Interventional Cardiology Joins The Match for First Time

Interventional cardiology training in the United States has joined the National Resident Matching Program, known as The Match, for the 2025 applicant year. With this change, all major cardiology areas are now part of the program, according to representatives of the specialty and of the matching program.

By joining The Match, directors of fellowship programs give up some control of their choice of fellows. But the benefits of joining The Match make it worthwhile, said Douglas Drachman, MD, director of the interventional cardiology fellowship program at Massachusetts General Hospital in Boston and a co-chair of the Society for Cardiovascular Angiography & Interventions (SCAI) task force that spearheaded the change.

The process for 2025 “enabled all program directors to look at the candidates without time pressure,” he said. “It’s a much more deliberate, earnest, and fair process.”

Fierce Competition, ‘Exploding Offers’

Before they joined The Match, each interventional cardiology fellowship program considered applicants separately and chose who to interview and who to offer fellowship positions to. This led to competition among programs and applicants, explained J. Dawn Abbott, MD, who was also a co-chair of the task force and is director of the Interventional Cardiology and Cardiac Catheterization Laboratories at the Brown University Health Cardiovascular Institute in Providence, Rhode Island.

Competition became tougher as interventional cardiology became a more mature specialty, she explained, and when the pandemic led to virtual interviews on short timelines.

“Initially, we would be looking for candidates toward the end of their second year, in April or May for the following July. As programs began to vie for applicants, the time started moving earlier.” To get top applicants, programs needed to compress the number of weeks they normally would need to go through resumes, decide on applicants, and set up interviews.

In December 2021, when Drachman and other program directors were attending a SCAI event, the Electronic Residency Application Service opened for applications. “Fellows started contacting me saying they were getting offers,” said Drachman.

In some cases, programs made candidates an offer that they had to accept in 24 or 48 hours, called an “exploding offer,” Drachman and Abbott pointed out. “The process was so accelerated that it created high-pressure, high-stakes situations for candidates,” said Abbott. “It was a free-for-all.”

Drachman said several fellowship program directors who met at lunch said, “This has got to stop, this is unfair.”

A Change in Cardiology Training

Drachman and Abbott worked with SCAI to convince their colleagues to move to The Match.

“We had a mission to explain to all stakeholders the pros and cons,” said Abbott. The task force held focus groups and webinars and did grassroots campaigning. “We heard program directors’ concerns.”

The society championed the transition, which was critical, Abbott said. “Having SCAI behind it changed a lot of people’s minds.”

The Match requires that 75% of training programs and positions be included to bring a new specialty on board. In fact, 89% of training programs, encompassing 80% of fellowship positions, were part of the first Match, held on December 4, 2024, for fellowships that will begin in July. Abbott credits the high participation rate to the work the society and task force did.

Overall, 97% of the applicants found a fellowship through The Match, and the society continued to help the 3% — in this case 14 applicants — who didn’t match to find a fellowship, Abbott reported. Combining the programs into a single process allowed the specialty to get statistics on training matches. “It’s the first time we actually knew we had more spots than people who applied,” she said.

Benefits for Programs and Fellows

In The Match, program directors choose applicants for interviews, then rank their choices. Applicants who participate in interviews rank their top programs, and the match is made by a computer algorithm.

The benefits to programs and applicants include set dates, with enough time for programs to consider a large number of candidates.

For the program’s first year in The Match, “I interviewed a greater number of candidates than I had in years past,” said Drachman. 

And applicants had a longer period to consider programs before applying. “Fellows can take their time, talk to their family members and loved ones. The match is in their favor,” Abbott said.

Darcy Banco, MD, said she is happy she was an applicant in the first year that interventional cardiology participated in The Match. “I felt the process was very well run.” She is currently training in New York and applied to her current institution, as well as to three others in Boston, where she has family.

Another benefit is that programs and applicants commit to accepting The Match results. Before, offers and contracts were not binding and were presented to applicants at different times, Abbott explained.

That situation was not ideal. “People felt a little vulnerable going through the process. They couldn’t explore options as freely as they would like. They got nervous about losing an opportunity or closing doors,” Banco said.

She was fortunately matched with her first-choice program and pointed out that it’s important for applicants to rank only the programs in which they think they would be happy. “There’s a chance you will be matched to a program that’s last on your list, and it’s a binding contract,” she explained.

Another benefit to applicants is that The Match has a later timetable, and potential fellows are considering positions at the end of their second year or the beginning of their third year, said Abbott.

This timing made a difference for Banco, giving her time to decide that interventional cardiology was the right choice for her. “I don’t know if I would have had the confidence to do that if I had to do it earlier in my career.”

Joining The Match has moved interventional cardiology training “from a program-focused to a trainee-focused environment,” said Abbott.

The transition has also had a positive effect on the specialty. “This was a real bringing together of the interventional community to move with a common purpose,” Drachman said. “We are all, as a community, communicating now and discussing how to improve, to optimize outcomes for the programs and the candidates.”