Cardiac fellowship rank list

[hardworker101]

Hi all

I'm trying to figure out my rank list for cardiac and having difficulty. I am not sure what to care about more: reputation vs location and also not sure how hard I'm willing to work.

So far my list looks like this:
UCSD
Northwestern
Vanderbilt
Duke
Cedar Sinai
Upenn
Cleveland Clinic
Mount Sinai

I would like some input on these places and what you would pick as your top choices if you were in my shoes. I have no ties anywhere in the country.

Thanks

---

Members don't see this ad.

 

[Wiscoblue]

Upenn Cleveland clinic and then either SLU or WashU.

 

[sethco]

Where do you want to be after you finish fellowship?

 

[anesthesiaU]

what should one be looking for if wanting to do private practice? more supervision or more doing your own cases?

big prestigious name in another region of the country or small lesser known program closer to where one wants to train?

 

[BostonBoys]

Nice list. For me, I liked Northwestern, UPenn and Cleveland Clinic for different reasons.

 

[bkell101]

what should one be looking for if wanting to do private practice? more supervision or more doing your own cases?

big prestigious name in another region of the country or small lesser known program closer to where one wants to train?

I'd like to know people's thoughts on this too...places like duke and ccf (very well respected "names") do their own cases...I've heard people say "becoming a ca-4 or glorified resident is not the goal of fellowship"....if your future job is supervisory, is it better to go to a program with that type of role? (potentially pass up a place like duke for a "mid tier "place!?!?) I can see advantages of both sides, but would love to hear some more experienced people chime in...any advice is much appreciated

 

[bkell101]

I guess I'll play the rank my list game too...

Brigham
Duke
Ccf
Penn
Hopkins
Mgh
Chicago
Uw

 

[amyl]

Ccf 100% - by far the best

 

[deleted171991]

I'd like to know people's thoughts on this too...places like duke and ccf (very well respected "names") do their own cases...I've heard people say "becoming a ca-4 or glorified resident is not the goal of fellowship"....if your future job is supervisory, is it better to go to a program with that type of role? (potentially pass up a place like duke for a "mid tier "place!?!?) I can see advantages of both sides, but would love to hear some more experienced people chime in...any advice is much appreciated

I am not cardiac-trained, but maybe I can still be helpful...

I strongly believe that one cannot properly supervise something that one hasn't mastered by doing it solo many times. One has to be able to lead by example.

Yes, it's always cushier to do a fellowship where one has a resident slave, but all those days of hard work during fellowship will pay off big time, especially in private practice. It just has to be meaningful hard work, not just scut, i.e. it has to have excellent teaching attached. If a place excels at teaching fellows, you have to believe that everything they do has a purpose, including you doing your own cases, always or occasionally (e.g. Stanford CCM has their fellows work the first month as simple residents).

Anesthesia is a hands-on specialty. As an attending, one is supposed to run circles around the resident/CRNA one medically directs. Even in critical care, which is the most cerebral subspecialty with the most human resources available, the buck stops with the attending physician. A fellowship is not about learning how to supervise, is about doing stuff, just like a residency. You learn how to excel at your future job, just like in residency. You plug your holes, find and fix your weaknesses, try things you would be afraid to while you still have a safety net etc. Because next year it will be you, nobody else, who has to fix everything others have screwed up before.

tl;dr
Go where you'll get good training, not where it's cushy. This year will cost you $2-300K; get your money's worth. On the other hand, stay away from places with malignant people; it's much harder to get a good training if you are stressed out all the time.

 

[mostwanted]

Currently doing a CV fellowship, interviewed at some great programs. I agree with FFP's comments, doing your own cases is key especially in the first six months.

I disagree with CCF being the best to train, it certainly has the most volume.

I would pick Duke, Texas Heart, Brigham, and Beth Israel Deacons over CCF.

 

[bkell101]

I am not cardiac-trained, but maybe I can still be helpful...

I strongly believe that one cannot properly supervise something that one hasn't mastered by doing it solo many times. One has to be able to lead by example.

Yes, it's always cushier to do a fellowship where one has a resident slave, but all those days of hard work during fellowship will pay off big time, especially in private practice. It just has to be meaningful hard work, not just scut, i.e. it has to have excellent teaching attached. If a place excels at teaching fellows, you have to believe that everything they do has a purpose, including you doing your own cases, always or occasionally (e.g. Stanford CCM has their fellows work the first month as simple residents).

Anesthesia is a hands-on specialty. As an attending, one is supposed to run circles around the resident/CRNA one medically directs. Even in critical care, which is the most cerebral subspecialty with the most human resources available, the buck stops with the attending physician. A fellowship is not about learning how to supervise, is about doing stuff, just like a residency. You learn how to excel at your future job, just like in residency. You plug your holes, find and fix your weaknesses, try things you would be afraid to while you still have a safety net etc. Because next year it will be you, nobody else, who has to fix everything others have screwed up before.

tl;dr
Go where you'll get good training, not where it's cushy. This year will cost you $2-300K; get your money's worth. On the other hand, stay away from places with malignant people; it's much harder to get a good training if you are stressed out all the time.

My gut agrees with you...."MEANINGFUL HARD WORK"......this is how you get to the next level

 

[bkell101]

Currently doing a CV fellowship, interviewed at some great programs. I agree with FFP's comments, doing your own cases is key especially in the first six months.

I disagree with CCF being the best to train, it certainly has the most volume.

I would pick Duke, Texas Heart, Brigham, and Beth Israel Deacons over CCF.

How come?

 

[anesthesiaU]

Isn't doing a cardiac fellowship all about getting TEE certified so that you can market yourself as TEE certified and fellowship trained? In that case why would you need the extra reps that you get in a program where you do all your own cases? Most people say you don't need a fellowship to do cardiac cases in private practice, but that any decent residency should give you enough cases.

I was under the impression that the quality of the TEE training is what to look for. Then again most fellows pass the TEE exam no matter where they trained it seems.

Any clarification or insight from past fellows currently in private practice would be greatly appreciated.

 

[chmd]

I think it's better to mostly supervise. That way you get 2-3 times the echo experience.

 

[krodUT]

I'm a current fellow at a large program going into private practice in a couple of months. Here's my two cents.

1) I would recommend doing your own cases. Yes you learn how to cardiac cases in residency (I did ~100 pump cases in residency) but if you supervise and start a case with yourself, a resident, an attending and maybe even a tech around, you lose the learning that comes with starting cases on your own. My program has a mix between fast private practice style cases (2.5-3 hour door to door CABGs or AVRs) and slower-style academic surgeons. To be able to go into a room and start your a-line, go to sleep, toss in a central line, +/- swan, and insert and do an echo exam in 25-45 minutes while managing the hemodynamics on your own (granted with attending supervision) is a lot different than supervising. Don't get me wrong, I have friends doing fellowships where they supervise but depending on where you end up, you'll be much more prepared to knock out a pump case safely and efficiently under production pressure.

2) Get as much surgical variety as you can. Having just gone through the interview process (and listening to all my cofellows' stories) you want to be prepared to do everything. A private practice or academic group may desire to hire a fellowship trained person not just because they are increasing their volume, but because they're expanding their surgical services. This means go somewhere where you will do heart transplants, lung transplants, plenty of VADS, complex aortic surgery requiring CSF drains, and TAVR's. Having done robotic heart cases in residency and not in fellowship I feel like you can learn how to place coronary sinus catheters with a good foundation that fellowship provides. No matter what a places hiring needs are, you want to be confident you'll be able to handle the cases

3) Echo is of course a big part of the training. Supervising vs. doing your own cases may or may not effect what your numbers are. Don't forget though, all programs should be able to supply you with the 300 "interpreted"but they may differ on how many you "personally perform". For example, I went to a residency program where the fellows supervised which was great because on every one of their 6 OR months (stander for all fellowships) they could bounce between 1 and 2 rooms to look at the echoes. However on the 1 or 2 months of echo, they went to the cardiology reading room and learned echo post-exam. In doing my own cases I spend my 6 OR months doing 1 or 2 echoes for my own cases each day. On my 2 echo months, I go to every OR that has a probe in (~6/day) and do an exam so we usually get about 150-200 performed exams just from the echo months). Bottom line is that you're smart people that are professional test takers at this point. You'll be driven, learn the material and do well on the exam. Just ask the details on how the echo months work.

4) I'm not trying to solicit and have no affiliation with northeast programs but Tommy Burch, MD from BID has an incredible website called PTEMasters.com which has about 100 1-hour video lectures on echo which I feel are essential. It's normally $1000k a year but every July it goes on "special" for $300. I would HIGHLY recommend it.

5) No matter what you do be happy. Get well trained but don't kill yourself in the process. It's a busy year. By far the busiest you'll have in your training. Written boards in July, getting the wheels rolling on the job search and interviewing, oral boards and echo boards.

Good luck everyone!

 

[anesthesiaU]

rank lists due in a few days.

any more words of wisdom from current and past fellows?

 

[hardworker101]

My question is I currently go to residency at a good respectable program, so is it worth moving to another place like Duke, Cleveland Clinic or Texas Heart for one year? Since they have bigger "name" and more volume?

I have no location preference

Thanks all

 

[mostwanted]

My question is I currently go to residency at a good respectable program, so is it worth moving to another place like Duke, Cleveland Clinic or Texas Heart for one year? Since they have bigger "name" and more volume?

I have no location preference

Thanks all

Current CV fellow: If location is not a preference, I would strongly recommend going to a top notch program. I currently work with an attending from Duke; his clinical acumen and knowledge base is clearly a step above most. Also search for a thread I saw recently on Texas Heart. The diversity of cases and breadth of training can be useful in the current job climate especially for new grads.

 

[anesthesiaU]

What programs will give you a leg up in getting the best job after fellowship? If looking at private practice, will doing tons of vads/transplants really make a difference?

thanks

 

[hardworker101]

i would like to know the answer to the above questions as well since most programs will teach you the bread/butter cases

 

[bigdan]

Current CCF fellow. Let me know if I can answer questions.

 

[nimbus]

What programs will give you a leg up in getting the best job after fellowship? If looking at private practice, will doing tons of vads/transplants really make a difference?

thanks

You may be surprised to learn what "private practice hearts" is these days. VADs and transplants, along with TAVRs and perc retro cases are not limited to academia. If you are giving up a year of income and going through the trouble of a fellowship, you should get experience and proficiency with these cases. Hopefully residency prepared you for the basic stuff.

 

[bkell101]

Ccf, duke , and Texas seem to be talked about quite a bit...any hidden gems out there that offer a great experience?

 

[bkell101]

Wh

Current CV fellow: If location is not a preference, I would strongly recommend going to a top notch program. I currently work with an attending from Duke; his clinical acumen and knowledge base is clearly a step above most. Also search for a thread I saw recently on Texas Heart. The diversity of cases and breadth of training can be useful in the current job climate especially for new grads.

Beyond ccf, duke, and texas what do you guys consider top notch?

 

[krodUT]

You may be surprised to learn what "private practice hearts" is these days. VADs and transplants, along with TAVRs and perc retro cases are not limited to academia. If you are giving up a year of income and going through the trouble of a fellowship, you should get experience and proficiency with these cases. Hopefully residency prepared you for the basic stuff.

I agree with this statement. Advocate Christ is the busiest heart hospital in Illinois and is ran by a private practice group without an academic appointment. Learn to be as efficient as possible. Transplants, complex aortic surgery, VAD's and TAVR's are becoming less rare in non-academic hospitals. Particularly with the future stipulation that in order to do VAD's, a hospital must also do heart transplants.

Good luck!

 

[GaseousClay]

From what I hear UCSD's cardiac volume has skyrocketed in recent years so the experience is really good. Along with Heart/Lung transplants, VADs, laser lead extractions, TAVRs, All valves, etc. They are as you know the pioneers of PTE surgery and do more than anyone in the country combined. That experience alone makes UCSD top notch for CV fellowship. People may name Stanford, penn, CCF, etc because of the name and volume but its the quality of cases that matter. Obviously there are a ton of great programs out there, but from researching west coast programs and talking to multiple people, UCSD is hard to beat for CV fellowship.

 

[mostwanted]

Wh


Beyond ccf, duke, and texas what do you guys consider top notch?

There are a number of great programs around the country: Upenn, Emory, Beth Israel(Boston), Brigham, Stanford, based on recent visit to SCA- Echo Week (I think Univ of Nebraska is probably also a great place to train)

 

[hardworker101]

From what I hear UCSD's cardiac volume has skyrocketed in recent years so the experience is really good. Along with Heart/Lung transplants, VADs, laser lead extractions, TAVRs, All valves, etc. They are as you know the pioneers of PTE surgery and do more than anyone in the country combined. That experience alone makes UCSD top notch for CV fellowship. People may name Stanford, penn, CCF, etc because of the name and volume but its the quality of cases that matter. Obviously there are a ton of great programs out there, but from researching west coast programs and talking to multiple people, UCSD is hard to beat for CV fellowship.

Isn't their volume 800 pump cases a year based on SCA's website? I loved UCSD but do you think their training is comprehensive/great compared to some of the bigger name places like CCF,Duke, and such? just wondering

 

[GaseousClay]

From a recent fellow: TEE training is second to none (every year UCSD hosts a periop echo course that is very well attended: https://cme.ucsd.edu/echo/); Case volume is now well above 800 a year, also there are only so many cases one fellow can do per day and you will have no shortage of cases (only 3 fellows/year). CT surgeons are very respectful of the Anesthesia team and have a great relationship with the attendings/fellows/residents. CT ICU is closed and run by anesthesia service also. Not saying UCSD is superior to duke, ccf, etc just saying you will get very comprehensive training there and also be living in San Diego which definitely is a superior city IMO.