VM Fellowship Funding Mechanisms

Despite a significant unmet need for physicians with formal training in vascular medicine in the country, there are very few programs that currently offer a formal training pathway.¹ One of the main impediments is a lack of direct institutional graduate medical education (GME) funding as vascular medicine fellowships are not ACGME accredited.

This section discusses the costs associated with running a fellowship program and considers several possible funding avenues. Since resources and opportunities vary significantly between institutions, health systems and geographic locations, individual programs can use a combination of strategies to attain there funding goals.

Cost of VM Fellowship Program

Most trainees will be at a PGY4 level (if starting after an Internal Medicine Residency) or PGY 7 (if starting after a Cardiology Fellowship). The total annual cost will vary depending on geographic regions and instructional practice and more precise amounts can be obtained from the institutional GME office. In 2014, the Alliance for Academic Internal Medicine estimated the total direct and indirect costs to train a resident was about $183,416 per year.² However, this estimate includes indirect costs such as coordinator salary, part salary of department chair, call room charges, program director salary support along with resident salary and benefits.

Since Vascular Medicine fellowships in most programs have a small footprint in terms of number of fellows trained most of these costs can be absorbed by the larger internal medicine or cardiovascular medicine programs with significantly less indirect cost. Though program director time and teaching faculty time should be compensated per institutional practice to ensure committed instruction for the fellows.

Annual direct costs include salary and standard benefits (such as health insurance, FICA, educational stipend for conferences, etc…) can be in the range of about $100,000 to 120,000 depending on geographic location, institution, and PGY level. Other costs to consider may include: cost of board certifications, office space, textbookks, white coats, etc.

Possible Funding Sources for VM Fellowship Program

There are several possible sources of funding that are being used by various institutions across the country – there is currently no universal approach. The mechanism utilized will depend upon local resources and support. Several possible funding mechanisms have been effectively utilized at various institutions for vascular medicine fellowship programs. A combination different sources may also be an option to creatively support the costs.

Institutional and departmental support: The funding for the fellowship program may be provided in full or partial from an institution or department/section, particularly if institutional leadership understand the value a vascular medicine program avails to the care of vascular patients. This can be direct support such as funding salary for the trainee, but also indirect support such as absorbing indirect costs such as that for administrative support for program coordinator salary, teaching faculty time, educational stipends, and even program directors time.

Multi-disciplinary Institutional support: With a growing emphasis on the benefits of comprehensive medical management of vascular patients, there is a growing realization in other vascular specialties of the significant benefits of vascular medicine training. In fact, increasingly vascular surgery and vascular interventional radiology residents and fellows are rotating with vascular medicine on formal rotations. Further, increasingly multidisciplinary vascular programs are recruiting vascular medicine physicians as a part of the vascular team. In many cases vascular medicine physicians are being hired by vascular surgery program as well. This creates an opportunity for a pooling of resources amongst various departments (vascular surgery, interventional radiology, and internal medicine/cardiovascular medicine) to co-fund a vascular medicine fellowship program recognizing the need to train and recruit more vascular medicine physicians.

Industry support: There are potential funding opportunities available through several large industry partners who are involved in the treatment of patients with vascular diseases. Applications for these opportunities can be submitted through their websites for full or partial support. However, industry support has been controversial and involvement of industry in training of physicians has been discussed in published medical literature.³ It is highly recommended that if industry support is sought then the grant be unrestricted and not tied to a particular trainee and not appear on open payments as a grant to an individual.

Not-for-profit organization support: NGOs (non-governmental organizations) involved with vascular diseases and rare vascular diseases have been helpful and supportive of training vascular medicine physicians. These often obtain funding from industry but administer in an unrestricted manner. An example of this was the Anticoagulation Forum’s Ansel Vascular Medicine Training grants that helped train vascular medicine physicians for several years but is not currently active. While not a clinical training grant, another example of NGO support for vascular medicine research training is the Marfan foundation research grant program to support trainees interested in genetic vascular diseases to work with mentors in the field to develop an independent research career.

Philanthropy and endowments: This can be a source of significant long-term funding for supporting vascular medicine training. Many institutional endowment programs are eager to help connect physicians, educators and researchers with potential donors who are interested in donating to valued causes. The availability of a well-established vascular programs with respected physicians in the field of vascular medicine can aid this effort. In addition, grateful patients can also help either donate themselves or help organize community efforts to secure funds. Endowed professorships for vascular diseases can also be a source of funding. Each institution is different but reaching out to local corporate giving and endowments can lead to successful funding.

Training grants and research grants: There are various sources of funds that may be available for vascular medicine training in specific institutions.

1. NIH supported research and training grants, such as T-32 awards, may be available to certain institutions. These may allow for some clinical exposure but are typically limited as a >75% research time commitment is required.
2. Research funding: Established vascular medicine researchers who have independent funding may be able to support partial or full funding of trainees as it may bring significant value to their research. These training pathways are typically 2 years rather than 1 year to allow both research activities and clinical training.

Building salary support into the fellowship training programs: This model involves trainees generating salary support from clinical activities. It has been adopted by other non-accredited fellowship training programs including structural cardiology and advanced imaging fellowship programs.⁴ Essentially, it involves the trainee being appointed as an instructor or faculty at the institution then for part of their fellowship year they work as an attending to generate revenue to help support their salary. As an example, an internal medicine graduate can work as a hospitalist (but it is suggested no more than about 20% FTE).

VM Fellowship Funding Mechanisms

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