Changing with the times: How interventional cardiology finally met its Match
Interventional cardiology (IC) is now part of the National Resident Match Program (NRMP), changing the steps necessary for interested trainees to specialty fellowships. Many other healthcare specialties have been participating in the Match program for decades now, using it to pair up eager medical students with residency programs. Until now, however, IC has not been involved in this process, leaving both students and residency programs in a situation that many stakeholders agreed was less than ideal for the specialty’s future.
The Society for Cardiovascular Angiography and Interventions (SCAI) led the charge to make this move a reality, and now its members have shared an in-depth look at the change in JSCAI.[1] The group emphasized that IC has undergone significant changes over the years, making the need for change more and more apparent as time went on.
“In the nearly 25 years since the first IC program was accredited, the field has dramatically evolved,” wrote lead author Douglas Drachman, MD, co-chair of the SCAI Interventional Cardiology Match Task Force and director of education at Massachusetts General Hospital, and colleagues. “Despite declining coronary procedural volumes by operators in the U.S., the complexity of cases and patient risk profile have risen substantially. Additionally, the introduction of transcatheter valve technologies and structural heart interventions, the growing number of endovascular procedures for peripheral vascular disease, and further subspecialization in complex coronary intervention have expanded the spectrum of training in IC.”
Identifying flaws in the interventional cardiology recruitment process
SCAI and its members identified multiple “flaws” with the old recruitment process for interventional cardiologists. Training programs were able to create their own rules, for example, leading to “significant variation” when it came to application deadlines, interview schedules and other crucial steps of the process. In addition, some programs required specific institutional application to be submitted, but others did not.
“From the applicant’s perspective, the lack of a structured timeline for the application process required candidates to make career decisions early in the first year of cardiovascular disease training and to compose their application materials two years in advance of starting IC training,” the group explained. “With the Electronic Residency Application Service (ERAS) open to application submission in the fall of the second year for the December release to programs, fellows had limited time on clinical rotations to determine their interest and aptitude for IC. Additionally, letters of recommendation, written at this early stage, risked not being fully reflective of each candidate’s capacity to improve and develop the technical skills and clinical knowledge important for success in the field … Another problem with the existing system was that the pressure to recruit candidates on a tight timeline limited the opportunity to interview applicants from a wide variety and diversity of programs, potentially reducing the ability to recruit underrepresented candidates from varied programs.”
Social media makes an impact
These issues, among others, led many interventional cardiologists to start wondering why IC was not a part of the popular Match program used by so many other healthcare specialties. In 2021, the concept gained significant momentum when interventional cardiologist Ajay J. Kirtane, MD, one of the specialty’s most well-known figures, asked on social media if it was time for an interventional cardiology Match. Drachman et al. called this the “Tweet heard ‘round the world,” noting that SCAI quickly took advantage of the extra attention by putting together a task force specifically dedicated to investigating the idea.
In September 2022, SCAI surged ahead by launching a nationwide campaign to increase support for this cause. This was a long and challenging process the authors noted in JSCAI, but it proved to be “highly effective.” Just two months later, the required 75% threshold of programs and positions had agreed to make the move, and the NRMP was officially notified. SCAI announced the news to its members in December 2022.
A new timeline to learn on the path toward ‘Match Day’
“As a result of the successful implementation of the Match in IC, the first Match cycle for incoming IC fellows will open in the summer of 2024,” the authors wrote. “Individuals eligible to apply include cardiovascular disease fellows in their third or final year of training and graduates who have completed fellowship and are in clinical practice. This class will start IC training in July 2025. ERAS will open its site for programs to download applications in July 2024. Programs must register with the NRMP to receive a unique nine- to 11-character code for applicants to use when ranking programs.”
Drachman and colleagues noted that applicants are expected to build their list of ranked candidates by Nov. 13, 2024. On Match Day, Dec. 4, applicants then find out which programs they match with—and the academic year begins in July 2025.
Advantages and disadvantages of interventional cardiology’s shift to the Match program
Drachman and colleagues noted that this shift is associated with several benefits for the field of IC. However, there will also be new challenges.
Benefits include giving training programs more time to review applicants, a more immediate selection process, the potential of improved diversity and the establishment of “binding contracts between applicant and program.”
Possible disadvantages of this change, on the other hand, include an increased workload for programs that have typically relied on recruiting within and less “control” over the final Match Day selections.
Looking ahead
The SCAI members who helped make this move a reality sound excited as they look to the future.
“Program directors, candidates, and leaders of national societies banded together with a common purpose and a belief that converting to a Match was ethical and necessary,” the group wrote. “This outcome represents a success for IC on many levels … The successful implementation of the IC Match is another step in the evolution of IC training that addresses the increasingly complex nature of IC and lays the groundwork for the field’s continued success.”
Read the full breakdown in JSCAI here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.