Physician Assistants and Cardiology

In the field of cardiology, PAs' rigorous medical education, versatility, and commitment to patient care are "just what the doctor ordered." The addition of a PA to a practice offers a busy cardiologist the benefits of higher patient satisfaction levels, increased revenues, and a more flexible work schedule. Today's high-pressure medical environment for cardiologists reflects the expanding role of managed care plans and increased frequency of invasive procedures. The intense demand for cardiologists is demonstrated by the 300 percent increase in cardiac catheterizations in the last 10 years. Cardiology PAs can make life easier and patient care more satisfying for overworked cardiologists by offering a more rational, coordinated approach to patient care across the spectrum of cardiology practice.

The physician-PA team enhances medicine by design. The training of PA students in a traditional medical school model, including intensive study in basic medical sciences as well as clinical subjects, prepares them to be effective providers of physician-directed medical care. This knowledge base enables the PA to be an effective team member, enabling the cardiologist to selectively care for patients suffering from more complex and urgent disorders. In all states, the District of Columbia, and Guam, physicians may delegate to PAs those medical duties that are within the physician's scope of practice, the PA's training and experience, and state law.

As of January, there were 46,000 PAs in clinical practice, with approximately 1,400 working in cardiology. Cardiology PAs perform patient histories and physical exams; administer stress tests and other measures of cardiac health, including cardiac catheterizations; perform admissions; take call; make daily patient rounds; provide important patient education and lifestyle counseling, and write discharge summaries. Cardiology PAs' knowledge of the pharmacologic effects of vasoactive/cardiotonic drugs, ventilator management, and artificial cardiac devices facilitates the treatment of inpatients and outpatients with cardiac conditions. By sharing the task of rounding, PAs free physicians to spend more time on complex cases, and act as a vital communication link between patients, families, and physicians.

PA Cardiology Care: One Example

The work of one physician assistant in a large East Coast cardiology practice demonstrates the range and versatility of cardiology PAs. On a typical day, this PA takes complete histories and physicals of new patients. She explores in depth the details of each patient's cardiovascular health and general habits. The PA presents the essentials of the patient history to the cardiologist, who directs patient care from that point forward.

Consulting with the physician throughout the process, the PA conducts key tests, including stress tests, nuclear stress tests, and tilt table tests. She consults in the hospital, revisits patients after discharge from MI's and BP medication titration. The PA explains cardiology procedures to patients, performs site checks after placement of catheters or pacemakers, and monitors chest pains that do not require ED evaluation.

In the hospital, a cardiologist reviews the PA's notes on the tests, adding a note to her interpretation and electronically signing the reports. Typically, the cardiologist will call the referring physician with any "positive" stress results. The PA's inpatient responsibilities include seeing non-ICU patients. She writes orders and progress notes, sees patient consults, and dictates the consultations. The hospital bylaws where she works require that a cardiologist see the patient at some point during the day.

By seeing patients, writing notes and orders, and dealing with labs and x-rays in advance, the PA enhances continuity of care, while the cardiologist gains time and ease of case management. Patients and their families appreciate having their questions and concerns addressed by the PA. Back at the office, the PA sees patients for follow-up visits. She performs post-procedure site checks, titrates blood pressure, coordinates medications, and promotes recovery through discussion of diet, exercise and lifestyle issues.

A Study in PA Excellence

PAs have successfully performed important cardiology procedures for many years. As a 1987 study published in the American Journal of Cardiology found, PAs performed coronary arteriographies with the same success rate as cardiology fellows. A study carried out by Duke University in 2001 found that trained and supervised physician assistants performed cardiac catheterizations with skill and efficiency. The study, presented at the Annual Scientific Session of the American College of Cardiology, confirmed that PAs could perform diagnostic cardiac catheterization, including coronary angiography, with procedural times and complication rates similar to those of cardiology fellows. Comparing 929 diagnostic catheterizations performed by PAs with supervision by a cardiologist to 4,521 catheterizations performed by cardiology fellows, the study showed the incidence of major complications, such as myocardial infarction, stroke, arrhythmia requiring defibrillation or pacemaker placement, pulmonary edema requiring mechanical ventilation, and vascular complications requiring surgical intervention, were nearly identical in both groups. For PAs, the complication rate was 0.54 percent compared to a 0.58 percent complication rate for cardiology fellows.

The study demonstrates the effectiveness of PAs trained thoroughly in cardiac catheterizations. The implications for cardiologists: considerable research and consultation time can be freed up through physician assistant participation in patient testing. With a skilled PA partner, cardiologists are freed to concentrate on the data generated by catheterization and to focus on the challenges of cardiac follow-up care.

Boosting Patient Satisfaction

The PA improves patient satisfaction in several important ways. The PA enhances patient health and contentment through counseling in both preventive measures and in medication usage, through improved coordination of care when the cardiologist is in the laboratory, and by acting as an important communication link to family members and other health care providers.

With a PA on staff, patient waiting times are lessened, improving patient satisfaction through increased access to care. No cardiologist can be available to patients every moment of every day. Physician assistants, as part of a team, enhance continuity of care and patient compliance. Recent studies conducted by the Kaiser Permanente Center for Health Research found patient satisfaction levels with physician assistants high, ranging between 89 and 96 percent.

PA reimbursement

Medicare covers medical services provided by PAs at 85 percent of the physician fee schedule. Medicare generally allows PAs to deliver the same services as physicians (within the PA's scope of practice as determined by state law) using the same Current Procedural Terminology (CPT) codes. Payment is made to the practice. Changes to Medicare policy in 1999 specifically allow PAs to personally perform cardiac stress tests and other related diagnostic procedures.

Medicare follows PA regulations in each state regarding the degree of physician supervision required. Under Medicare's guidelines, the physician supervisor need not be physically present with the PA when a service is being performed unless specifically required by state law or by facility policy. Private insurers generally follow Medicare's lead on reimbursement policy.

Information Resources

For additional information on cardiology PAs, contact AAPA's Jennifer Anne Hohman (703/836-2272, ext. 3220;  jhohman@aapa.org) and the Association of Physician Assistants in Cariology (jeflesher@hotmail.com;   http://home.supernet.com/~jeflesher/apac.html). AAPA's Web site (www.aapa.org) features in-depth information on the PA profession, including resources for prospective employers of PAs. AAPA's publication, Hiring a Physician Assistant, provides guidance on key topics for new employers of PAs, from recruiting a PA to contract negotiation, benefits, and the dynamics of team care. Order this resource from AAPA's online store or call toll-free, 800/708-7581. The cost is $25 for AAPA members and $50 for non-members.

Issue Brief: Physician Assistants and Cardiology
7/03

 

 

Last Revised: 7/8/03