Procedure volume without advanced fellowship

[AZhopeful]

I recently interviewed at a program that has me thinking about something I haven't anticipated(though probably should have). This program has no advanced fellowships, and their spin on this is that the general cards fellows therefore do many more procedures and are more involved in them than they would otherwise be. Whereas my home program essentially says they ensure that you will hit your ACGME minimum number of Caths/echos/etc , this other program's fellows end up doing several times as many. The early F3 giving my tour, planning on general cards next year, had done almost 800 Caths, 50 devices(apparently getting to do much of the procedure), and 200 TEEs. Everyone there said that because of their numbers, fellows have no problem getting interventional or ep fellowships elsewhere.

For the SDN cards brain trust: does this pass the sniff test? I am still early on the interview trail so I am not sure how believable or common these kinds of numbers are, or how easy it would be to get an advanced fellowship in another location, and whether that much procedural experience would waltz me right into an interventional or ep fellowship. Given the fellowship experiences you guys have had, how much would you value the stuff in the above description? Can you foresee any red flags? Everyone there seems super happy and with manageable hours, at least as far as cards fellowships go.

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[josephf1]

my program is similar
PGY6 now, did 200 CATHs, 100+ TEEs, have no interest in devices.
Nice not to have advanced fellows hogging everything
everyone who wanted to got and advanced fellowship (cath, ep, chf) these are basically not competitive except in the big name places, we even got people into MGH for CATH but they had lots of pubs and some personal hookups
in fact they are basically giving away 2014 spots in CHF and EP even at good places that havent filled.
i think if you are seeing numbers like '800 caths' they are counting RHC and LHC on the same patient as 2 separate procedures which I did not in my numbers above

 

[joejabjab]

There is a distinction that needs to be understood. When people state the numbers they do, one needs to ask if they are referring to left vs right heart caths (or both), diagnostic vs interventional portion (or both), primary vs secondary operator, hands on vs double scrub, etc. A single number is not clear.

2nd yr fellow here. We do several hundred diagnostic left heart caths as general fellows. Our interventional fellows barely do any; they do the intervention portion. I believe most institutions with an interventional fellow function this way.

 

[CanIMakeIt]

We do about 100-150 diagnostic caths every month on university side and about 50 or so at VA side. Total 7-8 months of cath for every fellow. Interventional fellows do interventions only if general fellows are available. After my first VA month, I had more than 20 as primary hands-on first operator caths. Can't wait for the next Cath month at university. We don't do any devices as EP fellows do those. TEE is not an issue for level 2 for general fellows.

 

[Instatewaiter]

I recently interviewed at a program that has me thinking about something I haven't anticipated(though probably should have). This program has no advanced fellowships, and their spin on this is that the general cards fellows therefore do many more procedures and are more involved in them than they would otherwise be. Whereas my home program essentially says they ensure that you will hit your ACGME minimum number of Caths/echos/etc , this other program's fellows end up doing several times as many. The early F3 giving my tour, planning on general cards next year, had done almost 800 Caths, 50 devices(apparently getting to do much of the procedure), and 200 TEEs. Everyone there said that because of their numbers, fellows have no problem getting interventional or ep fellowships elsewhere.

For the SDN cards brain trust: does this pass the sniff test? I am still early on the interview trail so I am not sure how believable or common these kinds of numbers are, or how easy it would be to get an advanced fellowship in another location, and whether that much procedural experience would waltz me right into an interventional or ep fellowship. Given the fellowship experiences you guys have had, how much would you value the stuff in the above description? Can you foresee any red flags? Everyone there seems super happy and with manageable hours, at least as far as cards fellowships go.

If they're really getting to do that kind of stuff sounds like a good deal but anywhere that has that kind if volume usually has an interventional program. Also depends on if they are counting rhcs, balloons and the like. Weak sauce if they are. Sounds suspect to me.

The general fellows at my program usually hit the 500-700 mark in 3 years for diagnostics depending on if they are going into interventional or not, and it is a pretty procedurally heavy program. 800, if real is a strong number especially this early in the year for a third year. It sounds suspect though.

That said, volumes are down. During my first year i am on track to hit about 180 caths which is lower than first years fromprevious years.

 

[dragonfly99]

800 is a big #. they are probably counting R hrt caths separately and they might be counting procedures where they were the 2nd operator...not sure.
Usually interventional fellows have no interest in "hogging" diagnostic caths...at most places they don't want to do it and just want to do interventions, so that is not a big issue that I know of at most places.

If you want to do EP you might get more experience doing pacemaker at a place w/o EP fellows to compete, but if your program has no EP fellowship that means you automatically will have to move AGAIN after 3 years of fellowship in order to do EP. You have to think about if you will want to do that/uproot yourself again just to do a 1 or 2 year fellowship and move to who knows where. Also, places with no EP program usually don't have as large a volume of EP procedures, so I think that whether you get to "do" stuff in the EP lab IMHO has more to do with your programs propensity to scut you out doing another a fib consult versus the attending willing to be burdened with your presence in the EP lab. As a trainee, you are basically "in the way" and some places don't have a culture where the attendings feel they have to teach you, if you are no an EP fellow. I think it is hard, at a lot of places, to get level 2 for pacemakers, for example. It would be nice to be able to have learned that in general fellowship, and I think most reasonably intelligent cardio fellows could be taught to put in a dual chamber pacemaker in a 3 year general fellowship. This just isn't a priority in a lot of training programs. There could be some fear of competition as well on the part of the attendings (fear of creating a doc who in future could be putting in his/her own devices instead of referring to them).

EP and CHF are not hard fellowships to get...I got emails all the time as a 3rd year fellow from EP programs looking to find a fellow, and they were reasonably well reputed university programs. Unless you are hooked on only going to a "top" place all you would need to get an EP spot would be decent LOR's and a pulse. CHF you would only need a pulse and probably 1 LOR...LOL.

 

[P Diddy]

EP and CHF are not hard fellowships to get...I got emails all the time as a 3rd year fellow from EP programs looking to find a fellow, and they were reasonably well reputed university programs. Unless you are hooked on only going to a "top" place all you would need to get an EP spot would be decent LOR's and a pulse. CHF you would only need a pulse and probably 1 LOR...LOL.

The above advice is completely false for HF fellowships. HF fellowships are now ACGME accredited, and there is great demand for HF trained physicians. We have had had many more applicants than positions the past two years.

p diddy

 

[dragonfly99]

OK, but I only graduated from general cardiology fellowship 1 year ago...and I can tell you there were unfilled CHF programs emailing my fellowship program fairly frequently.
There is a market for CHF doctors but not a ton of job ads requiring someone with CHF training...I have seen more looking for general cardiology but people with multiple capabilities (in other words, if you can do diagnostic cath and read nuclears and do TEE's as well, etc.). Also there are still places looking for interventionalists...particularly smaller towns and Midwest, South, etc. If you are in California or Washington, it's not going to be places in LA, SF or Seattle that are looking for the interventionalists, for the most part.
All I was saying is it's easier to get CHF or EP fellowship than interventional, still.

Also, the fact that your CHF fellowship gets a lot of applicants does not mean that it's hard to get a CHF fellowship, in general. It might mean your particular CHF fellowship is sought after...but it doesn't mean that all of them or most of them are hard to get into.
It could also be that more cardiology fellows are applying to subspecialty fellowship this year versus last, perhaps due to fears about the economy and job market...