To get into a cards fellowship whether it's mid or top tier (not even sure what those definitions are besides doing cards fellowship at a very strong heart center) you usually need to go to a strong IM residency and there lies the rub. You look at any IM match for most DO match lists and you see the 98% got a community program many which are really unknown to the academic field.
Going to MGH or UCSD or Emory for IM isn't just about prestige it's the fact that if you want to do cards you probably have the absolute best in clinical and research in that field. You get to work with leaders and add substantial work to your cv which makes you a strong candidate for cards come app time.
Now with all that there are specific community programs that have a good affiliation with a university or in themselves are very strong. Places like Northshore, Cedars Sinai, Scripps Green, Einstein Health in Philly all seem to blue solid programs where matching into fellowship can happen.
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