A New Norm for Early-Career Advanced Heart Failure Clinicians

Abstract

The path to become an advanced heart failure and transplant cardiologist (AHFTC) is long and arduous. In the final year of postgraduate training, fellows are expected to rapidly acquire 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.( 1 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 PubMed Google Scholar ) The challenges that early career cardiologists face have been well-documented ( 2 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 Jun 3; 63: 2199-2208 Crossref PubMed Scopus (44) Google Scholar ), but for nearly three years, the coronavirus disease 2019 (COVID-19) pandemic has additionally and irrevocably impacted this particularly vulnerable time in junior AHFTCs’ careers (Figure 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 healthcare 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, 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.( 3 Chuzi S Reza N. Cultivating Interest in Heart Failure Careers: Can We Reverse the Current Trend?: Cultivating Interest in Heart Failure Careers. J Card Fail. 2021 Jul; 27: 819-821 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar )