Question about Cardiology Residency?

<p>I was wondering because I know that I want to go into medicine. I also know that when I do get there, my desire to become an interventional cardiologist is likely to change drastically. I will admit that I have yet to experience enough areas of medicine to fully say that as my final choice. I do still have a question regarding it and other specialties similar to it. It is my understanding that to become an interventional cardiologist, one must first complete an internal medicine residency, then a cardiology residency and finally an interventional cardiologist fellowship. Here is my question. Are you matched with cardiology after graduating from medical school or are you matched with internal medicine and after three years, you must hope to land a cardiology residency or else you will be stuck as an internist if that wasn't your goal. Basically, are cardiology programs six years all-inclusive? Where you are matched to one directly after medical school. The same question can then be applied to a CT surgeon (something I'm not that interested in but still curious). Do you do a five year general surgery residency independently of the CT fellowship? Likewise with neurology, etc.
Also the areas of radiology, urology, and anesthesiology are all directly after medical school without any general areas in between, correct? (Besides the usual 1 year thing at first)</p>

<p>Bump, I'd really like to know</p>

<p>1) give posts some time to mellow. There's not enough traffic on this board for quick replies</p>

<p>2) Cardiology (and other fellowships through IM or peds) are applied for during the second year of residency. I suppose it's possible that there might be some categorical cards programs but I'd be shocked if they existed.</p>

<p>3) As for interventional or EP subfellowships, I honestly don't know the exact process, but figure it's probably a combination of looking for cards fellowships that have a particular type of subfellowship (programs look out for their own), and then applying to that and other programs in the 2nd or 3rd year of a cards fellowship. It appears there's no match process for these extra years of training</p>

<p>4) CT fellowships will follow a similar path - you'll match gen surg out of med school, then apply for fellowship positions later.</p>

<p>5) Anesthesia and sub-specialties like urology, ortho, derm and radiology are different. For one there are categorical positions which include placement in a PG-1 year position, and there are also transitional programs and peds/im/fp/gen surg programs that take extra interns each year, knowing that these residents will not progress through the program. These are the Prelim year programs. You do match into these directly out of medical school. Students thus match into 2 programs on Match Day. But there's also increased flexibility in this as well. My roommate's fiancee, matched anesthesia and then scrambled into a prelim spot at our school so that he could stay close to my roommate. I have another friend who matched into a prelim surgery year at his home school to be near his fiancee, and they are going through the couples match together this year. </p>

<p>Categorical programs tend to be more competitive, simply because it makes for fewer interviews, costs less to apply and avoids the upheaval that comes from moving. But there are a lot fewer categorical spots than those available for advanced training (programs that just have the required years of one specialty). So many people settle for prelim programs different than their advanced training programs. Some times this means having to move huge distances twice in one year...One anesthesiologist I know moved from Portland OR to Des Moines IA to Davis CA from med school to prelim to anesthesia residency years.</p>

<p>Hey, thanks a lot. I'll try to be more patient the next time. So, it is possible that if I wanted to become a cardiologist out of med school that I could not end up getting it if I cant match one after intern residency?
Also, I'm kinda confused on this prelim thing. Does that mean that it allows you to switch from what you originally matched?
I really wanted to be an interventional radiologist but I thought that specializing in the heart would be very interesting. Which is easier or less competitive to do. Become a radiologist or become a cardiologist.? I imagine that both are high profile areas that would attract a lot of people. What can you do to make yourself more open to these positions? I know that you should have good scores when you are doing rotations in that area and have good grades and board scores. Is there anything else?</p>

<p>1) Yes it's possible that you could enter an internal medicine residency, apply for cardiology fellowship (because that's the first step to interventional), and then not match in cardiology. Cards is one of the more competitive fellowship fields. Unfortunately, the NRMP Med specialties match statistics aren't very helpful in telling exactly how competitive, as it groups all applicants for all fellowships together (the peds side has the individual fellowships listed separately).</p>

<p>The thing to remember though is that you can apply multiple times. You are interviewing for positions that will open 2 years away (interview in Post grad year -PGY- 2 for a position you'll start as a PGY4). So you can just as easily apply as a PGY3, but you'll have to find a job for the gap year. But this is where residency program directors, department chairs and faculty mentors come into play. Residency programs want to place their grads into jobs, and if you've matched, options certainly exist...</p>

<p>There certainly are a number of individuals who do decide to change from being generalists to entering fellowship training years after they've finished residency. You'll take a rather large pay cut while you're a fellow, but people do it.</p>

<p>2) is a little confusing. Let me try this again.</p>

<p>The first year out of medical school (intern year) is generally considered to be the most significant jump in knowledge and understanding of how to take care of patients out of the entirety of medical training. So it's an extremely important year, because it really is when you learn the basic skills of patient management. Surgery interns typically see an extremely limited amount of time in the Operating Room because they need to be able to manage patients before they learn operative techniques. That's how important this year is in the development of being a physician.</p>

<p>So with that in mind, a number of different specialties, particularly the ones in which more advanced training is highly specialized towards a certain system or modality - derm, radiology, ortho, ENT, anesthesia, optho, PM&R - require a "prelim year" so that their future residents have the basic skills down. This is a REQUIREMENT, and you cannot enter advanced training without successful completion of a prelim year.</p>

<p>Let's take an example. One of my good friends is currently an in his PGY-2. He is an anesthesia resident at a program in the western US. Coming out of medical school, he was set on doing anesthesia. So he applied to a lot of anesthesia programs. Now in total, prelim year included, anesthesia residency is 4 years long (1 year prelim, 3 years anesthesia). Some programs you can match to are 4 years in length and some are only 3 years. The 4 year programs are termed 'Categorical' and if you match in them, you move to that location, they rotate you through a prelim year (either with their surgery or internal medicine or some combination thereof) at their institution. Essentially their hospital has the extra spots available to take on the burden of providing that training. Other programs - "advanced" - only offer three years of training. Advanced programs are essentially offering you a spot 2 years ahead of time (ie my friend graduated med school in 2007, but rather than starting anesthesia training in 2007, he had to wait until 2008 for his PGY2 to start). </p>

<p>Now because my friend applied to both categorical and advanced training programs for anesthesia, he also had to find programs that would train him for the prelim year he needed. So he had to apply to and interview at those programs as well. </p>

<p>Now there are a variety of different options that exist for prelim years. Internal medicine, general surgery, family medicine and pediatrics programs all may offer prelim year spots. They may have a need for a certain number of interns to cover their wards and so they have extra spots in their intern classes, or they can simply accommodate the extra staff. At a large academic institution that has some categorical programs, some of these "extra" spots may be 'reserved' for matched applicants in a particular field. So if there are 15 extra intern spots in the Internal medicine program, maybe 3 of those are reserved for anesthesia categorical interns, 3 are for Derm and 2 are for optho. The rest are simply 'available' for applicants who need a prelim spot to apply for, whether they're hoping to match into some program at that place or not (because again, remember, if they're going into a certain field, they have to have that year of experience).</p>

<p>Now to further complicate things, some anesthesia programs may have both advanced AND categorical spots...maybe they have 9 spots total for their PGY2 class, but they offer only 3 categorical positions. So med students may apply to both the categorical and the advanced spots. Why offer both? Well it goes back to the situation about where they can put their interns. The agreement they may have with Internal Medicine may only allow for those 3 interns. But for the Anesthesia program, it may also attract higher quality of applicants to have the categorical positions because those tend to be more desirable.</p>

<p>To further complicate the issue, in addition to medicine, surgery, family and peds prelim year spots, there are also some places that offer "transitional year" programs. Unlike the intern years of those other programs, these offer the intern the chance to rotate through a variety of different fields to gain experience. And unlike the schedules in the prelim years which match those of categorical medicine, surgery or peds residents, the transitional year programs tend to offer a lot more elective time. As someone going into pediatrics, I can tell you that most programs don't offer more than one 4 week block of elective time. Those doing prelim years don't get any different training than the people who are going on to complete full medicine/surg/peds residencies. For example, my friend got to do 2 months of anesthesia towards the end of his transitional year program. It certainly was different than what he's going through now, but he got to do things that general medicine interns would never get to do. Because of this flexibility, transitional years are highly competitive. The common belief is also that transitional year programs tend to be easier because you're doing a number of different fields and aren't going through the tasks that other interns are. So for example, a transitional year intern may do a month of pediatric wards, but won't be doing time in the NICU.</p>

<p>Now when my friend submitted is rank-order-list for the match, he had two lists: one for anesthesia programs and one for his PG1 year which included transitional and prelim year programs. And he got two results when Match Day came. </p>

<p>3) Prelim years are not designed to change your career goals. Occasionally it might happen, but the way the match is set up, there are a number of hurdles that exist to getting out of your binding agreement to go to the program that you matched at. As I can tell you from having to register for it this year, by registering for the match, applicants and programs enter into binding agreement that the results are firm and any match that occurs will be adhered to. The biggest rule to putting together a rank-order-list for programs and applicants is that you don't include any program or individual that you'll regret. There are a couple programs I've interviewed at that I absolutely will not rank because I don't want to run the risk of ending up there. I'm sure there will be a program or two that feels the same about me and I won't make their ROL.</p>

<p>WOW. Thank you so much for that detailed response. I am truly grateful.
I do have one more question. Let's say that a person was interested in two areas and did not care which area he got into as long as it was at least one of the two. During the time of matching, can you apply to more than one area or do they have to be all the same areas? And, do you apply for multiple places offering the same thing like you do for college or medical school? Like say one in LA and another in ATL</p>

<p>Yes, you can apply for multiple areas if you like, but you will find that this is very rare - people tend to know what specialty they want to go into. And you have to be aware that you are contractually obligated to whichever program you match into, so you had better be 100% sure that you would be okay with any specialty that you rank on your match list. There are some residencies that train you and allow you to be boarded in two specialties, such as Peds/IM, IM/FM, FM/EM, IM/EM, EM/Peds, etc. (obviously, the selection is limited for these combined residencies).</p>

<p>And yes, people tend to apply to residencies all over. Its really just like college or med school applications. You find programs you are interested in, apply, interview, etc. The main difference is that you rank the programs you like best and the end choice is more or less out of your hands and up to the computers at the NRMP.</p>

<p>Actually it's not that rare for people to apply to multiple specialties...but when they do, it's usually not because they're equally content with both. Typically, individuals who are aiming for very competitive specialties will generate back up programs to interview at so that they can match. I have several friends who are doing this - one hoping for urology has internal medicine programs she's applying to, another is hoping for ENT but also looking at pediatrics programs.</p>

<p>For those who are looking at combined residency programs like med/peds, it's even more common because not every location has combined programs. I was looking into med/peds for a long time but there were a lot of locations I was looking at that didn't have a program, so I was going to apply to the peds programs, interview and then rank based solely on how I liked the programs (not based on whether they were med/peds or not). In the end, my plans for fellowship changed, so I was able to switch entirely to just pediatric programs.</p>

<p>As for where people apply, it can be all over. But you have to remember that the people going through residency match are older. I'll be 26 when I start residency, and considering that the average age for people starting med school is 24 or 25 depending on the year, I'm among the youngest going through the match (and I'm an April birthday on top of it all). Plenty of my classmates are engaged or married, some have kids, some have older parents they're taking care of. There are other pressures on final destinations than what you find for people applying for college or medical school. Many people limit themselves to certain geographic regions. I certainly get surprised looks when I tell people I have interviews at Utah, Ohio State, Arkansas and Wake Forest. I'm not a rarity by any means, but definitely geographically diverse. You can check the interview invite threads on SDN and see how people limit themselves geographically (the search and highlight tool on firefox is handy for this).</p>

<p>Lastly, I'd say that while the final control is out of your hands when it comes to where you'll end up, in a way you actually have a lot more certainty about the process. For one, you have to do a residency at some point, so you'll eventually have to get a position in something. While there are a few people who will take a year off after med school, it's extremely few. That certainly isn't the case for college or especially medical school. Second, the statistics are very much in favor of the students. For US Seniors, ~93% get a position through the Match (the remainder go through the Scramble). Of that 93%, about 85% get one of their top three choices (including 50% who get their top choice) and more than 90% get one of their top 4. That's for all comers, regardless of specialty, so for certain fields (ie IM, peds, FP) it's probably higher.</p>

<p>One other thing. The large scale analysis of match outcomes the past several years by the NRMP has demonstrated that the key to getting into a particular field is the number of contiguous programs in that field from the number one position on down. It's a slightly flawed metric, because in competitive fields, the number of interviews one receives (and thus number of programs one can rank) directly reflects the quality of the candidate, but even in fields like IM and peds, it's been consistently shown that ranking more programs is the strategy for success. For peds, the average matched applicant ranked 8 programs while the average unmatched candidate only ranked 3. So it is important to rank enough programs to ensure getting a match.</p>

<p>WOW!!! Thanks a lot BRM and Icarus. You have been extremely helpful. I'm glad that you can still devote time to CC out of your busy schedule. Thanks!</p>