Plan B to reapply to Gen Cards: external chief resident position or HF fellowship

[Doctor_Strange]

Everyone told me they expected me to be a good candidate for at least 10 interviews or so. I only ended up with 3 (1 internal, 1 through a connection). and I am weighing my options for Plan B.

I go to a university program in the South, USDO. Steps 243/237, Level 3 pass. No obvious red flags (at least not obvious enough where my faculty, PD, or mentors have warned me). As far as scholarship activity, our PD primarily supports case reports saying "It's a numbers game", but I have a few manuscripts published as well, and including journal abstracts, I have about 20 publications. Anyways, it's tough to know what held back my app. Part of me thinks a) it is so competitive now I am just one of the hundreds of other applicants and nothing, in particular, stood out or b) I have a red flag, maybe even a LOR (I do not think this is the case, maybe more that my LORs are not glowing as others). And so, I am left with thinking of Plan B. On ERAS, you can select "Chief Resident" and after conversations with other applicants, including current chiefs, it seems it carries a lot of weight. So far that has been my Plan B. I am aware of the HF fellowships out there, but part of my hesitation is that I may still need to be able to have programs lay eyes on my app. I also worry not enough time will pass for faculty and or new mentors to advocate on my behalf. And the final, practical reason, is that with a Chief position, I could have more time to moonlight and make some meaningful money. From what I have seen, HF fellowships are very intense, and not only is the opportunity for moonlighting limited, but because these fellowships are not ACGME certified they can really overwork fellows (I am only worried about this as it pertains to studying for the ABIM next year and also to make some money on the side as I will be newly married). Again, this is what I have heard and written.

One likely scenario I may face in the coming weeks/months: would pursuing a Chief Resident position at a community program without an in-house fellowship be worth it just for the "ERAS Chief Resident box selected" versus pursuing an HF fellowship and banking on connections/networking?

Also, what does networking look like as a resident? If I go to ACC, do I bring a business card? Chat up PDs? I feel like networking means having a mentor advocate on your behalf etc.

Thank you for reading

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[NotAProgDirector]

Whatever you do in your gap time will only help if it addresses whatever caused you to get few IV's in the first place. I am concerned that DO + those step scores may not bode well. Those are low scores for US MD's. If that's the problem, nothing is likely to change the outcome.

For research, fellowship programs are usually looking for new work done during residency. I disagree with your PD -- case reports are not impressive. It may be that fellowship PD's are using a filter to look for adequate research -- but if so and then they see you have a bunch of case reports only, your application is getting tossed.

Being a chief helps in the fellowship match program, but I suspect this is mostly for internal chiefs. Fellowships know that programs tend to offer chief positions to their best-and-brightest, and use that as a strong marker of someone whom will succeed in fellowship. An external chief, especially one that's not connected to a program with a cards fellowship, I'm not convinced that's going to move the needle much.

In any case, if you want this to work you'll need to maximize what you get out of any gap year. Moonlighting may be good for income, but it will not help your fellowship aspirations. Your stated goals are at odds with one another -- any time you spend moonlighting is time you could have spent doing research / QI / something else that might boost your fellowship app. So you can't really have it both ways.

In the end, you'll need to decide how badly you want a cards fellowship. If you really want one, your best choice is a research type position / non ACGME fellowship. What you can improve in your application is research and connections. There is a very good chance that it will take 2 years to be successful -- should you try to apply again next year, you will have very little new on your application. You should focus your time on being productive in your work, and not on moonlighting.

I doubt this answer makes you happy, but I think it's what you need to hear.

 

[thecalccobra]

How many programs did you apply to?

 

[thecalccobra]

How many programs did you apply to?

 

[Doctor_Strange]

How many programs did you apply to?

120.

 

[Doctor_Strange]

Whatever you do in your gap time will only help if it addresses whatever caused you to get few IV's in the first place. I am concerned that DO + those step scores may not bode well. Those are low scores for US MD's. If that's the problem, nothing is likely to change the outcome.

For research, fellowship programs are usually looking for new work done during residency. I disagree with your PD -- case reports are not impressive. It may be that fellowship PD's are using a filter to look for adequate research -- but if so and then they see you have a bunch of case reports only, your application is getting tossed.

Being a chief helps in the fellowship match program, but I suspect this is mostly for internal chiefs. Fellowships know that programs tend to offer chief positions to their best-and-brightest, and use that as a strong marker of someone whom will succeed in fellowship. An external chief, especially one that's not connected to a program with a cards fellowship, I'm not convinced that's going to move the needle much.

In any case, if you want this to work you'll need to maximize what you get out of any gap year. Moonlighting may be good for income, but it will not help your fellowship aspirations. Your stated goals are at odds with one another -- any time you spend moonlighting is time you could have spent doing research / QI / something else that might boost your fellowship app. So you can't really have it both ways.

In the end, you'll need to decide how badly you want a cards fellowship. If you really want one, your best choice is a research type position / non ACGME fellowship. What you can improve in your application is research and connections. There is a very good chance that it will take 2 years to be successful -- should you try to apply again next year, you will have very little new on your application. You should focus your time on being productive in your work, and not on moonlighting.

I doubt this answer makes you happy, but I think it's what you need to hear.

I don't know I have been getting mixed responses from people I trust too. I agree, that the allure of being a Chief decreases if external, but I think it still shows leadership potential. If I pursue a HF or Cards fellowship, the surface area for interactions w/ cards faculty increases and perhaps ability to call and advocate on my behalf etc. Still unsure of what to pursue.

 

[ewax]

I don't know I have been getting mixed responses from people I trust too. I agree, that the allure of being a Chief decreases if external, but I think it still shows leadership potential. If I pursue a HF or Cards fellowship, the surface area for interactions w/ cards faculty increases and perhaps ability to call and advocate on my behalf etc. Still unsure of what to pursue.

Another option to think about if the others don't pan out is cardiac hospitalist. I think Iowa and Dartmouth have these kinds of positions and you basically admit and cross cover cardiology floor patients.

Could be another good opportunity to get more interaction with faculty/research and help future match prospects.

 

[shouldigomd]

I don't think anyone knows the answer because ultimately it comes down to the decisions of a few people (PD / faculty / sometimes fellows) which vary from place to place.

This is just my opinion based on my experience but I think being a hospitalist / moonlighting is the least helpful. In my program we (the fellows) view that as a red flag if anything. Doing a chief year or a HF program is probably the most helpful especially if you can do it at a place where you have a chance of getting in for cards. Your stats are decent so I feel its unlucky you didn't get many interviews. Do more research of any variety even if it is just case reports. Reach out to programs you are interested in and have a shot at getting in to see what advice they have to buff your resume.

 

[Doctor_Strange]

I don't think anyone knows the answer because ultimately it comes down to the decisions of a few people (PD / faculty / sometimes fellows) which vary from place to place.

This is just my opinion based on my experience but I think being a hospitalist / moonlighting is the least helpful. In my program we (the fellows) view that as a red flag if anything. Doing a chief year or a HF program is probably the most helpful especially if you can do it at a place where you have a chance of getting in for cards. Your stats are decent so I feel its unlucky you didn't get many interviews. Do more research of any variety even if it is just case reports. Reach out to programs you are interested in and have a shot at getting in to see what advice they have to buff your resume.

I do not want to dox myself but I learned that one of my LORs wrote the wrong name and I was told by a Cards PD it was pretty underwhelming. My other Cards letter I was told was "ok". I am debating just sending in three LORs next year and not 4. Not sure yet.

 

[shouldigomd]

I do not want to dox myself but I learned that one of my LORs wrote the wrong name and I was told by a Cards PD it was pretty underwhelming. My other Cards letter I was told was "ok". I am debating just sending in three LORs next year and not 4. Not sure yet.

Sounds sketchy. Just get hospitalist LORs rather than risking a sub par cardiology LOR.

 

[Doctor_Strange]

I've been offered an external Chief Resident position. It is at a residency with an in-house cardiology fellowship (small, newish program). I am getting some cold feet making the decision. I think if I do not do this and be a community hospitalist and then reapply, I will be at a disadvantage. At least with this move, I could at a minimum select Chief Resident on ERAS. And with improved LORs, I think my chances would be better. I hope that is. I may apply to another specialty as well like PCCM.

Any additional thoughts or wisdom? I don’t have any loans so that’s nice. My wife and will move to this location which is nice area. I’ll be 31 when I graduate residency next year also.

 

[The kitchen sink]

I've been offered an external Chief Resident position. It is at a residency with an in-house cardiology fellowship (small, newish program). I am getting some cold feet making the decision. I think if I do not do this and be a community hospitalist and then reapply, I will be at a disadvantage. At least with this move, I could at a minimum select Chief Resident on ERAS. And with improved LORs, I think my chances would be better. I hope that is. I may apply to another specialty as well like PCCM.

Any additional thoughts or wisdom? I don’t have any loans so that’s nice. My wife and will move to this location which is nice area. I’ll be 31 when I graduate residency next year also.

Sounds worth a shot to follow ur dreams