Interventional cardiology training has evolved from see-one, do-one, teach-one; to informal mentoring of established practitioners; to informal fellowships during or after cardiology fellowship; to formal sanctioned training, testing, and certification. When I took the proposal for an interventional cardiology subspecialty to the American Board of Medical Specialists (ABMS) in 1998, it was not at all clear that it would be approved. In fact, what was agreed to was a certificate of added competence in interventional cardiovascular medicine with the actual board certification in the discipline to follow a few years later. Most of the candidates who successfully achieved that designation were cardiologists who had picked up angioplasty while in practice. After five years, the board examination was limited to those completing an ABMS interventional cardiology fellowship. Obtaining a position in one of those fellowships required an application, interviews, and recommendations with the best candidates, among the many who applied, being selected. There were few fellowship programs back then, and competition for the slots was significant.

Now, after a quarter of a century, the process of obtaining a position has evolved to a rank-order matching process as has been in place for general cardiology and all the other cardiology subspecialties. That match was proposed as a solution to what was described as a chaotic process in which applicants are pressured to accept an offer very early in their cardiology training without being able to adequately investigate their best option. From the training program perspective, there was an incentive to lock down trainees to fill the positions before other candidates could be evaluated. This was not consistent for all programs as the most popular ones could easily obtain candidates while less notable programs had a more difficult time filling their slots.