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A New Norm for Early Career Advanced Heart Failure Clinicians

  • Nikhil Narang
    Affiliations
    Advocate Christ Medical Center, Oak Lawn, Illinois 60453
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  • Nosheen Reza
    Correspondence
    Corresponding author. Nosheen Reza MD, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, the University of Pennsylvania, 11 South Tower, Room 11-145, 3400 Civic Center Boulevard, Philadelphia, PA 19104, Tel: +1-215-615-0044
    Affiliations
    Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 11 South Tower, Room 11-145, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104
    Search for articles by this author
      The path to become an advanced heart failure and transplant cardiologist (AHFTC) is long and arduous. In the final year of postgraduate training, fellows are expected to rapidly acquire inpatient and outpatient expertise in heart failure, pulmonary hypertension, mechanical circulatory support, and heart transplantation in addition to numerous other competencies that are now expected in the skillset of an AHFTC. Moreover, trainees must cement a new, foundational knowledge base regarding the ethical, social, and economic implications of limited resource stewardship and cardiovascular health inequities.(
      • Jessup M
      • Drazner MH
      • Book W
      • Cleveland JC
      • Dauber I
      • Farkas S
      • et al.
      2017 ACC/AHA/HFSA/ISHLT/ACP Advanced Training Statement on Advanced Heart Failure and Transplant Cardiology (Revision of the ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant): A Report of the ACC Competency Management Committee.
      ) The challenges that early career cardiologists face have been well-documented (
      • Tong CW
      • Ahmad T
      • Brittain EL
      • Bunch TJ
      • Damp JB
      • Dardas T
      • et al.
      Challenges facing early career academic cardiologists.
      ), but for nearly three years, the coronavirus disease 2019 (COVID-19) pandemic has additionally and irrevocably impacted this particularly vulnerable time in junior AHFTCs’ careers (Figure 1). We were frequently “redeployed” as bedside COVID-19 clinicians, working long hours under, at times, hazardous conditions. The first year of the pandemic truncated the typical AHFT training experience by nearly 25% as trainees were reassigned from their native training programs to other patient care roles, and since then, nearly every aspect of medical education and healthcare delivery has been transformed. Enforcing historical training and fellow-to-faculty transition models amidst this persistent disruption has meant that AHFT graduates may be underprepared for independent practice, where we must confront new challenges in clinical decision making; adapt to new institutions, cultures, and workflows; build practices, relationships, referral bases; maintain productivity; and launch research, administrative, and teaching careers. More training may be beneficial to bolster these skills, though asking trainees to prolong fellowship is likely to result in further decline in interest in AHFT cardiology.(
      • Chuzi S
      • Reza N.
      Cultivating Interest in Heart Failure Careers: Can We Reverse the Current Trend?: Cultivating Interest in Heart Failure Careers.
      )
      Figure 1
      Figure 1Recalibration of goals for early career advanced heart failure cardiologists (AHFTCs).

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