Cardiac Fellowship

[NCMED101]

Currently a CA2. I am starting cardiac rotation next week, no exposure to it prior. Seeing as how the application opened today. Would I be at a significant disadvantage and would it be worthwhile applying late? Say I enjoyed the rotation and able to submit application beginning/mid December would it be worth it? Thanks.

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[Nivens]

Just have your app in by the first week of January.

 

[abolt18]

Currently a CA2. I am starting cardiac rotation next week, no exposure to it prior. Seeing as how the application opened today. Would I be at a significant disadvantage and would it be worthwhile applying late? Say I enjoyed the rotation and able to submit application beginning/mid December would it be worth it? Thanks.

I'll tell you the fellowship director at my program recommended "earlier is better" so if you decide you love it, I'd definitely ask for letters early and try to get in during December.

He also said that most programs probably won't even look at apps before Dec. 1, so that likely gives some margin for safety.

 

[EBTrailRunner]

Currently a CA2. I am starting cardiac rotation next week, no exposure to it prior. Seeing as how the application opened today. Would I be at a significant disadvantage and would it be worthwhile applying late? Say I enjoyed the rotation and able to submit application beginning/mid December would it be worth it? Thanks.

If you can have your application submitted by the end of December, you should not be at a competitive disadvantage.


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[AdmiralChz]

He also said that most programs probably won't even look at apps before Dec. 1, so that likely gives some margin for safety.

Yeah. We started lightly looking over around Dec 15th or so but picked up after New Years. There was a big second rush (larger than the initial few) of apps around Christmas/NYE. Another peak around Feb (late interest).

You want to be in the pile early - we were a large fellowship and offered interviews on a rolling basis, once we started to fill up we became much more stringent with who we invited. After March one would probably be better off just applying the next year unless your home program will take you (TONS of inbreeding in anesthesia fellowships).

 

[ToKingdomCome]

I want to do primarily CCM. Is CCM/CT combined less competitive than CT alone?

 

[AdmiralChz]

I want to do primarily CCM. Is CCM/CT combined less competitive than CT alone?

There aren’t many truly “combined” programs as it’s usually just one year followed by another. But many do offer guaranteed back-to-back years and it falls outside of the match.

That being said, the applicant pool that seriously wants to do this is small. CCM will literally takes anyone with a pulse, so that’s not a factor. In general it’s not hard to find a spot to do this.

One last caveat, when a good friend of mine was interviewing around for this a couple of years ago it was tough to find a program with 2 good fellowships at the same place. Most were strong in one or the other. He ended up splitting his year.

 

[ToKingdomCome]

There aren’t many truly “combined” programs as it’s usually just one year followed by another. But many do offer guaranteed back-to-back years and it falls outside of the match.

That being said, the applicant pool that seriously wants to do this is small. CCM will literally takes anyone with a pulse, so that’s not a factor. In general it’s not hard to find a spot to do this.

One last caveat, when a good friend of mine was interviewing around for this a couple of years ago it was tough to find a program with 2 good fellowships at the same place. Most were strong in one or the other. He ended up splitting his year.

I see, so should I apply for CCM my CA-2 year and then apply for CT my CA-3 year if I can’t get a combined program? Or just wait for my CCM program do the heavy lifting to help me find a Program when I’m there?

 

[psychbender]

I see, so should I apply for CCM my CA-2 year and then apply for CT my CA-3 year if I can’t get a combined program? Or just wait for my CCM program do the heavy lifting to help me find a Program when I’m there?

If you wait to apply when you're a CCM fellow, you're likely to have a gap year between fellowships. CT tends to fill up in the match. Now, if you went CT first, then you could interview for one of the many still vacant CCM spots during your CT year, and manage to go straight from one to the other (maybe not at the same place, though). Most don't usually go that route, though.

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[deleted171991]

Always do CCM first, CT last. The only problem with this arrangement is watching the dumbness as a fellow in the cardiac room, once you're already an intensivist.

 

[ToKingdomCome]

I see so apply during CA-3 year

 

[AdmiralChz]

I see so apply during CA-3 year

No, you’ll have to do a gap year. Apply during CA-2 as usual and mention you are interested in both on your interviews or preferable before-hand if they have a formalized policy. If you match to a program they will probably drag you along into the CT fellowship afterwards unless you are a marginal candidate.

 

[MoMoGesiologist]

Always do CCM first, CT last. The only problem with this arrangement is watching the dumbness as a fellow in the cardiac room, once you're already an intensivist.

What dumbness do you notice as an intensivist in the cardiac rooms?

 

[vector2]

What dumbness do you notice as an intensivist in the cardiac rooms?

Mostly the stupidity I’ve seen has been due to ct surgeon involvement. Those guys (esp the older ones) do all kinds of dumb stuff like request inotropes when pt needs volume. Req volume when pt needs inotropes. Req blood unnecessarily. Req bicarb unnecessarily. Etc etc

 

[AdmiralChz]

Mostly the stupidity I’ve seen has been due to ct surgeon involvement. Those guys (esp the older ones) do all kinds of dumb stuff like request inotropes when pt needs volume. Req volume when pt needs inotropes. Req blood unnecessarily. Req bicarb unnecessarily. Etc etc

“Oh, the urine output is a little low? Let’s start some renal-dose dopamine”

Used to hear this weekly in fellowship.

 

[deleted697535]

Older ct surgeons have basically seen every horrific pathology known to man and are still at it. Those dudes open a chest in seconds. I'd cut them some/a lot of slack.

I've seen plenty of ICU fellows that can't butter bread also!

 

[Nivens]

Older ct surgeons have basically seen every horrific pathology known to man and are still at it. Those dudes open a chest in seconds. I'd cut them some/a lot of slack.

I've seen plenty of ICU fellows that can't butter bread also!

ICU fellows seem to come in two flavors: outstanding physicians committed to becoming more complete perioperative doctors, and hopeless ragamuffins who couldn’t hack it in the OR.

The former often do seem to know the data better than their older surgical colleagues, but the longer I do this, the more slack I try and cut the guy with 20 years experience holding the heart. If what he/she is at all reasonable and/or not dangerous, I’m inclined to go along with it even if it isn’t my preferred strategy.

 

[Drangue]

Following.

The more input the better.

 

[DrN2O]

Any CTA application that shows up before Xmas isn't late. Remember the rate limiting step is usually your letter writers. So start talking to people now.

Apply to the fellowship you really want to do. A combined application sent to CTA may never get to the CCM PD, or vice versa. How do you figure doing both is less competitive than CTA alone? The only thing easier about it would be taking a match exception and lock down your 2 year before everyone else waiting for the computer to spit out their fate.

If splitting up, having secured a CTA fellowship as CA-2, would probably guarantee you a CCM spot at the CTA institute or most other places in the country if you apply as CA-3. Not the other way around. Go look at the SF Match data, supply and demand for the two are flipped.

 

[ToKingdomCome]

What's a decent ITE score for cardiac?

 

[J Peterman]

Couldn’t pay me any amount of money to do a CCM fellowship. Make sure you know what you’re getting yourself into considering the 2 years of extra training (read: indentured servitude), and no real benefit if you’re considering a career in PP. CT/CCM is really only viable in an academic environment.

That said, CT fellowship was entirely worth it, especially if you go to a solid echo program with a focus on 3D and structural interventions in the cath lab, which is the future of the field. Being a strong CT anesthesiologist IMO makes you a better clinician in the OR than a CCM background. I say that from experience, working with both in a PP environment.

Get solid letters of rec from at least one of your cardiac attendings, do as well as you can on your ITE, have a reputation as a hard worker in your program and good things will come your way. CT fellowship is competitive these days. Get your application in when the SFMatch opens around the holidays of your CA-2 year, IIRC.

 

[26B]

What's a decent ITE score for cardiac?

> 70th percentile