The Physician assistant profession is one of the fastest growing in the country and here at BWH, and Barry Shopnick, PA-C, has watched this growth from Cardiac Surgery for two decades.
Physician assistants are at or near the top of every national list of growing professions. Money Magazine listed PAs as the fifth best job in America, and the U.S. Bureau of Labor Statistics projects the job as the country’s third-fastest growing occupation through 2012.
Brigham and Women’s Hospital is part of this amazing growth. The hospital has seen its number of PAs explode in recent years from approximately 25 dispersed throughout the hospital to more than 100 as these highly trained medical professionals are intimately involved in all aspects of patient care.
The rapid growth in BWH’s reliance on PAs is a combination of limits imposed on work hours for residents and the high level of skill and ability of physician assistants, Chief Medical Officer Andy Whittemore, MD, said. “We now have physician assistants in almost 20 sections and divisions throughout the hospital delivering the high-caliber care Brigham and Women’s is known for,” Whittemore said.
Recently, the hospital developed a comprehensive benefits package for physician assistants, in addition to the standard BWH benefits program that allows for reimbursements for professional development and state-required continuing medical education courses and recertifications. The PA compensation program was reviewed and revised as well, and a career ladder program is in development. In October, a combined BWH/DFCI case-based PA grand rounds program will be rolled out.
“This reworked compensation and benefits package demonstrates the hospital’s commitment to maintaining and growing our physician assistant program while recognizing our PAs as true professionals,” said Debra Leven, director of special projects and physician assistant services.
On Oct. 5, BWH is kicking off National Physician Assistants week, celebrating the contributions and professionalism of its PAs with a formal recognition dinner at the Museum of Fine Arts.
“PAs are invaluable members of our teams, and we couldn’t function without them,” Richard Baum, MD, chief of Angiography and Interventional Radiology, said “I can’t imagine our practice without PAs.” His division has three PAs who extend and expand BWH quality care.
Physicians assistants date back to the 1960s when Duke University Medical Center trained the first class of PAs. Now there are approximately 200 PA education programs throughout the country and more than 62,000 practicing PAs. The programs include at least 12 months of classroom instruction and 12 to 14 months of clinical rotations similar to rotations medical school students must complete.
Upon graduation, physician assistants must pass a national certification exam developed by the national Commission on Certification of PAs in conjunction with the National Board of Medical Examiners. PAs must log 200 CME hours every two years and sit for recertification every six years.
PAs practice under the direction and license of supervising physicians and perform a wide range of functions. In Cardiac Surgery, for example, there are 11 PAs who assist in surgeries and provide coverage in the Cardiac Surgery ICU on Tower 8, said Barry Shopnick, chief PA for Cardiac Surgery.
For a typical cardiac surgery, a fellow and PA would start the case, open the chest and cannulate the patient. Cardiac surgery PAs also are involved in minimally invasive endoscopic vein harvesting for bypass operations, said Shopnick, who has been a PA in Cardiac Surgery for 20 years.
“We have a close working relationship with residents,” Shopnick said. “On the Pod, sometimes patients are a little confused as to who’s who, but they know they’re well cared for. They’re happy as long as we answer their questions and they feel cared for.”
Cheryl Arena was hired a little more than a year ago as the only physician assistant in Gynecologic Oncology. She writes discharge orders, maintains contact with local physicians for patient follow-ups, works closely with nurse practitioners at the Dana-Farber Cancer Institute and spends a lot of time with patients. “I help maintain the continuity of care and act as the eyes and ears for our physicians,” she said.
Arena’s supervising physician is Ross Berkowitz, MD, director of Gynecology and Gynecologic Oncology. “PAs make sure we continue to offer the best patient care with diminished resident involvement, and through the help of PAs, we have been able to provide an exceptional level of care,” he said.
PAs offer a continuity of care not possible through the resident system because of rotations, Berkowitz said. “We have wonderful residents, but every six weeks, they change and each new group needs to be oriented to our standards of practice,” he said. “The consistency of having a physician assistant like Cheryl is invaluable.”
Claire Cavatorta, PA-C, prepares patient Raymond Hamel for discharge following his bypass surgery.