What a top 5 cardiology program looks for, and should you even care.

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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!
 
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IMreshopeful

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Cardiology fellow here. The above post regarding academic career section is why I’m so, so glad I plan to go into practice and leave the political, self-masturbatory, self-serving and self-aggrandizing environment of academia behind. I can’t wait.
 
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doctorbeastmode

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Cardiology fellow here. The above post regarding academic career section is why I’m so, so glad I plan to go into practice and leave the political, self-masturbatory, self-serving and self-aggrandizing environment of academia behind. I can’t wait.

Definitely nothing self masturbatory, self-serving, or self aggrandizing about cranking through rich surbaban patients in private practice so you can afford the Maserati you roll into work with every day. Toyota’s are for peasants. So much more selfish to take a massive pay cut because you have a passion for educating the next generation of docs or generating new insights into disease. Would def be a better world if all of us took your view. Spread it on amigo!
 
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IMreshopeful

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Definitely nothing self masturbatory, self-serving, or self aggrandizing about cranking through rich surbaban patients in private practice so you can afford the Maserati you roll into work with every day. Toyota’s are for peasants. So much more selfish to take a massive pay cut because you have a passion for educating the next generation of docs or generating new insights into disease. Would def be a better world if all of us took your view. Spread it on amigo!

I like treating patients and doing clinical work. I hate begging for grants, spending hours writing or working in a lab, dealing with the egos and personalities of academia, or becoming so disconnected from clinical medicine that I am an expert at one thing and forget how to treat everything else. I doubt I’ll make enough to ever afford a Maserati and I’m interested in treating the underserved and doing international work. I loved teaching residents and fellows but hate the “research” part of academia and have nothing but the utmost respect for those who want to do it - I just really, really hate the culture as I stated and personally want nothing to do with it. And nothing wrong with wanting to make more money, though you seem to have a false understanding of what I’m looking at in my future.

But sure you go ahead with your assumptions about what I want in my life, bub. All the power to you if you want to embark on a selfless endeavor of discovery - I want to treat patients and make their lives better on the front lines.
 
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NewYorkDoctors

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For academic physicians (not necessarily cardiologists ) , is there a “purgatory state” in which this individual ends up neither a leader of the field and pioneer who attains many honoraria and grants (the doctors who give the board review courses, for instance) and just does many smaller scale research? These individuals can still find success in other ways ? And let’s define success as some combination of salary work life balance tenure and leadership positions ?
 

doctorbeastmode

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Hey man I was just having a little fun - I’m sure you’re a good guy and I’m sure you’ll be a great doc. You just came out swinging there and a lot of your post wasn’t about the politics or the culture - it was about the individuals who were doing it. You used the word “self” three different times, so hard to read it any other way.

For the record, I got nothing against private practice either. Good people and it’s hard work and does a lot of good for the world. I was satiring your take on academics.

Academic purgatory is a real thing for sure.
 
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TAVR2sday

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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!

All of this. Great post.
 
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BigRedBeta

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Fantastic post and for the most part broadly applicable into other fields as well besides Adult Cards. As a Pediatric ICU attending, there are lots of truths to what you've posted in my field as well. The point about narrowed clinical focus and leverage is probably completely overlooked by most everyone. Personally, I got one job offer at a program with an academic reputation far beyond my expectations because I filled the exact administrative niche a soon-to-depart faculty member was vacating. If it hadn't been for that, the program likely wouldn't have given me the time of day because I surely wasn't bringing external funding or particular research expertise to the table.

Without a doubt, the academic purgatory is real and probably represents the vast majority of academic physicians especially as you examine the faculty profiles at medical schools outside the top 20 or 30. Some one has to teach the IM clerkship in West Virginia, or run the pediatric hospitalist service in Omaha or Grand Rapids MI, right? And I'd bet that those people are likely quite content with their position through some combination of being close to family (or ties to the state), work/life balance, teaching, clinical duties, and the like.
 

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Definitely nothing self masturbatory, self-serving, or self aggrandizing about cranking through rich surbaban patients in private practice so you can afford the Maserati you roll into work with every day. Toyota’s are for peasants. So much more selfish to take a massive pay cut because you have a passion for educating the next generation of docs or generating new insights into disease. Would def be a better world if all of us took your view. Spread it on amigo!

:laugh:
 

loeffy

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Cards fellow here from a major program, agree with everything mentioned, just wanted to re-emphasize some points. The OP was referencing top academic programs, where generally the main thrust is producing researchers. "Top program" is a very loose term, SDN loves rankings but there is no clear ranking of cardiology programs. As the OP mentioned, the top program for someone interested in hardcore research is vastly different than top program for someone wanting to work private practice. Often hardcore academic programs produce average clinicians due to emphasis on research over clinical acumen. Going to a big-name program that doesn't support your interests may be more detrimental than going to a 'lesser' program that does. Or going to a 'lesser' program in the city you want to live in after training and getting your foot in the door may be more beneficial. As cliche as it sounds, fit really does matter. Applicants need to figure out what exactly they want in their career and out of their training and make sure the program meets it, chasing reputation may lead to disappointment. No program is perfect, every program differs in training, vibe, culture, etc. and it can certainly affect your overall happiness and training outcome.

I would also add programs like Michigan, UW, Vandy and even NYU to the OP's list. Also, while attendings connections can help, connections to current fellows, even indirectly, can be an even bigger help. It pays to be an excellent resident and person overall, you never know how it may help you in the future. In my program, if fellows don't know the applicant but know someone who might, we definitely ask around.

Outside of hardcore academic programs, most programs will give you 'good enough' training, I'm not as optimistic as the OP regarding 'outstanding' training. Ironically, major academic hospitals will often see a high volume and variety of patients that could yield a robust clinical experience, yet fellows can't necessarily take advantage of that due to other obligations. Also, autonomy, especially hands-on experience, can vary greatly between programs. Some programs the 3rd year fellow is still assisting, while others the fellows is primary operator within 6 months.

Cardiology fellow here. The above post regarding academic career section is why I’m so, so glad I plan to go into practice and leave the political, self-masturbatory, self-serving and self-aggrandizing environment of academia behind. I can’t wait.

A little harsh, but agree with the sentiment. As the OP mentioned, it's just different. PP and academics are both important. However, I'm not a fan of the superiority complex some in academics have, looking down on PP or anyone who wants to do it. I remember some programs being pretty negative about it, but also some being surprisingly supportive.
 
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jdh71

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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!

Good post. Same for "top pulm". Maybe even especially so in my experience. I didnt go to the tippy top but I broke into the top 20 (or 30 whatever [everyone has an opinion!]) with an interest in an academic research career. But I ended up disliking the environment and lack of help with a specific plan from fellowship to funded faculty. So I walked away. Most of those 18 months of research would have been better spent doing something clinical.
 

IMreshopeful

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Cards fellow here from a major program, agree with everything mentioned, just wanted to re-emphasize some points. The OP was referencing top academic programs, where generally the main thrust is producing researchers. "Top program" is a very loose term, SDN loves rankings but there is no clear ranking of cardiology programs. As the OP mentioned, the top program for someone interested in hardcore research is vastly different than top program for someone wanting to work private practice. Often hardcore academic programs produce average clinicians due to emphasis on research over clinical acumen. Going to a big-name program that doesn't support your interests may be more detrimental than going to a 'lesser' program that does. Or going to a 'lesser' program in the city you want to live in after training and getting your foot in the door may be more beneficial. As cliche as it sounds, fit really does matter. Applicants need to figure out what exactly they want in their career and out of their training and make sure the program meets it, chasing reputation may lead to disappointment. No program is perfect, every program differs in training, vibe, culture, etc. and it can certainly affect your overall happiness and training outcome.

I would also add programs like Michigan, UW, Vandy and even NYU to the OP's list. Also, while attendings connections can help, connections to current fellows, even indirectly, can be an even bigger help. It pays to be an excellent resident and person overall, you never know how it may help you in the future. In my program, if fellows don't know the applicant but know someone who might, we definitely ask around.

Outside of hardcore academic programs, most programs will give you 'good enough' training, I'm not as optimistic as the OP regarding 'outstanding' training. Ironically, major academic hospitals will often see a high volume and variety of patients that could yield a robust clinical experience, yet fellows can't necessarily take advantage of that due to other obligations. Also, autonomy, especially hands-on experience, can vary greatly between programs. Some programs the 3rd year fellow is still assisting, while others the fellows is primary operator within 6 months.



A little harsh, but agree with the sentiment. As the OP mentioned, it's just different. PP and academics are both important. However, I'm not a fan of the superiority complex some in academics have, looking down on PP or anyone who wants to do it. I remember some programs being pretty negative about it, but also some being surprisingly supportive.

Yeah I feel a little bad how I put it but my point I think is reflected in what you said. I have friends at other programs which are much “higher tier” than mine but have far more limited clinical training. It’s a bizarre paradox that the sickest patients get referred to tertiary institutions but this may not reflect in a better clinical education for the fellows (though usually does reflect good education for residents). It reflects a push for the top programs to foist an emphasis on academic output and research on these fellows and I know of a couple who are frustrated because they just want to go into practice and don’t feel supported or prepared. A large proportion of the fellows at my program either go into practice or subspecialty EP or IC training, so I do feel like we are supported. The converse is certainly true.

It reflects also this culture that is foisted on medical students that academia = good, practice = bad from pretty early on - which is of course not true and unfair. I personally think that programs should consider making “pure clinical” tracks for cardiology which are based around either preparing for practice or for subfellowship training.

The differential in procedural training is definitely huge between programs. I am usually primary cath operator (except PCI or structural) at this point in my second year... some programs don’t allow fellows to even get femoral access. There’s some well regarded top programs which are good both clinically and academically, but i personally feel those are in the minority.
 
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IMreshopeful

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Good post. Same for "top pulm". Maybe even especially so in my experience. I didnt go to the tippy top but I broke into the top 20 (or 30 whatever [everyone has an opinion!]) with an interest in an academic research career. But I ended up disliking the environment and lack of help with a specific plan from fellowship to funded faculty. So I walked away. Most of those 18 months of research would have been better spent doing something clinical.

I know multiple pulm fellows who are frustrated with how the second year is purely research when all they want is to go into clinical practice or do a sleep fellowship. Do you think it could potentially be shortened to two years for those fellows who don’t want to do it? I doubt that would happen, but still
 

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I know multiple pulm fellows who are frustrated with how the second year is purely research when all they want is to go into clinical practice or do a sleep fellowship. Do you think it could potentially be shortened to two years for those fellows who don’t want to do it? I doubt that would happen, but still

No. You are doing two fellowships. You need the time I think.

Even though I was doing research I was still covering call and seeing patients in clinic two days per week (my clinic and sub sub specialty clinic). The clinic time with attendings who know what they are doing is invaluable.
 
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IMreshopeful

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No. You are doing two fellowships. You need the time I think.

Even though I was doing research I was still covering call and seeing patients in clinic two days per week (my clinic and sub sub specialty clinic). The clinic time with attendings who know what they are doing is invaluable.

Yeah... but that’s a half afternoon a week. We also do that but with other clinical duties (cath, echo, etc). In that case would it not make more sense to pair it up with some sort of clinical elective more relevant to pulm?

This is not to be snarky; I genuinely wonder if this is the best way to set it up and am curious
 

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Yeah I feel a little bad how I put it but my point I think is reflected in what you said. I have friends at other programs which are much “higher tier” than mine but have far more limited clinical training. It’s a bizarre paradox that the sickest patients get referred to tertiary institutions but this may not reflect in a better clinical education for the fellows (though usually does reflect good education for residents). It reflects a push for the top programs to foist an emphasis on academic output and research on these fellows and I know of a couple who are frustrated because they just want to go into practice and don’t feel supported or prepared. A large proportion of the fellows at my program either go into practice or subspecialty EP or IC training, so I do feel like we are supported. The converse is certainly true.

It reflects also this culture that is foisted on medical students that academia = good, practice = bad from pretty early on - which is of course not true and unfair. I personally think that programs should consider making “pure clinical” tracks for cardiology which are based around either preparing for practice or for subfellowship training.

The differential in procedural training is definitely huge between programs. I am usually primary cath operator (except PCI or structural) at this point in my second year... some programs don’t allow fellows to even get femoral access. There’s some well regarded top programs which are good both clinically and academically, but i personally feel those are in the minority.

It is hilarious to me that people equate lack of clinical training and tons of research as a top program when truly these fellows come out only prepared to do research. We all get trained in academic medical institutions and are told it is the only way. It gets ingrained in people that private practice is bad and only academic medicine is the only thing that is good. It causes people to become as closeminded and stuck up as the OP and forced into tracks where they will be untrained and forced to accept utterly insulting pay. Some people realize the scam in residency or fellowship and bail but others don't. And those that don't, end up having to justify their decisions with contempt for the non-academic universe. Guess who trains the next round of med students to continue the cycle?

It is funny to see the transition as people end fellowship when the curtain is lifted. We all think we are going to do academics and have to play the game of research to get fellowships. By the end of fellowship when we start interviewing, we truly realize what it means to end up in academics. A handful of my cofellows were initially convinced they were going into academic medicine. Then they started interviewing and realized that they litterally get paid less than half as much in academia to do the same job. Few remained committed to academics but most bailed for greener pastures. They then laugh at jokers who make posts like the OPs
 
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HarryGary

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It is hilarious to me that people equate lack of clinical training and tons of research as a top program when truly these fellows come out only prepared to do research. We all get trained in academic medical institutions and are told it is the only way. It gets ingrained in people that private practice is bad and only academic medicine is the only thing that is good. It causes people to become as closeminded and stuck up as the OP and forced into tracks where they will be untrained and forced to accept utterly insulting pay. Some people realize the scam in residency or fellowship and bail but others don't. And those that don't, end up having to justify their decisions with contempt for the non-academic universe. Guess who trains the next round of med students to continue the cycle?

It is funny to see the transition as people end fellowship when the curtain is lifted. We all think we are going to do academics and have to play the game of research to get fellowships. By the end of fellowship when we start interviewing, we truly realize what it means to end up in academics. A handful of my cofellows were initially convinced they were going into academic medicine. Then they started interviewing and realized that they litterally get paid less than half as much in academia to do the same job. Few remained committed to academics but most bailed for greener pastures. They then laugh at jokers who make posts like the OPs

I guess you didn't notice the use of quotation marks or the last five words of the title.

I posted because this forum is primarily young MDs and medical students debating rankings that often times don't account for career goals or training program goals, and because of this, are pretty much nonsense. There are threads about "up and coming" programs, "over ranked" and "under ranked" residencies that not only are inaccurate, but more importantly don't incorporate what a young MD is trying to achieve professionally. That's silly.

People should understand what the training thrust of a "top" program entails. They should ask the question if that aligns with their personal goals.

People should understand that an academic career implies either a) having a means to fund research time, or b) having a clinical career that is significantly under compensated. Perhaps they pursue b) because they love teaching or being a part of tertiary care center. I get that, and respect that, but wouldn't personally do that.

People should understand that there's nothing wrong with private practice. It's simply a different career model.

This forum glamorizes academics without understanding it.
 
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Elixir6

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I guess you didn't notice the use of quotation marks or the last five words of the title.

I posted because this forum is primarily young MDs and medical students debating rankings that often times don't account for career goals or training program goals, and because of this, are pretty much nonsense. There are threads about "up and coming" programs, "over ranked" and "under ranked" residencies that not only are inaccurate, but more importantly don't incorporate what a young MD is trying to achieve professionally. That's silly.

People should understand what the training thrust of a "top" program entails. They should ask the question if that aligns with their personal goals.

People should understand that an academic career implies either a) having a means to fund research time, or b) having a clinical career that is significantly under compensated. Perhaps they pursue b) because they love teaching or being a part of tertiary care center. I get that, and respect that, but wouldn't personally do that.

People should understand that there's nothing wrong with private practice. It's simply a different career model.

This forum glamorizes academics without understanding it.

For what it's worth, you post was excellent and nuanced, and discussed very clearly what prestigious academic programs are looking for and how the personal goals of applicants whether they are interested in academic or private practice may differ from what the selection committee seeks. Of course many people change their tune when they see the all of the work required to become faculty and climb the ladder with much lower compensation as compared to PP, and yes, it's unfortunate that taking the PP route is often looked down upon.

Not sure why some people here are getting their panties in a bunch when you clearly stated most all of this, or why it's felt necessary to poo poo on you based on their opinion of the training at these academic centers. If the clinical training of an academic is so poor then why is that these same very competent and efficient community docs send their patients to academic centers for highly specialized care? Is it just because they want to get rid of a patient who might take up a lot of their time - no, where I am training many community docs send their patients when the diagnosis/management is difficult and/or unclear.
 

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For what it's worth, you post was excellent and nuanced, and discussed very clearly what prestigious academic programs are looking for and how the personal goals of applicants whether they are interested in academic or private practice may differ from what the selection committee seeks. Of course many people change their tune when they see the all of the work required to become faculty and climb the ladder with much lower compensation as compared to PP, and yes, it's unfortunate that taking the PP route is often looked down upon.

Not sure why some people here are getting their panties in a bunch when you clearly stated most all of this, or why it's felt necessary to poo poo on you based on their opinion of the training at these academic centers. If the clinical training of an academic is so poor then why is that these same very competent and efficient community docs send their patients to academic centers for highly specialized care? Is it just because they want to get rid of a patient who might take up a lot of their time - no, where I am training many community docs send their patients when the diagnosis/management is difficult and/or unclear.

Nobody is saying that the care of patients at these centers is bad. Of course if you send a patient to an academic center which specializes in HCM, their treatment of HCM is going to be better because they have experts there. That does not mean the training is going to be so much better. It is very common for medical fellowships that value research and publications from their fellows to undervalue clinically being well rounded. I know more than a few interventional attendings who don’t know how to read echos or can’t interpret an ICD interrogation... and I don’t want to be that guy.
 
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aafisahar

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I guess you didn't notice the use of quotation marks or the last five words of the title.

I posted because this forum is primarily young MDs and medical students debating rankings that often times don't account for career goals or training program goals, and because of this, are pretty much nonsense. There are threads about "up and coming" programs, "over ranked" and "under ranked" residencies that not only are inaccurate, but more importantly don't incorporate what a young MD is trying to achieve professionally. That's silly.

People should understand what the training thrust of a "top" program entails. They should ask the question if that aligns with their personal goals.

People should understand that an academic career implies either a) having a means to fund research time, or b) having a clinical career that is significantly under compensated. Perhaps they pursue b) because they love teaching or being a part of tertiary care center. I get that, and respect that, but wouldn't personally do that.

People should understand that there's nothing wrong with private practice. It's simply a different career model.

This forum glamorizes academics without understanding it.

This forum gives advice on how to match into a competitive fellowship (eg cards) and that entails playing the game. If you want broad, high quality training, you need to be at a decently academic place. No academic place is going to take a fellow that says "I want to go into private practice and make a ****ton of money". PDs want to hear how future fellows are devoted to academics and research in particular. They understand that they may bat 10-20% on fellows actually staying on as faculty to do research, but that's far better than if they just took the PP bound fellow.

That said, a research heavy fellowship (eg 1-2 years dedicated research) probably attracts one of two types. The person who truly intends to do research or the person looking to cash in on the name (eg Hopkins trained).
 

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Nobody is saying that the care of patients at these centers is bad. Of course if you send a patient to an academic center which specializes in HCM, their treatment of HCM is going to be better because they have experts there. That does not mean the training is going to be so much better. It is very common for medical fellowships that value research and publications from their fellows to undervalue clinically being well rounded. I know more than a few interventional attendings who don’t know how to read echos or can’t interpret an ICD interrogation... and I don’t want to be that guy.
The care of those patients IS bad. These lousy OSH cuss-heads transfer their train wrecks to me and almost certainly cackle as they count their doubloons.
 
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IMreshopeful

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The care of those patients IS bad. These lousy OSH cuss-heads transfer their train wrecks to me and almost certainly cackle as they count their doubloons.

Did you read my post? I was talking about the academic centers where these patients get transferred. If you actually read it I said that nobody is claiming that the patient care is substandard especially if it’s a specialty hospital - but that doesn’t always translate to better training
 
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Did you read my post? I was talking about the academic centers where these patients get transferred. If you actually read it I said that nobody is claiming that the patient care is substandard especially if it’s a specialty hospital - but that doesn’t always translate to better training
I didn’t read your post.
 
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Deferoxamine

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So many generalizations in this thread from both sides of the aisle.
I'm with Instatewaiter. Honorable mention to IMreshopeful. But that's from my own personal experiences. Academia can work out well for some, but not for most others. "Top institutions" never seem to tell you that, especially if you're the type that works your butt off and delivers... after all, why not exploit you a little more if they can?
 
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The post by HarryGarry (OP) is spot on. Unfortunately, we spend a lot of time talking about academia but the vast majority of fellows end up in pure private practice or clinical practice (meaning being a clinician in academic institution). My two cents is that unless you are really driven to be have a big research career, try to get the best clinical training regardless of where you end up, because the odds are the you will be a clinician and you might as well be good at what you do.
 

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This is an accurate post. I think people being critical of the OP or accusing him of elitism should re-read the post in its entirety. He provides some important insight into the politics of why it can in some instances be more challenging to gain broad clinical exposure/competency (whether this is defined as broad COCATS level II competency, or the more challenging to assess/define procedural competency) at a "Top 5" institution. These institutions aim to produce leaders within narrow academic niches that do not exist in private practice. While the clinical opportunities are present at most places (not all), fellows who publish papers in a specific field of interest (EP, IC, imaging) rather than learn to interpret echocardiograms (insert any skill) on their echo rotation (insert any rotation) may be the most internally valued. Be honest with yourself about what you want to get out of your training.
 
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Trisphorin

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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!

I really appreciate your insights, I think many on the SDN are too. It appears from your post that for someone who isn't from top ranked residency and isn't a minority or did PhD to make it to the interview stage, research is the key. I was wondering this is still true for fellowships are highly competitive, more emphasize on clinical skils/volume and not necessarily big academic powerhouse like Harvard/Duke/Penn/Columbia? I can't think of a specific example, maybe programs like texas heart?
 
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CatFactorial

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It should also be said that top programs, regardless of the niches into which they might pigeonhole their fellows, produce graduates who can likely find work wherever they want. The guy who goes to a community program and comes out a superior clinical cardiologist will be employable in his immediate region. However, even if significant research were to circumscribe the Cleveland Clinic (or insert fancy program here) grad’s training the program name opens up the entire country for him.
 
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HarryGary

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This is an accurate post. I think people being critical of the OP or accusing him of elitism should re-read the post in its entirety. He provides some important insight into the politics of why it can in some instances be more challenging to gain broad clinical exposure/competency (whether this is defined as broad COCATS level II competency, or the more challenging to assess/define procedural competency) at a "Top 5" institution. These institutions aim to produce leaders within narrow academic niches that do not exist in private practice. While the clinical opportunities are present at most places (not all), fellows who publish papers in a specific field of interest (EP, IC, imaging) rather than learn to interpret echocardiograms (insert any skill) on their echo rotation (insert any rotation) may be the most internally valued. Be honest with yourself about what you want to get out of your training.

Exactly. Can show you some excellent clinically trained cardiologists who had a lot of uncomfortable meetings with their PD.
 
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HarryGary

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It should also be said that top programs, regardless of the niches into which they might pigeonhole their fellows, produce graduates who can likely find work wherever they want. The guy who goes to a community program and comes out a superior clinical cardiologist will be employable in his immediate region. However, even if significant research were to circumscribe the Cleveland Clinic (or insert fancy program here) grad’s training the program name opens up the entire country for him.

Disagree. Try getting a private practice job with level II in ECG only. Try getting an academic research job without a plan for funding in place. They will be happy to hire you for a fellow's salary.

Also, people aren't picking between the top and a community program; they're picking between a high prestige academic program and another American university program with less academic pedigree. Graduates of the second are also highly sought after.
 
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So many generalizations in this thread from both sides of the aisle.
I'm with Instatewaiter. Honorable mention to IMreshopeful. But that's from my own personal experiences. Academia can work out well for some, but not for most others. "Top institutions" never seem to tell you that, especially if you're the type that works your butt off and delivers... after all, why not exploit you a little more if they can?

Sorry for the generalizations. Next time I will include actual applicants' admissions essays, their letters of recommendations, and the interviewer's comments.

Goal was to be nuanced and provide actual insight into what a heavily academic program seeks and is trying to provide training wise.

I did this because a lot of the younger MDs on this board are making residency rankings in an attempt to get into one of these type programs, and I worry they don't really know what that means or if it aligns with their real career goals.
 
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HarryGary

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This forum gives advice on how to match into a competitive fellowship (eg cards) and that entails playing the game. If you want broad, high quality training, you need to be at a decently academic place. No academic place is going to take a fellow that says "I want to go into private practice and make a ****ton of money". PDs want to hear how future fellows are devoted to academics and research in particular. They understand that they may bat 10-20% on fellows actually staying on as faculty to do research, but that's far better than if they just took the PP bound fellow.

Ha. Fair point.
 
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OK all, apologies for offending some people. Look forward to reading the annual residency rankings later this summer.
 

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Disagree. Try getting a private practice job with level II in ECG only. Try getting an academic research job without a plan for funding in place. They will be happy to hire you for a fellow's salary.

Also, people aren't picking between the top and a community program; they're picking between a high prestige academic program and another American university program with less academic pedigree. Graduates of the second are also highly sought after.

Fair points, but perhaps not as applicable to non procedural fields without such sub-sub qualifications as cardiology. As far oncology goes, unless I’ve been living under a rock and am due for a rude awakening when I start fellowship in a few months, one doesn’t have certifications for interpreting smears or what have you. If one were single boarded, that might (but not certainly) signify to private practices limited clinical scope and give pause for hiring. However if you’re dual boarded and coming from the highest tier (and I mean maybe just MSK, MDACC, Hopkins, DFCI), I do believe that if funding weren’t to work out and you had to leave academics for the greener pastures of private practice, you could find plum jobs anywhere, desireable markets included.

If on the other hand, you trained at powerhouses like Arkansas (myeloma), Indiana (GU onc), Nebraska (lymphoma) with the ambition of an academic career in those fields and found that it didn’t work out, you wouldn’t likely have as much success landing that PP job in San Francisco as folks coming from the aforementioned tippy top. I could be wrong though.

OK all, apologies for offending some people. Look forward to reading the annual residency rankings later this summer.

Not offended; this is a useful discussion. However, when I was on the interview trail it seemed to me that top programs offered less robust clinical training but graduates who opted for PP ended up doing more than fine. I thought the clinical training at Sloan was significantly lacking (no autonomy; patients want to be treated by the attendings) compared to regional academic programs that throw fellows into their own clinic in the first year. I would still advise those contemplating PP with top-flight fellowship prospects to seriously consider them however.
 
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Deferoxamine

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Sorry for the generalizations. Next time I will include actual applicants' admissions essays, their letters of recommendations, and the interviewer's comments.

Yawn. Not impressed. By your attempts at sarcasm or your attempts to show off in your first post of this thread. Which, let's all be honest here, was the primary reason you posted this thread in the first place.

I am also a graduate from "top programs". And here's a clue for you, buddy - The day you leave those places, NO. ONE. CARES. WHERE. YOU. TRAINED. 90% of what people will remember about you is: Did you try your best to make Grandma feel better, did you explain what the hell was actually going on in words they could all understand, and were you a nice guy?

Get over yourself.

(And... still LOL at your idea that fellowship programs should give a **** what your Step 1 score was.)
 
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Instatewaiter

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I guess you didn't notice the use of quotation marks or the last five words of the title.

I posted because this forum is primarily young MDs and medical students debating rankings that often times don't account for career goals or training program goals, and because of this, are pretty much nonsense. There are threads about "up and coming" programs, "over ranked" and "under ranked" residencies that not only are inaccurate, but more importantly don't incorporate what a young MD is trying to achieve professionally. That's silly.

People should understand what the training thrust of a "top" program entails. They should ask the question if that aligns with their personal goals.

People should understand that an academic career implies either a) having a means to fund research time, or b) having a clinical career that is significantly under compensated. Perhaps they pursue b) because they love teaching or being a part of tertiary care center. I get that, and respect that, but wouldn't personally do that.

People should understand that there's nothing wrong with private practice. It's simply a different career model.

This forum glamorizes academics without understanding it.

Yes perhaps I missed the quotation marks or the last 5 words of the title. Or perhaps I just realized that this thread was the fellow version of the pre-allo humble-brag.

Ever wonder why the residents who do residencies at these places with "top 5" cardiology programs often flee for programs that will allow them to learn cardiology? It is why Hopkins Cards, whose residency sends 15-20 into cardiology each year is full of people who did med school in the carribean and various random residencies rather than hopkins grads. It is why Duke has gone unmatched a handful of times in the last decade.
 
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Instatewaiter

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It should also be said that top programs, regardless of the niches into which they might pigeonhole their fellows, produce graduates who can likely find work wherever they want. The guy who goes to a community program and comes out a superior clinical cardiologist will be employable in his immediate region. However, even if significant research were to circumscribe the Cleveland Clinic (or insert fancy program here) grad’s training the program name opens up the entire country for him.

I suspect the OP was intentionally leaving out places like CCF and Texas heart as not in that Top 5 as in these places you may publish but you just can't escape the clinical volume. I can tell you his top 5 would probably be: Columbia, Hopkins, Duke, MGH/Brigham and Penn or Mayo.
 

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Often times I see "academic" used to encompass both research and teaching. For someone that casually enjoys clinical research (a review or two in a year - certainly not in a publish or perish sense) but wants to primarily have a teaching career, is it still important to pursue training at a "top" academic program?
 

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Often times I see "academic" used to encompass both research and teaching. For someone that casually enjoys clinical research (a review or two in a year - certainly not in a publish or perish sense) but wants to primarily have a teaching career, is it still important to pursue training at a "top" academic program?

I think you need to think about what you want. It sounds like you mainly want to teach residents and fellows. Sure you can be hired by academic centers looking for an people to do work - but expect no promotions unless you publish (which is the main way you get pay raises). So two reviews a year ain’t gonna cut it and it’s hard to publish reviews of a topic in a big cards journal unless you’re a well known person in that field. That’s why Brilakis has published like ten reviews on CTOs.

The clinician educator track is definitely feasible, but if you want to be mostly clinical with some education your best bet is working with some hospital system that has its own community residency but is mainly looking for you to do clinical work.
 

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Fair points, but perhaps not as applicable to non procedural fields without such sub-sub qualifications as cardiology. As far oncology goes, unless I’ve been living under a rock and am due for a rude awakening when I start fellowship in a few months, one doesn’t have certifications for interpreting smears or what have you. If one were single boarded, that might (but not certainly) signify to private practices limited clinical scope and give pause for hiring. However if you’re dual boarded and coming from the highest tier (and I mean maybe just MSK, MDACC, Hopkins, DFCI), I do believe that if funding weren’t to work out and you had to leave academics for the greener pastures of private practice, you could find plum jobs anywhere, desireable markets included.

If on the other hand, you trained at powerhouses like Arkansas (myeloma), Indiana (GU onc), Nebraska (lymphoma) with the ambition of an academic career in those fields and found that it didn’t work out, you wouldn’t likely have as much success landing that PP job in San Francisco as folks coming from the aforementioned tippy top. I could be wrong though.



Not offended; this is a useful discussion. However, when I was on the interview trail it seemed to me that top programs offered less robust clinical training but graduates who opted for PP ended up doing more than fine. I thought the clinical training at Sloan was significantly lacking (no autonomy; patients want to be treated by the attendings) compared to regional academic programs that throw fellows into their own clinic in the first year. I would still advise those contemplating PP with top-flight fellowship prospects to seriously consider them however.

It’s very difficult to compare oncology training to that of cardiology as you have intimated here. Cards is very procedural and as such having a large repertoire is much more marketable. The Ivy League grad coming out of fellowship with level 1 in most things and can’t independently read echos, do TEE, nucs, or stress echo and saw patients for a few months during their first year is not gonna be very marketable. But as noted here, there are very strong clinical fellowships around who do a good job of making their fellows marketable by giving them the skills to make it. So if that’s your goal, it might be better to think about that upper mid tier cardiology program which may not get you to publish in JACC four or five times a year or let your mom say “my son went to this place!” but will ultimately make you a competent doctor
 
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ROBINHO

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It’s very difficult to compare oncology training to that of cardiology as you have intimated here. Cards is very procedural and as such having a large repertoire is much more marketable. The Ivy League grad coming out of fellowship with level 1 in most things and can’t independently read echos, do TEE, nucs, or stress echo and saw patients for a few months during their first year is not gonna be very marketable. But as noted here, there are very strong clinical fellowships around who do a good job of making their fellows marketable by giving them the skills to make it. So if that’s your goal, it might be better to think about that upper mid tier cardiology program which may not get you to publish in JACC four or five times a year or let your mom say “my son went to this place!” but will ultimately make you a competent doctor

U make it sound like the cardiologists coming out of Mayo, Hopkins, Columbia , Cleveland clinic etc are automatically poor clinicians. At some of these places the fellows manage sick patients that you will never see in a regular community hospital. Granted I am not at one of these Ivy league places, some of my mentors come from are from these top institutions and they happen to be excellent clinicians.

The initial post might have strike some chords. But I think some people are competitive and want to go to the very top programs and there is nothing wrong with that. The initial post will be useful to some people. I think we need both academic and private practice cardiologist. There are obviously pros and Cons. and am feeling the discussion on that too.
 

Instatewaiter

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U make it sound like the cardiologists coming out of Mayo, Hopkins, Columbia , Cleveland clinic etc are automatically poor clinicians. At some of these places the fellows manage sick patients that you will never see in a regular community hospital. Granted I am not at one of these Ivy league places, some of my mentors come from are from these top institutions and they happen to be excellent clinicians.

The initial post might have strike some chords. But I think some people are competitive and want to go to the very top programs and there is nothing wrong with that. The initial post will be useful to some people. I think we need both academic and private practice cardiologist. There are obviously pros and Cons. and am feeling the discussion on that too.

Yeah, Cleveland is not an "academic" fellowship. It is likely the busiest clinical fellowship in the country (perhaps Texas Heart is busier) where it is understood you'll get level 2 in echo, nuc, cath just by showing up and CT/MR training if you'd like.

Usually when Academic Blowhards are talking about "top" programs they are intentionally leaving out clinical programs like Cleveland or Texas Heart as a dig at their volume of clinical training rather than research
 
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Dapik

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I think you need to think about what you want. It sounds like you mainly want to teach residents and fellows. Sure you can be hired by academic centers looking for an people to do work - but expect no promotions unless you publish (which is the main way you get pay raises). So two reviews a year ain’t gonna cut it and it’s hard to publish reviews of a topic in a big cards journal unless you’re a well known person in that field. That’s why Brilakis has published like ten reviews on CTOs.

The clinician educator track is definitely feasible, but if you want to be mostly clinical with some education your best bet is working with some hospital system that has its own community residency but is mainly looking for you to do clinical work.

That was helpful insight, thank you.
 

rhymeswithcoffee

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Does this means Step 3 matters for cardiology applicants? And if so, how does everyone approach it to get over a 250 when there are no designated resources?
 

gutonc

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Does this means Step 3 matters for cardiology applicants? And if so, how does everyone approach it to get over a 250 when there are no designated resources?
Step 3 is by far the easiest exam you'll take in this whole ridiculous process. And it's kind of ludicrous to say there are no designated resources. There's tons of stuff out there.
 

HoldTheCoffee

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I think this post is fairly accurate despite the backlash OP received from some members. When I applied, it seemed like the most important things were residency program rep/LORs and research. Honestly even at the "top tier" programs, if you come from a big-name residency odds are you'll still get interviewed for a fellowship position, even if your research during residency wasn't very fruitful
 

IMreshopeful

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I think this post is fairly accurate despite the backlash OP received from some members. When I applied, it seemed like the most important things were residency program rep/LORs and research. Honestly even at the "top tier" programs, if you come from a big-name residency odds are you'll still get interviewed for a fellowship position, even if your research during residency wasn't very fruitful

The post was a humble brag. Let’s call a spade a spade. That’s neither here nor there. We all know that to get into a good fellowship you need to play the research game and pretend that you one day want to be the next big authority on (insert random topic here) and that, why of course you plan on doing academics, how could you think any different. It’s like the equivalent of when applicants for medical school all intend to one day work in impoverished rural family medicine clinics while simultaneously doing clinical missions overseas.
 
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aafisahar

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Often times I see "academic" used to encompass both research and teaching. For someone that casually enjoys clinical research (a review or two in a year - certainly not in a publish or perish sense) but wants to primarily have a teaching career, is it still important to pursue training at a "top" academic program?

When you say education, do you mean beside teaching or curriculum design/being an aPD. We often say education to mean be a great bedside teacher. Fellowships and residencies are looking for people who can design and implement a curriculum. Few places are looking for exclusive bedside teachers. Your job as an educator involves spending time on committees trying to get xyz integrated into the existing curriculum for the program. It's usually a 50/50 clinician/educator job and pays accordingly except you can't boost your income with grant money except in the rarest of cases.

Once people realize that, they typically ditch educator tracks and go print money in a pirate practice setting.
 
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