Thoughts on CHIP Fellowship!

[Stone Cold]

Hi,

I was recently exposed to a CHIP fellowship program at one of the largest hospital in the northeast which got me excited. Can anyone share more thoughts on it, difference between a general IC and CHIP in terms of the complexity, lifestyle, opportunities and pay.

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[BMW M5]

Hi,

I was recently exposed to a CHIP fellowship program at one of the largest hospital in the northeast which got me excited. Can anyone share more thoughts on it, difference between a general IC and CHIP in terms of the complexity, lifestyle, opportunities and pay. I'm trying to get more insight on the pros & cons and if it's worth pursuing that route

If you are interested in IC, you'll have to decide closer to graduating general cardiology fellowship whether or not you will want to apply for a CHIP fellowship (Complex & High Risk Coronary Interventional Procedures - non-ACGME accredited fellowship). Most of the folks that end up doing an extra non-accredited year after IC fellowship will want to join a tertiary center where they will get a lot of referrals and be able to do a lot of high risk coronary work (e.g. complex chronic total occlusions).

I'm not aware of any financial advantage over traditional IC. Not a lot of hospitals want to invest in such long procedures because of diminishing returns and use of a lot of equipment.

Once you are closer to graduation, you should start reaching out to cardiologists in the geographic area that you are are interested and look into the need of a "coronary CTO person". You may not find all that demand but hospitals need STEMI coverage so chances are, you can at least do that as IC but that also questions whether or not to pursue an additional year.

Good Luck!

 

[timpview]

Just remember you’re allowed to kill or seriously hurt three people in your first job (years 0-2) before your career is at-risk.

First one raises eyebrows.

Second one puts everyone on notice. You’re now being discussed behind your back at multiple closed door meetings.

Third one there is open debate on whether to fire you.

Now anyone fired for complications after their first job out of fellowship is going to have to go to the very Deep South to find another job.

It’s one thing if Dr Shaw who has been there for ten years has a devastating CTO complication. It’s a whole another thing if “newly hired out fellowship”, who is this guy???, Dr Thompson does.

So there’s that angle too in terms of how complex you want to get early in your career, especially when really bad things can happen to anyone just doing the basics or when the death tallies are just with the ones already dead (vf arrest) or going to die (stemi)

I know a whole lot more people who start doing CTOs and say screw this.. vs those that make a career out of it (maybe 90% plus??). But obviously that is why such fellowships now exist since no one else wants to do these cases and maybe “CHIP” trained ICs are given a little bit more rope before they hang you.

Though stuff that “sounds cool” isn’t always appreciated (or understood) in the real world by those that employ you and control your future.

 

[deleted980918]

Is there any data to support CTO interventions anyway?

IMHO, ICs tend to do lot of things just because they want to prove they can.

Keep it simple.

 

[timpview]

Is there any data to support CTO interventions anyway?

IMHO, ICs tend to do lot of things just because they want to prove they can.

Keep it simple.

Not really… but it is nice having someone in your area still willing to take on tough cases in this day and age. That willingness is still needed.. even if ego is the driver for many of them.

So in that regard, I actually think the whole CHIP thing is a good idea. Put the risk in the guys hands that often have a little more latitude/cushion than others and who have more volume then the typical ICs. I just don’t think it’s a safe route for new attendings.

 

[Full Metal IC]

Before you decide to do it...go scrub into a CTO. It all sounds really cool until you're 4 hours in elbow deep and your back hurts. I personally don't think CHIP fellowships in general are a positive. Besides the few places that really have so much volume that their first year IC fellows can't physically be in all the high-risk cases, it just dilutes case volume between more fellows and gatekeeps the first years.

 

[Phospholipid]

Been practicing for almost 5 yrs now. IMO, CHIP fellowship is a waste of time. If you really want to learn super complex CTO stuff, you can learn it on the job. But I can tell you that majority of places in the US does not want this. If you are fortunate that admin wants this from you, it is easily a learnable skill, just read up about it, watch youtube. It is just an extension of IC skills, and does not need an extra year of training for this. I am confident if you take the well known "CTO" operators in the nation and pluck them into my hospital as is, and they practice like they are at their home institution, they would not last. It is not so much godlike skillset that nobody else possess, but more the ability to do that kind of thing at the institution. Outcomes matters a lot to hospitals, and some tertiary centers say screw the outcomes, we are the best, and we have bad outcomes because we tackle complex cases. If that is the administration point of view at your institution, then you can be the high volume CTO operator.

This should be warning to fellows. I know watching CTO videos and live cases are cool and all, and coming out of fellowship I wanted to be that CTO operator. Reality really sets in when you get your first job. I myself almost lost my job (more due to politics than complications), and had to adapt significantly. I also know of 1 other friend who had to leave his job because of doing what he felt was right (but very very aggressive when compared to his partners). Be careful out there. IMO, CTO should only really be considered for proximal LAD, proximal dominant LCx/RCA with a large territory. In many high volume CTO places, I find that they are tackling CTO left and right for everything, vessels that really don't make that big of a difference. Many doesn't even make sense, and does little for the patient, and worst when they restenose. You don't see this as a fellow, but definately when you are an attending following a patient for years.

Interventional field is fraught with a lot of subjective assessment, and if you are not on the right side of politics, things could end very badly for you.

 

[aafisahar]

take your ego out of this and look at the evidence.

marginal benefit for angina, otherwise, no benefit to mortality, EF, etc.

most patients don't benefit (eg >90%) and you exposure yourself to lots of risk (complications, orthopedic issues, radiation), and expose patients to lots of risk including death.