdmiralChz says, there will be an non-insignificant amount of spots that open up during the year. Keep proactive - call the places you interviewed and let them know you're still interested, have it on your calendar to check the SFmatch website every week to check on vacancies.

But again, this might be a blessing in disguise.

Yes, this. Just gave this advice to an excellent applicant who didn’t match. I’m shocked, wondering what the match rate will be this year. He was strong and cast a wide net.

 

[Beeftenderloin]

Are these other residents who didn’t match at places without a home program? My theory was that most places would fill internally and the Skype interviews wouldn’t count.

Not necessarily. I have no home program and matched at a place I Skype interviewed with.

My condolences for not matching though. Happened to me for residency match and really, really sucked. But it also sent me down a completely new path that I otherwise would have never considered and has turned out to be a net positive in my life. Keep your head up and good luck moving forward!

 

[Man o War]

Are these other residents who didn’t match at places without a home program? My theory was that most places would fill internally and the Skype interviews wouldn’t count.

The one I’m speaking of does not have a home program.
Are most of these places filling internally for CT now? I do not work in academics, but we are a rotation site.

 

[dchz]

Congrats to those that matched. You're one step closer to being a competent cardiac anesthesiologist.

For those that didn't match.

The most important thing for you is your mental health right now. Take time for yourself to recenter, ground, and look at the big picture. This is different from residency, your alternative is to make a six figure salary.

Unless there are vacancies (which I don't think there are this year). Nothing is going to change for you in the next 4 weeks. Take this time to recenter yourself. Get over it emotionally. Use positive coping mechanisms. And step away a little bit.

DO NOT BURN any bridges.

Regroup with yourself after a few weeks. Then figure out the next step.

 

[Dam272]

DO NOT BURN any bridges.

GOLD


Sent from my iPhone using SDN

 

[AdmiralChz]

I echo @dchz’s sentiments and comments here. Given all that is going on this year’s application cycle is anything but typical, and I am sure there were many programs that just took the safest option (go with known internal candidates). I know what it’s like to not match (happened to me out of medical school) and can sympathize! It sucks and you feel real down on yourself.

Don’t dwell too long on this. A year is a long time and tons can happen over that time. I know several would-be fellows that decided that it wasn’t really for them which opened slots. And with the pandemic still lingering around, who knows what the next 12 months will bring. I have seen the value of having a diversified practice as our hospital’s cardiac surgery program basically shuttered for 2 months (case load down a staggering 80-90%), and that may make prospective fellows somewhat skittish.

So, take a deep breath, relax and try to enjoy the warm weather (if you can). Not much movement will happen in the next month or so but once Fall comes around that’s when some movement occurs. Keep your ear to the ground and reach out to programs saying you’d still be interested if an opening comes up.

 

[deleted697535]

Honestly im not really sure i get what all the hoo haa is about cardiac. Long days, working with surgeons who have declared themselves deities, very busy intra-op sometimes. Transplants and Type A exclusively happen at 2am after a long day already. Moneys good but not that much better.

Its great and all, but its definitely not the be all and end all!

 

[pgg]

Honestly im not really sure i get what all the hoo haa is about cardiac. Long days, working with surgeons who have declared themselves deities, very busy intra-op sometimes. Transplants and Type A exclusively happen at 2am after a long day already. Moneys good but not that much better.

Its great and all, but its definitely not the be all and end all!

Most cardiac jobs don't involve transplant. There are lifestyle cardiac surgery practices out there. Mostly elective valves and CABGs being done by experienced surgeons who aren't jerks. TEE is cool. What's not to like?

Give me that over a day with a dozen peds ENT cases any time. Or the aged BMI 50 pulm cripple getting a lifestyle-enhancing RCR before her lung reduction surgery ...

 

[NiemannPick]

I'm hearing more and more that you need to do the CT/ICU combined fellowship if you want a great cardiac spot somewhere, as they prefer those applicants (Stanford, Duke, etc). Is this actually the case? I love CT but honestly dread ICU workflow.

 

[deleted697535]

Most cardiac jobs don't involve transplant. There are lifestyle cardiac surgery practices out there. Mostly elective valves and CABGs being done by experienced surgeons who aren't jerks. TEE is cool. What's not to like?

Give me that over a day with a dozen peds ENT cases any time. Or the aged BMI 50 pulm cripple getting a lifestyle-enhancing RCR before her lung reduction surgery ...

I hear ya, and 100% agree. Certain people can make almost any situation 'work' for them and others want to complain about even the best job.

Ive long since stopped heeding much 'advice' except from a few good buddies. Everything is so subjective...

As an ex engineer and farmers son from a place on the wild atlantic, i can assure you even the worst anesthesiologist job is like a holiday camp! if ye think c sections at 3 am are onerous, try pulling calves at an equally ungodly hour with the cow trying to kill you and it raining sleet sideways in January

 

[JiPo]

I'm hearing more and more that you need to do the CT/ICU combined fellowship if you want a great cardiac spot somewhere, as they prefer those applicants (Stanford, Duke, etc). Is this actually the case? I love CT but honestly dread ICU workflow.

No, I matched at a fantastic program (I would argue that it is the best CT program after interviewing at so many, but I am clearly biased ) as an external candidate for CT-only this year.

Applying dual will definitely give you a boost, but if you can’t stomach an year of ICU, do not do it.

 

[pgg]

I'm hearing more and more that you need to do the CT/ICU combined fellowship if you want a great cardiac spot somewhere, as they prefer those applicants (Stanford, Duke, etc). Is this actually the case? I love CT but honestly dread ICU workflow.

As of a couple years ago, Duke wouldn't hire anyone to the CT division who wasn't double fellowship trained. I assume they're still doing that. I think those places are definitely the exception. I mean, we're still living in a USA where many (most?) hearts are being done by people without either fellowship.

For every Duke where the CTICU is run by the anesthesiology dept there are probably 40 "heart hospitals" where they're just glad to get someone who can get more than a 4 chamber view on TEE.

Also - there's no reason you can't go back and do another fellowship year at some time in the future, if you eventually decided your interests or career goals needed it.

 

[dchz]

Applying dual will definitely give you a boost, but if you can’t stomach an year of ICU, do not do it.

I once thought about doing an extra year of ICU just to get a spot at one of the top tier places.

They saw through that at the interview and I'm kinda glad they didn't offer me the spot. I would rather do CT in BFE without a fellowship than do a year of ICU in the northeast.

 

[dchz]

For every Duke where the CTICU is run by the anesthesiology dept there are probably 40 "heart hospitals" where they're just glad to get someone who can get more than a 4 chamber view on TEE.

I can get the 5 chamber view. Where's my contract?

 

[abolt18]

Just adding my name to the list of those who didn't match this year, despite an otherwise strong application (ITEs 95%ile, top 10% on basic, good letters, etc...) and 7 interviews.

I was pretty upset about it, but I've cooled down over the last few days. Now I get to start looking at options for next year. Most likely look for physician-only PP and run with it.

 

[Dam272]

I'm hearing more and more that you need to do the CT/ICU combined fellowship if you want a great cardiac spot somewhere, as they prefer those applicants (Stanford, Duke, etc). Is this actually the case? I love CT but honestly dread ICU workflow.

I heard that too, from multiple sources. I am doing dual, but my decision was primarily for my love of ICU and not just market or advice driven

 

[AdmiralChz]

Do NOT do an extra ICU year just to get into CT unless you actually are interested and want to be an intensivist. That is typically a brutal year and you are seriously underpaid as a fellow (compare to what you could make as an attending).

Big Ivory Tower programs love dual applicants but I can tell you the number of true applicants for both is very low. We would interview dual applicants and test them by saying “would you be interested in a cardiac only“ and if they got all giddy and thrilled we knew we had a faker. Happened at least twice. It’s a powerful combo but it’s a ton of work and decidedly not for everyone.

Just to be clear here - the reason programs love dual applicants is because it fills unpopular ICU spots that otherwise would be filled often with fellows outside of anesthesia like EM which simply isn’t as desirable.

 

[sethco]

Do NOT do an extra ICU year just to get into CT unless you actually are interested and want to be an intensivist. That is typically a brutal year and you are seriously underpaid as a fellow (compare to what you could make as an attending).

Big Ivory Tower programs love dual applicants but I can tell you the number of true applicants for both is very low. We would interview dual applicants and test them by saying “would you be interested in a cardiac only“ and if they got all giddy and thrilled we knew we had a faker. Happened at least twice. It’s a powerful combo but it’s a ton of work and decidedly not for everyone.

Just to be clear here - the reason programs love dual applicants is because it fills unpopular ICU spots that otherwise would be filled often with fellows outside of anesthesia like EM which simply isn’t as desirable.

How many do you think do dual fellowship with Cardiac first, then ICU and drop out after they finish the Cardiac year?

 

[vector2]

How many do you think do dual fellowship with Cardiac first, then ICU and drop out after they finish the Cardiac year?

The number of dual applicants who do cardiac first is ~0

 

[Lidolover]

The number of dual applicants who do cardiac first is ~0

This is not true. I would say ~ 10-20% of ppl I know who did dual, had cardiac as their first year. It’s not the standard for sure and each year depends on multiple factors, mainly related to the arrangements the program had made with current or future fellows and availability.

 

[RK.md]

This is not true. I would say ~ 10-20% of ppl I know who did dual, had cardiac as their first year. It’s not the standard for sure and each year depends on multiple factors, mainly related to the arrangements the program had made with current or future fellows and availability.

Agree.