The Cardiovascular Physician Assistant (CVPA)
A cardiovascular surgery team consists of specialists devoted to providing the highest quality medical and surgical care. An integral member of this team is the Cardiovascular Physician Assistant (CVPA) who provides all aspects of surgical care under the direction of the cardiovascular surgeon.
WHAT IS A CVPA?
The Cardiovascular Physician Assistant (CVPA) is a physician assistant that is credentialed by the National Commission on Certification of Physician Assistants (NCCPA), holds a license to practice medicine by the state in which they practice, and practices medicine with the supervision of surgeons in the field of cardiovascular and/or thoracic surgery.
HOW IS THE CVPA TRAINED?
The supervising cardiovascular surgeon is responsible for determining the skill level of the physician assistant to assure that all clinical duties are performed safely and competently. Therefore, primary instruction and training for the CVPA in the postgraduate setting is provided by the supervising cardiovascular surgeon. This primary instruction and training can be augmented by programs specific for cardiovascular surgery such as continuing medical education programs or by technical skills workshops. The CVPA also has the opportunity to participate in an accredited post-graduate residency program in cardiovascular surgery, a one year training program designed to enhance the decision making and surgical skills of the CVPA.
In the practice setting, the CVPA must be properly credentialed and be granted privileges by the hospitals in which they will practice. This is accomplished by receiving appropriate instruction and training in all procedures and also must perform a predefined number of procedures with the direct supervision of their supervising physician prior to being granted full privileges.
Click here to read the APACVS Position Paper on Post Graduate Education for the CVPA.
WHAT CAN A CVPA DO?
Few other specialties provide a physician assistant with more autonomy in the operating room or the critical care units as does the field of cardiovascular surgery.
In addition to performing routine duties such as histories & physical exams, pre and postoperative patient care, patient education, and discharge summaries, the CVPA can have advanced knowledge of hemodynamic management, ventilators, and artificial cardiac devices, allowing extensive responsibility in the cardiac intensive care unit.
Under the supervision of a cardiovascular surgeon, they may also perform procedures that may include:
- First assisting in surgery;
- Opening and closure of sternotomy;
- Conduit procurement for coronary artery bypass surgery including:
1. endoscopic greater and lesser saphenous vein harvest,
2. endoscopic radial artery harvest and internal mammary artery take-down; - Arterial line placement;
- Central line placement;
- Pulmonary artery catheter placement;
- Thoracentesis;
- Placement of, and removal of, intra-aortic balloons;
- Placement and removal of chest tubes;
- Flourocoscopic nasal-jejunal feeding tube placement;
- Placement of nasal septal harness;
- Organ procurement for transplantation;
THREE REASONS TO CHOOSE THE CVPA?
1) The CVPA is committed to the “physician-directed team” concept.
The practice model of the CVPA is that of a team approach relationship with surgeons. We are the only profession trained specifically to be an extension of the surgeon and not as a replacement for or act as another type of independent practitioner.
2) The CVPA is trained with the same medical philosophy as their supervising
cardiovascular surgeon.
Because of the close working relationship physician assistants (PA’s) have with physicians, PA’s are educated in a medical model designed to complement physician training. PA’s are taught, as are medical students, to diagnose and treat medical problems.
3) The CVPA is affiliated with a professional organization dedicated to
cardiovascular surgery.
The Association of Physician Assistants in Cardiovascular Surgery (APACVS) is the only non-physician professional organization dedicated to cardiovascular surgery. This organization is devoted to the promotion of clinical and academic excellence for its members, and enhancing quality medical care to its patients. The APACVS is affiliated with the Society of Thoracic Surgeons (STS) and aligns its annual winter conference with that of the STS so that is members may benefit from a leading cardiovascular surgeon educational meeting.
THE CVPA IS THE PARADIGM EXTENDER.
The CVPA sets the height of the bar for the cardiovascular surgeon extender.
“I submit to you that this incredible advance has come about and been successfully proliferated throughout our profession solely because of the dedication and perseverance of our right-hand men and women, our comrades-at-arms: the cardiovascular physician’s assistants (CVPAs). These men and women are the excellent part of this story. They alone have brought about this advance in the safe application of our craft and have allowed us to claim another small victory in that thing we do. Yes, there have been surgeons involved along the way—Fogarty, Moon, Perrault, Puskas—but these are a few who have championed the cause to the masses of surgeons; there are fewer still who have taken the time to perform EVH themselves on a routine basis. And, yes, it often required some prodding and patience on our part, but for the most part, the widespread application of EVH came about because of the excellence of determination and steadfast will of the CVPAs”
Anthony P. Furnary, MD, J Thorac Cardiovasc Surg 2005;129:488-90
Read the History of the Organization