Cardiology fellowshiop

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wsingh

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This is a question directed to all you cardiology fellows and cardiologists. I am currently an osteopathic MS III and starting to think about cardiology as a career choice. Keep in mind I have not yet done a cardiology rotation (coming up soon). I wanted to get an idea of how competitive it is to get a cardiology fellowship (I am willing to move anywhere in the US). Is it better to do my IM residency at a place that has a fellowship program or it doesn't matter? Any input would be appreciated. Thanks.

WS

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I am not a cardiology fellow or a cardiologist, but because I don't think that there are any of those two that post in these forums, I will try to answer your questions for you. Cardiology is currently very competetive, but most students who train at allopathic university mid-tier and above programs are able to match as long as they are flexible with what location they can train at. I was given the impression while on the interview trail that many mid-tier and above allopathic university IM programs had very few to no osteopathic physicians training at them, but I don't know if this was due to self-selection on the student's part because I interviewed mostly at east coast programs, or whether or not there was broad dismissal of osteopathic applicants at these schools as I know occurs in other specialties. Anyways, if you are a good student, I'm certain that you can find a decent allopathic university IM program to train at; you should just do some research before applying into which schools have taken osteopathic physicians in the past. Most allopathic university programs do have cardiology fellowship programs, and I wouldn't reccomend doing your residency at any place that doesn't have one. The reason for this is because most cardiology and other fellowships choose to accept ~20-50% of their own residents as fellows, so if you do not train at a program with a fellowship program, you will be missing out on those spots that may be easier for you to match into.

For more info on what you can do to help yourself get into a cardiology fellowship, I'd reccomend reading the FAQ at the top of the page. There is a link there that has what one person thought cardiology fellowship programs look for in applicants too.
 
I think I said this once before, but as an alternative for you as a D.O. --

I met an intern at one of the very competitive IM residencies that I interviewed at who had done a year of internship at a DO IM program, and then gone on to this upper tier allopathic IM residency to do ANOTHER intern year. Not sure if I would recommend this, but she had the very specific goal of going to a high-powered academic cards fellowship. She also looked pretty f'in burned out :)
 
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Thanks for the input. I also did a search on the threads and found some good info.
 
wsingh,

I'm a 3rd year cardiology fellow and a DO.

THere are 3 routes to take as a DO for CV training. You could take the DO route: do your post grad IM training through an osteopathic hospital then apply for DO CV Fellowship. Issues with this route as I see it: 1) there are only a handful of good DO IM GME training programs, 2) there are very few DO CV fellowship positions available, 3) those DO CV fellowship positions may not offer good training (or complete training in all aspects of cardiovascular care) therefore limiting your options when you start practice.

You could do osteopathic IM training and then apply for ACGME CV fellowship. It's been done in the past, however, CV fellowship is very competitive, plus there are certification issues to consider when your training is completed. The ABIM requires board certification in IM before being eligible to sit for the cardiology boards. This wasn't such a big issue in the past, but now many insurance panels require board certification in order to bill and some hospitals require this for privilleging... (I don't think you can do ACGME IM training and then do a DO CV fellowship: the AOA is a stickler on this).

The final and prob'ly best route for CV training is through the ACGME. There are many more CV programs in the MD world, all of which open doors to more advanced training (re: intervention, EP, nuclear, echo, MRI, etc). I agree that training at a University IM program with it's own CV fellowship is good advice. Not only does this usually give you better odds of matching at your home institution, but also gives you an opportunity to work with acedemic cardiologists who are known by other program directors (get recommendation letters from these people).

The question of whether to go to a top IM program and be middle-of-the-road resident VS going to a smaller program and being a star is a good one... Our program director looks at an applicant's achievements more than where they trained. I know that other programs only interview candidates from top-tier IM programs. (I guess if you can be a star at Cleveland, Barnes, Bringham, UCSF, etc, then this isn't an issue).

I also suggest getting involved in research ASAP. Make a real effort to present at a nat'l meeting (ACP, AHA, ACC). Putting together an abstract and poster really isn't that hard, work with a CV fellow or staff. Once you've published an abstract, submit the manuscript. When you find a niche, the publications just take off... I've seen many residents ruin their chances at a CV spot by making only a half-hearted attempt at research, and starting a only few months b-4 applying for fellowship. Seems like almost all CV programs want fellows who have done and are interested in research. This makes sense because cardiology is very evidence-based and 'why would a cardiologist go into academics?'... to do research.

Good luck with your training...
 
as someone who is nearing the end of the cards fellowship application cycle, here is my advice:

1) go to the very best acgme university program that you can. applying from an acgme community program will be a problem for you, given how extremely competitive the process has become (my hospitals cards program recieved over 800 applications, and interviewed 70 of these for 4 available spots.) At my interviews, I can count on one hand the people I met from community programs.

2) doing research as an intern and resident is a REQUIREMENT. start as early as possible (middle of intern year at the latest). work with people at your hospital who are well known across the country, because your research mentors are the people who will be writing letters for you and making phone calls for you to fellowship program directors.

3) i agree that going to a program with its own cards program is a very good idea. Again, many program will take some to all of their fellows from their own residency programs.

4) apply widely, to at least 30 programs.
 
Sorry to hijack this thread, just want to comment on how unusual it is to see two such "old-timers" on the same thread. Make that three!
 
So what is the cardiology fellowship itself entail? (once you get in?)
I've heard that the fellowship is actually tougher than IM residency... Is it really worse than intern year? as a cardiology fellow would you be spending all your time at the hospital, night and day? how often are you on call, etc?
 
What is considered to be "good enough" as far as research is concerned to get a cards fellowship? Would one abstract presented at AHA be good enough? Also, is it crucial to be first author on an abstract and/or manuscript or will second or third authorship be good enough, assuming you're name is alongside some big names in the field?

Also, what do you think the average number of abstracts/publications are of an accepted applicant into a cards fellowship?
 
Do you need to do an AOA rotating year to apply for a DO fellowship?

If so, then you can just do the intern year and an ACGME residency and apply to both allopathic and osteopathic fellowships.
 
I'll take a stab at answering some of your questions,

Nestle;

Yes, I found fellowship to be more demanding than residency... I'm at the hospital more, fewer days off, and no leaving early post-call. However, it is also more rewarding. Also, call is better (home) and when I do come in, it's for something interesting (eg: tranvenous pacer, pericardiocentesis, echo, ST-MI, etc...). In our program, we cover two hospitals and take q6 weekday call and q3 weekend in 1st and 2nd year, then 1 weekday call/mos in 3rd year.

Most of our clinical resposibilities are in the first year of fellowship, prob'ly harder than internship, mostly because you are the 'go-to-guy(gal)'. Everyone on the wards or units needs cardiology for something. But it's great being able to make the diagnosis, do the procedures and offer the definitive treatment that the other services want...

Echoburress;

Of course, the amount of research that's 'good enough' at one program may not be at another. A simple rule of thumb would be to do something and try to get published. If you are making a concerted effort to contribute to research in some fashion that'll help. Even if you are not published, list this on your CV under a heading titled "current research": 1) the title of your project, 2) under who's direction, 3) at what facility, and 4) dates of involvement.

My best advice regarding research would be to get started early, you can't start soon enough. In fact, there are 2 (TWO!) 4th year med students who come to our interventional research meetings each week. Plus, they both had abstracts at the AHA this year and have submitted manuscripts (one' first author on a manuscript in Circ already). Of course, these are the guys we all hated in med school, making the rest of us look like slackers. But, they are going to Bringham and Womens and Mayo next year and will be able to choose what Cards program they want...

So, even if you didn't start research in med school, start now! Ask a cardiology fellow or staff about their research and see if you can help. You won't be first author for the first paper, but often you can spear-head a sub-analysis and take first author on that. I suggest doing retrospective research. Prospective will take too long for it to produce publications for you. Also, you could come up with your own idea for research, but that's not easy... Best is to help develop a database (eg: I put together a procedural database and have been publishing from that). You'll find that once you get started with something, you'll be able to do multiple anaylses with that. It's not hard to put together an abstract, submit it to a nat'l meeting and write up a manuscript. You'll want to work with someone who's published and knows how to write and can proof for you... Good luck.

Mollie;

I didn't do a rotating internship. I went straight to ACGME IM residency. If you want to work in one of the 5 states requiring DO internship, you may want to do this. Although, I've heard, there are ways around that rule as well. If you do do an internship, I'd do it as part of a track for IM residency, so you don't loose a year. Most ACGME programs won't give you credit for the internship if you leave the AOA after your first year though (but, you could do internship as part of a dually-acredited AOA/ACGME program).

I'm not sure if doing a DO internship then an ACGME IM residency would make you eligible for DO cards fellowship. You would be eligible for ACGME cards fellowship though... (Again, if you went to a dually-acreditted program, you should be eligible for both).

That would open more options for you, however, I'd do ACGME fellowship first and use AOA fellowships as a back-up. Interestingly, as I've been getting calls from recruiters and as a DO, I am asked specifically if my training was through the ACGME or AOA. Recruiters tell me many groups specifically state they are interested in only ACGME trainees.
 
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