Good morning, everybody. It's 10.35, so maybe we'll get going. For any of you whom I haven't met, I'm Doug Drachman. I'm an interventional cardiologist at Mass General with also clinical focus in vascular medicine and intervention. I'm also an interventional cardiology fellowship program director. And I had a tremendous privilege to work with Sky and with Sky's advocacy and along with Don Abbott to co-lead the efforts to develop a match for interventional cardiology. And so I intend to present for about six minutes or so and then to have time, I hope, in the agenda for questions and answer and stuff to talk about the match. And so it's interesting. The title is Why Sky Joined the Match, but it was really why Sky led the efforts to create a match for interventional cardiology. These are my disclosures, which have absolutely no bearing on anything that I'll say today. And so the objectives in this presentation to describe the historical situation for interventional cardiology fellow recruitment, which I think you probably all know and have lived if you're program directors, to highlight the advantages of having an interventional cardiology fellowship match, to talk about our strategy that we employed to get to the match, and then to talk briefly about what to expect, because I think that's probably first and foremost on everybody's mind. So as I promised, we'll start with the historical situation, the IC fellowship recruitment. You know, we know it was the Wild West. There was no structured timeline, and there was an accelerating cadence that got earlier and earlier every year. I think of it as an arms race, where we were getting calls from fellows more than a year and a half prior to their matriculation date to say they were given an offer, and they had to decide within 24 hours, and could we interview them for our program as well, because they wanted to consider our program. This is not, I'm not saying this out of vanity. I'm saying this out of recognition of what was going on, kind of, in the context over the years, and this got to be earlier and earlier. I had some calls in Thanksgiving. So these were first-year fellows, started in July and in November, they were being asked to make a decision about their interventional training. I mean, this timeline is absolutely inconsistent with any other advanced training program, so we were outliers in the way that this was done, and this was a high-pressure, high-stakes situation for everybody involved. There were exploding offers, 24 hours to let me know, or else I'm gonna go to another fellow in your program, and we'll offer it to them, and I think that it also put program directors in a funny position as well, untenable position, because they had to then consider these candidates at times earlier without considering the entire terrain of potentially available candidates, and ultimately, it was just an unfair system. It was unfair to the candidates. I think it was undesirable, I would argue, to program directors. I hope you all agree. So what are some of the advantages? That was the sort of before. What are some of the advantages to this? Is this a panacea? First, definitely having a match will standardize the timeline. We hope that it will introduce a greater sense of fairness for candidates, and that by offering time and space for programs and for candidates to consider the options, it offers opportunity to be more comprehensive in how you look. You don't round up the usual suspects. You don't have to go only entirely to your internal candidates or to quote-unquote top-tier programs to select and call out specific or select individuals, but you have an opportunity to look at the entire playing field and think more comprehensively about what is strategically important to you, to your program, and to the pathway, really, for the development of the future of interventional cardiology. And ultimately, it's binding. There's none of this like you gave an offer, they accepted it, and then they get an offer sort of on the slide from somebody else, and then they back out of it. Or as a fellow, a program could potentially also make another decision before you have matriculated. So it's binding, and I think that creates a sense of ethics, fairness, and really deliberate decision-making. So this is a slide that just sort of highlights how the timeline has changed because I mentioned ERAS used to open in December, but again, you could even put like the yellow dot further to the left here because people were being considered even without an application being formally submitted. So there were decisions being made at TCT, there were decisions happening before Thanksgiving. And 18 months later, they would matriculate. So, and I think you probably all can remember in 2021 when ERAS opened, and it was like within hours of the opening of the site, there were interviews being offered, offers being given, and just this arms race to recruit the top candidates in lightning fast decision-making. So system was broken, and here now for the match in 2025, what will happen is, we've all noticed ERAS didn't open in December, it's gonna open in July. So we can start to see the applications. And then we can start to consider the match really in August, the sort of match submissions, like your list and the fellows list. I think the fellows list is due the 13th and our lists as program directors will be due the 20th of November, I believe, and then match day is gonna be December 4th. So that's a timeline, it leaves 12 months, and then these fellows will matriculate in July. So, how do we get here? How did it work? So, first of all, and I'll go back over like a specific timeline of when it started and how we did each of these steps, but the key elements were, there was a member to member influence campaign. We thought that was gonna be most effective. We had a task force or a work group that was established by Sky, and a lot of phone calls, a lot of emails, a lot of messaging campaign to program directors across the country, and it required a lot of resources and a lot of tremendous insight and help from the Sky staff to identify like, where are all the programs? Who are the program directors? Is there a list serve? How do we get in touch with everybody? And it's surprisingly a little tricky to have even just that index of all of who is involved. So that was incredibly helpful, instrumental, I would say, and kind of brought together the community of program directors. There were weekly articles that were being published in Sky member publications about this. We hosted a couple of town halls, opportunities really like this one here now that were in person, but virtually for people to have questions answered about the match and air their concerns, air their desires. We had several fellow interviews that were posted on social media to try to get kind of a 360, if you will, of the terrain and what people saw as potential opportunity here. We had some engagement with the press, and then there was outreach to other cardiology societies as well so that we could kind of bring kind of all stakeholders, if you will, into the frame here. This is the timeline that I promised to show, and I'll just say, you know, I kind of added this part here. This is gonna be published in JSky. The whole process of coming to the match is gonna be published within the next few weeks in JSky, so you can look for it there. I kind of pirated out of embargo one of the images here, so, you know, do with that as you will. But on the left-hand side here, there was a conversation that was held at the Sky Fellows course. We were down in Florida and Miami, and a number of us were sitting at a table bemoaning in 2021 how, like, basically, the website, the ERAS website, opened like while we were there, and we were all getting emails from people saying like, hey, you know, I've already got an offer, and it was like, holy cannoli. I mean, it was like, this was like within hours of the site opening, and so we were sitting at lunch and had a conversation and just said, what are we gonna do about this? And it was remarkable because, you know, it was at Sky, hosted by Sky, and people just jumped in and said, we have to make this better. We have to make a change. And so that was, and Ajay Kirtanay was involved in this conversation, and he posted on Twitter when he used to be on Twitter, you know, a poll that said, like, what do you think about having a match? And it just started this whole conversation on a national level, and then many of you may also be on, like, Mark Kern's listserv. He put out an email to, like, some of the, you know, more stalwart, or I won't say older, members of the cardiology community to say, like, what do you all think of a match as well? So it was on social media. It was on the email. It was never sent by an actual letter to anybody. But there was a lot of weighing in and a lot of discussion, a lot of controversy. So that sort of inspired, however, a request from the education committee. I believe Sahil Parikh was the chair of the education committee to the president, who at the time was Neil Rao, to convene a task force. And so a task force was convened in March to consider going to a match. We met at Sky in 2022, and then there was a page focused on the match that was published on sky.org that was sort of a repository for all meetings, all data, comments, a message board. Fellows were surveyed. There was a kind of survey that went out to program directors and fellows, and the results were published. And then we had a PR campaign. So like I mentioned, there were some fellows' videos. There was press that came from TCT and also Becker's Hospital Review. So the press got involved, and then we had a couple of town halls. And ultimately, through this sort of also member-to-member communication, the message board that was on sky.org that included programs that had decided to commit to the match was listed there, and we needed a 75% threshold for the National Residency Matching Program, the NRMP, to consider interventional cardiology. And we exceeded the 75% threshold both for number of programs and the number of fellowship positions that were going to be committed to the match, because we had designated that this wasn't an all-in. Not every fellowship spot had to be committed through the match in order for a program to desire to participate. But they'd committed to 75% of the spots. We met the threshold, and so the match was on. Very exciting. And so here are the numbers. This is sort of like the running ticker tape, if you will, on sky.org when we broke the threshold. And then this was just, Laura, thank you so much, Laura Porter, for bringing this all together. In April 19th, it was sort of queried, and the number of committed positions and programs now exceeds 80%. So we're very, very excited with the enthusiasm from program directors' community here. So finally, what should we expect? I'm just gonna borrow from the publication that is upcoming, a table that we put in here, and you can review this later. It'll be published. Hopefully you can have access to these slides too, and I'm always happy to go over it again. But what we perceive to be advantages and disadvantages, I wanna present balance here, and we can all kind of discuss these after. But first and foremost, it de-stresses the timeline here. So we all will have additional time to allow for consideration of candidates, interviews, considering all potential opportunities. Because you're receiving files from fellows who will now be at the end of their second year, because it's July, so they will now have finished their second year. It's not just like kind of in the middle of their first year or earlier. They will probably have more complete letters of recommendation, greater numbers of rotations in the cath lab to understand what their technical expertise is, or their career aspirations, and more fully formed sort of perspective. This same segue in timing occurred when I was a general cardiology fellowship or program director many years ago, and it moved six months later, and we said, wow, you know, because it used to happen like kind of December-ish, and then the match happened in the summer, and now it's gonna be like reviewing applicants in the summer. So everything was six months later, and what we saw in the candidate files was categorically different. Like you just get a better picture of who they are. It's not like I knew this person, they're pretty good, we'll see what they do. It was here's their formed objectives, their opinion, their perspective, what they're gonna do in their lives. So I think that's incredibly helpful to have it six months later. There is really going to be more convenience to this because it's immediate selection, but there's not this like iterative, do you like us, we like you, what are you gonna do, or subterfuge among multiple internal candidates as you select one, but then the next, and how are you moving down the chain? And we hope that this will introduce the opportunities for a diverse, inclusive pathway to recruit candidates. And it's binding, as I mentioned before. You know, what are some of the disadvantages? We heard plenty of them voiced as we went through the process of trying to come to a match. It's gonna increase our workload. Instead of going to one candidate and saying, you know, you look great, we'd like to have you, you have to screen as many as you think you're gonna need to be able to recruit the number of slots that you have. So that's gonna change the workflow and maybe increase the number you have to see. It'll be similar timelines for all fellowship match within cardiology. So for our administrative staff, this is gonna be an additional potential burden if they're helping to screen candidates or if they're helping to schedule application and or interview blocks. So that will be important as well to consider. And we'll have less control over the final outcome. It's a match. You know, it's an algorithm. So there's some seeding of how you ultimately can kind of control all the cards. And there's not the ability to guarantee that you're gonna fill. You know, that's fundamental to this. And also, because everything's six months later, you know, for us, we often will recruit people from outside of the US. We have to think about visa issues, other things to onboard candidates for them to find housing and so on and so forth. But this happened the same way, I think, in general cardiology. And we managed to make it work quite easily and readily. So I think hopefully the same will be true in interventional cardiology. So what does it mean for fellows? You know, as mentioned, they're gonna apply in their second year of cardiology fellowship so they'll have more formulated career objectives. It helps to avoid the variability of the application timeline from previous. And the interview dates used to be all over the map for them. And then the exploiting offers used to happen. And so now they're gonna be applying in their third year. So just at the end of their second year, the standardized application timeline will exist and the interview timeline will be also within certain confines. And then they can, and we can, rank list our priority. So instead of saying what's the best place that I think I can get into right now, they can think about their top choice. So we hope it'll be favorable to all included. This is my final slide, which is just basically here's our article that we're gonna publish in J-SKY within, I think, a couple of weeks. And I just wanted to make sure that I had a chance to really thank the SKY leadership who had the sort of faith and confidence that this was worthwhile. And to put together our task force, all the people who were on the task force, that SKY staff were unbelievable and did an amazing job. And then certainly to you all, the program directors and to our fellows. I listed right here, sky.org forward slash match. That's the website if you wanna look there for any additional resources or other information.

interventional cardiology match

recruitment process standardization

fair selection processes

match system advantages

strategic approach in cardiology recruitment