Cardiac Fellowship Rank List 2016

[San Marzano]

Maybe we will now have requirements to be double boarded in CT and CCM to do liver transplants. Seems to be the way of things now, eh?

At my program which is a major transplant center in the pacific northwest, you don't even need to be ABA certified to be on the transplant team, let alone CT or CCM boarded. The only pre-requisite to joining the transplant team is a willingness to take a disproportionately large amount of call for no additional pay whatsoever.

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[Robotic Wis-Hipple]

[Dodging all the swinging d!@&$] Nobody is giving away 300k to do a year of sick hearts and lung transplants so they can do livers......

 

[deleted171991]

At my program which is a major transplant center in the pacific northwest, you don't even need to be ABA certified to be on the transplant team, let alone CT or CCM boarded. The only pre-requisite to joining the transplant team is a willingness to take a disproportionately large amount of call for no additional pay whatsoever.

The explanation for the first half of your post is the second half.

The moment people would start making good money doing liver transplant (it's an up to half million dollar-bundle for the hospital), suddenly the leadership would discover that one needs some special qualification. As in why can only cardiac-trained people do even simple CABG's? Ten or twenty years ago many of these things were done by properly-trained generalists, and they still are in some places.

Where I did my residency, one or two good generalists and a cardiac attending were also on the transplant call list. Almost anything can be done by anybody, if properly trained. It's just that, nowadays, employers don't want to train you on the job anymore, they just want to milk the cow, hence the fellowships.

It's a win-win for them; they pay us the big bucks only when we are ready to rock and roll, and we are the ones basically paying for our training, even if we might not need it in the future, or we might not get reimbursed extra for it (except for cardiac, pain and maybe peds). Isn't it awesome?

 

[thinkorswim]

You mean my big part of a year resuscitating crazy sick people on 3-4 pressors? Or the kind with EF under 10%, playing pheo crysis on me? I am soooo scared of the reperfusion syndrome. Never seen anything like that. Nope. I have no idea what tubefeeds to prescribe for them. Let me look it up on my iPad...

Oh wait, I did reperfusion back in residency on sick mofos after 12 hours of surgery. I still remember loading them up with pressors to an SBP of 180, then roller coaster down to 50-60, while pushing some more sticks of pressors and, voila, calm waters. This coupled with labs every 30 mins for most of the surgery (these were sick dudes), and really textbook management of the patients (including TEE when needed), only with intensivists. You know, the kind of people who don't push a stick of bicarbonate just so that the blood gas looks better on paper, because studies prove it would alter tubefeed absorption.

With all due respect for cardiac anesthesiologists, who are great for cardiovascular and hemodynamic stuff, this is intensive care territory, unless it's on not so sick recipients.

Just because all you learned in the ICU in residency is how to write tube feed orders, there is no need to denigrate critical care. It makes you sound like a CRNA, with their "years of ICU experience".

Oh please, check your ego at the door for a minute here. We all learned how to resuscitate patients in residency. My point is that liver transplants don't have "critical care" written all over them. Anyone who has done enough transplants in residency is more than capable of doing them after. The facetiousness of my post was clearly lost on you.

But while we're puffing our chests out, none of what you described requires critical care training at all. You're the one denigrating cardiac anesthesiology here, insinuating that doing a fellowship in it is a waste of time and money. In fact, if you would get off your high horse and quit drinking the Kool-Aid, you would realize that cardiac and critical care training are remarkably similar in many ways. What you do in the ICU over hours/days is basically what a cardiac anesthesiologist does over minutes/hours in the OR. Just because you've decided to become the surgeons' slave outside of the OR is no reason to think you're better equipped to handle issues in the OR. At my institution, most of our critical care trained attendings are doing general ambulatory cases while the complex and truly sick patients are cared for by the cardiac guys. Maybe the culture is different where you practice, but my point is that neither one is by far and away superior in any way. So just quit it...

And for the record, the only people I have ever seen give bicarb to fix the blood gas are critical care trained.

 

[deleted171991]

Oh please, check your ego at the door for a minute here. We all learned how to resuscitate patients in residency. My point is that liver transplants don't have "critical care" written all over them. Anyone who has done enough transplants in residency is more than capable of doing them after. The facetiousness of my post was clearly lost on you.

But while we're puffing our chests out, none of what you described requires critical care training at all. You're the one denigrating cardiac anesthesiology here, insinuating that doing a fellowship in it is a waste of time and money. In fact, if you would get off your high horse and quit drinking the Kool-Aid, you would realize that cardiac and critical care training are remarkably similar in many ways. What you do in the ICU over hours/days is basically what a cardiac anesthesiologist does over minutes/hours in the OR. Just because you've decided to become the surgeons' slave outside of the OR is no reason to think you're better equipped to handle issues in the OR. At my institution, most of our critical care trained attendings are doing general ambulatory cases while the complex and truly sick patients are cared for by the cardiac guys. Maybe the culture is different where you practice, but my point is that neither one is by far and away superior in any way. So just quit it...

And for the record, the only people I have ever seen give bicarb to fix the blood gas are critical care trained.

I think you misread my intentions here, but that's also my fault.

A cardiac fellowship is probably still the best fellowship to invest in nowadays, much better than CCM. I just wonder what will happen with all these cardiac-trained people when there won't be enough cardiac cases. Same with all these peds people and not enough sick kids. And the reason CCM people do easy cases in the OR is to rest them, between ICU weeks, the same way Noyac alternates between cardiac and regional, for example.

I'll stop the mine is bigger discussion here. I didn't want to be disrespectful to cardiac anesthesiologists. I just find that sick livers are much more than just difficult hemodynamics, especially in the anhepatic phase. But you are right; anybody with the right residency training should be able to do most liver patients, especially since certain centers transplant much earlier, to decrease bad outcomes (they lose UNOS accreditation above a certain percentage, and that's regardless how sick the patients are). That was not the case where I trained (we transplanted late and at high MELDs, because of fewer livers), hence my possibly skewed perception compared to other parts of the country.

 

[Man o War]

Well....if I ever need a liver transplant I'll gladly take any of you, fellowship or not, over an independent CRNA.

 

[weirdomikey014]

I agree. This fellowship year seems much more competitive. And the match rate would have been even lower if not for the 16 additional fellowship slots. I think this year's applicants should make note to take their application seriously and get their apps in early. Cross their t's and dot their i's. I think program directors are in the driver's seat this year if the trend continues. So I suggest having your best foot forward.





This thread has really devolved into which fellowship grad can thump their chest the loudest. In my opinion, every fellowship graduate has a different skillset. And all bring exceptional skills from their training.

let's get back on target and maybe away from the who is better argument...

wow almost a 25% increase in applicants, goes along with what many were being told on the interview trail. Much, much more competitive overall. Probably some good applicants didn't make the cut who likely would have in other years.