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“Match day” for Internal Medicine subspecialties came and went this year, despite the turbulence that the COVID-19 pandemic brought upon us. As 2020 draws closer to an end, the light at the end of the tunnel seems to get brighter and brighter. Future cardiologists have found their new homes in programs across the country. Some cardiology fellows have taken that extra leap and added an additional year of training in Advanced Heart Failure/Transplant or Electrophysiology. There’s always excitement that surrounds the results of match day, but jubilation for some brings disappointment for others. This year just felt different. The pandemic forced programs to offer virtual recruitment platforms to avoid the spread of this deadly virus that has drastically affected our lives.

Every year, the National Residency Matching Program (NRMP) provides an opportunity for medical students, residents, and fellows to match with various programs in a number of specialties across the U.S to complete their training. In cardiovascular diseases, this process is daunting. This year, data from NRMP demonstrates that 66.4% of applicants matched in cardiology.

NRMP Match Data: https://www.nrmp.org/fellowship-match-data/

Current trainees are now faced with making career decisions in an ever more competitive field. Historically, a career path is guided by research interests, an affinity for a procedure or disease entity, and/or by mentors in the field (let’s be honest and not forget, financial incentives). In addition, training in cardiology is becoming increasingly sub-specialized, residents and fellows find themselves pressured to pursue specialty training in order to maintain a competitive advantage.

To pursue a career in interventional cardiology (IC) for example, a cardiology fellow must be prepared to submit applications during their second year of training. That process remains “outside the match” with programs offering positions shortly after interviews take place in the winter. During interview season, fellows find themselves fielding questions about their potential interests which may include advanced coronary (aka CHIP), structural, and/or peripheral interventions. With the development of structural procedures such as TAVR/Mitra-Clip, pursuing additional training in structural heart disease was considered an attractive thought several years ago. Concerns regarding the lack of dedicated jobs post-training have decreased that enthusiasm over time. A similar trend appears to be occurring with new CHIP (Complex-High Risk and Indicated Procedure) fellowships being created. Nonetheless, training programs continue to offer dedicated specialty training that provides fellows the opportunity to acquire new skills and become experts in the field. In specialties like interventional cardiology, where competency has been associated with procedural volumes, trainees find the temptation to pursue additional training difficult to avoid.

The process isn’t perfect and these conservations will continue to shape our perspective on the optimal training pathways for future cardiovascular clinicians. The only thing for certain is that cardiovascular medicine is an ever-changing field and I hope those pursuing careers in cardiology find their homes.

REFERENCES

1. NRMP Match Data: https://www.nrmp.org/fellowship-match-data/

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