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Non-ACGME Cardiac Surgery Fellowships / Superfellowships

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Junior22

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Outside of Congenital, Transplant / Mechanical Assist device / Heart failure, I've noticed that there are a lot of senior fellows/residents taking 6 months to a year for further super fellowship training following graduation. Was interested to see what everyone's opinions were on the different super fellowships and what would actually be beneficial and make one attractive post-training vs becoming some senior attending's b*tch to just open and close their cases.

Additionally, at what point do you run the risk of having too much training and people just think you're hiding and can't operate? Also, if there are any I forgot / don't know about, that would be great to know as well.

- It seems there are a few Advanced Aortic Programs; Penn, Baylor come to mind. I have heart a lot of good things about working with Bavaria.

- Advanced Thoracic Endovascular training. Seems like Cedar Sinai has a robust program. I'm sure there's some overseas (German...) opportunities that could be worthwhile.

- Mitral valve? I know everyone boasts their fellows and residents come out fully trained to do every procedure, but the more I see, the less I feel comfortable that every single graduating fellow will be able to be a mitral valve surgeon right out of the gates.

- Coronary revascularization? Are there any programs? Or is there any benefit to going with a renowned coronary surgeon for extra training? I've seen it numerous times where the new Transplant or Aortic attending join the hospital and the intensivists / cardiologists / senior faculty get upset when they're performing CABGs when brought in to be a transplant / device guy.


Thanks all.
 

Thanatos

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Outside of Congenital, Transplant / Mechanical Assist device / Heart failure, I've noticed that there are a lot of senior fellows/residents taking 6 months to a year for further super fellowship training following graduation. Was interested to see what everyone's opinions were on the different super fellowships and what would actually be beneficial and make one attractive post-training vs becoming some senior attending's b*tch to just open and close their cases.

Additionally, at what point do you run the risk of having too much training and people just think you're hiding and can't operate? Also, if there are any I forgot / don't know about, that would be great to know as well.

- It seems there are a few Advanced Aortic Programs; Penn, Baylor come to mind. I have heart a lot of good things about working with Bavaria.

- Advanced Thoracic Endovascular training. Seems like Cedar Sinai has a robust program. I'm sure there's some overseas (German...) opportunities that could be worthwhile.

- Mitral valve? I know everyone boasts their fellows and residents come out fully trained to do every procedure, but the more I see, the less I feel comfortable that every single graduating fellow will be able to be a mitral valve surgeon right out of the gates.

- Coronary revascularization? Are there any programs? Or is there any benefit to going with a renowned coronary surgeon for extra training? I've seen it numerous times where the new Transplant or Aortic attending join the hospital and the intensivists / cardiologists / senior faculty get upset when they're performing CABGs when brought in to be a transplant / device guy.


Thanks all.

In a strange twist of fate I just posted on this topic in the applications forum, so I'll copy below and then try to answer some of your specific questions which are all very good I think.

Thread: Superfellowships vs. working as an attending

I think the super fellowships are beneficial in that you get a lot of experience in your chosen specialty field.....transplant (my field) and TAVR are certainly the most well defined/understood in that most of us didn't get a ton of exposure to these in training either because your program didn't do a lot of them (or if they did they had a super fellow who did them all lol!). That and you spent fellowship learning how to do cardiac surgery which is challenging enough. Essentially this is a voluntary endeavor so you have to tailor it to what you want to do....but I think if you want to be an aortic super specialist and make that your focus a super fellowship is a great way to start. Everyone knows Bavaria, and if you do that year and come out and tell people you want to be an aortic surgeon well that kinda makes sense....I think it gives you some street cred in the job market on top of all the specialty skills you'll pick up that year.

Super fellowship is a nice year, you can get attending privileges and some increased pay while still getting the full support of the department.....a lot of us are taking boards and learning how to bill and navigate the politics of being an attending and you can still phone a friend that has to come help you. You pick up some nice advanced skills and meet a whole new group of people that can help you find and get that first job. You don't have to deal with all the BS from the ACGME and being the "resident," I've been treated like one of the attendings for the most part. My first day all the staff was like look just manage the patients however you want, please feel free to call if you need help but frankly we don't give a **** when you take the chest tubes out. Our transplant service has a few PAs and I go over plans with them in the morning and they execute them....no one is micro managing me. Its a nice transition into being an attending......that being said when **** hits the fan I have a group of people I can call that kinda has to answer the phone and help me. If you just go out into practice maybe your partner is a good person....maybe they're not and you're left holding the bag. I think this is probably uncommon overall, but we've all heard of careers ending prematurely when someone went out and tackled a bit too much without support.

The rub is yes its another year where you're not making fat stacks of cash and making it rain in da club or whatever and you will probably be doing some opening/closing and take backs for the division chief.....being a new attending in general may not be too much different fyi. Ever notice how its always the young attendings on call for the holidays and etc....get used to it for the next 10 years no matter what you want to call yourself. Obviously you want to avoid just being someone's take back specialist but I get the impression this is not common....having a super fellow is a sweet gig for the attendings in that if you weren't there they might get the integrated PGY2 in the middle of the night, and they don't want you to go out after doing their special year and not be able to do that special thing. Unlike residency if they treat you too poorly technically you can quit and just go get another job....all those years of watching nurses and PAs get away with murder because if you push them too hard they'll just leave...that kind of applies to you now. You can't get away with as much as they can obviously, but I think its understood that they can't treat you too terribly when the overall job market isn't too bad.

I'm glad you brought up the stigma of additional training actually, in that people think you suck or whatever for doing fellowships......I have honestly not encountered this in cardiac surgery. In my experience this was isolated to general surgery, where doing any extra training was seen as a weakness and met with criticism. I was at ACS one year where some high ranking guy went on a 20 minute tirade from the podium about breast fellowships and how he mocked his chief residents for doing this training.....I made a mental note to never work for that guy. Interestingly despite the derision, isn't it like 80% of gen surg residents now do fellowships? Its worth noting that people who do MIS, breast, endocrine and trauma are doing many of the same cases they did in residency.....or at least using the same equipment or operating in the same body cavity. Meanwhile you get what.....2-3 years to learn all of cardiac surgery? If you go to a two year program and spend a year doing thoracic and congenital to meet your board requirements you may only do essentially on year of cardiac training.....and cardiac surgery is hard, I felt like there was very very little carry over from gen surg training. Things go wrong quickly in the OR, ICU and floor....when you go on bypass and the LV distends and you can't figure it out you don't have time to phone a friend, that patient will be dead in the OR if you can't figure it out in a minute or two. For these reasons not only will cardiac surgeons not judge you for doing extra training they will likely encourage it.....one of my attendings used to say that you should do as much training as you can possibly stand! Maybe I've drank too much of my own kool-aid, but I don't understand this opposition to being as prepared as you can to take care of other humans. You can bet your ass when I get some sort of adrenal cancer I'm going to some fellowship trained endocrine guy to take it out and I will take my sister to the world's best trained breast surgeon I can find....would you take your mother to some guy who trained in the 80's and wanted to do a radical mastectomy with an axillary dissection for DCIS? Would you turn over all your savings to a financial advisor who didn't graduate from college because he was "tired of all the training and ready to go out and just make some money and get started on life? Besides my friends all dropped out of college and are making fun of me for wanting to do a masters.....give me all your money I have a plan." I'll take the person who did some extra training, thank you. In my opinion FWIW, do the extra training in another place, learn some new moves/tricks, meet new people for networking, establish yourself as a super specialist and leverage that to get a better job and launch what will be the rest of your career. You don't have to, but it certainly can't hurt.

For aorta I would certainly look at Penn and Duke, for transplant the big places were Duke, Wash U, Stanford and Cleveland. I don't know much about Cedars honestly but endovascular surgery is not at all for me so I may just be in the dark on that one.

Interesting point about the mitral valve, in that its hard to get your staff to turn over a mitral valve repair. For those of you not as well versed in cardiac, you really get one shot at the repair or they essentially get a replacement which is associated with a worse outcome. And mitral valve repair is ****ing hard...personally I feel comfortable tackling an isolated P2 prolapse or slightly more advanced posterior leaflet pathology as well as just good old functional MR......and I trained at a place that does a lot of mitral surgery. Once we start talking anterior leaflet and chords I'll be referring that to a senior partner......if forced into it I'll try but my threshold to just replace the damn thing and leave the OR with a living patient is quite low. That being said one of the advantages of being a transplant surgeon is I plan to avoid these situations....if I'm willing to do your low EF cabg and put them on ECMO to get out of the room you can do an elective mitral for me and we'll call it even.

For CABG I can't say I've heard of someone doing an advanced fellowship for that specifically outside of minimally invasive work.....although there are some people who weren't happy with their training or felt like volume was too low so did additional training in adult cardiac surgery and that's okay too, I think only you can decide when you're ready to tackle independent practice.

Alternatively just come to the dark side and do transplant :)
 
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deleted547339

In a strange twist of fate I just posted on this topic in the applications forum, so I'll copy below and then try to answer some of your specific questions which are all very good I think.

Thread: Superfellowships vs. working as an attending

I think the super fellowships are beneficial in that you get a lot of experience in your chosen specialty field.....transplant (my field) and TAVR are certainly the most well defined/understood in that most of us didn't get a ton of exposure to these in training either because your program didn't do a lot of them (or if they did they had a super fellow who did them all lol!). That and you spent fellowship learning how to do cardiac surgery which is challenging enough. Essentially this is a voluntary endeavor so you have to tailor it to what you want to do....but I think if you want to be an aortic super specialist and make that your focus a super fellowship is a great way to start. Everyone knows Bavaria, and if you do that year and come out and tell people you want to be an aortic surgeon well that kinda makes sense....I think it gives you some street cred in the job market on top of all the specialty skills you'll pick up that year.

Super fellowship is a nice year, you can get attending privileges and some increased pay while still getting the full support of the department.....a lot of us are taking boards and learning how to bill and navigate the politics of being an attending and you can still phone a friend that has to come help you. You pick up some nice advanced skills and meet a whole new group of people that can help you find and get that first job. You don't have to deal with all the BS from the ACGME and being the "resident," I've been treated like one of the attendings for the most part. My first day all the staff was like look just manage the patients however you want, please feel free to call if you need help but frankly we don't give a **** when you take the chest tubes out. Our transplant service has a few PAs and I go over plans with them in the morning and they execute them....no one is micro managing me. Its a nice transition into being an attending......that being said when **** hits the fan I have a group of people I can call that kinda has to answer the phone and help me. If you just go out into practice maybe your partner is a good person....maybe they're not and you're left holding the bag. I think this is probably uncommon overall, but we've all heard of careers ending prematurely when someone went out and tackled a bit too much without support.

The rub is yes its another year where you're not making fat stacks of cash and making it rain in da club or whatever and you will probably be doing some opening/closing and take backs for the division chief.....being a new attending in general may not be too much different fyi. Ever notice how its always the young attendings on call for the holidays and etc....get used to it for the next 10 years no matter what you want to call yourself. Obviously you want to avoid just being someone's take back specialist but I get the impression this is not common....having a super fellow is a sweet gig for the attendings in that if you weren't there they might get the integrated PGY2 in the middle of the night, and they don't want you to go out after doing their special year and not be able to do that special thing. Unlike residency if they treat you too poorly technically you can quit and just go get another job....all those years of watching nurses and PAs get away with murder because if you push them too hard they'll just leave...that kind of applies to you now. You can't get away with as much as they can obviously, but I think its understood that they can't treat you too terribly when the overall job market isn't too bad.

I'm glad you brought up the stigma of additional training actually, in that people think you suck or whatever for doing fellowships......I have honestly not encountered this in cardiac surgery. In my experience this was isolated to general surgery, where doing any extra training was seen as a weakness and met with criticism. I was at ACS one year where some high ranking guy went on a 20 minute tirade from the podium about breast fellowships and how he mocked his chief residents for doing this training.....I made a mental note to never work for that guy. Interestingly despite the derision, isn't it like 80% of gen surg residents now do fellowships? Its worth noting that people who do MIS, breast, endocrine and trauma are doing many of the same cases they did in residency.....or at least using the same equipment or operating in the same body cavity. Meanwhile you get what.....2-3 years to learn all of cardiac surgery? If you go to a two year program and spend a year doing thoracic and congenital to meet your board requirements you may only do essentially on year of cardiac training.....and cardiac surgery is hard, I felt like there was very very little carry over from gen surg training. Things go wrong quickly in the OR, ICU and floor....when you go on bypass and the LV distends and you can't figure it out you don't have time to phone a friend, that patient will be dead in the OR if you can't figure it out in a minute or two. For these reasons not only will cardiac surgeons not judge you for doing extra training they will likely encourage it.....one of my attendings used to say that you should do as much training as you can possibly stand! Maybe I've drank too much of my own kool-aid, but I don't understand this opposition to being as prepared as you can to take care of other humans. You can bet your ass when I get some sort of adrenal cancer I'm going to some fellowship trained endocrine guy to take it out and I will take my sister to the world's best trained breast surgeon I can find....would you take your mother to some guy who trained in the 80's and wanted to do a radical mastectomy with an axillary dissection for DCIS? Would you turn over all your savings to a financial advisor who didn't graduate from college because he was "tired of all the training and ready to go out and just make some money and get started on life? Besides my friends all dropped out of college and are making fun of me for wanting to do a masters.....give me all your money I have a plan." I'll take the person who did some extra training, thank you. In my opinion FWIW, do the extra training in another place, learn some new moves/tricks, meet new people for networking, establish yourself as a super specialist and leverage that to get a better job and launch what will be the rest of your career. You don't have to, but it certainly can't hurt.

For aorta I would certainly look at Penn and Duke, for transplant the big places were Duke, Wash U, Stanford and Cleveland. I don't know much about Cedars honestly but endovascular surgery is not at all for me so I may just be in the dark on that one.

Interesting point about the mitral valve, in that its hard to get your staff to turn over a mitral valve repair. For those of you not as well versed in cardiac, you really get one shot at the repair or they essentially get a replacement which is associated with a worse outcome. And mitral valve repair is ****ing hard...personally I feel comfortable tackling an isolated P2 prolapse or slightly more advanced posterior leaflet pathology as well as just good old functional MR......and I trained at a place that does a lot of mitral surgery. Once we start talking anterior leaflet and chords I'll be referring that to a senior partner......if forced into it I'll try but my threshold to just replace the damn thing and leave the OR with a living patient is quite low. That being said one of the advantages of being a transplant surgeon is I plan to avoid these situations....if I'm willing to do your low EF cabg and put them on ECMO to get out of the room you can do an elective mitral for me and we'll call it even.

For CABG I can't say I've heard of someone doing an advanced fellowship for that specifically outside of minimally invasive work.....although there are some people who weren't happy with their training or felt like volume was too low so did additional training in adult cardiac surgery and that's okay too, I think only you can decide when you're ready to tackle independent practice.

Alternatively just come to the dark side and do transplant :)

Very interesting. I’m an intensivist. My n=2. Where I did fellowship, we had two cardiac surgery super fellows during my tenure. One was incredible. Supposedly he great hands, smart, cared about the patient, responded to pages immediately, came in when he needed to immediately, friendly, would walk through exactly what they did in the OR and how it will affect postoperative care. He was one of my favorite surgeon - probably one of my favorite people in the hospital. The other was lazy, dismissive and seemed pretty dumb - rumor had it he did the fellowship because he wasn’t competent for independent practice.

You also bring up an interesting point that has been discussed in another thread a while back - the go to the worlds best surgeon in X, Y, Z specialty at Harvard, Hopkins, Stanford, Wheverver vs. the most competent surgeon in your area.
 

ThoracicGuy

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In a strange twist of fate I just posted on this topic in the applications forum, so I'll copy below and then try to answer some of your specific questions which are all very good I think.

Thread: Superfellowships vs. working as an attending

I think the super fellowships are beneficial in that you get a lot of experience in your chosen specialty field.....transplant (my field) and TAVR are certainly the most well defined/understood in that most of us didn't get a ton of exposure to these in training either because your program didn't do a lot of them (or if they did they had a super fellow who did them all lol!). That and you spent fellowship learning how to do cardiac surgery which is challenging enough. Essentially this is a voluntary endeavor so you have to tailor it to what you want to do....but I think if you want to be an aortic super specialist and make that your focus a super fellowship is a great way to start. Everyone knows Bavaria, and if you do that year and come out and tell people you want to be an aortic surgeon well that kinda makes sense....I think it gives you some street cred in the job market on top of all the specialty skills you'll pick up that year.

Super fellowship is a nice year, you can get attending privileges and some increased pay while still getting the full support of the department.....a lot of us are taking boards and learning how to bill and navigate the politics of being an attending and you can still phone a friend that has to come help you. You pick up some nice advanced skills and meet a whole new group of people that can help you find and get that first job. You don't have to deal with all the BS from the ACGME and being the "resident," I've been treated like one of the attendings for the most part. My first day all the staff was like look just manage the patients however you want, please feel free to call if you need help but frankly we don't give a **** when you take the chest tubes out. Our transplant service has a few PAs and I go over plans with them in the morning and they execute them....no one is micro managing me. Its a nice transition into being an attending......that being said when **** hits the fan I have a group of people I can call that kinda has to answer the phone and help me. If you just go out into practice maybe your partner is a good person....maybe they're not and you're left holding the bag. I think this is probably uncommon overall, but we've all heard of careers ending prematurely when someone went out and tackled a bit too much without support.

The rub is yes its another year where you're not making fat stacks of cash and making it rain in da club or whatever and you will probably be doing some opening/closing and take backs for the division chief.....being a new attending in general may not be too much different fyi. Ever notice how its always the young attendings on call for the holidays and etc....get used to it for the next 10 years no matter what you want to call yourself. Obviously you want to avoid just being someone's take back specialist but I get the impression this is not common....having a super fellow is a sweet gig for the attendings in that if you weren't there they might get the integrated PGY2 in the middle of the night, and they don't want you to go out after doing their special year and not be able to do that special thing. Unlike residency if they treat you too poorly technically you can quit and just go get another job....all those years of watching nurses and PAs get away with murder because if you push them too hard they'll just leave...that kind of applies to you now. You can't get away with as much as they can obviously, but I think its understood that they can't treat you too terribly when the overall job market isn't too bad.

I'm glad you brought up the stigma of additional training actually, in that people think you suck or whatever for doing fellowships......I have honestly not encountered this in cardiac surgery. In my experience this was isolated to general surgery, where doing any extra training was seen as a weakness and met with criticism. I was at ACS one year where some high ranking guy went on a 20 minute tirade from the podium about breast fellowships and how he mocked his chief residents for doing this training.....I made a mental note to never work for that guy. Interestingly despite the derision, isn't it like 80% of gen surg residents now do fellowships? Its worth noting that people who do MIS, breast, endocrine and trauma are doing many of the same cases they did in residency.....or at least using the same equipment or operating in the same body cavity. Meanwhile you get what.....2-3 years to learn all of cardiac surgery? If you go to a two year program and spend a year doing thoracic and congenital to meet your board requirements you may only do essentially on year of cardiac training.....and cardiac surgery is hard, I felt like there was very very little carry over from gen surg training. Things go wrong quickly in the OR, ICU and floor....when you go on bypass and the LV distends and you can't figure it out you don't have time to phone a friend, that patient will be dead in the OR if you can't figure it out in a minute or two. For these reasons not only will cardiac surgeons not judge you for doing extra training they will likely encourage it.....one of my attendings used to say that you should do as much training as you can possibly stand! Maybe I've drank too much of my own kool-aid, but I don't understand this opposition to being as prepared as you can to take care of other humans. You can bet your ass when I get some sort of adrenal cancer I'm going to some fellowship trained endocrine guy to take it out and I will take my sister to the world's best trained breast surgeon I can find....would you take your mother to some guy who trained in the 80's and wanted to do a radical mastectomy with an axillary dissection for DCIS? Would you turn over all your savings to a financial advisor who didn't graduate from college because he was "tired of all the training and ready to go out and just make some money and get started on life? Besides my friends all dropped out of college and are making fun of me for wanting to do a masters.....give me all your money I have a plan." I'll take the person who did some extra training, thank you. In my opinion FWIW, do the extra training in another place, learn some new moves/tricks, meet new people for networking, establish yourself as a super specialist and leverage that to get a better job and launch what will be the rest of your career. You don't have to, but it certainly can't hurt.

For aorta I would certainly look at Penn and Duke, for transplant the big places were Duke, Wash U, Stanford and Cleveland. I don't know much about Cedars honestly but endovascular surgery is not at all for me so I may just be in the dark on that one.

Interesting point about the mitral valve, in that its hard to get your staff to turn over a mitral valve repair. For those of you not as well versed in cardiac, you really get one shot at the repair or they essentially get a replacement which is associated with a worse outcome. And mitral valve repair is ****ing hard...personally I feel comfortable tackling an isolated P2 prolapse or slightly more advanced posterior leaflet pathology as well as just good old functional MR......and I trained at a place that does a lot of mitral surgery. Once we start talking anterior leaflet and chords I'll be referring that to a senior partner......if forced into it I'll try but my threshold to just replace the damn thing and leave the OR with a living patient is quite low. That being said one of the advantages of being a transplant surgeon is I plan to avoid these situations....if I'm willing to do your low EF cabg and put them on ECMO to get out of the room you can do an elective mitral for me and we'll call it even.

For CABG I can't say I've heard of someone doing an advanced fellowship for that specifically outside of minimally invasive work.....although there are some people who weren't happy with their training or felt like volume was too low so did additional training in adult cardiac surgery and that's okay too, I think only you can decide when you're ready to tackle independent practice.

Alternatively just come to the dark side and do transplant :)

This is an underrated post.
 
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