Transplant medicine

[winterallsummer]

Can any PAs that worked in transplant medicine comment on it and how much medicine vs surg was involved? What is the PAs role in this setting?

[ATCLATEMTB]

I work in both Adult Cardiothoracic Surgery and Thoracic Transplant and Mechanical Circulatory Support Departments in our hospital.  There is a fair amount of medicine in both roles, with transplant being more medicine based.  Yes, I do spend all night in the OR tossing some lungs in or a new heart---- but the pre-op and post-op work is a great deal more time consuming.  Sitting on the committee for both, which reviews each and every patients workup including social environment, all sorts of consults from Dental to GI to Derm to Psych to GI -- you have to pull on your broad preparation as a PA to digest.  VAD and ECMO patients are also extremely complicated to manage at times-- we tend to keep most of the medicine to only those on committees and request consults infrequently and to only those teams we trust.  Physiology is greatly different when you have a pump take over for blood flow and / or oxygenation.  

 

That being said we always have a Fellowship trained Advanced Heart failure  Cardiologist or Pulmonologist take care of these patients in concert with us as they are on committee and ultimately are the ones who bring us the patients to cut on.  

 

PA's roles vary from place to place on the team.  I have seen jobs where they are the OR providers and only function in the OR.  I have interviewed for jobs where they manage the patients on the floors and do not ever set foot in the OR.  I currently do both and would not have it any other way.  

[coloradopa]

Can any PAs that worked in transplant medicine comment on it and how much medicine vs surg was involved? What is the PAs role in this setting?

It will really depend on the environment. At a big academic medical center the push will be for the fellows to do cases. Most work will be in inpatient and outpatient management. There might be some time in the OR but most time will be managing the patients on the floor. In programs without fellows then PAs frequently get into the OR as first assist. There are also some PAs that do donors. 

[kem2127]

I work in-patient at a large academic hospital and the surgeons and the transplant fellows do the OR, but the transplant service is PA run (no residents). We manage the floor which includes pre and post op of recent solid organ transplant recipients (both living and deceased donor cases for kidney and liver), post op living donors for our living cases, post op hepatobiliary surgery/intestinal & ex vivo transplants, and post op single and double lung transplant.

 

We are also responsible for direct admissions to the floor, outside hospital transfers or admits through the ED to any patient that has a history of a solid organ transplant with a medical or surgical complaint or if they have any abnormal lab work or biopsy results in routine clinic visit. On any given day I'd guess it's about 50% surgery and 50% medicine. Because they are so immunosupressed many admissions are working up rejection vs infection (or both!) and then managment which is always a balancing act. 

 

Our patients are followed by different pre and post outpatient teams in clinic after the surgeries. They often meet with an NP as the hospital hires PAs but clinic is primarily staffed with NPs with a few PAs under the patient's primary nephrologist, hepatologist or pulmonologist. 

[ambulatoryalliances1]

It will really depend on the environment. At a big academic medical center the push will be for the fellows to do cases. Most work will be in inpatient and outpatient management. There might be some time in the OR but most time will be managing the patients on the floor. In programs without fellows then PAs frequently get into the OR as first assist. There are also some PAs that do donors. 

Very True..