Jump to content

Are CT surgical PAs in trouble???


Recommended Posts

I agree with EMEDPA the specialty isn't going away anytime soon. CABG is known to last for 20 years and is a lot more reliable than stents, especially in younger populations. Closing defects is becoming an issue because of the deployable occlusion devices, however these devices can usually only treat straightforward lesions reliably, still leaving room for CT surg repair for more complicated cases. Interventional valves have been around since early 2000's in europe, and the first deployable transcatheter aortic valve was just approved by the FDA, however all the studies I reviewed clearly place them in the realm of high risk candidates for surgical valve replacement. Then there are all the thoracic diseases which interven cardio has nothing to do with. I think what is currently happening, and what will continue to happen is that IC will continue to advance in treatment of diseases, while CT surg will continue to treat sicker and sicker patients that years ago would have already been dead. In other words, the complexity will rise, but CT surg isn't going away.

Link to post
Share on other sites

Problem is, the interventional cardiologists are the first ones to see the patient and they're plugging stents into these people regardless of what the studies show. I'm currently contemplating a move into CV surgery and this is a real concern of mine. We are a large regional center and our cases are down quite a bit over the last 2 years. On the bright side this has made for better working conditions for the PA's. Our surgeons have been diversifying too, doing more lung cases, vascular procedures and robotics. The specialty certainly will not go away but I think there will be much LESS need for CV surgery PA's in the future.

Link to post
Share on other sites

Rubbish.

 

Currently, we have an overcapacity of CV surgeons, but because of this, and the rise of interventional cardiology, we have a problem on the horizon.

 

The average age of a CV surgeon is in the late 50's......From a workforce capacity, this is the only surgical specialty (outside of rural gen surg) where we face a real shortage in about 10-15 years as the number of retiring CV surgeons exceeds the number of surgeons entering the specialty.

 

There is always the possibility of an (as of now) unknown interventional cardiac technology displacing, or creating a "disruptive innovation" that affects CV surgery, but as of now, they aren't going anywhere.

Link to post
Share on other sites

My impression is that there is currently a need for CT surgery PAs. I find it highly unlikely that CT surgery would get severely undercut by interventional cardiology to the point where there was a shortage of work to be done. And even if there was, the skill set you develop as a CT surgical PA makes you extremely valuable and able to transition into many other specialties fairly easily.

Link to post
Share on other sites

The demand is still out there.

Everyone brings up good points. The advances in PCI have changed the CABG landscape for sure. When I entered my current practice we did ~75% CABG and ~25% valves. Now the numbers are almost reversed. Overall coronary volumes are down nationwide.

 

In the medical literature and lay press there has been much talk about the appropriateness of PCI. What crieman mentioned was covered this past yr, I think in the NYT. Cardiologists are the gatekeepers and they are not always presenting the surigcal options; or, to put it better, there is not enough of an interdisciplinary conference on as many patients as there should be.

 

That said, there are still plenty of cases out there. A lot of this is seen through the perspective of the older CABG days when it was not uncommon to graft a LIMA-LAD (when that would be a chip shot stent 99 times out of 100 nowadays). So perhaps the early surgery volumes were inflated and now its approaching more reasonable numbers.

 

I don't think robotic surgery is having a negative effect. PAs are often assisting at the table while the surgeon as at the console. And of course, someone still has to do the perioperative care on these patients.

 

Transcatheter valves will be a branching point. Surgeons realize what they lost when they let the cardiologists have PCI. So, surgeons are now part of the TAVI team.

 

There is no impending sea change that will alter the need for cardiac PAs that I am aware of. We have proven competency and quality in the OR , ICU, and periop areas. Of all diseases which have interventional/catheter based approaches, there are many pts who are excluded from these techniques.

 

If anything we may see more PAs entering sub-sub specialty and working with surgeons/groups who specialize in one CTs niche- TAVI, VAD, arrhythmia surgery, etc.

Link to post
Share on other sites

Agree with andersen. As a former robotic surgery PA, I can say that PAs will probably always be the assist choice for surgeons. None of the surgeons I worked with wanted to assist in robotic cases because of the reimbursement, and yet there has to be someone at the patient's side for these surgeries. As a former CV PA, I still get lots of calls and offers for CV jobs, even though I haven't done CV surgery in years. So I think the demand is definitely out there still.

Link to post
Share on other sites

I agree with the chorus of voices that believe that CT PAs will continue to have a strong role. While it is true that we are in a changing field, we are well equipped to roll with the changes. If a PA has good hands, is an excellent intensivist, and is not afraid to work hard in clinic then he or she will continue to be a valued member of the team. I have not noticed any drop in the availability of jobs.

 

It is notable that the Cardiac Surgery Fellowships are having difficulty filling all of the training positions. This means that Cardiac surgery teams in the future will continue to have a need for trained PAs to help manage patients. It currently means that the hospitals that depend on the fellows for staffing currently need to fill a void.

 

My fear is not whether we will continue to have jobs. My concern is can we continue to provide trained enough PAs to meet the demand. If we cannot then surgeons and hospitals will turn elsewhere to fill their needs.

 

My advice to anybody interested in CT is to join APACVS and meet other PAs who are currently in the field so that you can start heading in the right direction.

Link to post
Share on other sites
  • 2 weeks later...

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More