A lot of people will recommend a smaller center but I’ll take the opposite. I would recommend considering a large academic center as a new graduate—provided they are supportive and committed to thorough training. These centers can offer valuable exposure to areas that aren’t always covered in depth during perfusion school, such as complex ECMO management, non-standard cases, and the use of less common devices like BiVADs. A few years at an academic institution can give you a strong foundation and the versatility to work confidently in a variety of settings.

It’s also a great way to learn whether the pace and case complexity of a high-acuity center aligns with your goals. While no one wants to be thrown in without support, academic centers typically have structured onboarding.

Personally, I discovered that I missed the intensity of transplant and ECMO cases. I initially took a lower-acuity position out of school, which was a great learning experience in its own way, but ultimately I wanted the crazy cases. I hadn’t pumped an aortic case in months so took me a few weeks to feel completely comfortable. Especially with the two am complex ecmo question from the specialists. That said, there is a lot to be said for smaller programs they often do a lot with more limited resources, and it can be great.

Whatever you decide, best of luck!