Physician Assistant Specialty: Cardiology

Posted By: Paul   |   Physician Assistant Specialties   |   33 Comments

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

33 Comments

  1. ashley December 14, 2011 at 11:30 am - Reply

    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

  2. Shannon reynolds January 13, 2012 at 3:48 pm - Reply

    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.

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

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

  3. Darryl March 2, 2012 at 12:23 am - Reply

    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!

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

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

  4. Aika March 13, 2012 at 5:18 am - Reply

    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

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

      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.

  5. Sally March 27, 2012 at 12:30 pm - Reply

    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!

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

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

  6. Evan May 7, 2012 at 10:16 pm - Reply

    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!

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

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

  7. PA Rookie May 19, 2012 at 3:12 pm - Reply

    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!

  8. Patricia July 30, 2012 at 1:53 pm - Reply

    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.
    .

  9. Kitkat85 August 10, 2012 at 2:33 pm - Reply

    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.

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

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

  10. Greg October 8, 2012 at 6:10 pm - Reply

    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?

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

      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.

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