I sometimes read this forum and can’t help but jump in with a controversial take with something I figured out during my fellowship interview process. For the record I did both residency and fellowship at BIDMC.
I started by applying widely for ACTA, had a very competitive application, and received interviews to almost everywhere I applied. I went on interviews to Duke, Columbia, THI, etc. All these programs were powerhouses in the fact you will get to do really big cases – lots of transplants, LVADs, lines, circ arrests, research, etc. They will all prepare you to practice in a similar environment and do these cases.
The thing they are all missing and where I felt BIDMC is different - structural heart. Even as a CA2 I was in the room holding the probe with Mahmood over my shoulder doing ASD closure, VSD closure, PVL closure, mitraclip, Watchman, TAVR with 3D TEE (sizing valve, coronary heights, etc), valve-in-valve mitral/tricuspid, etc. As a fellow you do this room 1-2 times per week and it’s the best TEE training on the planet. The volume of structural heart is immense and anesthesia residents/fellows get to hold the probe and are intimately involved throughout these cases. As a fellow you will learn with interventional cardiology, etc.
The big wakeup I remember (coming off a CA2 month doing TEE - essentially following Dr Mahmood around) was following other fellows in the OR during interviews. By that time, I knew more about TEE than the Jan/Feb/Mar fellows I shadowed in the OR during these interview days. What I perceived as lack of TEE skill in the second half of fellowship at the above programs was mind-blowing and concerning. And I’m sure they studied up at the end of the year and passed TEE boards without any issue. But the nagging feeling I left with that the TEE training at all these programs was garbage in comparison - was a feeling I couldn’t shake the entire rest of the year and the reason I stayed at BIDMC.
I’m now in private practice and director of a big structural heart program. When the cardiologists are having difficulty with imaging a mitraclip they call me. When they need TEE sizing for TAVR with high Cr they book around my schedule. I am integral the success of the program and these relationships have meant the world during hospital contracts, committees, etc.
I think I am equally as comfortable doing the type A on call, transplant, or LVAD as anyone from any of those above programs although my case numbers would likely be less than any of those above programs.
Just realize there are pluses and minuses to everything you pick and there is a reason BIDMC would be seen as #1 on a cardiology website and it’s for very good reason. A reason that may be more likely to translate to professional success for the rest of your career than many of the other programs mentioned. Good luck during the fellowship interview and matching process.