This is an editorial piece based on personal experience and peer discussions. I trained in the USA at two venerable institutions—Vanderbilt University and the University of Washington. I owe much to these academic centres and to my many outstanding teachers and mentors. Beyond internal medicine and cardiology, I developed skills in medical education, curriculum development, and some areas of advanced cardiac imaging. I worked in valvular heart disease and adult congenital heart disease (ACHD) clinic, and my elective time focused on cardiac imaging. Ultimately, I accepted a community cardiology position in Boise, Idaho.

Every summer, a fresh group of cardiologists completes training and makes the transition from fellowship to early career. This transition is difficult regardless of the practice setting. There are clear challenges to establishing a successful academic medicine career, and the American College of Cardiology (ACC) has suggested ways to better support academic-bound trainees.1 However, an ACC early career survey estimated that 90% of US-based cardiology fellows begin their career in community practice.1 For this majority, finding the right position can be a daunting prospect. Many fellows have little exposure to the practice of medicine outside of academic centres and are not educated in contract negotiations, community job options or the business aspects of medicine. The stakes are high, as these decisions will largely govern one’s daily practice. This makes the transition from training to community practice a vulnerable time for fellows as they navigate an unfamiliar landscape through the job search process to sculpt the shape of their early career.

Fellowship education must expose learners to the full array of cardiovascular disease, developing competency across a broad swath of procedural and clinical skills. Achieving general competency has grown more challenging with the rapid expansion of subspecialty technology. Training programmes must also foster key non-clinical skills …