Structural Heart Disease Fellowship

[cardio-nerd]

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Can anyone provide information about the structural heart disease programs available in term of number, autonomy, spectrum of procedure, preference for internal candidates.. etc?

Also when is a good time to start applying/looking?

 

[Cardiologyoncall]

What’s everyone’s opinion on doing a structural fellowship post IC? I’m hearing more and more structural jobs are harder and harder to find.

 

[CardCard]

Hey guys. I have heard that jobs are getting harder. but I have a crazy question to anyone out there.
What do you think about doing a EP and structural training with minimal to no cors. otherwise spend 3 years after general cards in a combined EP/structural fellowship where I would spend 3-3.5 days in EP and 1.5-2 days doing structural interventions.

 

[Phospholipid]

I believe structural fellowship and CHIP fellowship is a waste of time. If a program is efficient, you can get complex coronaries, and structural in one year, but now everybody wants to extend training for no real good reason.

One thing that is not talked often is that, you do continue to learn while in practice. It is much better to be proctored on the job for structural rather than invest in a year to do a fellowship on it. Even if you did a fellowship, you probably STILL need to be proctored on the job in the beginning.

Having a CHIP fellowship and structural fellowship in your interventional training dilutes your experience, and its frustrating. Also, I would be even more frustrated that if you are a structural fellow, and you are secondary operator to an attending who is getting PROCTERED on the job, which is seen very frequently.

 

[yyy103]

There are probably two parts to this. The last thing mentioned - about second operating while an attending is getting trained to do a structural procedure - is a relevant problem, but should be much less so in a high-volume, established program (i.e. the sorts of program that offer dedicated structural training).

As to your broader point, I think it comes down to economics. The jump in salary from fellow to attending makes US doctors reluctant to undertake further training. This is not so much a factor in other countries and healthcare systems,

The idea that you can be adequately trained in general intervention, complex coronaries, and structural within one year (particularly when most fellows have little first-operator PCI exposure at the outset of their Fellowship year) is seen as utter lunacy everywhere worldwide, bar the US.

 

[Phospholipid]

The idea that you can be adequately trained in general intervention, complex coronaries, and structural within one year (particularly when most fellows have little first-operator PCI exposure at the outset of their Fellowship year) is seen as utter lunacy everywhere worldwide, bar the US.

Not if your program is efficient and does not scut the fellow out. Learning coronaries, TAVR and mitral clip is very doable in a year if the place you train at has volume, and is run efficiently and allows you to be true first operator. It is less likely nowadays, since the trend is doing more and more training to gain these experiences, which unfortunately forces many fellows to have to do extra training year due to advanced fellows diluting the training of the 1 yr Interventional Fellows.

TAVRs, Mitral Clips, PFO, ASD closures, PPM placement, Carotids can ALL be learned on the job proctoring. You just have to find a job that is welling to mentor you and proctor you on it, and learn from the reps. It is much more time and cost effective to do this, rather than invest in a year of structural, and you STILL probably will need to be proctored on the job in the beginning ANYWAYS.

Learning complex coronaries can also be learned on the job depending on your hospital, how proactive you are to learn new techniques and having a good mentor. A CHIP fellowship is complete bull**** and waste of time, however, I am sure there are some good CHIP fellowship that you learn a lot in 1 year, and some fellows may benefit from that. But imo, they benefit from that because their 1 yr interventional fellowship did not adequately train them.

 

[yyy103]

We will have to agree to disagree. I do not think it possible to be adequately trained in complex coronary intervention and structural intervention in one year. I think it's possible to have some exposure and experience to it all, but you'll be heavily leaning on more senior attendings when qualified - i.e. not adequately trained. As I said, outside the US it is considered insanity that someone could describe themselves as fully trained in basic coronary intervention, complex coronary intervention and "mainstream" structural (TAVR, mitraclip, PFO and ASD) within a year.

(N.B I am not saying that doing additional Fellowships means you won't need support from senior faculty when you first start out in practice; I just think taking the time to get better, fuller training will make you more independent in the early stages.)

 

[IMreshopeful]

I have seen several graduates of programs who do one year of coronary/peripheral or coronary/structural who get proctored in structural or whatever procedure they learn on the job and do very well. Most good fellowships will give you good experience doing complex coronary stuff and if it’s not there, that’s a problem. Some of the big academic programs unfortunately def have this issue (the fellows at BWH, etc have trouble getting their numbers)

 

[yyy103]

Well, exactly. You're not fully trained at the end of the year if you need a large amount of proctoring and hands-on training on the job. That's absolutely fine.

 

[cardio776]

Reviving this post as it's been 4-5 years. Any changes in general impression now on the future of structural in terms of job market, hands-on training vs doing a dedicated year of fellowship, are you severely limited geographically, etc? Hearing all different types of response when this topic is brought up casually to IC folks (some of whom are structural attendings), so just wondering what others (especially those who have completed structural fellowship) think.

 

[Full Metal IC]

Reviving this post as it's been 4-5 years. Any changes in general impression now on the future of structural in terms of job market, hands-on training vs doing a dedicated year of fellowship, are you severely limited geographically, etc? Hearing all different types of response when this topic is brought up casually to IC folks (some of whom are structural attendings), so just wondering what others (especially those who have completed structural fellowship) think.

I don't think it's gotten any better. Structural market still dominated by mid-careers and old heads. Geographic limitation seems to still be a major issue especially if you want reasonable volume. As for dedicated year of fellowship, I think if you want to solely do TAVR and nothing else, you probably don't need it if you can find the right job (that doesn't sell you on false promises). Just going by what I have heard from graduating IC fellows.

 

[timpview]

Structural market is still tight in my region..

I also wouldn’t bank on being able to get into structural in this day and age without a dedicated structural fellowship year… though im sure there are exceptions to that.

With how almost everyone is feeling the corporate squeeze these days, I just don’t see many who would waste their time/production, increase their risk exposure, or train their future replacement in the eyes of admin with really no tangible benefit to them.

 

[BMW M5]

Structural market is still tight in my region..

I also wouldn’t bank on being able to get into structural in this day and age without a dedicated structural fellowship year… though im sure there are exceptions to that.

With how almost everyone is feeling the corporate squeeze these days, I just don’t see many who would waste their time/production, increase their risk exposure, or train their future replacement in the eyes of admin with really no tangible benefit to them.

In addition to coronary work, I got exposure to a lot of peripheral work, carotid artery stenting, EVARs, some venous work, PFO closures and LAAO.

It would be hard to do a structural year for just TAVR. Not interested in doing mitral or tricuspid valve interventions.

The significant majority of IC practicing structural cardiology didn’t do a formal year. Not quite sure why training needs to be extended.

I think being proctored on the job for 1-2 more procedures is perfectly reasonable. We can’t stay in training forever. A lot of these procedures weren’t done 20 years ago anyway.

Training in IM or general cardiology should probably be shortened to accomodate a future 2 year IC fellowship. More than 7 years of medical training is really pushing it.