As I started the journey for my last stage of training as an advanced heart failure (HF) and transplant fellow, like many of my colleagues, I had the seemingly overwhelming task of finding a job. After countless years of training, it seemed like such a simple yet difficult task. Perhaps a bittersweet realization was that there were no more matches to rely on. My goal was to acquire a job that matched my interests and strengths and subsequently allowed me to build a career that I envisioned for myself. Simple enough, right? This proved to be a demanding task that motivated me to think about my future aspirations – ranging from the job environment, nature of the clinical work, location, opportunities for growth in the field and where there was mentorship so I could experience challenges and achieve success.

Initially, the predictable thought between academic and private practice came to mind. Moreover, the field of HF offers a spectrum of jobs including becoming the community HF guru, destination therapy left ventricular assist devices (DT LVAD) practice, and academic centers performing both LVAD and transplants to name a few. With the increasing need for community outreach in this field, many institutions were also implementing the hub-and-spoke model with the primary location highly integrated with community-based multidisciplinary teams that would serve as a new hire's primary site to enhance specialty care.

I was fortunate enough to speak with a few colleagues and friends alike in both private and academic models within the field of advanced HF and transplant.

First and foremost, most spoke about the importance of location and family as a key aspect in their job search. Furthermore, the mentorship they had during training shaped prospects and desires to be in certain institutions. For all, there was an inherent sense of productive collaboration with various cardiology specialties, cardiothoracic surgeons and the overall stability of the providers and program over time. Teaching and working with fellows was a highlight for many.

With regards to private practice, along with exposure to both transplant and LVAD (through a main hospital) or a DT LVAD center, many practices involve clinics and care of patients in general cardiology. My discussion with folks who pursued this explained that they enjoyed this aspect of their job as it allowed them to keep up with reading echocardiograms, nuclear studies and ultimately staying in-touch with their basic skill set. Within this realm, some practices are looking for new hires to build a community HF program, ranging from the ground up to a network of referrals for advanced therapies. Salary and compensation are also important to explore along with inquiring if the work involves RVU based compensation.

For academic institutions, there are different aspects at play. In addition to the clinical nuances, there is added responsibility (that many seek) of research and teaching which comes with some level of protected time. Opportunities to lead clinical trials may be more numerous along with increasing level of opportunities for leadership within the structure of the system. At the same time, it may take longer than private practice to move up the ladder based on academic productivity and contributions to the field. Continuing to delve in the non-invasive world such as officially reading echocardiograms, CT/MRI may not be feasible in the setting of sub-specialization and with other general cardiologists. On the other hand, many institutions are partnered with community hospitals to provide specialized care so physicians have the ability to practice in more than one setting.

Ultimately, I decided to pursue an academic model which aligned with my desire of a strong clinical practice involving ICU care while having the ability to teach, perform research in the background of an invaluable mentor. I do believe that timing is an instrumental part of this process and largely out of one's control. There is no one-size-fits-all. Pursuing a job that tailors to your needs and aspirations is key. It can be difficult to predict the next path therefore imperative to reflect on goals, explore all opportunities, and choose the best fit for personal and professional growth and success.

I would like to thank Alex T. Michaels, MD, (Henry Ford Hospital), Arpan Patel, DO, (Penn State Health Lancaster Medical Center), Kartik Telukuntla, MD, FACC, (North Texas Heart Center), Anju Bhardwaj, MD, FACC, (University of Texas) and Rachna Kataria, MD, (Brown University) for providing insight and sharing words of wisdom.

This article was written by Lindsey Aurora, MD, advanced heart failure and transplant fellow at University of Michigan. Twitter: @LAuroraMD.