UT Houston Cardiology Fellowship (UTH)

[Parzival__MD]

Hey guys,

I have been meaning to post on here and other forums for quite some time. First, I am a relatively recent grad from cards fellowship at UT Houston Cardiology (UTH). I wish you all the best of luck in the application cycle.

This is meant as a public service announcement about UT Houston Cardiology program. After training there, I can tell you it's probably one of the worst academic programs in the country.

1. The culture is horrendous. From day 1, you will be used as cheap labor to do scut work, refill potassium and see mindless consults at MD Anderson. The teaching is EXTREMELY poor, there is no curriculum and no PROTECTED teaching time. The attendings have no desire or ability to teach; you are there to keep the wheels moving and do their work. Most time if you are in conference you will be paged away to answer calls or consent patients. Attendings treat you more like residents or med students then colleagues. The PAs/NPs and device reps get treated far better than any of the fellows. I have heard from current fellows that they may be on probation from the ACGME as they were investigated last year for duty hour violations. The fellows also told me that some PDs forced fellows to falsify their duty hours to be compliant. That is INSANE.

You have to carry a spectra link mobile phone so nurses or anyone can call you 24/7 while in hospital.

You do 24 hour call and night call the first year which includes covering CCU(15-20 beds), Heart Failure ICU(40-60 beds!!!), CV ICU(15-20 beds), floor beds(50-60), ER consults/STEMI, EP consults, Private attending consults(yes, private attendings who you have never met before), supervise residents(many of which weren't signed off on lines in their 3rd year). That spectralink sound will give you PTSD.

2. Don't buy the "high volume center" nonsense. I have friends who trained all of the country in academic and community programs and they were always shocked about our workload. High volume just means more scut work for you. Also, high volume doesn't mean anything if you are not taught the basics or mentored properly. You may have the "numbers" as I did but I still didn't feel completely comfortable doing a TEE or cath completely on my own. I know most fellows leaving the program, despite 'high volume advanced heart failure center' are not comfortable troubleshooting IABP, ECMOs, LVADs, PA waveforms. I saw mutliple interventional fellows who trained at UTH struggle with basic diagnostic caths/radial access(most cases at UTH are femoral access which is NOT the norm anymore, most labs do > 80% radial approach). Resident scut work is fine but fellowship should be about honing your skills, having time to study and learning the nuances of the field imo.

3. Ask to see the schedule for the 3 years of training. You will quickly realize there are NO ELECTIVES in this fellowship even in your 3rd year. You get 1 month of nuc med in 3 years, yes only 1 month. Most of my colleagues at other programs had 6-12 months of electives in 3rd year to tailor their schedule. I was way behind my peers when i did advanced training as most of them were familiar with the basics. You are also always pulled to cover other BS when you are on your "research month"

There are plenty of great programs out there and if you really need to stay in Houston, the 3 other programs (Baylor, THI, Methodist) are better alternatives.

I wish someone had told me this when I was applying for fellowship and I happy to help any and all of you along with your journey.

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[EPADHA]

I am very sorry to hear this. UTH traditionally has been a major TAVR and transplant/MCS center. As some one who interviewed with the HF group some time back, your perspective is interesting to hear. During my interview, Memorial Herrman sounded like a slave-factory with not much emphasis on academic stuff etc. They wanted me to round on 30-40 patients daily as attending when on service (every other week) and read 20-30 imaging studies. LOL!
The leadership also did not seem very nice either. I dont know how much Drs Kar and Loyalka are involved with fellows etc. It sounds like emphasis is on clinical productivity and academics etc come a distant second. They should hire more fellows and put 2 fellows on call, or pay fellows to moonlight.

 

[logitech123]

Thank you for the information. What about Baylor college of medicine program? and how about Baylor/St luke/Texas heart program? Thank you

 

[CVPD]

Hello,

I am currently the co-program director of the Cardiovascular Disease Fellowship at UT Houston. I am truly sorry that you feel this way about the program.

The first thing that I can say is the description on this post appears nothing like the training program we currently have at UTH. Furthermore, this opinion is very different from that of the vast majority of UTH cardiology fellows, either current or graduated. As one of the largest cardiology fellowships in the country, most of our graduates are successfully practicing, are confident that they are well trained, and are often leaders in their own practices. This is a busy program with a comprehensive cardiovascular training, and the fellows who put the effort to learn are rewarded with excellent opportunities after finishing fellowship.

There are some points I wanted to comment on. We DO NOT have any issues with the program as it relates to ACGME. In fact, we just had a thorough ACGME site visit this year and we are accredited for the next 10 years. None of the current PDs have ever advocated for falsifying duty hours nor will we. Teaching is something we take very seriously. Our fellows are well trained and we currently have a 100% ABIM CV boards pass rate. Night call was historically a challenge. Since you left and in response to fellow feedback, we have instituted a night float system with senior backup and this has been very well received by the fellows. Because the program is large, we are able to provide electives for the second and third year fellows in order for them to concentrate on their preferred paths. For example, one of our third-year fellows who is destined for ITV chose to have additional 4 months of cath during his third year. Several of our third year fellows are also spending a whole month in a health care management course and will receive a business certificate for their efforts.

Overall, we remain extremely receptive to feedback from former and current fellows. All the faculty and PDs have “open door policies” and we invite anyone to visit our website or call/email our program to inquire further or express any concerns. Sadly, your comments in this forum are neither constructive nor really representative of what we have to offer at UTH. Regardless of how you feel, I hope that you will remember that you will always be associated with UTH, so please feel free to give us a call and we can work through these issues in a fruitful way.

Thank you,
Cardiovascular Disease Fellowship PD
UT Health Sciences Center at Houston

 

[aafisahar]

Recent interviewee, so I don't have any skin in the game except matching.

I didn't get the sense that the program is as malignant as it may have been 3-7 years ago. They've made some promising changes including a night float system, more support on nights (eg swing fellow). You still work really hard however but every fellow (~10) I talked to had great things to say about the program including feeling educationally supported. Fellows get insane numbers including radial caths. One fellow reported a 100% echo board pass rate this year.

 

[lonslow]

Well that escalated quickly. No direct experience here either but speaking to those closer to the program, some people had the OP feelings (granted it was a few years ago) while others positivity about the program just rubbed me the wrong way, but to each their own. But this brings up interesting points about volume, scut work, etc. that applies to all programs. SDN is obsessed about "high volumes" but it's often nonsense. It's all about what you actually get to see, do and learn. Some programs tout their high volumes but that includes non-teaching services, or fellows are doing research or scut work that an NP could do rather than seeing those "high volumes." Or you could have a program that leverages free fellow labor to do all the work, giving no time to actually learn properly or give good patient care. I know of a few big-name programs like this that can get away with it because of their rep. High volume doesn't necessarily mean competency, autonomy and the like. And scut work isn't just writing notes, but also being abused by the hospital and other depts for your services. Instead of volumes, I'm more interested in what a fellow has seen, done and can do. I'd rather have the fellow who has done 300 caths (barely level 2) on complex anatomy, lvads, scrubbed in for pci's, tavr's, or obese patients, etc., over the fellow who did a "high volume" of caths in a routine outpatient setting on relatively healthy patients. You don't necessarily need to be busy or worked hard to get good training.

Thank you for the information. What about Baylor college of medicine program? and how about Baylor/St luke/Texas heart program? Thank you

There's been some reviews of these programs in the past, do a search.

One fellow reported a 100% echo board pass rate this year.

I'm not sure what that point is but that's not a reflection of the program or even quality of the doctor, imo. It's a somewhat pointless test (like most boards are), even some attendings thought some of this year's questions were bogus, and it's something that depends heavily on the individual, their study habits and test-taking skills.

 

[DoctorRicky]

I did my residency and cardiology fellowships at UT Houston and I am currently an EP fellow at the same institution. In my 7 years here I have seen a lot change for the better. It is true that 5 to 6 years ago the cardiology program did have the reputation of being a "malignant" one, and perhaps some of that was warranted. However, at that time, the Heart Failure team had just come over from St. Lukes and brought a lot of volume, but there were only 6 to 7 fellows per year and they were spread thin, doing 28 hr calls once a week. Since then, the Heart Failure service has settled in and hired support staff and more junior attendings. The cardiology fellowship now has 10 to 11 fellows per year. Furthermore, 28 hour calls are long gone. There is now a night float system in place. Dr. Kar is the head of the heart failure program and an excellent interventional cardiologist. In cath lab he will teach you a lot and also let you do a lot once he gets to know you. He was one of my favorite attendings to scrub in with. During my 3rd year of fellowship I had 2 research months and 2 elective advanced imaging months. During these months I was able to work on several projects. I had a QI project that I presented at a national conference in California and the Hospital sponsored my entire trip. I was also able to work on a case series with several EP and interventional faculty members and present this case series at HRS. I also had an elective rotation in Corpus Christi where I was given a lot of autonomy and was able to perform and assist in TEE's, Coronary Angios and PCI's via radial approach, TAVR's, pacemaker implants. I was actually surprised how much I was able to do well and proud of what I had learned at UT Houston. The UT Houston Cardiology program has vastly improved and is one of the premier cardiology fellowships in the country. We do all of the routine procedures, but also get referrals from all over Texas for complex procedures that can't be done at most places. Our faculty has also improved a lot and most of them take time to teach and review relevant studies after rounds. Dr. Nils Johnson is one of the brightest people that I have ever met and truly practices evidence based medicine in the wards and in the cath lab. One morning of rounds with him is like spending a week reading the Up To Date. He takes the time to always review recent papers that are relevant to the issues that we come across during rounds or in tough cases. Also, Dr. Reddy (one of our new program directors) has changed the conference structure and taken the time to hear feedback from fellows and helped make this a much more academic program. His EKG conferences every Friday morning are amazing. He always treats the fellows with respect and explains things politely no matter how stupid your questions or responses may be.

There will always be pessimists that will constantly complain and only find the negative things about everything. However, overall, most fellows are genuinely happy here and get along well. Furthermore, it shows when fellows choose to stay for advanced fellowships. This year, all 3 interventional fellows and the 2 first year EP fellows are graduates from the general cardiology program. Also, if you choose to go elsewhere, our graduating fellows go on to advanced fellowships in heart failure at premier institutions such a UCSF and Bringham Women's/Harvard. Several of our fellows also go to Methodist for advanced imaging fellowships and train with the guys that write the echo guidelines. UT Houston is honestly a premier cardiology fellowship and continues to improve on a daily basis.

 

[seismicCHICK]

I don’t usually post on forums but I felt inclined to respond to this post. I also am a recent grad at UTH Cardiology Fellowship and I’ll have to say that my experiences there were markedly different than the OP. Although some of OP’s points are valid, I believe that other points are an exaggeration and possibly even reflective of OP’s own deficiencies (and NOT of everyone’s as a whole).

First off, this program is front loaded. This is something you should know coming in. As a first year fellow, you will take all the in-house calls, second year fellows do STEMI calls, and third year fellows will do weekend nuc coverage on weekends and “emergency calls” aka back up to STEMI fellow. When I trained, we were still doing 24 hr in-house calls, split among all the first year fellows. Obviously, the more fellows in each class, the less frequent your calls will be. OP’s comment about all the beds you were expected to cover is true. We were a relatively smaller class and took more frequent calls and I do indeed have PTSD from that spectralink. With that being said, I’ve learned invaluable things during those night calls, including appropriate triaging skills, trouble shooting of our extracirc support etc. For very critical patients, the attendings were also just a phone call away and some of them even stayed in-house during the critical times. If you stayed late taking care of a patient on a non-call day, chances are, your attending was there with you. For times when they weren’t with you, I personally did not feel like I couldn’t reach any of them when I needed to as you had access to their cell phones. Yes, I spent some nights doing 10+ admissions/consults (all of which I’ve called every single attending for to get their feedback on plan, until towards the end of my first year when I felt more comfortable). I do not see doing admissions/consults as “scut work” as this will be a critical part of your job as a general cardiologist, whether you want to admit it or not.

I believe that since my time there, the program has made a lot of changes towards the above mentioned structure. Obviously you can see how one can very easily be overwhelmed with the amount of work to do, and currently they’ve gone away from 24 hr call and implemented a night call system which involves one overnight first year fellow, a short call first year fellow who stays until 10pm or so, as well as a back-up second year fellow (at least for the first 6 months of the fellowship). I don’t know how the current fellows are doing with this structure but it seems to be a step in the right direction.

In terms of the culture of the program…in any big program, you’ll have a huge discrepancy in the way you are treated depending on many factors. Of course, there will be some who treat you bad and some who treat you well. Believe it or not, just because you have MD after your name, does not mean you know everything and there can very well be times when an NP/PA may know more about a certain topic than you (*gasp – I said it!). OP should know that respect is earned, and not given. Of course I’ve had bad experiences with unwarranted attitude, but overall, I’ve been treated well by the majority of people (Faculty, ancillary staff, colleagues). I hate to say it, but if OP feels that EVERYONE has been rude/mean/disrespectful to him/her, I suggest reflecting on one’s own attitude and seeing whether or not the problem lies within.

This program is indeed very high volume. We saw a lot of patients and did a lot of procedures. There are many aspects to a procedure, which I believe that a general cardiology fellow needs to be involved in. Yes, if you will do a procedure on someone, you SHOULD be the one getting consent. Will there be times that you get consent on patients who you don’t touch? Of course, that’s just the name of the game. But even the process of consenting the patient is a learning process. Yes, you will write the procedure note afterwards and yes, you will be called if there are problems with the patient afterwards. You cannot expect to walk into a room, do a procedure, and then leave and have no responsibility afterwards – that’s just unrealistic. Some parts of learning is “scut”, and I use that term loosely.

I feel very confident in my cath skills, echo reading skills, and nuc reading skills. You can sit behind a book all day but you will not get good at the above things if you do not see/do enough cases, simple as that. The volume allowed me to get the experience I needed to feel confident in my skills. I’m not sure what the OP is talking about with “multiple” interventional fellows struggling with basic diagnostic caths as I personally have not experienced this. Though I’ll say that I cannot speak much about the interventional cardiology fellowship.

In terms of didactic, when I was a fellow there, there were always 1-2 lectures each day. I agree with OP and believe that the program did not emphasis protected time enough. I’m not sure what steps are being taken now to change this. With that being said, despite not having protected time, the Cardiology Boards pass rate has been 100% for at least the past 2 years. So I guess it is possible to learn things without sitting down in a formal lecture hall!

To sum up my long post, UT Cardiology is a very high volume center and you should probably expect to do a lot of fun things but also a lot of not so fun things – it’s just the nature of the beast. The program is making changes to address fellows’ concerns about being overwhelmed with work and hopefully it will be the change that is needed to make this program one of the best. You will leave UTH more confident and more skillful than many due to the sheer case load but being that this is a large program, you can also leave knowing nothing, if that’s how you choose to spend your 3 years. I hope this post was helpful. I felt that it’s important that the record be set straight. There is a lot that can be done to make this program better but there is also a lot of potential here. Overall, I am very happy with the training I received and would do it again.

 

[NightCitizen]

I really feel heartbroken reading such a post about the training at UTH especially coming from one its recent graduates. I am also a recent graduate of UTH Cardiology Fellowship and I evidently disagree with Parzival_MD comments.

I truly believe based on my training experience that UT Houston is one of the most rounded cardiology programs in the US. My cardiology training at The University of Texas at Houston has given me an exemplary opportunity to get a state-of-the-art clinical training in various aspect of cardiology. There is the exceptional clinical training experience in cardio oncology at the University of Texas at MD Anderson ,the extensive experience in managing LVAD ,ECMO and heart transplant patients at one of the most active advanced Heart Failure and cardiac transplantation program in the US and the experience in evaluating and managing structural heart disease patients undergoing Transcatheter Aortic Valve Replacement ,PFO/ASD closure and mitral clip procedures at one of the busiest and most experienced centers. You rarely can find all these training experiences in one cardiology program. While I have seen fellows in other programs struggle to get their competencies/numbers in various cardiology procedures, this was clearly not the case at UTH. It combines the mixture of high volume and complex anatomy

I would imagine Parzival_MD to feel fortunate doing her general cardiology training at UTH since all its graduates are well trained and all have successful careers in academia and private practice. It enabled me to achieve my career goal of working in academics while playing a key role in the further development of the field of cardiology.

I clearly disagree with the comments above as I felt I was working in a highly interactive and collaborative environment that helped me become a strong advocate for the patient and being a role-model to the students, residents that I worked with. I felt comfortable managing advanced heart failure patient and troubleshooting IABP, ECMOs, LVADs, and swan-guanz catheters.
By mid-second year I was performing TEE completely on my own under the direct supervision of the faculty, and by mid to late third year I was performing diagnostic Cath including radial access on my own under the direct supervision of the faculty.
As for the 3rd year schedule, it is tailored to one’s future career interest (whether it is IC, AHF, EP or Imaging).

I will always be proud to be associated with UTH.

 

[Atherectomy]

As a recent graduate fellow from this institution, I have to agree with OP. This program is horrible for several reasons. Fellows feel pressured to say or comments on things/cases they have not been involved in just to throw your fellow colleagues under the bus. They expect you to read an echo by yourself day 1 and they faculty gets mad if you don't do it, bc they are so used to just come in, sign the report and peace out. This program hired around 6 years ago some docs with minimal experience or bad reputation. One of the IC PD came from an institution where he was sued for a complication. Who gets sued in an academic institution these days? Gotta be very negligent. Also despite claiming being a CTO operator his complications are out of the charts. Very low volume for IC which has gotten very evident during and post covid. The previous PD was a well known to be very malignant mistreating his fellows and staff. One of his former graduates tried to get TAVR privileges there and he tried everything to block him. Lies, lies and more lies. That's the reason despite more than 30 years at UT he never rose to the higher academic ranks despite trying several times, being the IC PD for more than 20 years! Seems a little corrupt, maybe? lol. One of the attendings, who was supposed to be #2 in line has been suffered with grandiose complex thinking he could do high risk cases, getting major complications even in the trivial ones. His complications rate are also terrible, blaming the radiation has given a 'stroke-like' syndrome years ago and the reason his kids have been suffering of some sort of mental disability. This place is ridiculous. The HF center is a good place to learn within this institution but most of the attendings there are not part of the core cardiology fellowship. Dr Loyalka also was there, but this was before my time. And when he worked together with the current HF staff, they took over the entire Memorial Hermann hospital leaving the core fellowship division with the left overs from the ED. Pathetic! I agree with OP in regarding the conferences. No big trials are being held there. Very low publication rates, majority of publications are published in journals no one reads. Bottom line: Stay away from this program. And if you get an interview from there, run, run as fast as you can.....

 

[perita]

Hi Atherectomy, I'm applying for the HF this cycle and I have an interview there. Is the HF still good?