I used to read this board a lot when I was a resident applying to cardiology fellowships. There is no shortage of confidence in what people post here, but I think there is a lot advice that is misinformed.
As a graduate of a top cardiology program, and who has spent (brief) time on the admissions committee, here is what our program looks for in applicants, and what I think is probably generalizable to peer fellowship programs.
Numbers
Each year we get about 600+ applications for about 50-60 interview spots. We match 8. So if you're offered an interview, you are being seriously considered.
Who gets an interview
The PD usually scans through the applications and pulls out people he thinks would be good candidates. Most applicants who go to the selection committee have board scores that average 245+, come from a well known residency program, have uniformly strong letters, or have multiple high impact publications.
The residencies most often considered are not surprises: MGH, Brigham, UCSF, Hopkins, Penn, Duke, Columbia, Yale, UChicago, Northwestern, Stanford, Cornell, UCLA, BID, UTSW, Wash U, Mt Sinai.
Attending one of the residencies above does not get you an interview, but it just gives your application some extra attention. Every year, we also invite strong candidates from people outside those programs as well. Usually those applicants have outstanding research background or are basic scientists. Applicants with PHDs and interest and success in basic science have an edge because they are rare.
If an application makes it to committee everyone reads the personal statement, reviews scores, etc. Often times, there are somewhat arbitrary reasons an applicant doesn't make it beyond the committee to an actual interview. Someone on the committee for some reason doesn't like something minor. It's easy to get black balled.
After the pool of interviews are assembled, a committee whose focus is increasing women and minority recruitment goes back through the total pool and identifies more candidates from non-traditional residencies. They often find fantastic applicants who were overlooked in the initial process.
What is a program looking for
Really the program is looking for junior faculty. There is an assumption that people will be strong clinically, but what the recruitment really team wants is people who will help with research and grow the academic mission. To be blunt, it takes a lot of time to write a paper, and it's easier for the faculty if they have talented fellows to write papers for them or who can manage their patients while they do that work. But by and large the committee is focused on finding people who will help faculty do research.
How important is it to match at a "Top" Program
It depends. If you want to have an academic research career, the opportunity to find a mentor and develop skills for research and grant writing is probably best at a large academic center. However, this can be accomplished anywhere a good mentor can be found. If you have a good mentor at a smaller program, there's no guarantee you'll find another good mentor at a bigger one. If you attend a "top" program but leave without many publications, you will not be highly sought after for faculty positions by other academic institutions. Publish or perish is real. More realistic and relevant probably is, "will you be bringing grant money with you to your new job, or do you have a plan to fund your research career when you come on faculty?". If you don't have a plan, and you want to go academic, then in my view, you are setting yourself up to have a poorly reimbursed clinical career. Academic institutions have no shortage of people willing to come on faculty for clinical jobs, and they tend to pay far worse than private practice. On the flip side, these jobs may offer better work life balance, or allow for a teaching/education career that may not be available elsewhere. It really helps for you to be honest with yourself about what your career goals are, and what kind of job you want. An academic career is not "better" or more "pure" than a private practice job. It's just different.
What about clinical skills?
Top programs tend to be high volume centers where you can get excellent exposure to cutting edge procedures and talented clinical mentors. However, big programs generally don't need cardiologists who are broadly trained. They need a world expert in something narrow, since they have a large pool of cardiologists to begin with. Cyncially, a narrowly trained cardiologist also has poor negotiating power with the academic institutions, as private practices seek more well rounded cardiologists with multiple skills. So if you are an applicant to cardiology considering private practice, a "Top" program is probably a bad fit. The program will pressure you to do research and to develop a narrow clinical skill set. This can be lessened if you seek an advanced fellowship after general training (heart failure, EP, interventional/structural, MRI), as those skills usually have a market. A fully trained cardiologist who is flexible in location can make a very nice living. The recent Medscape survey is accurate.
Advice for future applicants:
Work hard in residency to be the best clinician you can be. Be involved in research to demonstrate interest in pursuing an academic career. Be honest with yourself about what type of practice you eventually want to have. Almost all American university programs offer outstanding clinical training. If you just want to practice medicine and take care of patients, there is no need to seek out "top" residency or fellowship programs. A "lesser" program may even be better at offering you more well rounded clinical training since there will be less pressure to do research, which is time consuming and hard.
Last, take everything you read on these boards with a large grain of salt. Most people who post on this board are interns and third or fourth year medical students, with less insight than they realize. The rest of the posters are a holes like me.
Good luck!
As a graduate of a top cardiology program, and who has spent (brief) time on the admissions committee, here is what our program looks for in applicants, and what I think is probably generalizable to peer fellowship programs.
Numbers
Each year we get about 600+ applications for about 50-60 interview spots. We match 8. So if you're offered an interview, you are being seriously considered.
Who gets an interview
The PD usually scans through the applications and pulls out people he thinks would be good candidates. Most applicants who go to the selection committee have board scores that average 245+, come from a well known residency program, have uniformly strong letters, or have multiple high impact publications.
The residencies most often considered are not surprises: MGH, Brigham, UCSF, Hopkins, Penn, Duke, Columbia, Yale, UChicago, Northwestern, Stanford, Cornell, UCLA, BID, UTSW, Wash U, Mt Sinai.
Attending one of the residencies above does not get you an interview, but it just gives your application some extra attention. Every year, we also invite strong candidates from people outside those programs as well. Usually those applicants have outstanding research background or are basic scientists. Applicants with PHDs and interest and success in basic science have an edge because they are rare.
If an application makes it to committee everyone reads the personal statement, reviews scores, etc. Often times, there are somewhat arbitrary reasons an applicant doesn't make it beyond the committee to an actual interview. Someone on the committee for some reason doesn't like something minor. It's easy to get black balled.
After the pool of interviews are assembled, a committee whose focus is increasing women and minority recruitment goes back through the total pool and identifies more candidates from non-traditional residencies. They often find fantastic applicants who were overlooked in the initial process.
What is a program looking for
Really the program is looking for junior faculty. There is an assumption that people will be strong clinically, but what the recruitment really team wants is people who will help with research and grow the academic mission. To be blunt, it takes a lot of time to write a paper, and it's easier for the faculty if they have talented fellows to write papers for them or who can manage their patients while they do that work. But by and large the committee is focused on finding people who will help faculty do research.
How important is it to match at a "Top" Program
It depends. If you want to have an academic research career, the opportunity to find a mentor and develop skills for research and grant writing is probably best at a large academic center. However, this can be accomplished anywhere a good mentor can be found. If you have a good mentor at a smaller program, there's no guarantee you'll find another good mentor at a bigger one. If you attend a "top" program but leave without many publications, you will not be highly sought after for faculty positions by other academic institutions. Publish or perish is real. More realistic and relevant probably is, "will you be bringing grant money with you to your new job, or do you have a plan to fund your research career when you come on faculty?". If you don't have a plan, and you want to go academic, then in my view, you are setting yourself up to have a poorly reimbursed clinical career. Academic institutions have no shortage of people willing to come on faculty for clinical jobs, and they tend to pay far worse than private practice. On the flip side, these jobs may offer better work life balance, or allow for a teaching/education career that may not be available elsewhere. It really helps for you to be honest with yourself about what your career goals are, and what kind of job you want. An academic career is not "better" or more "pure" than a private practice job. It's just different.
What about clinical skills?
Top programs tend to be high volume centers where you can get excellent exposure to cutting edge procedures and talented clinical mentors. However, big programs generally don't need cardiologists who are broadly trained. They need a world expert in something narrow, since they have a large pool of cardiologists to begin with. Cyncially, a narrowly trained cardiologist also has poor negotiating power with the academic institutions, as private practices seek more well rounded cardiologists with multiple skills. So if you are an applicant to cardiology considering private practice, a "Top" program is probably a bad fit. The program will pressure you to do research and to develop a narrow clinical skill set. This can be lessened if you seek an advanced fellowship after general training (heart failure, EP, interventional/structural, MRI), as those skills usually have a market. A fully trained cardiologist who is flexible in location can make a very nice living. The recent Medscape survey is accurate.
Advice for future applicants:
Work hard in residency to be the best clinician you can be. Be involved in research to demonstrate interest in pursuing an academic career. Be honest with yourself about what type of practice you eventually want to have. Almost all American university programs offer outstanding clinical training. If you just want to practice medicine and take care of patients, there is no need to seek out "top" residency or fellowship programs. A "lesser" program may even be better at offering you more well rounded clinical training since there will be less pressure to do research, which is time consuming and hard.
Last, take everything you read on these boards with a large grain of salt. Most people who post on this board are interns and third or fourth year medical students, with less insight than they realize. The rest of the posters are a holes like me.
Good luck!
