Guest Post: Future Cardiologists Lack Vision

Editor’s note: Ethan Weiss, MD, is a cardiologist at the University of California at San Francisco. He recently tweeted his thoughts after interviewing applicants for his hospital’s cardiology fellowship. Here is a lightly edited version of his thread.

Just finished cardiology fellowship interviews for the season – a few thoughts:

  1. Career path: Still fewer applicants interested in basic sciences. Fewer clinical/translational scientists. Stable interest in QI & a big increase in interest in global health.
  2. Clinical interests: feels like interventional cardiology has rebounded – less imaging.

  3. General thoughts. Applicants seem more polished and there is a huge emphasis on publications even as a resident. Seems as if there is expectation that applicants will a) have a clear idea what they will do and b) will have a publication track record. I think this is bad.

It’s bad for so many reasons.

A few: I think we’re emphasizing product over process. Productivity comes at expense of sophisticated thinking.

Obviously prior scholarly productivity is important and predicts future success, but the kinds of work people can do as residents leads to an emphasis on quantity not quality. I think this identifies applicants who work hard, have good time management skills and can finish.

Those are good things. But I worry about what I perceive to be a lack of deep thinking not just around their research but also their careers.

Here are a few examples. And I don’t mean this as a criticism of the applicants. They are wonderful and bright. This is on us.

Example 1. The applicant interested in QI and CHF and tells me all about how to reduce 30-day readmissions without allowing that the QI measure might not impact the clinical outcomes (in the ways we expect).

Example 2: buzz words. I heard a lot of “implementation science” but did not hear a lot about what that means. More generally, I did not get a sense that applicants thought about what they saw as mission. When I asked about what was going to get them out of bed, I got process.

I did not get a vision of what the big problems in cardiovascular medicine/science were and how they were going to approach.

Again, I don’t mean this to be critical of our applicants. I think this is a criticism of our training/mentorship. That said, these are 30ish year old young adults and they do have some responsibility (some).

Last thing, I think there are a few simple things we can do to begin to fix. The first is to change the application and to include something of a “mission statement”. This might be a nice forcing event for residents and mentors. Overall, I love meeting these incredible young people and love hearing about them and their lives. I believe we can make this process better.


  1. Joseph Chemplavil, MD, FACE says

    The above observations on the cardiology fellowship applicants are interesting. Is it a reflection of our 21st century high-tech medicine without the soft-touch practice? Caring for the patient is hard and probably boring but doing procedures and interventions are cool and exciting. One would hope that we are not training our specialists, to become members of the healing profession, with those attitudes and mind-sets!

  2. If future cardiologists had vision they’d have chosen a different speciality. The great CVD epidemic is ending.

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