Being a Vascular Surgery PA

1. Being a Vascular Surgery PA Kimberly Nicole Kurtz, MPA, PA-C

2. Objectives Personal Background Tips on Getting Into College and Grad School Explaining Physician Assistant Role and Career Outlook Specifically what I do as a Vascular Surgery PA Questions

3. Why do you want a career in medicine?

4. Background • Benicia High School, 2002 • Cumulative GPA 4.33, Senior Year 4.5 • SAT score 1250 • Cheerleader, Key Club/Honors Club, Part-time job • Diablo Valley College, 02-03 • Santa Barbara City College, 03-04 • William Oliverius Scholarship for Excellence in Biology • Volunteered 4-6hrs week at Cottage Hospital

5. Background • Cancer Research Internship, Wayne State University, Detroit, MI – Summer 2004 • University of California, San Diego, 2006 • BS – Human Biology, GPA 3.6 • Kappa Alpha Theta Sorority • Crew Team • Teacher’s Assistant, Into to Nutrition Class • MCAT score 29R • Part-time job, Customer Service Representative • Observed Surgical Procedures • What to do next?? • Medical School? • Physician Assistant School? • Pharmacy School? Podiatry? Optometry? • Masters of Nursing? • Medical Device/Pharmaceutical Rep?

6. PA school vs. Medical School • PA school • Approx $50,000/year X 2.5yrs = $150,000 • Master’s Degree • Can start working as soon as you pass PANCE exam • Medical School • Total average cost of attendance $67,000/yr • X 4yrs= $268,000 • Average residency pays $50,000 - $80,000/yr X 5 yrs • At least 2 years of fellowship for surgical specialties

7. Prep For PA School • Front Office Medical Assistant, ENT and Medical File Clerk for Pain Management • Clinical Back Office Medical Assistant, Bay Area Surgical Specialists, Walnut Creek, CA • GRE • Anatomy class • CASPA application • Visit Schools, School Interviews

8. PA School • Samuel Merritt University, Oakland, CA • Master Physician Assistant Degree, 2010 • Didactic Curriculum – 1.5 yrs, condensed medical school • Clinical Rotations – 1yr, nine 5-week long rotations • Geriatrics, Pediatrics, Women’s Health, Internal Medicine, Family Medicine, Emergency, Surgery • 2 electives – Vascular Surgery and Plastic Surgery

9. Certification • NCCPA Certified - Jan 2011 • California State Medical License – Jan 2011 • DEA Certified • Controlled Substance Course • ACLS/BLS Certified

10. So What is a PA? “A physician assistant (PA) is a medical professional who works as part of a team with a doctor. A PA is a graduate of an accredited PA educational program who is nationally certified and state-licensed to practice medicine with the supervision of a physician.” - AAPA

11. How do doctors and PAs work together? • “By design, physicians and PAs work together as a team, and all PAs practice medicine with physician supervision. Supervision does not mean, though, that a supervising physician must always be present with the PA or direct every aspect of PA-provided care. • PAs are trained and educated similarly to physicians, and therefore share similar diagnostic and therapeutic reasoning. Physician-PA practice can be described as delegated autonomy. Physicians delegate duties to PAs, and within those range of duties, PAs use autonomous decision-making for patient care. This team model is an efficient way to provide high-quality medical care. In rural areas, the PA may be the only healthcare provider on-site, collaborating with a physician elsewhere through telecommunication.” – AAPA

12. What Can PAs Do? Prescribe medication, including narcotics Order labs, tests, radiologic scans, nursing care, etc. First- assist in surgery Perform in-office surgical procedures under his/her scope of practice See patients in the office and hospital independently

13. What is the Difference Between an NP and a PA? • Not much difference from the patient perspective • Nurse practitioners are trained in the nursing model • Patient care centered • Physician assistants are trained in the medical model • Diagnosing and treating disease • NPs tend to stick in family practice, women’s health, pediatrics • PAs are more widely distributed among specialties

14. History of PA Profession • PA profession was created to improve and expand healthcare • First PA program at Duke University • Graduating class 1965 • Navy corpsman from Vietnam • More common on east coast

15. Present PA Statistics • Currently 86,500 nationally certified PAs • First-year PA students – 6,630 • Graduating PA students – 5,964 • In California, 6,723 practicing PAs • 20% of US population lives in rural areas • Only 10% of doctors are in rural areas • 17% of PAs practice in Rural areas

16. Practice Type of PAs

17. Future of PA Profession The Bureau of Labor Statistics predicts that PAs will be the second-fastest-growing profession in the next decade, increasing from 74,800 in 2008 to 103,900 in 2018. Growing physician shortages Aging Population More people seeking medical care with the Affordable Care Act

18. Future of PA Profession US News and World Report – in Top 50 Careers of 2011 Money Magagzine, Nov 2010 – 2nd Best Job in America Forbes.com ranked physician assistant first in its list of best master’s degrees for jobs. Kiplinger’s named PA as one of its great careers for your future.

19. Current Salary Estimates According to the Medical Group Management Association (MGMA), the average annual compensation for physician assistants is $84,326 in primary care, and $97,207 for surgical specialties. CA SLRP Loan repays students loans up to $60,000 for 2 years in a rural area

20. Job Satisfaction • “Would you become a PA if you had to do it all over again?” • “Yes!” – 88% • “Definitely” – 52% • “Probably” – 36% Source: 2009 AAPA Census

21. What I do as a PA • Vascular Surgery PA • Washington Township Medical Foundation • Hired Jan 2011 • 2 Supervising Physicians • John Thomas Mehigan, M.D • Gabriel Herscu, M.D.

22. Primary Responsibilities • First-assist in OR • First-assist in Cath Lab • Rounding on inpatients • Write post-op orders and note • See patients in office • New pts, f/u, post-op, pre-op • Dictate History and Physical Reports • Consult new patients in hospital/ED • Wound Care Clinic • On Call 24/7 for nursing orders/questions

23. Day in the Life • 7:15AM – Arrive at hospital, meet up with SP discuss plan for the day • 7:30 – Preround on the computer looking up lab results and other doctors’ notes • 7:45 See a critical pt in ICU, write new orders • 8:00 – Scrub into the first surgery, prep pt, and first-assist, carotid endarterectomy • 10:00 – Accompany pt to PACU and write post-op orders and post-op note • 10:10 – Meet up with SP and start inpt rounds • 10:45 – Go to Cath lab and obtain ultrasound-guided percutaneous access into femoral artery, assist in angiogram • 11:45 – Scrub into AVF creation, first assist • 1:00 – Post-op orders/note • 1:15 – Find family and discuss case, give further instructions • 1:20 – Pre-op next pt/mark site

24. Day in the Life • 1:30 – Finish inpt rounds • 2:00 – Revisit critical pts, f/u on ordered labs, return phonecalls • 2:15 – Scrub into toe amputation and foot debridement • 3:00 – Post- op orders/note • 3:15 – Check on Cath lab pt, and discharge pt • 3:30 – Wound debridement, lower extremity • 4:00 – Post- op orders/note • 4:15 – Go home

25. Types of Surgeries I Perform • Including limb savage – lower extremity revascularization, bypass procedures • Amputations • Carotid endarterectomy • Fistula creation and revision • Embolectomy • AAA repair • Aneurysmectomy • Wound debridement/Wound VAC placement • Temporal artery biopsy • Fasciotomy • Line placement arterial and venous • Dialysis catheter placement, CAPD catheter • Ultrasound guided percutaneous access • Intra-operative fluoroscopy(I do not step on pedal) • Angioplasty and stenting • Vein stripping and ligation • IVC filter placement, • Mediport placement • Tunneled cuffed hemedialysis catheter placement and removal

26. Diseases That I Treat • Peripheral Vascular Disease /Atherosclerosis • End Stage Renal Disease • Diabetes, Type 2 • Chronic Wounds • Hypercoaguable states • Giant Cell Arteritis • Venous Insufficiency • Pelvic Venous Compression Syndrome • Aortic Aneuyrsms • Strokes • Renal Artery Stenosis • Hypertension • Infectious Diseases • Superior Vena Cava Syndrome

27. Resources for More Info • www.aapa.org • www.capanet.org • https://portal.caspaonline.org • Rodican, Andrew J. Getting into the Physician Assistant School of Your Choice. 2003 • www.vascularweb.org

28. Questions?