November 17, 2023
PA Encourages Specialty Practice
October 2, 2019
By Eileen Denne, CAE, APR
Ever wonder what a PA who specializes in cardiac electrophysiology does? David J. Bunnell, MSHS, PA-C, Lead Medical Center PA at the Washington, D.C., Veteran’s Affairs (VA) Medical Center, tells us.
“Clinically I care for people as in-patients and out-patients. I coordinate the schedule and clinical needs of our lab which is responsible for our region in Washington, D.C., as well as parts of West Virginia, Maryland, Virginia, and Pennsylvania. I serve as clinical support for the Eastern Pacemaker Surveillance Center that monitors most veterans who have cardiac devices in the eastern half of the U.S. I occasionally coordinate research projects and am currently engaged in a protocol evaluating the efficacy of primary prevention ICDs in the elderly.”
Bunnell says as Lead Medical Center PA he acts as a subject matter expert for all conversations about PA practice. He works with the medical center director, chief of staff, chiefs of medicine and surgery, and department chiefs in order to make sure PAs work at the top of their training, education, and experience in accordance with VA policies to meet the needs of the growing veteran population. He works directly with PAs to enable them to provide the best care for their patients. He also serves in the credentialing process by reviewing and taking part in approving scope of practice documents.
Move from cardiothoracic surgery to cardiac electrophysiology
Bunnell hasn’t always worked in cardiac electrophysiology. After his wife Rebecca, a PA serving in the US Public Health service, introduced him to the PA profession, he graduated from the George Washington University PA Program and worked for a VA Medical Center in cardiothoracic surgery and surgical critical care. After a decade in cardiothoracic surgery he had an opportunity to expand his skills into cardiac electrophysiology where he specializes in arrhythmias and cardiovascular implantable electronic devices.
Asked why he made the move, Bunnell reports, “I love cardiothoracic surgery and surgical critical care. However, I needed some breathing space in order to have the time to be fully present for my wife and children during important parts of their lives. This realization occurred when I knew my cardiology colleagues were looking for someone with surgical skills who knew how to get things done. This is an excellent definition of the cardiothoracic PA community, so I fit in well. I am grateful to expand my knowledge and skill set into the dynamic and underserved world of cardiac electrophysiology.”
Career path to get into the field
For PAs considering the field of cardiac electrophysiology, Bunnell has several recommendations. Cardiac Electrophysiology (EP) is a dynamic field that lives at the intersection of complex physiology and complex technology, he relates. Access to this care is limited by the relatively few providers who specialize in EP.
“Patients range from having specific problems which can be cured with cardiac ablation of arrhythmias to people who have a lifetime relationship with your service based on their implanted cardiac device. While there are some notably talented PAs with national impact in EP, we are under-represented compared to our nursing colleagues. If the EP community fully understood what a PA can bring to a practice in terms of access to care and clinical ability, we would have a much larger footprint.
“As for entering the field, I highly recommend the Heart Rhythm Society (HRS) as a professional organization which excels at education and lives into the ideals of team-based care in ways that few other organizations are capable. If you are thinking about EP then look up HRS and start learning.”
Cardiothoracic surgery and surgical critical care have been foundational for Bunnell’s practice and continue to be a source of professional community. Bunnell relates, “PAs are at the center of this specialty and vital members of these teams. The Association of PAs in Cardiothoracic and Vascular Surgery (APACVS) is the professional home for this community and without the benefit of mentoring and growth in this organization, my career would not have been as rewarding as it has been so far.”
Advice for new grads
In addition to his busy job at the VA Medical Center, Bunnell has been increasingly engaged in PA education. He was accepted into the PA Leadership and Learning Academy as an academic fellow at the University of Maryland, Baltimore. This fellowship provides education expertise to clinically practicing PAs. He also teaches at Frostburg State University PA Program and participates in their admissions process.
Bunnell offers this advice to students considering either cardiothoracic and vascular surgery or electrophysiology: “There is a great deal of appropriate conversation about how the world is underserved by primary care providers. These clinicians are vital. However, PAs increase access to specialties which also make people feel better and live longer. If you or a loved one needs to have a cardiac operation, a lung cancer removed, or has a threatened limb due to vascular disease, you are going to want to have immediate access to dedicated professionals. If your life is affected by disabling symptoms, recurrent ventricular tachycardia, or significant heart failure symptoms, you are going to need professionals to be in your corner. PAs provide expert access for these patients and work side-by-side with all members of the medical team.
“There is a common misperception that recent PA graduates need to pursue a practice other than one that lights them on fire before they go after their interests. I disagree with that point of view. If you feel that your contribution to society is to become an excellent PA who practices in a specialty, then I encourage you to follow that passion.”
Meaningful opportunities to contribute to the profession
In addition to his clinical work, Bunnell currently serves as chair of the AAPA Governance Commission. He is also vice president of the Association of PAs in Cardiothoracic and Vascular Surgery as well editor-in-chief for the Journal of the APACVS. He considers the volunteer roles his practical education in leadership and business which continues to provide meaningful opportunities to contribute to the profession.
“Through APACVS I am honored to serve as chief delegate to AAPA House of Delegates where our colleagues discuss our relationship with patients, society, and each other. I have been humbled to be asked to serve in the past as chair of the AAPA Research and Strategic Initiatives Commission and participated in the Optimal Team Practice Task Force which was one of the initial sparks for our current efforts to modernize PA practice.”