Individuals who aspire to become medical doctors know that it takes years of formal schooling, residency, and a fellowship for some specialties. Medical students have the option of choosing Indirect Patient Care, namely radiology and pathology, or Direct Patient Care. The latter consists of three areas, according to the Stanford School of Medicine:
Surgical – General Surgery, CT Surgery, Neurosurgery, Orthopedics, Vascular Surgery, and Plastic Surgery
Mixed – ENT, Ophthalmology, Urology, Ob/Gyn, Anesthesia, Dermatology, and Emergency Med.
Medical – Internal Medicine, Pediatrics, Family Medicine, Neurology, Psychiatry, Radiation Oncology, and PM&R (physical medicine & rehabilitation).
Cardiology falls under the banner of Internal Medicine, which has an average residency of three years. Residency is the next step after graduating from medical school. Upon completing an internal medicine residency, the doctor can become certified through the American Board of Internal Medicine (ABIM). Certification displays to patients and colleagues that you have attained a high standard of clinical skills for patient care.
Doctors completing an internal medicine residency can begin practicing in this field. Those opting for the sub-specialty of cardiology will need to enroll in a cardiology fellowship after completing their three-year internal medicine residency. Acceptance is highly competitive. Furthermore, plan on spending six years after medical school to become a cardiologist.
There are exceptions. If a doctor wants to pursue pediatric cardiology, he/she will enroll in three years of pediatrics instead of internal medicine.
A cardiothoracic surgeon is also a different path – the doctor takes a five-year general surgery residency (not internal med). The road to this specialty culminates in a two to three-year cardiothoracic surgery residency program.
To become certified as a thoracic surgeon, doctors must complete at least 24 months of residency training in thoracic and cardiovascular surgery. The Accreditation Council for Graduate Medical Education (ACGME) Review Committee for thoracic surgery must accredit the program.
This program must be accredited by
Although some have stellar reputations, there is no official ranking for cardiology fellowships. Here is a glimpse at some of the specialty fellowship programs.
Massachusetts General Hospital
The Corrigan Minehan Heart Center has a three-year Cardiovascular Fellowship Program accredited by the Accreditation Council for Graduate Medical Education (ACGME). This non-profit organization sets standards for 830 institutions (2018) that amount to 11,200 residency and fellowship programs in 180 specialties and sub-specialties.
The first two years at Mass General include intensive clinical experiences in general cardiology and subspecialty fields. During year one of the general program, fellows explore general cardiology, echocardiography, cardiac catheterization, cardiovascular imaging, heart failure, consultative cardiology, and electrophysiology. Year two augments these skills through experiences in transplantation, mechanical circulatory support, vascular medicine, and adult congenital heart disease.
The program offers several electives for clinical experiences, such as cardio-oncology, heart valves, sports cardiology, and thoracic aortic study.
Their Fellowship Training Program in Cardiovascular Disease is an ACGME-accredited program that allows doctors to develop the clinical knowledge, procedural skills, judgment, and interpersonal skills required as a specialist in cardiovascular diseases. The general cardiovascular medicine training of the three-year fellowship involves a minimum 24-month period of monthly rotations. The various rotations include consultative care, cardiac intensive care unit, congestive heart failure, cardiac imaging (echo, nuclear, CT/MRI), interventional cardiology, and electrophysiology.
Clinical training occurs at the Yale-New Haven Hospital (YNHH) and the West Haven VA Hospital (VACT), a Connecticut primary care facility for veterans.
The core clinical training consists of nine months in consultative work, five to six months of inpatient services, two to three months in cardiac ICU, and one to two months in Heart Failure and Transplantation.
University of California-Los Angeles
UCLA Cardiology Fellowship offers two training tracks. The Clinical Training track involves two years of training and experience in cardiovascular medicine and research opportunities. After which, there are an additional 12 months devoted to research, electives, or specialized training. The other option is the Specialty Training and Advanced Research (STAR) track. The STAR program is for cardiologists pursuing an academic career. This program is also two years of clinical practice with additional research training that leads to a Masters of Clinical Research degree or a Ph.D.
Fellows train by rotating through three sites:
- Ronald Reagan UCLA Medical Center
- Olive-View UCLA Medical Center
- VA Greater Los Angeles Healthcare System
Additional specialized training is available in Interventional Cardiology, Heart Failure and Transplantation, Electrophysiology, and Adult Congenital Heart Disease.
University of Washington-Seattle
The UW Medical Center, Harborview Medical Center, and VA Puget Sound are training hospitals for the cardiology fellowship program. This training exposes fellows (trainees) to acutely ill inpatients, ICU patients, and diagnostic procedures (invasive and non-invasive). However, admission limits the selection to eight doctors to the three-year general cardiology program each year, starting with two years of clinical curriculum.
Advanced subspecialty fellowships are available in structural & Valve interventional cardiology, heart failure & cardiac transplantation, clinical electrophysiology, advanced imaging, and adult congenital heart disease. Each lasts one year, except for congenital heart disease and electrophysiology, which are two years – all have the ACGME accreditation.
University of Pennsylvania
Penn Medicine’s divisions of Cardiovascular Medicine, Cardiovascular Surgery, Vascular Medicine, and Vascular Surgery are recognized nationally for educating residents and fellows in medicine, surgery, and research. It is one of the few institutions with a laboratory dedicated to cardiovascular research. One of the renowned fellowships is cardiovascular disease, which involves a two-year clinical curriculum. Doctors may also opt for a one to three-year subspecialty/research training. There is the possibility that the additional training could lead to another three to six years of practice, depending on the research and subspecialty selection.
Penn also offers a fellowship in:
- Adult Congenital Heart Disease
- Advanced Heart Failure Transplant Cardiology
- Advanced Imaging
- Interventional Cardiology
Johns Hopkins University
The name seems synonymous with outstanding healthcare and educational resources. The acclaimed reputation began in 1873 when Johns Hopkins left $7 million in his will to create a university and hospital in Baltimore, Maryland. Even during the early years, the medical department had many unprecedented achievements. They were the first principal medical school in the United States to admit women, the first to use rubber gloves during surgery, and the first to develop renal dialysis and CPR.
The Heart and Valve Institute has a Cardiac Critical Care Fellowship – a one-year ACGME accredited program. Much of the training occurs in the Cardiovascular Surgical Intensive Care Unit (CVSICU) alongside specialists in Cardiac Surgery, Surgical Critical Care, Anesthesiology, and Pulmonary and Critical Care Medicine.
Clinical practice and research projects comprise the pediatric cardiology division that uses the Johns Hopkins Children’s Center. The facility is a 200+ bed hospital in collaboration with the Heart Center. The university also offers a Pediatric Cardiology Fellowship that lasts a minimum of three years.
Doctors who have completed five years of General Surgery training may apply for the two-year Vascular Surgery and Endovascular Therapy Fellowship. The JH Department of Surgery has a history of accomplishments in surgery; it was the first to perform an aneurysm repair in 1912 by Dr. William Halstead.
University of Michigan
Ranked #14 by U.S. News & World Report for Cardiology and Heart Surgery (2020-21), the Division of Cardiovascular Medicine in the Department of Internal Medicine partners with the Frankel Cardiovascular Center. Thirty-four fellows and 120 faculty care for 6,000 hospital inpatients and 35,000 outpatients each year across Michigan.
Consequently, physicians perform over 4,800 electrophysiological studies and procedures and more than 800 open-heart operations annually. Historically, the university has been involved in cardiology research and education since 1896
The three-year ACGME-accredited General Cardiology Disease Fellowship consists of two years of clinical curriculum, followed by a year of opportunities to tailor each fellow’s educational and career plan.
The Fellowship Programs are available in other areas of cardiology- examples are:
- Cardiovascular Electrophysiology
- Interventional Cardiology
- Heart Failure and Transplant
- Clinical Educator
- Vascular Medicine
University of Rochester
A sub-site for the Yale University Center, the Division of Pediatric Cardiology at UR has the second-highest pediatric cardiothoracic surgical volume in the state of New York. The Children’s Heart Center’s fellow performs 6,000 echocardiograms and conducts 5,800 patient visits annually.
The state-of-the-art Golisano Children’s Hospital of 245,000 square feet contains the latest equipment for cardiac catheterization and an electrophysiology lab, operating rooms, and pediatric intensive care unit. More impressive is the hospital offers a hospitality suite where parents can shower and prepare a home-cooked meal.
The hospital draws pediatric patients from New York, surrounding states, and Canada. U.S. News & World Report recognized it among the nation’s best hospitals for Pediatric Nephrology and Neonatology.
Another note-worthy facility is the Aab Cardiovascular Research Institute (CVRI), which opened in 2007 with nine cardiovascular research labs conducting 20 projects in heart disease.
Weill Cornell Medicine, in conjunction with the Maurice and Corinne Greenberg Division of Cardiology, offers four fellowship training programs:
- Cardiovascular Disease: A three to four-year fellowship that trains doctors for clinical and investigative cardiology careers. Training occurs at the New York-Presbyterian Hospital
- Electrophysiology: Fellows with prior research experience in cardiac arrhythmia management and general cardiology are candidates.
- Interventional Cardiology: The cardiac catheterization laboratory at Weill Cornell performs over 6,000 total cases, of which 2,000 are percutaneous coronary interventions annually.
- Advanced Heart Failure and Transplant Cardiology: Fellowship provides training in advanced congestive heart failure conditions, including acute decompensated heart failure, transplant mechanical assist devices, and conventional cardiac surgery.
The above programs have ACGME accreditation, and New York-Presbyterian Hospital ranked fourth in the United States in cardiology by U.S. News (2017-18). Moreover, Cornell University Medical College dates back to 1898, and its affiliation with this hospital since 1913.
University of Texas-Austin
The Cardiovascular Disease Fellowship at the Dell Medical School is a three-year program providing training in general cardiology. The acclaimed university uses Ascension Seton Medical Center, which is home to Central Texas’s largest left ventricular assist device and extracorporeal membrane oxygenation programs.
The residency training for cardiologists takes place at the 211-bed Level 1 trauma teaching hospital – the Dell Seton Medical Center.
The Dell Medical Center houses the Internal medicine residency programs, from which fellows may transition to general cardiology or fellowships in Cardiac Electrophysiology or Interventional Cardiology. The latter is a one-year fellowship that teaches advanced structural and vascular procedures and techniques. Applicants must first complete three years of cardiology fellowship.
The Seymour, Paul, and Gloria Milstein Division of Cardiology is highly selective in admitting trainees into the General Cardiology Fellowship. The Department of Medicine chooses fellows from an annual pool of more than 600 applicants. Only six or seven positions are open each year for the three to the four-year program that begins on July 1.
The clinical track lasts three years, beginning with two years of the core curriculum, and the third year is clinical rotations and research in a subspecialty. Rotations include adult congenital heart disease, pediatric electrophysiology, and pediatric cardiac catheterization.
The four-year research track adds two years to the standard two-year core curriculum with basic, translational, and clinical research opportunities.
Furthermore, the Milstein Division offers advanced fellowship training in specialties, including Cardiac Imaging, Structural Heart Disease, and Echocardiography.
The Department of Medicine Cardiovascular Disease Fellowship is a three-year ACGME-accredited program with an optional fourth year of advanced research training. Graduates will have the knowledge and skills to conduct cardiac patients’ diagnostic and evidence-based prevention services. During the training, fellows receive close supervision and autonomy as the fellows’ expertise warrants during the clinical rotations.
Some of the listed clinical rotations are:
- Cardiac Catheterization Lab (4 months)
- Echocardiography (5-6 months)
- Nuclear Cardiology (2 months)
- Coronary Care Unit (4 months)
- Electrophysiology Inpatient (2 months)
- Valvular & Congenital Heart Disease (1-2 months)
There are numerous cardiology fellowships available in eminent programs across the country. By the time a doctor enters the final year of residency, she/he will conduct her/his research and discussion with specialists in this field before deciding on a fellowship program. The intent of the information above is to provide a glimpse into the variety of programs for aspiring fellows.