Physician Assistant Specialty: Cardiology

Today, we examine a popular physician assistant specialty: cardiology.

I called in a favor and interviewed my good friend, cardiology physician assistant, Liz Torok.

Liz graduated just over a year ago from UC Davis School of Medicine’s PA Program, and works in Fremont, California as a cardiology PA.  She’s a very sharp but approachable lady with a fun and zany side.  Her work sounds complicated, and it is.  But don’t let that intimidate you–if you do this work, you’ll learn it all.  Here’s the transcript:

Physician Assistant Specialty Interview: Cardiology

Paul: So, Liz, what does your typical day look like as a cardiology physician assistant?

Liz: Hmm…is anything common in medicine? Not exactly.  That’s why I enjoy it; you never know how your day will turn out when you walk in the door.  My average day would goes something like this:
  1. I open the EMR (electronic medical records), where I inevitably have a list of messages waiting before I’ve even logged on.
  2. Authorize prescriptions, return calls to patients, and then start seeing the patients on my schedule.
  3. physician assistant specialty: ekg

    Interpretation of EKGs is a daily activity for cardiology physician assistants.

    Make rounds at the hospital, come back to clinic, grab a bite to eat, give a run down to my MD on the hospital patients.

  4. See my afternoon patients and then more phone calls, and prescriptions.
  5. I read any Holters (heart rhythm monitors that patients wear home) that have been completed that day, and maybe 10-12 hours later I go home.
  6. On pacemaker/ICD (implantable cardioverter/defibrillator) day I interpret the reports on my pacer patients, in addition to all of the above.
Paul: What procedures do you do, if any?
Liz:  cardiology is a medical specialty, not a surgical one.  Cardiology physician assistants have things like echocardiograms, EKGs,  ABIs (ankle/brachial index ultrasounds), and Holters, but these are mostly studies that a cardiology physician assistant interprets.  The medical assistants usually prepare these for us.  My MD does the Caths and inserts the Pacemakers.
Paul: What do you like most about your physician assistant specialty?
Liz: Call me a romantic… I’m all heart. HA! I’ve always been fascinated by the heart. It’s your plumber and electrician. When either stops working, you’ve got a BIG problem. Almost all of my patients have a chronic disease, which means it’s my job to teach them how to care for themselves and stay independent for as long as possible.  And when I’m  not teaching patients about chronic disease, I’m doing acute care, which is challenging.  When my patients get sick, they get BIG sick.  You have to be on your toes; you can’t make hasty decisions about their care.
Paul: What do you like least about your physician assistant specialty?
Liz: That’s a tough question.  I think my biggest frustration in physician assistant specialty care is trying to just manage “heart conditions.”  As a PA, it is beaten into you to look at the patient as a whole.  It’s hard to ignore their other chronic diseases, knowing that if you could manage those diseases, it would make it easier to manage the cardiac problems.  For example: a patient has uncontrolled diabetes, and I know that if I can control their sugars, their blood pressure will drop, their triglycerides will drop, and therefore their LDL (bad) cholesterol will drop.   So sometimes–okay, let’s be honest–a lot of the time, I am working on diabetes education or giving them a script for a diabetes medication knowing that I’m going to kill 3 birds with one stone by treating the underlying disease, and not just the heart condition that it causes.
Paul: What types of people go into this physician assistant specialty?  Okay if you have kids?
Liz:  Cardiology physician assistants are the ones who get the patient back after they’ve had their surgery and all the king’s horses and all the king’s men have left humpty dumpty.   Patients DON”T come to you with runny noses, or if do, they want to know which over-the-counter medications they can mix with the 10 other pills they already take, like digoxin and warfarin.  These are complex patients.
cardiology physician assistant holter monitor

A Holter monitor

It’s scary to be referred to a cardiologist.  It means that another doctor thinks something is so wrong with your heart, and that a specialist should see you.  Patients come in scared and sometimes angry, and they need someone who can handle the anger and reassure them.  You need good instincts.  These patients don’t fit in any box you learned about in school. They often look like a duck, walk like a duck but turn out to be a wolf.  You need to be very careful.

I work part time because I have a daughter. My days are pretty long and many days I leave some unfinished paperwork for the next day. But my schedule works great for me and my family.  Oh, and I should probably point out that cardiology has traditionally been a “Boys Club.”  Many of the physicians are men.  Out of the few fellows I saw at the ACC (American College of Cardiology) meeting  this year, I think I only saw 2 women.  But that means that the line is MUCH shorter for the women’s bathroom!

Paul: How much overlap is there, if any, between cardiology and cardiothoracic surgery?
Liz: A Lot.  And it’s not just cardiothoracic surgery–it’s also vascular surgery.  I feel very comfortable talking to my patients about surgery and post-op medical management because of my experience in cardiothoracic surgery.  Any great cardiothoracic surgeon will tell you that the hardest part isn’t the surgery, it’s the rehabilitation afterwards.  And that’s where my physician assistant specialty comes in.  It’s a GREAT idea to have a CT surgery rotation if you are considering cardiology. CT surgery shows you the anatomy of the disease that you treat in cardiology.  Seeing a beating heart, open in the chest and watching it transition from one bad electrical rhythm to another as it struggles to keep going is a visual you’ll never forget.  It helps you to know what’s going on in the heart when you read an EKG.  Cardiothoracic surgery gave me an appreciation for the medicine of cardiology.
Paul: Any advice for folks who think they might want to pursue this physician assistant specialty?
Liz: Sure:
1. Know your heart sounds – murmurs and bruits!  Many patients have more than one!
2. Know your EKGs!  Every patient has at least one.
3. Know your medications, especially the cardiac ones.  Not all beta blockers are alike, nor are the ARB (angiotensin receptor blockers) for that matter!
4. Take ACLS (Advanced Cardiac Life Support) and feel comfortable running a code.  911 still takes 20 minutes to get to your office, even if you are across the street from the hospital.
5. Educate yourself about lipids.  It’s ALL about the HDL cholesterol, not LDL cholesterol, as you learn in school.
6. Educate yourself about CT surgery procedures.  When medicine can’t help anymore, the next step is surgery, and you really need to know why you are referring them when you do.
7. Learn how to translate medical-eze into common English. Telling a patient, “You had a burst of ventricular tachycardia which probably precipitated your near-syncopal episode” will scare them more.   Instead, try: “Your heart was beating a little too fast so you felt dizzy.”
Sounds complicated, doesn’t it?  It is, but if you become a physician assistant, you’ll learn it all, and maybe more – just think how much Liz will know after she’s been in the field for a few more years.  Boggles the mind…   -P
  • ashley December 14, 2011, 11:30 am

    AWESOME! I love the heart and everything about cardiology:) I am planning to apply for PA school next year for entrance in the class of 2013 and this is definitely the specialty I want to enter. Thanks for posting

    Reply
  • Shannon reynolds January 13, 2012, 3:48 pm

    I really, really appreciated the in-depth look at a common day in a Cardiologist Assistant’s life, as this is the specialty I have chosen. I started a CMA class at San Joaquin Valley College here in Fresno, California a couple of months ago, and Cardiology was close to my heart. LOL. Anyway, thank you so much for your inside look, I read the whole article and was left wanting more.

    Reply
    • Paul January 13, 2012, 8:32 pm

      Thanks, Shannon. I working on Urgent Care for our next specialty article.

      Reply
  • Darryl March 2, 2012, 12:23 am

    Great great insight on cardiology PAs. In fact, great insight on all these specialties and what you’re doing to inform us pre-PAs and those thinking about going PA. It really helps, as I’ve been on the fence for PA vs. MD and still have been wondering what PAs do in-depth. KEEP UP THE GREAT WORK!

    Reply
    • Paul March 2, 2012, 7:08 am

      Thanks, Darryl! We’re hoping to have more specialties represented soon. Let us know how your PA vs MD deliberations go…

      Reply
  • Aika March 13, 2012, 5:18 am

    I’ve always wanted to be a doctor ever since I was a kid. It was then when I turned 16 I wanted to be a surgeon. Then on it never changed. I’m now 23 turning 24 this May 9. Because, lifes struggles hasn’t been easy on me for many years, I’ve had to stop school and work. Now, I’ve decided to finally come back to school again and make the time force the time and effort to make my dreams come true. PA is my first option in getting in Cardiology. I know in my heart. I can make this happen in God’s help and time. I will be taking Fall classes this 2012. Four year Bachelor of Science in Occupational Science. Graduate, work as an Occupational Therapist after. Then go to back to school trasfer to go to become a PA. Then, lord almighty help me reach my dream of being a Cardiologist one day!!! LOL

    Reply
    • Paul March 13, 2012, 9:21 am

      Aika – DON’T BECOME A PA – PLEASE! Why? Physician Assistant is a different career path from being a physician. If you want to become a cardiologist (MD), then that’s where you should put your energy, and there’s nothing wrong with that – get psyched about it and do it! But if what you truly want is to become a physician, becoming a PA is unlikely to help you get into medical school and could prove a disappointing diversion in your life. Physician assistants aren’t baby doctors, doctors-in-training, or Pre-meds killing time before beginning medical school. PA is a serious profession that demands time, energy, hard work, dedication, the right fit of personality, and passion. The PA field wants PAs who are passionate and dedicated in their love of the physician assistant profession.

      Reply
  • Sally March 27, 2012, 12:30 pm

    I am so glad I found this site! I’m a first year in college and had a change of heart and I have decided to pursue a career in health, and I feel like a PA career is one of my top choices. I am also interested in chronic diseases. I will definitely be coming back to this site again and again as I start my prereqs and volunteering.
    Thank you so much!

    Reply
    • Paul March 27, 2012, 2:18 pm

      Welcome, Sally! Thanks for your kind words – they keep us going.

      Reply
  • Evan May 7, 2012, 10:16 pm

    This was a very insightful post, and a great website for anyone interested in becoming a PA. Please keep up the good work! I just have a quick question: I’m set to start a PA program next year, and I’m very interested in the field of cardiology (in fact, it was my #2 pick on the MSAT). But, how does one specialize in cardiology? Is there post-graduate training or a residency?
    Thanks!

    Reply
    • Paul May 8, 2012, 12:49 am

      No, in most cases, PAs get jobs working with a cardiologist when thEy graduate. MOst PA specialties are like that.

      Reply
  • PA Rookie May 19, 2012, 3:12 pm

    Thanks for this very insightful interview. I begin PA school in August and I’ve been considering specialties that I might want to pursue. Cardiology is one of my top choices so I really enjoyed reading what I would be doing as a PA in cardiology. Sounds like a very challenging speciality!

    Reply
  • Patricia July 30, 2012, 1:53 pm

    Thanks for information regarding cardiologist physician assistant. I have changed careers and currently a Polysomnography technician. . Trying to think ahead to a specialty. Thanks again.
    .

    Reply
  • Kitkat85 August 10, 2012, 2:33 pm

    Great post! I’m in school right now for cardiovascular technology and I know I want to go to PA school after I work for a few years. I want to eventually specialize in cardiology. I really like this blog.

    Reply
    • Paul August 10, 2012, 7:24 pm

      Thanks! Liz is a great resource, and she makes the job look easy, but believe me, it isn’t!

      Reply
  • Greg October 8, 2012, 6:10 pm

    I’m a paramedic looking into going to PA school. I love cardiology and am wanting to go into it when I get out of school. I’ve been reading all sorts of ‘Visions and Missions’ and curiculums on school web pages and they all talk about family medicine but never cardiology. Do you know of one school over another that would be better for cardiology or should you just worry about getting a job with a cardiologist after graduation?

    Reply
    • Paul October 8, 2012, 7:39 pm

      Not really. PAs are primary care practitioners first, and so their curriculum focuses on that. But once you have your PA, you can pretty much specialize in anything (as long as you can find a physician who will hire you and give you on-the-job training). Don’t sweat it. Get your PA and all doors will be open to you.

      Reply
  • Tony Blay March 31, 2013, 7:41 pm

    Thank You guys for the great research ! I’m computer software engineer with Assiciate Degree but along the way I persuit a strong passion in the health field so therefore I took a PCT class & now working as EKG Technician But still in college taking respiratory classes & after my Bachelors I’m going for PA program & specialize in Cardiology .At first I wanted to be a Cardiologist but looking at the long years to complete it is WOW ! 16 good years uh huh !
    Note: I need an answer to this question please! Can one work as Physician Assistant with Bachelors Degree or it has to be masters. I mean what’s the entry level to work ad Physician Assistant. Thanks Folks

    Reply
    • Paul April 1, 2013, 10:58 pm

      You need at least an AA/AS. BUT, programs that will accept you with only an AA/AS are rapidly changing to BA/BS minimum. I suggest you get your bachelors degree – you will be much more competitive!

      P

      Reply
      • Tony Blay April 2, 2013, 6:57 am

        Thanks Paul ! So basically the entry level or the minimum to work as Physician Assistant is with Bachelors Degree right. Because I’m planning to be in City College of New York for Bachelors in PA,but for now I’m left with a year to be done with Associate in Respiratory therapy at BMCC.But wondering if I’m done with the Bachelors in PA I would get a work doing as PA ,because all I know, the entry level to work as PA is with Master’s Degree.

        Reply
  • Chris April 10, 2013, 1:05 pm

    I have a 10 year EMS background as a paramedic. I took a few years off to re-evaluate things. Recently, I completed an advanced EKG program, along with re-certifications in ACLS and PALS. I have a strong interest in becoming a PA-C in Cardiology. What would be my best course in obtaining this dream????

    Reply
    • Paul April 10, 2013, 6:14 pm

      You’ve done the legwork with your excellent HCE. I suggest you take the prerequisite courses, finish them with great grades, and apply. Any PA program will do – you choose your specialty according to what job you take when you finish school.

      Reply
  • roukiatou May 18, 2013, 10:41 am

    Thank you for a great description of PA’s.Cardiology is my #1 choice but i was just wondering if one can specialize in another field if their #1 choice doesn’t fit their interest or wasn’t what they expect. Basically what i want to know is that can one chance specialty.Great website thanks.

    Reply
    • Paul May 21, 2013, 5:51 pm

      Definitely. Changing specialties for PAs isn’t hard. You specialize in what you work in. If you want to become the guru of abdominal surgery, you work jobs in that. Obviously, it’s harder going from one specialty to an unrelated one, but it’s done all the time.

      Reply
  • Heather April 14, 2014, 8:09 pm

    I’m a clinical exercise physiologist working in a cardiac rehab setting with goals of becoming a PA specializing in Cardiology.. sounds like my absolute dream job and I’ve only just recently considered a career switch!! Question for Liz.. did you start off in Primary Care practice and switch over to Cardiology with further training or were you able to go right into Cardiology straight after PA school? Thank you for this site.. absolute godsend for me tonight!

    Reply
    • Paul April 19, 2014, 2:09 pm

      I can answer that one for Liz – she started off in cardiology right out of PA school. That should get you pumped, eh?

      Reply
  • Jissel June 18, 2014, 9:01 pm

    Wow! this post is AMAZING! Ive been wanting to look into an insight of a PA in this field and i came across this! Thank you! Getting ready to enter a 4 year BA program to move into my desired PA program because im seeing BA is required for alot of schools! Ive been in the medical field for 5 years now and knew that PA program was the path for me! Any specific recommendations to what classes to take? And also does it matter what BA program you enter? This would help me alot thank you so much for this motivating anf great post!

    Reply
    • Paul June 20, 2014, 10:31 pm

      Thanks, Jissel!

      We’ve written many many times about what majors you should consider. Put major in the search bar on the right of the main page and it should come up with some articles on the topic. We also have an entire podcast episode devoted to that topic. Also, we’ve written before on what classes you should take. Basically you should take the ones that interest you. Then, you should take the prerequisites for whatever PA schools you plan to attend. These generally include biology, chemistry, anatomy, physiology, and microbiology. Note that it does depend on the school.

      Reply
  • Jissel June 18, 2014, 9:02 pm

    Wow! this post is AMAZING! Ive been wanting to look into an insight of a PA in this field and i came across this! Thank you! Getting ready to enter a 4 year BA program to move into my desired PA program because im seeing BA is required for alot of schools! Ive been in the medical field for 5 years now and knew that PA program was the path for me! Any specific recommendations to what classes to take? And also does it matter what BA program you enter? This would help me alot thank you so much for this motivating and great post!

    Reply
  • Amy June 23, 2014, 8:23 am

    Hi Paul
    Thanks for this truly informative post.I have always wanted to be a PA and i have a bachelor’s degree in microbiology from a foreign university.I was wondering the chances of being accepted as an international student into a PA program
    Thank you

    Reply
    • Paul June 30, 2014, 7:34 pm

      It’s hard to say – there are just so many variables. But Microbiology is a good major for pre-PA students.

      Reply

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