Second Interventional Match Identifies Potential Pipeline Problem

The second annual interventional cardiology match, completed last week, was successful by some measures, with 97% of applicants obtaining a fellowship position beginning next year.

However, of the 307 slots available in 153 centers nationwide, only 236 were filled. This resulted in 49 programs facing the possibility of being understaffed, signaling a potential pipeline issue.

Historically, recruitment for interventional cardiology specialty training caused many headaches for trainees and program directors alike, with so-called “exploding offers” forcing applicants to commit to programs before potentially having the chance to interview at other institutions. A Society for Cardiovascular Angiography and Interventions (SCAI)-led effort resulted in a match process being introduced in 2024 for the academic year beginning in 2025, though programs were not forced to participate.

“Now there’s a sense of calm, a sense of purpose, and a sense of control and reason to the process, and we think it’s been incredibly effective,” Douglas Drachman, MD (Massachusetts General Hospital, Boston), co-chair of the SCAI Match Task Force, told TCTMD. “As we anticipated with the match, it also gives us a totally new vantage point. We didn’t used to be able to monitor what was happening within the pathway for people to develop as interventional cardiologists . . . . So, this is really our first chance ever to collect data on this and to have a 25,000-foot view.”

They’ve confirmed a “mismatch of supply and demand,” he said.

Potential Reasons

J. Dawn Abbott, MD (Brown University, Providence, RI), who co-chairs the SCAI Match Task Force with Drachman, said she was surprised to see the numbers this year, especially alongside a 100% match for general cardiology.

“I assumed there would be a little bit of a gap because we saw it last year,” she told TCTMD. “But the gap really increased without a clear change in anything else appreciable, so that’s where I’m a little bit interested to see: are people just choosing other subspecialties of cardiology? Because we don’t know how to address it until we know what the problem is.”

Sometimes you need a good rattle to get things moving again. J. Dawn Abbott

Beyond a potential lack of interest in candidates wanting to pursue careers in interventional cardiology, she guessed at several other factors at play, including the effect of the estimated 20 programs not participating in the match.

“The programs that are choosing to do the process outside the match have an advantage because they can lock in their candidates earlier, and in a sense, cannibalize the workforce away from the programs that are using the more preferred method of filling these spots in a global way that ensures people are treated fairly and considered fairly for the fellowship position,” Abbott said. “So that is something we have to deal with as a field.”

But if there were enough candidates to go around, it shouldn’t matter whether fellows found their positions inside or outside the match. “I wouldn’t blame the programs outside the match on the lack of applicants because if there were in enough applicants, both processes should work perfectly well,” she said. “Our job right now is to look at some trends about . . . the growth and the number of positions offered.”

If further analysis suggests that the field is offering more training opportunities than it needs, “then the way to address it may be to encourage programs to go to fewer trainees and give them higher volume and good quality and really look at the volumes of procedures fellows are getting,” Abbott said.

“And if people aren’t going into interventional, we need to understand are they going into other subspecialties like heart failure or electrophysiology or are they going out into the workforce into practice after their 3 years of cardiology?” she added, hinting that limited visa opportunities could also be playing a role.

Importantly, it’s not the match that lowered the supply of applicants, Abbott stressed. If recruitment had continued without it, “this would all be going on in isolated pockets,” she said. “It’s really important that we continue it and get momentum going again in the right direction, because even just that small drop in participation limits us a little bit more in understanding what’s going on.”

Drachman agreed. Introducing the match “took a tremendous amount of energy and we all, I think, want to make sure that we support and sustain and nurture this, so that this is the continued pathway for all that really optimizes everybody’s sense of elevating our careers and our [field],” he said. “We really want to share the insights that we learn with everybody so we can optimize the process.”

“This is one of the best fields of medicine, hands down, and we need to keep promoting it,” Abbott concluded. “And if there are any barriers [making it so] that people aren’t choosing it, we need to break them down. . . . Sometimes you need a good rattle to get things moving again.”