Totally agree with Noyac on the residency programs without tons of fellows. At a program the size of UTSW, we had two pain fellows, one or two cardiac fellows, two pedi fellows, one to two OB fellows, and 55-60 CA-1 to CA-3 residents. With the volume of cases at just Parkland alone, you are guaranteed to get enough of any case type you want. Yes, unfortunately, the ones that went into fellowship tended to be the ones who either really loved the subspecialty or the ones who couldn't get a job.
Your job search will be greatly eased if you can show your prospective employers/partners that you have adequate case loads to achieve proficiency with certain case types. Don't lie on your CV; we check these numbers out. One of my friends applied to a group in town and gave me his CV to review at which time, with simple math, I added up the months of subspecialty and general anesthesia he purported to have experienced and it added up to 42 months. Instant DQ.
If you want to do hearts without a fellowship, be damn sure that you are at the very least very comfortable manipulating the probe and acquiring all of the SCA mandated windows of examination of the heart and be sure that you have at the minimum 50-100 complete, documented hearts. Please don't do pedi hearts without a pedi fellowship altogether.
At least in Dallas, the hospitals require evidence of some type of TEE training, either the San Diego SCA TEE course, a letter from your cardiac director stating your proficiency in TEE, etc. Without it, you will be denied TEE priveleges.
TEE is not something you will bill for any significant amount of compensation. A medicare patient will pay about $45 for the complete, documented TEE exam, a private insurance patient will pay about $200-$250. For you PP guys using TEE, YOU MUST PUT "DIAGNOSTIC TEE PLACED" SOMEWHERE IN YOUR NARRATIVE in order for Medicare to pay out even the $45. Otherwise it is considered purely a monitoring device that cannot be billed for by the anesthesiologist (i.e. TEE = EKG = pulse oximetry, etc.).
I place a TEE in all of my hearts because on or off pump I encode 440.0 on the ICD coding (aortic atherosclerosis) as the primary diagnostic concern for which I am using the TEE. That is sufficient justification for using and billing for TEE services. Just this year alone (January through April), TEE in just my on or off pump CABG's has yielded 3 left atrial myxoma's, a Eustacian valve obstructing IVC cannula placement with subsequent IVC tear after surgeon's generous use of brutane to place the cannula, primum ASD with coronary sinus defect, clinically significant secundum/PFO defects, and one case of undiagnosed Ebstein's anomaly. Aside from being educational both to myself and the CT surgeon, it is truly an extra layer of safety that has allowed me to quickly diagnose and/or prevent problems from arising.
Case in point: During one OPCABG last month, the patient's systemic pressure suddenly dropped with sudden moderate MR, PAP rise, and ST segment elevation in primarily the lateral leads. Discussion of air embolus, coronary plaque embolization, etc. ensue but all appropriate therapeutic meds were already on board (NTG infusion at steady state, etc.). Adjusting the TEE from a 2C view to classic 4C and 5C views shows the culprit: A balled up and fully soaked lap sponge compressing the distal portion of the circ graft. Lap removed, instant ST segment normalization, pressures restored.
Regarding the issue of being a DO versus MD, ask about the group's policy before you waste your time and energy applying. Some groups traditionally do not hire DO's and it is in your best interest to find this out early to avoid wasting your time. Many will not come out and say that, but will hint to you that it is the case when they say they are not hiring despite a five month ad on Gaswork.
)in the OR. I used it in training often but as I said, I only used it in valves during PP. We used swans mostly in the CABG's and this was for post-op management more than anything. I didn't see the need for both a swan and a TEE. I know, this can be argued at length but thats my take on it. So therefore, I have lost some TEE skills I'm sure do to lack of use. But my curent gig doesn't have a heart program so thats fine. 
