The path to becoming an advanced heart failure and transplant cardiologist (AHFTC) is long and arduous. In the final year of postgraduate training, fellows are expected to acquire rapidly both 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.
1The challenges that early-career cardiologists face have been well documented,
- 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.
Circ Heart Fail. 2017; 10 (e000021)
2but for nearly 3 years, the coronavirus disease 2019 (COVID-19) pandemic has additionally and irrevocably impacted this particularly vulnerable time in junior AHFTCs’ careers (Fig. 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 health care 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 and 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.
- Tong CW
- Ahmad T
- Brittain EL
- Bunch TJ
- Damp JB
- Dardas T
- et al.
Challenges facing early career academic cardiologists.
J Am Coll Cardiol. 2014; 63: 2199-2208
- Chuzi S
- Reza N
Cultivating interest in heart failure careers: can we reverse the current trend?.
J Card Fail. 2021; 27: 819-821
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Published online: January 24, 2023
Accepted: December 27, 2022
Received in revised form: December 26, 2022
Received: April 15, 2022
Publication stageIn Press Journal Pre-Proof
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