Is there a national ranking list for CT anesthesia programs?
Cardiothoracic anesthesia (ACTA) fellowship 2025
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Gathering information from previous posts, seems Cleveland Clinic, Duke and THI are top programs with Columbia, Stanford, MGH/BWH closely following.
Was wondering more so for programs that are not as big name institutions. For instance buffalo versus Albany.
Like ranking for annual snow fall?
But seriously, most people on this board would say your training depends more on your own effort/aptitude than the perceived prestige of the program. It looks like you have an affinity to the geographic location. It would be more important to figure out whether people are happy at those places than some national ranking that have 15 places in the top 10.
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Even if this list did exist, I would highly recommend ignoring "prestige" when it comes to making a rank list. Train where you will be the happiest. Train where you want to work in the future. Stop chasing clout.
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UT Houston is split between Memorial Herman and Methodist. Memorial herman does a lot more bread-and-butter cases. Methodist does a lot of transplants and "bigger" cases. They are an up-and-coming program. The fellows are well trained. It's compared to BCM/THI a lot just because they are across the street from each other. You mainly sit your own cases there.
THI is a true "CA4" year. You sit your own cases and rarely supervise. You do cardiac/vascular/thoracic/liver tx/cath lab. The cases are generally very complex. There is nothing that is not done there and you get your mix of B&B CABG and valves. 70-100 lung tx. A lot of hearts tx/VADS. Known for their thoracoabdominal aneurysms and do multiples a week. Only 2 months of TEE and echo teaching is self-taught. The institution is by fellows/residents so sometimes you do noneducational cases. Regarded nationally up there with Cleveland Clinic/Duke. Fellows are very well trained there and their reputation is well known.
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Best Cardiac Anesthesia Fellowships Ranking List | Cardiology Fellowships
Find out what the 10 best cardiac anesthesia fellowships are and read our application tips and some common mistakes people make when applying to programs.
www.cardiologyfellowships.net
Best CT Fellowships?
What are the best CT fellowships in terms of quality of training and reasonability of responsibilities?
forums.studentdoctor.net
My two cents is that it is much more important what you are bringing to the fellowship in terms of drive and work ethic. Your key word is "autodidact" In a few years there will be technology and practices that your teachers/mentors never dreamed of.
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PM me with your contact info and I can discuss in much more detail. Are you applying in this cycle?
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I think you mainly should focus on what you want out of the fellowship.
Case quantity and complexity is huge to consider. I wanted a place doing transplants, LVADs, complex vascular and thoracic, terrible 3x redo sternotomies etc. and in high enough volume that I'd see a lot of them. That ruled out a decent amount of places.
Do you want to sit your own cases? Or supervise? Or both? Places like Cleveland, Duke, and THI are always sitting your own cases as I understand it. U of Michigan you do mostly supervision. Many places mix it up. My program did 3 months of own cases and 3 months of supervising residents so there was a good mix.
Depending on where you want to end up, your training program may be important geographically if pursuing a specific job in that locale or reputation may carry a lot of weight if you're trying to land at a big name academic place.
What's the call burden like? Some places wreck you with call. My call burden was not bad, and had plenty of flexibility (could switch on a whim if there was a good case I wanted to do).
Do you want to just explore someplace new for a year?
How big of a department do you want to be a part of? More or less co-fellows? Having at least one is nice to commiserate with and bounce ideas off of throughout the year.
Just a few thoughts.
In case it's unclear, the list of "best cardiac anesthesia fellowships" on a "CARDIOLOGY FELLOW" website should not be trusted.Best Cardiac Anesthesia Fellowships Ranking List | Cardiology Fellowships
Find out what the 10 best cardiac anesthesia fellowships are and read our application tips and some common mistakes people make when applying to programs.
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I sometimes read this forum and can’t help but jump in with a controversial take with something I figured out during my fellowship interview process. For the record I did both residency and fellowship at BIDMC.
I started by applying widely for ACTA, had a very competitive application, and received interviews to almost everywhere I applied. I went on interviews to Duke, Columbia, THI, etc. All these programs were powerhouses in the fact you will get to do really big cases – lots of transplants, LVADs, lines, circ arrests, research, etc. They will all prepare you to practice in a similar environment and do these cases.
The thing they are all missing and where I felt BIDMC is different - structural heart. Even as a CA2 I was in the room holding the probe with Mahmood over my shoulder doing ASD closure, VSD closure, PVL closure, mitraclip, Watchman, TAVR with 3D TEE (sizing valve, coronary heights, etc), valve-in-valve mitral/tricuspid, etc. As a fellow you do this room 1-2 times per week and it’s the best TEE training on the planet. The volume of structural heart is immense and anesthesia residents/fellows get to hold the probe and are intimately involved throughout these cases. As a fellow you will learn with interventional cardiology, etc.
The big wakeup I remember (coming off a CA2 month doing TEE - essentially following Dr Mahmood around) was following other fellows in the OR during interviews. By that time, I knew more about TEE than the Jan/Feb/Mar fellows I shadowed in the OR during these interview days. What I perceived as lack of TEE skill in the second half of fellowship at the above programs was mind-blowing and concerning. And I’m sure they studied up at the end of the year and passed TEE boards without any issue. But the nagging feeling I left with that the TEE training at all these programs was garbage in comparison - was a feeling I couldn’t shake the entire rest of the year and the reason I stayed at BIDMC.
I’m now in private practice and director of a big structural heart program. When the cardiologists are having difficulty with imaging a mitraclip they call me. When they need TEE sizing for TAVR with high Cr they book around my schedule. I am integral the success of the program and these relationships have meant the world during hospital contracts, committees, etc.
I think I am equally as comfortable doing the type A on call, transplant, or LVAD as anyone from any of those above programs although my case numbers would likely be less than any of those above programs.
Just realize there are pluses and minuses to everything you pick and there is a reason BIDMC would be seen as #1 on a cardiology website and it’s for very good reason. A reason that may be more likely to translate to professional success for the rest of your career than many of the other programs mentioned. Good luck during the fellowship interview and matching process.
I started by applying widely for ACTA, had a very competitive application, and received interviews to almost everywhere I applied. I went on interviews to Duke, Columbia, THI, etc. All these programs were powerhouses in the fact you will get to do really big cases – lots of transplants, LVADs, lines, circ arrests, research, etc. They will all prepare you to practice in a similar environment and do these cases.
The thing they are all missing and where I felt BIDMC is different - structural heart. Even as a CA2 I was in the room holding the probe with Mahmood over my shoulder doing ASD closure, VSD closure, PVL closure, mitraclip, Watchman, TAVR with 3D TEE (sizing valve, coronary heights, etc), valve-in-valve mitral/tricuspid, etc. As a fellow you do this room 1-2 times per week and it’s the best TEE training on the planet. The volume of structural heart is immense and anesthesia residents/fellows get to hold the probe and are intimately involved throughout these cases. As a fellow you will learn with interventional cardiology, etc.
The big wakeup I remember (coming off a CA2 month doing TEE - essentially following Dr Mahmood around) was following other fellows in the OR during interviews. By that time, I knew more about TEE than the Jan/Feb/Mar fellows I shadowed in the OR during these interview days. What I perceived as lack of TEE skill in the second half of fellowship at the above programs was mind-blowing and concerning. And I’m sure they studied up at the end of the year and passed TEE boards without any issue. But the nagging feeling I left with that the TEE training at all these programs was garbage in comparison - was a feeling I couldn’t shake the entire rest of the year and the reason I stayed at BIDMC.
I’m now in private practice and director of a big structural heart program. When the cardiologists are having difficulty with imaging a mitraclip they call me. When they need TEE sizing for TAVR with high Cr they book around my schedule. I am integral the success of the program and these relationships have meant the world during hospital contracts, committees, etc.
I think I am equally as comfortable doing the type A on call, transplant, or LVAD as anyone from any of those above programs although my case numbers would likely be less than any of those above programs.
Just realize there are pluses and minuses to everything you pick and there is a reason BIDMC would be seen as #1 on a cardiology website and it’s for very good reason. A reason that may be more likely to translate to professional success for the rest of your career than many of the other programs mentioned. Good luck during the fellowship interview and matching process.
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That is certainly unique. Very cool. I hung out with the cardiologist while they did the structural heart echoes but did none myself. We were pretty low volume for things like mitra-clips and valve-in-valve cases etc.
Of note, when I went to echo week in Atlanta last year, they were talking all about structural heart stuff before they eventually said "Raise your hand if the anesthesiologists are doing the echo at your institution for structural heart cases" and it was easily less than 10% who raised their hands, as cardiology is doing these at the large majority of institutions.
So, while doing a bunch of structural heart likely develops awesome echo skills, it is likely not essential to 90+% of practicing cardiac anesthesiologists. (Same could be said for LVADs, lung txps, etc. I realize)
Not saying someone shouldn't want to do it, just that it does not necessarily need to be a deal-breaker for someone.
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It is great that you found a job that lets you maximize your training, but the reality, as abolt mentioned, is that cardiologists do the structural heart echos and they refuse to share in most parts of this country. It is not about who has the skillset, but about the political landscape. I also trained at a place (not bid) where we held the probe and I felt very comfortable doing it by the end of my fellowship, but at least in the city that I am limited to, the echos are all done by the cardiologists, and they will never let me hold the probe until the political landscape changes.
Having said that, doing this in training is very educational since you really get to understand 3d and MPR in the process. You will be a better echocardiographer by doing it.
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What a laughable list
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Abolt where you do fellowship?
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I did a crit care fellowship. I keep having this itch to go and do a CT fellowship but I make about $650-700k and that alone makes it hard to go back . I really do like cardiac a lot and enjoy those cases
Porky_Pork_Chop
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same boat lol, couldn't be bothered to Grind that hard again after CA1 ITE and Basic. I heard some places ask for it anyone know where?
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Why would you go back to being a fellow after making 650-700k a year? Itch is just an itch. Don’t do it. Only do it if it literally kills you from the inside that you are not doing these cases.
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Let me be clear there’s like a 5% chance I go back. Wish I could though
Dang they pay intensivists that much? I did not know lol
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DM for details
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Well, one could make the same argument for a CA-3 to not do fellowship and go straight into private practice. The only real difference is that the CA-3 hasn't had any lifestyle inflation or experienced how nice it is to not be a trainee.
Any fellowship year is a ~half million dollar opportunity cost whether you do it right after residency or years later.
There are advantages to going back to fellowship after some time as an attending. Most of us who've done that are glad we did.
Anyway, the only other thing I'd add to the discussion of evaluating fellowship programs is that they can be divided, very broadly, into two types of fellowship: the "echo fellowship" in which the fellow does mostly supervisory work with residents and/or floats from OR to OR to do TEE, and the "workhorse fellowship" in which the fellows sit their own cases start to finish.
I was not personally impressed with the idea of doing an echo fellowship, so I chose a non supervisory program. The upside was I got amazing training and spent a lot of time in the OR. The downside was that at 5 PM on June 30th they had my slave ass in an OR doing a case.
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I'm sure that's true. I didn't look closely at a large number of programs, but the ones I did were very tilted one way or the other. I think I can count on one hand how many times I worked with a resident during my fellowship - just a couple of transplant cases on call.
When I was applying, I figured that every day I wasn't in an OR doing my own cases was going to be a day that left useful experience on the table. I was leaving practice as an attending and was going to be a geographic bachelor for the year, so I was giving up a lot for the experience. I wanted to squeeze every bit of benefit possible out of the year.
I feel pretty strongly that when it comes to learning and improving, supervision is inferior to doing cases yourself (incidentally - this is one of my primary dissatisfactions with ACT work in general). I think residents and fellows should be in ORs for long hours, not breezing in and out to do a bit of this and that here and there. I was also very put off by one of my interviews at a supervisory fellowship and decided I didn't want to be like them or a product of their system.
Usual caveats - anyone can coast through just about any fellowship and graduate. What you look like on the other side depends more on you and the case load you're exposed to than how the fellowship is structured.
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If you are a type of fellow that would just bail after induction and echo and just want to coast through the fellowship, what pgg said is absolutely true. If you are a motivated fellow that treats every case as your own, you get the best of the both worlds by going to a fellowship that lets you supervise 60-70% of the time. How much educational value does a case offer during CPB? You can use that time to go to another room for more exposure.
I think there’s a ton of value in doing your own cases all day every day for years . In more than one environment so you can get used to all different kinds of conditions. Those will always be the strongest anesthesiologists.
I think supervision has its place for experienced anesthesiologists that have spent years in the trenches. Because that is a separate skillset as well. And it’s the only realistic way to take on leadership responsibilities
This is just my opinion but Ideally the roadmap is solo personally performed as a fellow and an attending for at least 5 years before adding in supervision and then finally leadership if you want to take that final step
I think supervision has its place for experienced anesthesiologists that have spent years in the trenches. Because that is a separate skillset as well. And it’s the only realistic way to take on leadership responsibilities
This is just my opinion but Ideally the roadmap is solo personally performed as a fellow and an attending for at least 5 years before adding in supervision and then finally leadership if you want to take that final step
Hey, that's my job as the attending
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IMO there is tremendous value in actually watching the surgery all or most of the way through to understand what was done, how it was done, what problems they ran into, what if any plans changed, why it's taking longer or shorter than expected, etc.
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I love these kind of comments. So unbiased. So you handle the 'crisis' in your room that you recognize and treat all by yourself. I do the same except I get called into the room two minutes into it by the intern/resident/CRNA and have to catch up and figure out what is going on within seconds. But then a different crisis happens in one of my other rooms that afternoon so I actually end up having to manage two crises that day while you only get to manage one. And I'm exposed to way more 'conditions' because I'm covering three rooms, sometimes all over the hospital. But you're the strongest anesthesiologist? Not saying I am either, just saying this belief is ridiculous.
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I agree that you can learn a lot from surgeons and a good cardiac anesthesiologist should have a very good understanding of the surgical techniques. But you can talk to the surgeons, and any reasonable surgeon at an academic institution will be happy to explain what they did. You don’t need to spend a few hours sitting the case for it. I learned a ton from our surgeons during fellowship, but it was nice to have the option of doing something more productive during cpb rather than being chained to the room.
The important point that I think keeps getting overlooked is that being a supervisory fellow DOES NOT MEAN that you ditch the case. It is still the fellow’s case and the fellow can stay in the room 100% of the time if the fellow wants to, but also has the option of leaving the room.
Again, if the fellow is driven, this should not be an issue at all. You will get the same learning as sitting your own stool fellowship, and more, but I also see that it can be a slippery slope for the less motivated fellows.
There are programs that strike the balance very well. It does not have to be all or none.
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Rejection from CCF today
There really aren’t any crises in my rooms
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Lol same here. To fix the itch, I took the adult cardiac boards. And passed. The itch is gone.
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Ahh gotcha. Well good for you. Shame though that the best in our field is doing knee scopes and carpal tunnels. Well I’m sure if god forbid a crisis did occur you wouldn’t be rusty at all.
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LOL
I think what he's getting at is that if you're stamping out one crisis after another, there's probably an issue with anticipating and preventing said crises. Some of that is on the CRNA in the room, but most of it is on the anesthesiologist who made the plan.
The essence of our field is making it look like we're doing nothing at all.
Exceptions being events purely driven by surgical misadventures.
Maybe you've got a looser definition of crisis than me, but even when I'm ACT'ing my day away 3:1 or 4:1 it's not common for crises to arise and demand my immediate presence to save the day.
In any case, the context of this thread is whether FELLOWS are better off supervising and drifting from room to room, or sitting their own cases start to finish. Crises that truly can't be anticipated and prevented are very rare events. I think that if trainees want to see some of them occur and evolve, they need to be present. Not drifting around, waiting to be called after the critical moment has passed.
And the point is that the critical moment for most events is well before they deserve the "crisis" label.
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All good and well but you obviously don't work in a major academic center with trainees (anesthesia and surgical), traveling CRNA's, and frequent ASA 4's and 5's. It is not just surgical misadventures that pop up, and you can't be in the room all the time and shouldn't be because residents have to learn to troubleshoot. In your job if you're only putting out fires (crises, decompensations, issues, whatever you want to call it) once a year then that's great for your quality of life but may not make you the 'strongest anesthesiologist' that you think you are. It is actually ideal that neither of you work in academics because with your elite preparation skills there would never be any intraoperative issues so trainees would never learn intraop diagnosing/intervening. And it probably looks like you're doing nothing at all in your ASA 2 LMA CRNA room because .... you actually aren't doing anything.
I'm not weighing in on how this applies to fellowship. I think both models have benefits and can produce excellent cardiac anesthesiologists. I'm weighing in on the comment that the best anesthesiologists are those who do their own cases for a few years. I believe it's highly variable - there are good and bad anesthesiologists in both supervision and own cases settings. Is a cardiac guy in private practice doing his own case more efficient than me at starting a case? Probably. Am I better at supervising and teaching residents in a cardiac room while covering another room with a junior resident and also teaching medical students? Probably. A strong clinician would be good at either and would get better with time doing either.
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There it is.
I was waiting for the ivory tower disdain for private practice and our "healthy" patients.
Been there, done that. There is a lot of variability in "academics" of course. Apart from my own time as a resident and fellow, I've worked a little bit in relatively sedate rural academics, a lot at a middling busy military academic hospital, and a fair bit at a super busy major metro ****show academic centers. I don't do it now, but I've done it enough to draw some conclusions.
Look, there are terrible and helpless anesthesiologists out there working in private practice ACT models where CRNAs are doing the thinking and the work while they dribble donut dust onto their scrubs, and there are terrible and helpless academic anesthesiologists who need the crutch of a fellow to get through the day.
It's just my opinion that trainees and new attendings are better off doing lots of their own cases (ideally, complex ones) than supervising residents or CRNAs (even if it means they get exposure to 2x or 3x or 4x as many "cases"). You can disagree with that and make your own argument to the contrary, but throwing shade at non-academicians just exposes how limited your actual experience is.
lol he couldn't stop himself. He tried so hard
Something I tell the new people joining our CT team is the biggest adjustment for me going from academic CT to private was how much sicker the patients are. Especially the thoracic patients. I'll admit they caught me off guard as a new attending. I went from the ivory tower caseload which was largely pulmonary cancer resections to my current workplace which is a mix of ASA 4 and 5 decorts, penetrating thoracic trauma, thoracic source control operations for infection. The cardiac patients are arguably sicker too but the difference is probably minimal. Double valve endocarditis is pretty routine here, whereas my memories from fellowship were a ton of minimally invasive "elective" valves much of the time.
All else equal, the zipcode of your hospital is probably going to be a major determinant of your case complexity.
Something I tell the new people joining our CT team is the biggest adjustment for me going from academic CT to private was how much sicker the patients are. Especially the thoracic patients. I'll admit they caught me off guard as a new attending. I went from the ivory tower caseload which was largely pulmonary cancer resections to my current workplace which is a mix of ASA 4 and 5 decorts, penetrating thoracic trauma, thoracic source control operations for infection. The cardiac patients are arguably sicker too but the difference is probably minimal. Double valve endocarditis is pretty routine here, whereas my memories from fellowship were a ton of minimally invasive "elective" valves much of the time.
All else equal, the zipcode of your hospital is probably going to be a major determinant of your case complexity.
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There it is.
I was waiting for the routine private practice ASA 5 decort to come up.
Almost as predictable as the ivory tower disdain for your ASA 2 LMA.I think this argument has run it course. You have disdain for academic anesthesiologists who didn't sit their own cases after training. You cry about throwing shade, but this discussion began with burglar's shade. You're both biased - you think your career path makes you better anesthesiologists than those who took a different path. I'm not arguing that my path made me better than you, and there's no anesthesia Olympics we can send our top colleagues to unfortunately.
Burglar probably won't say it here but I'm guessing he/she also thinks that the absolute best anesthesiologists are the ones who went to the same medical school, residency program, and fellowship program that burglar did. Although even that wasn't enough to fully prepare burglar for having to put art lines in thoracic patients in the new job! Maybe we can close things down with more details about this - do burglar's awake art lines in thoracic patients require more or less propofol than his awake cardiac ones? I would guess a little less maybe since arteries not typically as calcified so not quite as many attempts required?
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There are anesthesiologists who have had exposure to academics only or to both academics and private practice. There aren’t any anesthesiologists who have only had exposure to private practice. Everybody has some personal experience of how things are done in academics. Not everybody has first hand experience of how things are in private practice.
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Does anyone feel this year’s ACTA match is more competitive than last year?
Porky_Pork_Chop
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Not sure how competitive it was last year, other than number of applicants slowly dwindling. Is there any data on how many people applied? I definitely do think that the top tier places are always going to be very competitive no matter what. What makes you think that this year is more?
Porky_Pork_Chop
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Also I do feel like I've seen a lot of the same faces around. So maybe people be hoarding interviews
Why? There’s probably less people applying overall once data comes out
A lot of familiar, friendly faces out there! There are smaller programs that need to be filled with many places only having 2-3 fellows and some with spots filling internally or with year2 of dual applied applicants. All of that kind of complicates the picture of why somewhere you were excited about might not have extended an invitation. At least that’s what I’m telling myself about the couple I was excited about but didn’t hear from.
