Interventional Cardiology Fellowship to Move to a Match for 2025

With slightly more than the required 75% of programs committed to change, the application process for interventional cardiology fellowship will shift forward 6 months and now be managed by a formal, voluntary match starting with fellows applying for 2025 positions.

The news was announced today by the Society for Cardiovascular Angiography and Interventions (SCAI) in a press release. Interventional cardiology had been the last subspeciality within cardiology that did not use a match system to place fellows into programs, which many over the past year claimed negatively affected the reputation and culture of the field.

SCAI’s Interventional Cardiology Match Task Force had led the initiative to bring about these changes after past years’ application cycles, which until now began in December, resulting in a chaotic “fire drill” of offers and quick decisions that wasn’t fair to programs and candidates alike, according to task force co-chair Douglas Drachman, MD (Massachusetts General Hospital, Boston). “Culturally, this represents a huge paradigm shift in fairness, equity, and thoughtfulness,” he said.

“Everybody is just breathing huge sigh of relief and feels elated, because I think the system will really favor fairness both for programs as well as for applicants,” he told TCTMD. “It is really going to give everybody the breathing room to step back to recognize the qualities that everybody has within them, whether it is nuances of how a program might fit the needs of a candidate or whether it is candidates that otherwise might not have come across the radar of program directors and bring great value to the table.”

Implications for Programs

Of the 177 US interventional cardiology training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), 136 signed on to SCAI’s initiative in support of the match, just over the 75% threshold needed for change. Because programs aren’t able to officially vote “no” to a match, it’s possible that some of those who did not sign on might still do so before the final list of programs is submitted to the National Resident Matching Program (NRMP), the organization that manages the match, in the Spring, Drachman said.

Clifford J. Kavinsky, MD, PhD (Rush University Medical Center, Chicago, IL), who serves as program director for his institution’s interventional cardiology fellowship, is one such holdout. For his program, which has filled internally for two open spots for the past decade, “it just didn't seem that [a match] served the purposes of our individual program well,” he told TCTMD, acknowledging that he is not opposed to the match in general. “[The match] is an unnecessary complication, it is an unnecessary expense, and it is an unnecessary complexity that we just do not need to add to the process.”

Not only has his program already selected fellows for the next academic year, but they have also chosen candidates for 2024-2025 through a simple review process, according to Kavinsky. “Fellows come to our program knowing that they will have an inside track to the interventional spots if they chose to do it. So it helps with our general cardiology fellow recruitment,” he said. “But you can see then that if we then open this up and say, ‘well, go ahead and look elsewhere,’ then we will end up right like with everyone else looking nationally for the same applicants. . . . I think the fellows appreciate the fact that they do not have to go through all that.”

Kavinsky said he’ll keep an open mind about signing up for the match in the future, especially if it seems to benefit his program.

Everybody is just breathing huge sigh of relief and feels elated, because I think the system will really favor fairness both for programs as well as for applicants. Douglas Drachman

Candidates and programs will still have the option to recruit outside of the match, but Drachman said over time that path will likely seem less appealing. “Candidates may recognize that among all of the programs, so many are participating in the match that they may need to defer any answer they can give to others until they have a chance to see how the match works,” he said. “While there is always the opportunity that individuals could make decisions outside of that, I think that they will not get to see the full range of options available to them.”

He hopes that program directors who haven’t yet committed to the match eventually have the mindset of wanting to “see and evaluate all of the candidates so [they] can help to reinforce the quality, fairness, and have a diverse and inclusive pipeline for the future of interventional cardiology.”

What About the Current Cycle?

Because of time needed for both the NRMP and the Electronic Residency Application Service (ERAS), the application service in which many programs participate, to make changes, the current cycle of applications for the 2024-2025 academic year will proceed as usual, with applications open as of today.

While he’s not looking forward to going through the old process this year, Drachman said he’s satisfied in knowing this will likely be the last time. And work for the SCAI task force hasn’t stopped, he added. The organization plans to hold educational events for both program directors and potential applicants so that everyone can better understand the process and learn some best practices. “Everyone is familiar with the match, because it is just a norm in everything else that we do,” he said, acknowledging that once next December comes around, people might feel strange not going through the process as before.

Ultimately, Drachman said, “we will look back on this and say: ‘Remember way back when, when there didn't used to be a match? Can you remember that? Can you imagine that?’ Everyone describes it as the Wild West. And now we have order restored and a sense of fairness, equity, and just that it is the right thing to do.’”