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IMResApplicant

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Hey everyone,
I was hoping to get some of your opinions on an idea I had. I am ultimately interested in Advanced Heart Failure Cardiology. My problem is that I am a US IMG from a mid-higher tier community hospital program in NYC, so my chances for the traditional cards then hf fellowship are slim. I was planning to do a nephrology fellowship at a large research institution to get some publications as nephro and cardiology have unique common grounds in heart failure patients. After interdepartmental research at this large institute I would then plan to then apply to cardiology. Yes it is a lot of training. Blah blah blah. It’s something I want to do. A chief year is not really on the table either since I don’t see the value of being a secretary for a year without much improvement to my CV when I can get a stellar CV boost from a 2-year nephro program. Any thoughts?
 

Renal_Prometheus

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So you are proposing to do 2 yrs of nephrology fellowship, then maybe get into a 3 yr cardiology program, then do another year of heart failure. How many working years do you have left before retirement? what a waste of human capital. Just so you know, IMGs have done a nephrology fellowship and then try to apply to IM and still could not get in.
 
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Chemist0157

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Looking at the match data, US IMG was basically 50/50 matched and unmatched with the main difference being contiguous ranks. I don’t know if more publications will make that much of a difference.

I would at least consider just applying for cardiology and applying widely before considering doing a different fellowship as prep for another fellowship.
 
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Renal_Prometheus

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Looking at the match data, US IMG was basically 50/50 matched and unmatched with the main difference being contiguous ranks. I don’t know if more publications will make that much of a difference.

I would at least consider just applying for cardiology and applying widely before considering doing a different fellowship as prep for another fellowship.


I cannot believe that I agree with Chemist0157 for once. People should not use another specialty as a stepping stone just because its easy to get into. There's already too many who go into nephrology as a second choice specialty. Once things get tough, they bail and go back to hospitalist. You are doing a disservice to yourself and the specialty for doing this.
 

rokshana

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Hey everyone,
I was hoping to get some of your opinions on an idea I had. I am ultimately interested in Advanced Heart Failure Cardiology. My problem is that I am a US IMG from a mid-higher tier community hospital program in NYC, so my chances for the traditional cards then hf fellowship are slim. I was planning to do a nephrology fellowship at a large research institution to get some publications as nephro and cardiology have unique common grounds in heart failure patients. After interdepartmental research at this large institute I would then plan to then apply to cardiology. Yes it is a lot of training. Blah blah blah. It’s something I want to do. A chief year is not really on the table either since I don’t see the value of being a secretary for a year without much improvement to my CV when I can get a stellar CV boost from a 2-year nephro program. Any thoughts?
The chief year will have more value in trying to get a cards fellowship, not nephrology...why not do a heart failure fellowship year and then do cards? That’s what most people who are not competitive for cards do to see if they can build their CV.
 

mszzeta

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Hey everyone,
I was hoping to get some of your opinions on an idea I had. I am ultimately interested in Advanced Heart Failure Cardiology. My problem is that I am a US IMG from a mid-higher tier community hospital program in NYC, so my chances for the traditional cards then hf fellowship are slim. I was planning to do a nephrology fellowship at a large research institution to get some publications as nephro and cardiology have unique common grounds in heart failure patients. After interdepartmental research at this large institute I would then plan to then apply to cardiology. Yes it is a lot of training. Blah blah blah. It’s something I want to do. A chief year is not really on the table either since I don’t see the value of being a secretary for a year without much improvement to my CV when I can get a stellar CV boost from a 2-year nephro program. Any thoughts?

"mid-higher tier community hospital program" should have a decent chance of matching cardiology if you work very hard with your clinical and research performance, unless we have different criteria for the tiers.

You are a US IMG so already have advantage than your colleagues needing visas. If you do a chief year, the chance will even be higher

And I have seen people even doing a heart failure fellowship BEFORE gen cards fellowship.

Doing IM residency + nephrology fellowship + cards fellowship + hf fellowship will be miserable and make you burn out.
 

NotAProgDirector

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A Nephrology fellowship will give you almost no exposure to cardiology faculty. You'll be spending lots of time in Neph clinic and the dialysis unit. Perhaps some overlap with CVVH and CCU patients -- but that's minimal. You might get some elective time but then your Neph PD will likely only let you do a single Cards elective, and you'll need to do Neph (not cards) research. I don't think this is a good plan.
 

IMResApplicant

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A Nephrology fellowship will give you almost no exposure to cardiology faculty. You'll be spending lots of time in Neph clinic and the dialysis unit. Perhaps some overlap with CVVH and CCU patients -- but that's minimal. You might get some elective time but then your Neph PD will likely only let you do a single Cards elective, and you'll need to do Neph (not cards) research. I don't think this is a good plan.
There is great interdepartmental research in the program I am eyeing so that won’t be an issue
 

IMResApplicant

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Looking at the match data, US IMG was basically 50/50 matched and unmatched with the main difference being contiguous ranks. I don’t know if more publications will make that much of a difference.

I would at least consider just applying for cardiology and applying widely before considering doing a different fellowship as prep for another fellowship.
I am sort of geographically limited so that is another reason I just want to apply to local cardiology/hf programs.
 

IMResApplicant

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So you are proposing to do 2 yrs of nephrology fellowship, then maybe get into a 3 yr cardiology program, then do another year of heart failure. How many working years do you have left before retirement? what a waste of human capital. Just so you know, IMGs have done a nephrology fellowship and then try to apply to IM and still could not get in.
How is that length of time any different from an IM res, chief year, cards fellowship, interventional fellowship (9 years) vs what I am proposing (also 9 years) but you don’t condemn interventionalists as being a waste of human capital. And FYI a lot of those imgs that pursue nephrology before completing an internal medicine residency have absolutely no interest in doing nephro after. I have spoke with a lot of them personally and they would rather do an easy nephro gig and get their foot in the door vs years of research, applying, etc vying just for an IM spot
 

Chemist0157

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I am sort of geographically limited so that is another reason I just want to apply to local cardiology/hf programs.
Well, that’s the real problem, and I’m not convinced a nephrology fellowship will help circumvent that limitation. You’d have to somehow rub enough elbows with the local programs as a renal fellow to get an edge, but they will not be locked in to accept you by any means.

I saw you have another thread in the cardiology forum and would point out that even though some renal knowledge could be helpful for a cardiology and heart failure fellow, that notion will probably not have any bearing on actually matching. Essentially all successful cards matches lead to successful cards careers without any renal training, correct?

Not trying to be a negative Nancy, but these are my thoughts from a renal standpoint.
 

thecalccobra

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Better to spend an extra year doing research/HF/preventive cardiology than doing Nephrology.

Nephrology is an okay track for those trying to back door into critical care, not cards.
 

IMResApplicant

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Better to spend an extra year doing research/HF/preventive cardiology than doing Nephrology.

Nephrology is an okay track for those trying to back door into critical care, not cards.
No absolutely not! Don’t feel like a negative Nancy, I want honestly and unfiltered feedback. I appreciate that. I mean honestly, I truly do love nephrology as well. I’m not using it purely as a “back door” into any specialty. I will gladly see nephrology and chf patients in my clinic down the road. I really wanted to combine both specialties, that’s why I think I am drawn to HF. Also, I have considered just going for one of those unaccredited fellowships, but I feel like I am so close to applying for nephro, I won’t get any support changing my mind so late and suddenly
 
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Renal_Prometheus

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No absolutely not! Don’t feel like a negative Nancy, I want honestly and unfiltered feedback. I appreciate that. I mean honestly, I truly do love nephrology as well. I’m not using it purely as a “back door” into any specialty. I will gladly see nephrology and chf patients in my clinic down the road. I really wanted to combine both specialties, that’s why I think I am drawn to HF. Also, I have considered just going for one of those unaccredited fellowships, but I feel like I am so close to applying for nephro, I won’t get any support changing my mind so late and suddenly

So let me give you a realistic scenario that can happen if you plan to do this. Lets say you finish nephrology fellowship and couldn't match into cardiology, are you going to practice nephrology? It that an ok outcome? Let's extend this out further and you practice nephrology for several years and realize you are working more hours and making less than a hospitalist. Are you ok with that outcome? Your decisions today will have years of repercussion.
 

IMResApplicant

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So let me give you a realistic scenario that can happen if you plan to do this. Lets say you finish nephrology fellowship and couldn't match into cardiology, are you going to practice nephrology? It that an ok outcome? Let's extend this out further and you practice nephrology for several years and realize you are working more hours and making less than a hospitalist. Are you ok with that outcome? Your decisions today will have years of repercussion.
If cards doesn’t work out I’ll go into crit care. Heck, I’m okay even being a nocturnist and doing outpt nephro during the day. HF is just to goal.
 

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Hm, can you clarify again what your goals are? It seems like you would be fine to do cards into HF or nephro into CC or nephro into nocturnist/outpatient nephro (which is super niche and I would not count on that).

You could apply for cards right out and roll the dice instead of doing things before that may not increase your chances of success. You could just do renal and see CKD/HF patients in clinic, but instead of milrinone and LVADs, it would primarily be diuretic recommendations and eventually RRT (PD sometimes earlier than normal for volume control) if it came to that. You could do CC after renal, but there’s no HF angle there. You could do hospital medicine at an academic center and do primarily the cards services. My program had a “hospitalist cardiology” service. Maybe doing something like that where you would be interacting with cardiology regularly would have a greater impact on your local academic faculty than the aforementioned options.
 

Renal_Prometheus

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If cards doesn’t work out I’ll go into crit care. Heck, I’m okay even being a nocturnist and doing outpt nephro during the day. HF is just to goal.
So just to be brutally honest because I’m very familiar with this. By the time you finish nephrology fellowship, everyone has figured out this specialty and will be applying for limited number of critical care spots. There’s no guarantee that you can get one. It sounds to me like you just don’t want to do hospitalist. But doing neph as a second choice specialty won’t necessarily get you anywhere either. You should only do nephrology if you are interested in the subject.
 
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I am sort of geographically limited so that is another reason I just want to apply to local cardiology/hf programs.
Dude/dudette. You’re willing to do an entire Nephrology fellowship in order to get into Cards, but you’re not willing to move to Kentucky?!
 
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IMResApplicant

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Hm, can you clarify again what your goals are? It seems like you would be fine to do cards into HF or nephro into CC or nephro into nocturnist/outpatient nephro (which is super niche and I would not count on that).

You could apply for cards right out and roll the dice instead of doing things before that may not increase your chances of success. You could just do renal and see CKD/HF patients in clinic, but instead of milrinone and LVADs, it would primarily be diuretic recommendations and eventually RRT (PD sometimes earlier than normal for volume control) if it came to that. You could do CC after renal, but there’s no HF angle there. You could do hospital medicine at an academic center and do primarily the cards services. My program had a “hospitalist cardiology” service. Maybe doing something like that where you would be interacting with cardiology regularly would have a greater impact on your local academic faculty than the aforementioned options.
My goal is simple. To be a heart failure specialist. I love medicine regardless, so I would be FINE with those other career paths, but am going to try for HF medicine.
Again, there is no point on becoming a chief. There is such a long “waiting list” of former chiefs from years ago still waiting for their spot at my home institution. So I know of programs that are close knit and take their own into their program. Whether that is after unaccredited or accredited fellowships. That’s ideally the arena I would be in. I’m too far into my residency now to change plans away from nephro anyway.
 

Chemist0157

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My goal is simple. To be a heart failure specialist. I love medicine regardless, so I would be FINE with those other career paths, but am going to try for HF medicine.
Again, there is no point on becoming a chief. There is such a long “waiting list” of former chiefs from years ago still waiting for their spot at my home institution. So I know of programs that are close knit and take their own into their program. Whether that is after unaccredited or accredited fellowships. That’s ideally the arena I would be in. I’m too far into my residency now to change plans away from nephro anyway.
Not sure if you needed to make two threads then regarding this topic if you feel you are locked in to doing renal anyway. Maybe you were just looking for reassurance... Good luck to you.
 

rokshana

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How is that length of time any different from an IM res, chief year, cards fellowship, interventional fellowship (9 years) vs what I am proposing (also 9 years) but you don’t condemn interventionalists as being a waste of human capital. And FYI a lot of those imgs that pursue nephrology before completing an internal medicine residency have absolutely no interest in doing nephro after. I have spoke with a lot of them personally and they would rather do an easy nephro gig and get their foot in the door vs years of research, applying, etc vying just for an IM spot
Because doing a cardiology fellowship gives you a good shot at interventional cards...doing a nephrology fellowship as a stepping stone to cards makes no sense...the cards programs will not find you to be a competitive candidate so many years out and you will be competing with all those residents with their cardiology focused research...you will spend 2-3 years with no realistic guarantee for a cards fellowship.
 

IMResApplicant

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Because doing a cardiology fellowship gives you a good shot at interventional cards...doing a nephrology fellowship as a stepping stone to cards makes no sense...the cards programs will not find you to be a competitive candidate so many years out and you will be competing with all those residents with their cardiology focused research...you will spend 2-3 years with no realistic guarantee for a cards fellowship.
What are you talking about? What precludes me from doing cardiac research during fellowship? At top institutions there are ample opportunities for interdepartmental research so I would be just as, if not more competitive.
 

Renal_Prometheus

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Not sure if you needed to make two threads then regarding this topic if you feel you are locked in to doing renal anyway. Maybe you were just looking for reassurance... Good luck to you.


Hey Chemist0157. This is between you and me. Looks like unfilled neph programs do take IMGs who couldn't get into IM. Maybe you don't know your own specialty as well as me.

IMResApplicant said:
How is that length of time any different from an IM res, chief year, cards fellowship, interventional fellowship (9 years) vs what I am proposing (also 9 years) but you don’t condemn interventionalists as being a waste of human capital. And FYI a lot of those imgs that pursue nephrology before completing an internal medicine residency have absolutely no interest in doing nephro after. I have spoke with a lot of them personally and they would rather do an easy nephro gig and get their foot in the door vs years of research, applying, etc vying just for an IM spot
 
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rokshana

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So when I was applying to endocrinology ( not a competitive fellowship by any means) I considered dual applying to nephrology...I had done a lot of renal as a resident and my research was renal endocrine and my research mentor was a nephrologist...I asked him what he thought about dual applying...he said apply to endocrine...if I didn’t match, he said he would make sure I had a nephrology spot...even then, nephrology was not difficult to get...apply to cardiology or heart failure fellowship and if you don’t match...there will be a nephrology spot available.
 
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rokshana

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What are you talking about? What precludes me from doing cardiac research during fellowship? At top institutions there are ample opportunities for interdepartmental research so I would be just as, if not more competitive.
You are being unrealistic...your fellowship PD is not going to approve of you doing cardiology research as a nephrology fellow...and cards won’t see a reason to take on a renal fellow when they have their own cards fellows and IM residents who are interested in cardiology...
If you want to be a nephrologist... be a nephrologist... if heart failure from a cardiology perspective is what you want to do... then do things that make you a competitive applicant for cards...doing a couple of years of cards research is going to get you better connections and publications that will help with that more than doing nephrology fellowship.
If you were hoping for someone here tell you that doing nephrology to get to cardiology is a good idea...you came to to the wrong place.
 
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rokshana

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Hey Chemist0157. This is between you and me. Looks like unfilled neph programs do take IMGs who couldn't get into IM. Maybe you don't know your own specialty as well as me.

IMResApplicant said:
How is that length of time any different from an IM res, chief year, cards fellowship, interventional fellowship (9 years) vs what I am proposing (also 9 years) but you don’t condemn interventionalists as being a waste of human capital. And FYI a lot of those imgs that pursue nephrology before completing an internal medicine residency have absolutely no interest in doing nephro after. I have spoke with a lot of them personally and they would rather do an easy nephro gig and get their foot in the door vs years of research, applying, etc vying just for an IM spot
Can you two take this to PMs... your personal fights don’t need to be in the threads
 

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It's possible that a Neph fellowship will help you get a Cards fellowship at that specific site if what you're saying here is accurate.

But if your plan is to be a heart failure specialist, I'd recommend just doing a HF fellowship and then building a practice as a heart failure specialist. You wouldn't be able to cath people, but could otherwise treat their heart failure.
 

IMResApplicant

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It's possible that a Neph fellowship will help you get a Cards fellowship at that specific site if what you're saying here is accurate.

But if your plan is to be a heart failure specialist, I'd recommend just doing a HF fellowship and then building a practice as a heart failure specialist. You wouldn't be able to cath people, but could otherwise treat their heart failure.
This is what is key. Yes the specific site I would do my nephro fellowship has a cards fellowship (and even a nonaccred CHF fellowship) and has a track record of taking their housestaff. Was not planning to apply widely to cards - just at that site.
 
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This is what is key. Yes the specific site I would do my nephro fellowship has a cards fellowship (and even a nonaccred CHF fellowship) and has a track record of taking their housestaff. Was not planning to apply widely to cards - just at that site.
One thing you haven’t really mentioned is ok are you with ending up in General IM or Nephrology?

If we look at the actual NRMP data, in 2018 US IMGs who ranked one program had a 19% match rate. If you look at all applicants from last year (this year has not been released yet) then about 38% of all applicants matched at their 1st choice.
 

the argus

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A chief year is not really on the table either since I don’t see the value of being a secretary for a year without much improvement to my CV when I can get a stellar CV boost from a 2-year nephro program. Any thoughts?
In my experience as a US-IMG that applied to one of the more competitive subspecialties (not cards), I actually think a chief year is a HUGE plus to your application. I think you get a much bigger CV boost from a chief year compared to a nephrology fellowship.

In my experience from a large university IM program with mixed grad types (USMD, DO, US-IMG and foreign-IMG), the US-IMGs that did a chief year always matched at higher tier programs compared to the other IMGs and DO.
 
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blue.jay

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OP, You are either too naive or the biggest nerd ever. Who does so many years of training to get paid less? 7-8 yrs for interventional cards makes sense.
Why would someone want to be a slave to these academic overlords for 9 years?
You learn the nuances of cardiorenal syndrome better as a cardiologists. Most renal programs are workhorse and you will rarely have time to focus on cardiology. You will probably see 30-40 new consults plus follow-ups a day.

I don't understand this fantasy with bogus fellowships. You will never be prepared regardless of how many fellowships you do. Medicine is a life long learning and you will learn so much more on the job.

It is also not a wise idea to just place your bets in a single program. Regardless whether you do a chief year, nephrology for heart failure fellowship there is no 100% guarantee that they will take you. Also, none of the above posters recommended your nephrology plan which is a telling sign.
 
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I would say apply for Cardiology directly +/- chief year for the CV boost. Chief year would be way way better than a nephrology fellowship for a CV boost. Don't undersell yourself with being a US-IMG, many have matched before you with a decent CV. Focus your efforts on research and connections right now and definitely don't do a nephrology fellowship for a CV boost.
 

aafisahar

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I am sort of geographically limited so that is another reason I just want to apply to local cardiology/hf programs.

Unless you are the sole provider to one of your parents on hospice, you do not have the luxury of being geographically limited for cardiology.

Time to put on your big boy pants and make a hard decision on what really matters to you.
 
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Renal_Prometheus

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I feel like the OP is still in the mindset of getting any specialty is a better than a hospitalist. Unfortunately, many of these unfilled specialties rely on these people for cheap labor and they are not aware they are the ones being taken advantage of. Sometimes you can do more damage to your career living on false hope.
 
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