As an internal medicine resident, I stood in the back corner of the cardiac catheterization laboratory, behind thirty cardiologists, witnessing our hospital’s first transcatheter aortic valve replacement (TAVR). For my senior resident lecture, I spoke about self-expanding versus balloon-expandable TAVR devices. As a general cardiology fellow, I stood twice more in the back corner of the laboratory during the hospital’s first MitraClip and Lariat procedures. I attended every structural procedure I could, wrote case reports and undertook a data registry analysis.

During my third year of general cardiology fellowship, I began to seek a fifth-year structural heart disease (SHD) training position to follow my fourth year, dedicated to coronary and peripheral intervention. Three notable challenges complicated this process.

The first challenge was finding fellowship programs for which to apply. I scoured the internet for programs willing to offer SHD training. More recently, the ACC compiled an online list of many SHD fellowship programs. This list, though not complete, is a great starting point for applicants. Since this list was not available at the time of my application, I phoned interventional cardiology fellowship programs at more than 75 institutions. Fifteen institutions were willing to accept my curriculum vitae and cover letter.

The second challenge was the application schedule: program timelines varied by 18 months, some beginning as early as July of the third year and some as late as December of the fourth year of fellowship. Over this 18-month period, I received interview invitations from 12 programs.

The third challenge was that, for the first time in my life, I was not applying within the framework of a match system. Interviews one through seven were discouraging for me: other candidates were selected for the positions immediately. Despite spending time and money traveling, and constantly requesting call coverage from my colleagues, I was no closer to my goal.

Interviews eight and nine occurred back-to-back on a Monday and Tuesday in November of my fourth year. Both program directors called me on Wednesday to offer me a position. Although each seemed to expect me to accept immediately on the phone, I negotiated giving a reply by Friday, giving me 48 hours to decide. Interview number 10, scheduled for Saturday, was now out of the question, as were numbers 11 and 12: I could not turn down two actual offers for the sake of interviews.

Forty-eight hours is not much time, which is another challenge in this process. I considered the programs carefully, and although cardiology fellows are not supposed to care about anything except cardiology, I dared to consider personal issues as well. Would my wife, also a medical subspecialist, find a job? Could we sell our home? Where would our children attend school? Where would we live?

Late Friday afternoon, with answers to none of these questions, I chose my fellowship. Everything has turned out splendidly. In four months, I have served as primary operator for 41 TAVRs and nine MitraClips. I have performed more than 30 coronary interventions as the attending cardiologist and I spend one day each week participating in peripheral vascular interventions. My wife is a successful assistant professor at our institution with external grant support for her research.

In fact, there’s only one problem with this happy ending to my fellowship quest: as my excellent fellowship unfolds, the more difficult search has begun for a permanent SHD job!

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This article was authored by Andrew M. Goldsweig, MD, FACC, RPVI, structural heart disease fellow at the Warren Alpert Medical School of Brown University.

Click the cover image above to read the latest issue of Cardiology: Interventions in e-pub format or click here to read it on the web!

Keywords: Cardiology Interventions, Aortic Valve, Cardiac Catheterization, Heart Defects, Congenital, Heart Valve Diseases, Mitral Valve, Registries, Transcatheter Aortic Valve Replacement

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