"Next tier" cardiology fellowships

[troponinI]

Hi all,

I'm a resident interested in cardiology. After a lot of reading, it seems like the undisputed "top tier" fellowships for those interested in an academic career would include Hopkins, Duke, MGH, UCSF, and for those interested in private practice, places like CCF and THI (understanding that "top tier" is very subjective, and a lot of other programs probably should/could be included). I'm wondering what programs would fall into that "next tier" category of being strong programs with great training that maybe don't get as much hype as those listed above. I'm more interested in clinically-oriented programs that prepare you well for private practice, but would really like to hear opinions for both types of programs. Couldn't find another thread that discusses this all in one space. Thanks!

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[MyTachyBradyHeart]

Hi all,

I'm a resident interested in cardiology. After a lot of reading, it seems like the undisputed "top tier" fellowships for those interested in an academic career would include Hopkins, Duke, MGH, UCSF, and for those interested in private practice, places like CCF and THI (understanding that "top tier" is very subjective, and a lot of other programs probably should/could be included). I'm wondering what programs would fall into that "next tier" category of being strong programs with great training that maybe don't get as much hype as those listed above. I'm more interested in clinically-oriented programs that prepare you well for private practice, but would really like to hear opinions for both types of programs. Couldn't find another thread that discusses this all in one space. Thanks!

Getting ready for another thread filled with people trying to rank programs and others bashing rankings...

I do want to give a shout out to a few programs I was pleasantly surprised by on the interview trail that are not traditionally considered powerhouses:

1. Montefiore - clinically rigorous and has a lot of research opportunities. Many ties to other NYC programs and serves a more underprivileged population in the Bronx. I personally liked the clinically fit there more than Sinai, but less than Columbia. With that being said, their interview day was quite disorganized and the location (and large population it serves) are deterrents since you'll be taking call beyond first year.

2. Vanderbilt - recently acquired the Stevensons and a chunk of the EP team from Brigham. TDoesn't seem too busy in terms of call. Top 5 in the country in terms of transplants/LVADs. Fellows all appeared to like each other. Strong women representation in program leadership. Downsides are again, a rather disorganized interview day, and not as much basic science research (for those interested). CCU is a combined medicine/surgical ICU run by anesthesia and during my interview, had a census of only 4 patients. Also, you have to be on call in the CCU at night beyond first year.

3. WashU - traditionally considered a top program. Strong leadership from chair and PD seems really supportive of fellows. Fellows were mostly down to earth although were quieter than some other places. Clinically strong in heart failure and EP with Phil Cuculich and the noninvasive ablations. Downside is St. Louis (although cheap, but still St. Louis) and they do not have their own imaging subspecialty (CMR run by radiology).

4. UCLA - for some reason, people consider it a tier below UCSF and Stanford, but I'm not sure why. Very strong clinically with separate tracks for those interested in clinical/basic science research. Program leadership seemed very supportive. Biggest downside to me was LA (I don't like that city), but other people will find that attractive.

 

[lonslow]

Where else would you consider "top tier"? I wouldn't have necessarily thought of hopkins or UCSF. In any case, most cardiology programs, especially at major centers, will train you well enough to be a private practice cardiologist. Ranking or categorizing them is pointless, every program has its nuances, and as cliche as it sounds, the best program for you is the one you're happy at and fit best. I hated some programs friends loved and vice versa, so who can say which is the best. I know fellows at big name programs who feel scutted, out of place or just aren't happy despite the "great" training their supposedly getting, it doesn't seem worth it. If you hate research, it's not worth being stressed to produce something at an academic program, and so on. Really, just take any name brand program and they'll likely fit in your 'next tier." I don't think the above mentioned programs needed shoutouts as I think they are already well-regarded programs, maybe not on SDN but in the cardiac world they seem to be.

 

[Onres]

Where else would you consider "top tier"? I wouldn't have necessarily thought of hopkins or UCSF. In any case, most cardiology programs, especially at major centers, will train you well enough to be a private practice cardiologist. Ranking or categorizing them is pointless, every program has its nuances, and as cliche as it sounds, the best program for you is the one you're happy at and fit best. I hated some programs friends loved and vice versa, so who can say which is the best. I know fellows at big name programs who feel scutted, out of place or just aren't happy despite the "great" training their supposedly getting, it doesn't seem worth it. If you hate research, it's not worth being stressed to produce something at an academic program, and so on. Really, just take any name brand program and they'll likely fit in your 'next tier." I don't think the above mentioned programs needed shoutouts as I think they are already well-regarded programs, maybe not on SDN but in the cardiac world they seem to be.

Along these lines, one way to approach this is to look at where fellows from places you are interested in end up e.g. % private vs. academic, specific subspecialties, all over or more local, etc...

 

[IMreshopeful]

Most cardiology programs, especially at major centers, will train you well enough to be a private practice cardiologist. Ranking or categorizing them is pointless, every program has its nuances, and as cliche as it sounds, the best program for you is the one you're happy at and fit best. I hated some programs friends loved and vice versa, so who can say which is the best. I know fellows at big name programs who feel scutted, out of place or just aren't happy despite the "great" training their supposedly getting, it doesn't seem worth it. If you hate research, it's not worth being stressed to produce something at an academic program, and so on. Really, just take any name brand program and they'll likely fit in your 'next tier." I don't think the above mentioned programs needed shoutouts as I think they are already well-regarded programs, maybe not on SDN but in the cardiac world they seem to be.

Agreed - if a program has good volume, good diversity of patients, good procedural experience (ie not being second assist until you’re a third year in the cath lab), good noninvasive procedural volume, then you will get excellent training for private practice. Understand that the way to become marketable in PP is to get good in as many modalities as possible (nuclear, echo, vascular, CT, etc), get solid clinical training, and if going IC/EP, have the opportunity to get good procedural numbers. Also if considering the latter, look for programs which are strong in those fields/good at placing fellows either elsewhere or their home program. Fit definitely matters - I interviewed at “ranked” programs or whatever and didn’t like them due to low volumes and lack of strong clinical exposure to various fields; also based it partly on how I felt I would fit in with the fellows there. I think worrying about prestige and research really only matters if you want a research career where 80-90% of the time you’re doing research and occasionally reading an EKG or seeing a patient.

There is a tendency on SDN to “rank” everything. It’s a bizarre thing that probably stems from the premed and med student anxiety that makes everyone want to compare themselves to each other. It doesn’t matter anymore. It’s not worth it.

 

[IMreshopeful]

Getting ready for another thread filled with people trying to rank programs and others bashing rankings...

I do want to give a shout out to a few programs I was pleasantly surprised by on the interview trail that are not traditionally considered powerhouses:

1. Montefiore - clinically rigorous and has a lot of research opportunities. Many ties to other NYC programs and serves a more underprivileged population in the Bronx. I personally liked the clinically fit there more than Sinai, but less than Columbia. With that being said, their interview day was quite disorganized and the location (and large population it serves) are deterrents since you'll be taking call beyond first year.

2. Vanderbilt - recently acquired the Stevensons and a chunk of the EP team from Brigham. TDoesn't seem too busy in terms of call. Top 5 in the country in terms of transplants/LVADs. Fellows all appeared to like each other. Strong women representation in program leadership. Downsides are again, a rather disorganized interview day, and not as much basic science research (for those interested). CCU is a combined medicine/surgical ICU run by anesthesia and during my interview, had a census of only 4 patients. Also, you have to be on call in the CCU at night beyond first year.

3. WashU - traditionally considered a top program. Strong leadership from chair and PD seems really supportive of fellows. Fellows were mostly down to earth although were quieter than some other places. Clinically strong in heart failure and EP with Phil Cuculich and the noninvasive ablations. Downside is St. Louis (although cheap, but still St. Louis) and they do not have their own imaging subspecialty (CMR run by radiology).

4. UCLA - for some reason, people consider it a tier below UCSF and Stanford, but I'm not sure why. Very strong clinically with separate tracks for those interested in clinical/basic science research. Program leadership seemed very supportive. Biggest downside to me was LA (I don't like that city), but other people will find that attractive.

These are all considered “name brand” programs. Since when is WashU or Vandy not considered a “known” program or “powerhouse” - lol SDN

 

[cat00]

There is a tendency on SDN to “rank” everything. It’s a bizarre thing that probably stems from the premed and med student anxiety that makes everyone want to compare themselves to each other. It doesn’t matter anymore. It’s not worth it.

 

[cardsguy2017]

Be wary of how you define "good". SDN reviews are subjective and "good" can mean different things for different people. For example, folks say X is good or strong, it's not often clear if they're referring to the research side (lots of output) or clinical side(high volume, breadth, etc.), because they don't necessarily correlate.

Along these lines, one way to approach this is to look at where fellows from places you are interested in end up e.g. % private vs. academic, specific subspecialties, all over or more local, etc...

To add on to this, look at how many fellow stay for subspecialty training vs those who leave. I think it can say a lot.

Understand that the way to become marketable in PP is to get good in as many modalities as possible (nuclear, echo, vascular, CT, etc),

I agree, on the surface you'll be more marketable the more you can do, but I wouldn't worry terribly about vascular, ct, mri if you're just doing gen cards (unless you're interested in it). These are somewhat niche fields and imo if you can do echo and nuc, maybe cath, you'll be fine. Many programs don't emphasize vascular, ct, mri and their fellows do fine, I wouldn't discredit a program because they lack it. My program offered it but no really does it and they find good jobs. In my area and a couple other areas I'm familiar with, those extra modalities aren't a big thing with practicing cardiologists, but maybe it's regional.

Edit: wanted to add a comment about "volume." Be wary of numbers programs throw at you, there's a difference between what fellows get to see/do and what the hospital or their system overall sees/does. A hospital's "high volume" could include outpatient, other hospitals/clinics within their system, private attendings, double-counting, etc. Check with current fellows.

 

[Doodl3s]

Honestly, having finally matched, after interviewing at "top" programs to "community" level with many FMG interviews (I had a limited geographic range, so I widened my 'prestige' range). It's not worth it anymore. If you want to be a cardiology, and you match, YOU MADE IT!

I ranked programs somewhat in according to their tier (like most do even if they deny it) - matched in the middle of my list to a program that recruited me during the cycle. It's not very known outside my area, but they do ECMO, LVAD, heart transplant, high STEMI volume, tertiary transfers; and the fellows are super nice and so is the faculty. I'm happy here

my 2 cents: Program should be high volume in all aspects (since you don't know what you want to do yet... you don't), Happy fellows, Happy supportive faculty (which you can glean from the fellows)

If you definitely know you want to do private practice, I probably wouldn't waste time at a program with things like transplant and difficult/busy calls. Go to something cush.

 

[IMreshopeful]

Be wary of how you define "good". SDN reviews are subjective and "good" can mean different things for different people. For example, folks say X is good or strong, it's not often clear if they're referring to the research side (lots of output) or clinical side(high volume, breadth, etc.), because they don't necessarily correlate.



To add on to this, look at how many fellow stay for subspecialty training vs those who leave. I think it can say a lot.



I agree, on the surface you'll be more marketable the more you can do, but I wouldn't worry terribly about vascular, ct, mri if you're just doing gen cards (unless you're interested in it). These are somewhat niche fields and imo if you can do echo and nuc, maybe cath, you'll be fine. Many programs don't emphasize vascular, ct, mri and their fellows do fine, I wouldn't discredit a program because they lack it. My program offered it but no really does it and they find good jobs. In my area and a couple other areas I'm familiar with, those extra modalities aren't a big thing with practicing cardiologists, but maybe it's regional.

I agree that it’s not absolutely necessary to have vascular, CT, MRI etc. Certainly for MRI it’s tough anyway to get boarded and proficient within cardiology fellowship alone.

 

[Limvostov]

I'm at a small community fellowship program and couldn't be happier. We have an interventional fellowship as well. From past graduates they are happy and have great jobs. The town is small and perfect for fellows with families. The volume is great at the hospital and plenty of cases to perform. The fellows where I'm at are like family. I'd say go where you're happy, study hard, network. People want to hire colleagues they like to be around. Don't forget to be human, it's not all about going to the "best" place because clearly very few do. I have attendings from both incredible and no-name institutions. The is no guarantee that a "top tier" program will make a great physician and good person to train under.

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[IMreshopeful]

Honestly, having finally matched, after interviewing at "top" programs to "community" level with many FMG interviews (I had a limited geographic range, so I widened my 'prestige' range). It's not worth it anymore. If you want to be a cardiology, and you match, YOU MADE IT!

I ranked programs somewhat in according to their tier (like most do even if they deny it) - matched in the middle of my list to a program that recruited me during the cycle. It's not very known outside my area, but they do ECMO, LVAD, heart transplant, high STEMI volume, tertiary transfers; and the fellows are super nice and so is the faculty. I'm happy here

my 2 cents: Program should be high volume in all aspects (since you don't know what you want to do yet... you don't), Happy fellows, Happy supportive faculty (which you can glean from the fellows)

If you definitely know you want to do private practice, I probably wouldn't waste time at a program with things like transplant and difficult/busy calls. Go to something cush.

Agreed with everything except the last point about avoiding transplant at your training program if you plan on going into practice. I think being at a busy program with sick patients holds a lot of value including advanced HF and transplant. LVADs and post transplant patients are becoming so much more common so even if you don’t take care of the guy with an OHT in your private practice, you might have to consult and know how to manage them in the hospital if they land there or deal with complications from a VAD or recognize VAD thrombosis etc. I’ve seen some terrible mismanagement of heart failure by community cardiologists who didn’t train in institutions with good exposure to this and they end up having bad outcomes.

 

[nlax30]

Agreed with everything except the last point about avoiding transplant at your training program if you plan on going into practice. I think being at a busy program with sick patients holds a lot of value including advanced HF and transplant. LVADs and post transplant patients are becoming so much more common so even if you don’t take care of the guy with an OHT in your private practice, you might have to consult and know how to manage them in the hospital if they land there or deal with complications from a VAD or recognize VAD thrombosis etc. I’ve seen some terrible mismanagement of heart failure by community cardiologists who didn’t train in institutions with good exposure to this and they end up having bad outcomes.

I agree. My gen cards fellowship was at a smaller community place without much exposure to those advanced therapies. My current fellowship is at a tertiary care center with all that and it's a another skill set caring for those patients that you should at least be exposed to.

 

[EPADHA]

I think more important than name is 'fit'. I have known people at famous places who are not happy, and people at not-so-famous places who are quite happy. Any medium size or large university or community program will have enough volume to satisfy training requirements. Institutional culture, educational emphasis, attending-fellow relationships and emphasis on subspecialization (for example more interventional fellows= less interventions for general fellows) are important factors to consider. Many 'famous' programs are great at churning out academic "subsub" specialists. For example I cant understand how programs in Boston can let general fellows graduate without significant TEE or nuclear experience.
Fellowships that produce good academic clinicians IMHO that fly under the radar (for blue-blooded coastal people) in no particular order are- Uchicago, Wash U, UAB, Michigan, Pittsburgh, Baylor Dallas, OHSU, UF Gainesville, Iowa, UVA, MCV etc.

 

[lonslow]

I think more important than name is 'fit'. I have known people at famous places who are not happy, and people at not-so-famous places who are quite happy. Any medium size or large university or community program will have enough volume to satisfy training requirements. Institutional culture, educational emphasis, attending-fellow relationships and emphasis on subspecialization (for example more interventional fellows= less interventions for general fellows) are important factors to consider. Many 'famous' programs are great at churning out academic "subsub" specialists. For example I cant understand how programs in Boston can let general fellows graduate without significant TEE or nuclear experience.
Fellowships that produce good academic clinicians IMHO that fly under the radar (for blue-blooded coastal people) in no particular order are- Uchicago, Wash U, UAB, Michigan, Pittsburgh, Baylor Dallas, OHSU, UF Gainesville, Iowa, UVA, MCV etc.

Well said. Fit, gut feeling, happy fellows, etc. all play a role here. Maybe for IM that was worth sacrificing slightly for reputation, but not necessary for fellowship, imo. Educational emphasis can go both ways, I think some programs can overdo it, some folks don't want to spend time excessively rounding, lectures (listening/preparing them), etc. Also, I don't see how # of interventions for general fellows matter, that's not the point of fellowship and you have to do an interventional year anyway.

 

[EPADHA]

if you can become proficient in PCI and groin closure etc as a general fellows the more up-to-full-speed you will be as a first month interventional fellow. Same goes for EP. For example some of the Kaiser jobs I looked at expected me to be able to put in permanent pacemakers. But I trained at a major university hospital, and was a designated non-EP fellow. Hence that experience was missing, or in other words I never could get the opportunity to put in permanent pacamekers etc. You need to do at least 25-30 to feel comfortable doing them in practice.

 

[lonslow]

Fair points. Kaiser though is a bit unique and I have seen atypical job postings from them. I was just thinking more about how some brag about X program allowing fellows to do PCIs as if its a hard selling point, but it depends and that's not all the matters. For example, if it's a small program w/o interventional fellows and general fellows do PCI, we can debate the quality of teaching, the quality or complexity of patients overall, having to leave for interventional training, etc. On the other hand, there could be a major program w/ interventional fellows and a general fellow may only assist, but sees a ton of variety and complexities, learns/observe good techniques and best practices and has an inside track to the fellowship. They may not be behind at all as a new interventional fellow. Granted, I'm aware there are major programs where general fellows are second assist on diag cath thru 3rd year or never see a PCI case. Again, it depends.