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