The key role played by physician assistants (PAs) as part of vascular surgery teams in the U.S. came into focus during the Vascular Societies’ Annual Scientific Meeting in Brighton, England.
Julie Ann Freischlag, MD, the former Society for Vascular Surgery (SVS) president and current CEO of Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina, outlined how the integration of PAs had positively impacted vascular practice over the course of the last couple of decades during a President’s Symposium session on multi-professional teams.
Freischlag provided attendees with a rundown of lessons learned during her career—from the point at which PAs were not part of the picture of vascular surgical practice, through the advent of the 80-hour work week limit for residents in training and their subsequent incorporation into the heart of surgical services and research.
For Freischlag, PAs entered the scene while she was practicing at Johns Hopkins in Washington, D.C., where an early PA surgical program was developed and rolled out.
Fast forward 20 years, and now at Wake Forest, she said PAs have helped across a number of fronts, with impacts made across areas such as patient length of stay and the length of time residents spend in the operating room (OR).
At present, Freischlag pointed out, some 3% of PAs work in general surgery, with about 18.7% operating in the surgical subspecialties. “When I moved from Hopkins to UC Davis and I was doing my first case—involving a thoracic outlet—my PA was talking to my really young partner about how to assemble the retractor and how to take care of that patient,” she reflected. “PAs who have worked with me on thoracic outlet can assess and treat and take care of postoperative patients as well as I can.”
She highlighted how she sees much more “continuity of care,” with improvements seen in care coordination and patients’ ability to navigate the healthcare system. “We do simulation in virtual encounters, working through scenarios together, so not only do the patients go through what they do when they get to the hospital but we do all this before they even show up so they are used to many different types of people around the bed, around the OR table,” Freischlag added.
To be able to safely and efficiently perform their roles in vascular surgery teams, PAs must satisfy heavy requirements that include 2,000 hours of supervised clinical practice. Freischlag also zeroed in on another dimension where their impact is felt: in the context of social determinants of health and health equity. She used an example from her own time as a resident to illustrate the PA effect, explaining how, while working at the VA, “we used to double book patients because many didn’t show up and we didn’t understand that it was mainly because of their social determinants.” Now, as PAs help patients navigate often labyrinthine health systems and with their ability to attend, those issues are being better tackled. “PAs, NPs [nurse practitioners], all of us need to know those impediments to care,” Freischlag noted.
Ultimately, she said, how PAs fit into vascular surgery teams might differ but “continuity throughout the perioperative period decreases complications and increases patient satisfaction, and that’s what is so important.”
