CARDIOVASCULAR
Physicians Assistants in Cardiothoracic Surgery: A
30-Year Experience in a University Center
Vinod H. Thourani, MD, and Joseph I. Miller, Jr, MD
Joseph B. Whitehead Department of Surgery, Section of General Thoracic Surgery, Emory University School of Medicine,
Atlanta, Georgia
Background. The purpose of this study was to evaluate
our 30 years of experience with the use of physician
assistants (PAs) on a cardiothoracic surgery (CTS)
service.
Methods. A retrospective review of the utilization of
CTS PAs was performed at a university center from 1973
to 2003.
Results. The number of PAs has increased from 2 (1973)
to 23 (2003), corresponding to the increased clinical
service demands with a constant resident number for the
past decade. Physician assistant employment has ex-
panded from one hospital to five hospitals in our univer-
sity system where CTS is performed. The CTS service has
expanded from 400 total cases per year (1973) to 4,000
cases (2002). We have had a 50% retention rate with
duration of employment from 6 months to 28 years (11
S ince the development of programs conceptualized to
specifically educate a physician assistant (PA) as a
new health professional was implemented at Duke Uni-
versity in 1965, the role for cardiothoracic surgical PAs
has increased substantially. After the changes in the
regulations of resident housestaff duty hours in 2003 [1],
there has been resurgence in the need and demand of
PAs and other nonphysician healthcare extenders. The
field of cardiothoracic surgery has historically utilized
PAs for preoperative, intraoperative, and postoperative
care.
Since 1973, two newly trained physician assistants from
the Duke University PA program were employed by the
division of cardiothoracic surgery at one academic teach-
ing hospital [25]. Our experience now covers 30 years
with a total of 23 physician assistants in five hospitals.
Material and Methods and Results
Our initial experience began in 1973, with the hiring of
two PAs in a single hospital with a case volume of 400
cases per year and a thoracic surgical volume of 250 cases
per year. Over the ensuing 30 years, we have expanded to
Accepted for publication July 11, 2005.
Presented at the Fiftieth Annual Meeting of the Southern Thoracic
Surgical Association, Bonita Springs, FL, Nov 1315, 2003.
Address correspondence to Dr Miller, Section of Thoracic Surgery,
Crawford Long Hospital, 550 Peachtree St NE, Suite 7700, Medical Office
Tower, Atlanta, GA 30308; e-mail: jmille6331@aol.com.
2006 by The Society of Thoracic Surgeons
Published by Elsevier Inc
PAs with service more than than 15 years). The PA role
has changed little, with duties varying from history and
physical examination, conduit harvesting, insertion of
invasive catheters and chest tubes, surgical first assisting,
closure of the chest, and optional primary intensive care
unit night-time in-house call. Salary currently ranges
from $55,000 to $100,000 depending on length of service
and overall merit. Job satisfaction for PAs employed
longer than 12 months has remained high.
Conclusions. The addition of PAs to our CTS univer-
sity service has allowed us to resolve many problems of
work assignment and coverage and enabled us to estab-
lish effective and efficient surgical teams without increas-
ing the number of categorical CTS residents.
(Ann Thorac Surg 2006;81:195200)
2006 by The Society of Thoracic Surgeons
five hospitals and more than 3,000 adult and pediatric
cardiac cases and approximately 700 thoracic cases in
2002. Table 1 shows the current distribution of residents,
cases, and PAs at Emory University Medical Center
during three periods (1973 to 1982, 1983 to 1992, and 1993
to 2003). The role of the PA within each of our hospital
varies; the predominant duties are listed in Table 2.
At Emory University Hospital (EUH), the number of
nonphysicians has increased from two PAs in 1973 to five
PAs, two nurse practitioners, and two surgical assistants
to accommodate the increase in CTS cases. A maximum
of nine PAs were utilized at EUH during the early and
mid 1980s. Although PAs are on second call by beeper for
operations at night, the PAs at EUH do not take in-house
call. Furthermore, the PAs at Emory University Hospital
do not participate in the management of patients in the
intensive care unit.
The second phase in our utilization of PAs began in
1974, when a new cardiovascular surgical service was
established at Crawford Long Hospital (CLH) of Emory
University (Tables 1 and 2). Because there were no
cardiothoracic residents at CLH in 1974, the PAs along
with the staff surgeon performed all aspects of preoper-
ative, intraoperative, and postoperative management.
The PAs took in-house first call on days when cardiac
cases were performed (overtime pay was provided for
those PAs performing in-house night call). Eventually,
the PAs shared in-house call responsibilities with the
cardiothoracic resident. As the number of residents has
increased at CLH, the PAs no longer take in-house call.
0003-4975/06/$32.00
doi:10.1016/j.athoracsur.2005.07.031
 196 THOURANI AND MILLER Ann Thorac Surg
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PHYSICIANS ASSISTANTS IN CARDIOTHORACIC SURGERY 2006;81:195200

Table 1. Trends in Hospital Cardiac Surgery Volume Among Hospitals of Emory Healthcare
No. of Hospital No. of Cardiac No. of CTS
Beds No. of PAs Cases Fellows

Crawford Long Hospital 500 beds

1973 to 1982 1 to 3 120 to 330 1
1983 to 1992 4 to 6 450 to 630 1
1993 to 2003 6 to 9 630 to 1270 2 to 3
Emory University Hospital 600 beds
1973 to 1982 1 to 5 300 to 1800 2 to 3
1983 to 1992 6 to 9 1100 to 1700 3 to 4
1993 to 2003 4 to 5 750 to 1150 3 to 4
Egleston Hospital 225 beds
1973 to 1982 1 to 3 50 to 190 1
1983 to 1992 3 to 5 150 to 380 1 to 2
1993 to 2003 5 to 6 400 to 550 1 to 2
Veterans Administration Hospital 250 beds
1973 to 1982 1 0 1
1983 to 1992 1 60 to 130 1
1993 to 2003 2 100 to 150 1
Grady Memorial Hospital 800 beds
1973 to 1982 1 70 to 85 1
1983 to 1992 1 80 to 130 1
1993 to 2003 1 90 to 150 1

CTS cardiothoracic surgery; PAs Physicians Assistants.

However, with the restrictions imposed by the Accredi-
tation Council for Graduate Medical Education
(ACGME) on resident work hours, PAs now have a
voluntary option for in-house first call for supplemental
pay.
The third hospital in our system to utilized PAs was the
Egleston Hospital of the Children Healthcare of Atlanta
(Tables 1 and 2). In addition to the rotating cardiac
surgery resident, a dedicated pediatric cardiothoracic
1-year fellow has been added to the Egleston Hospital
cardiac program since the mid-1980s. The PAs have
functioned to a large extent as in our community hospital
(CLH). In the role of the cardiothoracic resident, the PA
alternates taking in-house first call with the two other
cardiothoracic residents.
Adult cardiac surgery was initiated at the Veterans
Administration Hospital in Atlanta in 1987 (Tables 1 and
2). Before the initiation of the cardiac program, thoracic
surgery was performed there with the assistance of one
PA. With the increase in cardiac surgery volume, a total
of two PAs and one cardiothoracic resident currently
remain on this service. Adult cardiac surgery was initi-
ated at Grady Memorial Hospital in 1973. One cardiotho-
racic resident and one PA remain on this service. The
roles for the PA at the Veterans Administration Hospital
and Grady Memorial Hospital are as listed in Table 2.
Physician assistant job satisfaction has remained rela-
tively high in our academic cardiothoracic surgical pro-
gram. Eleven PAs (47.8%) have remained within our
division of cardiothoracic surgery for more than 15 years.
A confidential survey of all 23 PAs within our division
revealed that 10 PAs (43.4%) noted that their job satisfac-
tion was excellent, and 13 (56.5%) noted that their job
satisfaction was good.
Physicians Assistant Compensation
In the early 1970s, the salaries for cardiothoracic surgical
PAs at Emory University ranged from $15,000 to $25,000
per year, depending upon the length of service and
overall merit. It now ranges from $55,000 to $100,000
(mean, $84,000) in 2003, and is determined by the com-
pensation committees of the individual hospital system.
In 2003, consensus data from the American Academy of
Physician Assistants reveals a mean salary of all PAs in
the United States at $76,039 [6], and data from the
Association of Physician Assistants in Cardiovascular
Surgery [7] reveals that the average yearly salary for all
cardiothoracic PAs at approximately $90,000. Salary com-
pensation for cardiothoracic surgery PAs at EUH and
CLH and one half of the PAs at Egleston Hospital is from
our section funds of the division of cardiothoracic sur-
gery as generated by the income by the 16 members of
our section. The PAs at the Veterans Administration
Hospital, Grady Memorial Hospital, and one half of the
PAs at Egleston Hospital are compensated by the indi-
vidual hospitals.
Impact of PAs on the Cardiothoracic Residency
Although the number of cardiothoracic surgery training
programs and residency slots available for appointment
year from 1993 to 2003 has remained relatively constant at
between 89 and 95 programs and 132 to 146 positions, the
number of residency slots not filled has risen from a low
in 1998 of 5 positions to 21 unfilled positions in 2003.
Ann Thorac Surg THOURANI AND MILLER 197

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2006;81:195200 PHYSICIANS ASSISTANTS IN CARDIOTHORACIC SURGERY

Table 2. Duties of the Physician Assistant on a Cardiothoracic Service

1. Preoperative workup
a. Obtain information and record admission history on standard preprinted form.
b. Perform and record admission physical examination on standard preprinted form.
c. Write routine admission orders on standard preprinted form.
d. Explain the details and risks of operative procedures and may obtain the signature of the patient or legal guardian on the
operation permit.
2. Intraoperative assistance
a. Serve as a first or second assistant in the operating room.
b. Harvest saphenous vein and radial artery conduits using both endoscopic and open techniques.
c. Depending on skill level: open or close median sternotomy, or both; decannulation of ascending aortic and right atrial
cannulae; open or close thoracotomy incision, or both.
3. Perioperative care
a. Perform minor procedures such as suture removal, dressing changes, wound debridement, chest tube insertion, thoracentesis,
urinary bladder catheterization, arterial and venous punctures for laboratory blood work, placement and removal of intra-
aortic balloon pumps, initiation of temporary cardiac pacemaking.
b. Be available to the hospital staff as a resource person.
c. Provide continuity of care for the patient and the patients family.
d. Assess the need for written patient educational material and collaborate with others in this development.
e. Facilitate the development of interdisciplinary cooperation and rapport in providing comprehensive patient care.
f. Monitor progression of the patients diet.
g. Monitor progression of the patients level of activity.
h. Establish intravenous and oral fluid limits.
i. Perform routine laboratory work, chest voentigenograms, and electrocardiograms.
j. Change blood replacement as needed.
k. Discontinue central venous pressure, swan-ganz, or arterial catheters and temporary pacing wires. Remove appropriate
monitoring devices when no longer indicated.
l. Write transfer orders when patient no longer needs intensive care.
m. Guide respiratory support and the process of weaning.
4. Discharge care
a. Dictate appropriate narrative summary at the time of patient discharge.
b. Arrange follow-up plan, including time and place of appointment with appropriate physician.
c. Communicate with referring physicians and other medical personnel at the request of or with approval of the sponsoring
physician.
5. Research
a. Participate in clinical research under the supervision of the responsible cardiothoracic surgeon.

Moreover, the number of applicants from United States
medical schools has decreased from 161 in 1993 to 107 in
2003 [8]. These changes parallel trends showing a 30%
decrease in the number of medical students applying to
general surgery over the past 9 years. A multitude of
interesting issues have resulted in a decline in general
surgery and hence applications to cardiothoracic surgical
programs. These factors include presumed evidence of a
limited job market for residents completing cardiotho-
racic training. In a recent web-based survey by the
Thoracic Surgery Residents Association, Salazar and col-
leagues [9] noted that approximately 20% of finishing
fellows were unable to find jobs in 2003. Moreover, 87%
of these residents believed that the number of trainees
should be decreased to allow for improved job opportu-
nities and compensation.
Furthermore, the ACGME has mandated standards
addressing resident duty hours starting July 2003 [1]. As
the current study evaluated the role of the PA until June
2003, we did not assess the impact of PAs on resident
work. Further studies evaluating the impact of nonphy-
sician providers on resident work hour regulations are
warranted. In our practice, the interdigitation of the
cardiothoracic surgery resident staff with PAs has not
been a problem. The PA has been able to relieve the
residents of many time-consuming routine duties so that
more of their time can be devoted to operating room and
other more educational tasks. Furthermore, each resident
is able to participate to a greater extent in the operating
room than would be possible if many more residents and
fellows were required and utilized for the nonoperative
aspects of patient care. Residents must continue, how-
ever, to participate in preoperative and postoperative
care to assure their understanding of the associated
pathophysiology.
Comment
The discipline of cardiothoracic surgery uniquely pro-
vides limitless challenges for a cardiothoracic surgical
physician assistant. Numerous variables of patient age
(newborn, adult, or the elderly), diagnosis (congenital or
 198 THOURANI AND MILLER
CARDIOVASCULAR
PHYSICIANS ASSISTANTS IN CARDIOTHORACIC SURGERY
acquired cardiac, pulmonary, or esophageal disease), and
degrees of severity of illness (elective or emergent coro-
nary or valvular heart disease, simple or complex con-
genital heart defects, benign or malignant pulmonary
and esophageal diseases) allow the PA a wide array of
work opportunities and skills. These highly technical and
demanding skills are mastered only through years of
experience, and as the specialty of cardiothoracic surgery
continues to evolve, the flexible and adaptable nature of
the surgical PA will be an essential element for every
successful practice.
Function of the PA on Our Service
There is a multifactorial role for cardiothoracic surgical
PAs at an academic institution (Table 2). They play a vital
role in (1) education of patients, families, nurses, PA
students, and general surgery and cardiothoracic resi-
dents in training; (2) administrative functions of the
planning of admissions, scheduling of operations and
special procedures, arranging and presenting informa-
tion to patient-care conferences, and maintaining records
required for quality assurance, long-term patient evalu-
ation, and clinical research; (3) communication between
staff surgeons, cardiologists, and other consulting spe-
cialists; and (4) surgical assistant during the performance
of surgical procedures.
Although the role of a cardiac surgical PA may differ
from academic to private environments, most work 40
to 60 hours each week. They provide expertise in the
preoperative, intraoperative, and postoperative care of
the surgical patient. Cardiothoracic PAs frequently
assume the primary care aspects of the hospitalized
patient and should be proficient in the management of
hypertension, diabetes, and chronic obstructive pul-
monary disease.
The relationship between PAs and the nursing staff
has not been problematic. Because PAs do not infringe
on the traditional territory of nursing services, they
have developed a good working relationship with the
nurses. The PAs availability during day hours when
surgery residents and staff are commonly in the oper-
ating rooms allows for more efficient and thorough
patient care. Furthermore, that provides a continuity of
care that rotating cardiac residents are unable to pro-
vide. Overall, it is inevitable that the PA will play an
intermediary role, serving as the middle-person be-
tween the staff surgeon and nurses, patients, families,
and other physicians.
Over the past 30 years, the role of our PAs at Emory
University has expanded and their utilization in the
operating room has greatly increased. The cardiothoracic
PA has a significant amount of autonomy in the operating
room and performs the critical task of harvesting the
greater saphenous veins or radial arteries (utilizing open
or endoscopic techniques) for use as a bypass conduit as
an essential component of almost every coronary bypass
procedure. After preparation of the bypass conduit, the
PA either first or second assists during the remainder of
the case, including tasks of providing cardiac retraction,
closure of the incisions in the lower extremity, assist in
Ann Thorac Surg
2006;81:195200
cannulation and decannulation, and closure of the chest.
They function primarily as surgical first assistants,
especially at CLH, where there remains a discrepancy
in the number of cases performed and number of
cardiothoracic residents available. The PA is the ideal
first assistant in these settings, as they are trained
specifically to meet the needs of the staff surgeon and
are knowledgeable of the surgeons idiosyncrasies. As
expected, the exact role of the PA is determined by
their clinical experience and the discretion of the
attending cardiothoracic surgeon.
The usefulness of the PAs in each of our hospital
situations cannot be overestimated. The PA has enabled
us to expand our services without jeopardizing patient
care. In the operating room, they have functioned in the
roles of first and second assistants and have allowed us to
increase our surgical volume without increasing the
number of residents and fellows. With long-term job
commitment, the PAs own technical skills have become
very refined, and they are superb assistants to staff
surgeons and surgical residents. The PAs provide not
only a foundation for overall patient management within
our cardiothoracic services, but also bridge a gap be-
tween the nurses, cardiothoracic resident, and the staff
surgeon.
The Future: Physician Assistant Residencies and
Changing Roles
Challenges and unanswered questions facing the imple-
mentation of a new nonphysician healthcare provider to
our cardiothoracic surgery practice in 1973 included PA
job stability, usefulness in a complex surgical subspe-
cialty, compatibility with cardiothoracic residents and
nurses, long-term job satisfaction, and PA ability to
improve the efficiency and care of our cardiovascular
surgical service. After 30 years of experience, there re-
mains no doubt that PAs can adequately perform the
tasks at hand.
With the concordant restrictions in resident work
hours and potential hiring of more costly nonphysician
clinicians at hand, the more pressing question now has
become can the surgeons or the institution afford to
replace residents with PAs. One solution would be to
further develop PA surgical residencies. The creation of
surgery PA residency programs has been previously
described and has been shown to allow approved surgi-
cal resident physician programs to review manpower
needs [10, 11]. Standards, accreditation, and allocation of
economic resources for such programs are scarcely
available.
Overall, our cardiothoracic PAs are vital and an effec-
tive professional members of our team. On the basis of
our experience to date, we think that the addition of PAs
to our surgical service has allowed us to resolve many of
the problems of work assignment and coverage and has
enabled us to establish effective and efficient cardiovas-
cular and thoracic surgical teams in the various hospitals
of our university system.
Ann Thorac Surg
2006;81:195200
The authors appreciate the superb and endless efforts by the
previous and the following physician assistants currently em-
ployed in the care of adult and pediatric cardiothoracic patients
in hospitals affiliated with Emory University School of Medicine:
Aimee Abide, Barry Anderson, Sharon Ashe, Dianne Bailey,
Beth Bain, Randy Bundschu, Keith Causey, Gene Coughlin,
Masoud Daneshnia, Damon Denzin, Samantha Ellington, James
Farmer, Mandy Green, Larry Hogan, Michael Kandrach, Jan
Koehler, Jodi Lackey, Philip Miller, Jenny Nakaoka, Rene Nazar,
Wayne Olsen, David Seidel, and Kim Wettlaufer.
References
1. Accreditation Council for Graduate Medical Education.
Common program requirements for duty hours. Available
at: http://www.acgme.org. Accessed October 5, 2003.
2. Hatcher CR Jr, Fleming WH. The role of physicans assis-
tants in a university teaching service. J Thorac Cardiovasc
Surg 1974;68:750 6.
3. Miller JI, Hatcher CR Jr. Physicians assistants on a univer-
sity cardiothoracic surgical service. J Thorac Cardiovasc Surg
1978;76:639 42.
4. Miller JI, Craver JM, Hatcher CR. Use of physicians assis-
tants in thoracic and cardiovascular surgery in the commu-
nity hospital. Am Surgeon 1978;44:162 4.
DISCUSSION
DR MARK FELGER (Austin, TX): I will have you know, I
enjoyed your talk. I have a couple of questions. We have several
PAs in our private practice, which is a little bit different than
what you have laid out here, but I was wondering who is
responsible and how do you clinically manage your PAs, be-
cause we are having a hard time trying to keep our PAs satisfied
and having one central person that they are responsible to.
DR THOURANI: Thank you for that question, Mark. Obviously
Dr Guyton, being the chief of the entire division, has the overall
management of the cardiothoracic PAs. As you may recall, there
are chiefs at each of our five affiliated hospitals: Emory Hospital,
Crawford Long Hospital, the VA, Grady Memorial Hospital, and
Egleston Hospital of the Childrens Healthcare of Atlanta. The
cardiothoracic surgeon who is the chief of that hospital is
specifically involved with the day-to-day activities of the cardio-
thoracic PAs in that hospital. For example, Dr Joseph Craver at
Emory Hospital, is in charge, per se, for the day-to-day practices
of the PAs at Emory Hospital. We do have one person, Keith
Causey, PA-C, who is in charge of all the PAs employed by our
division and is really the go-between from Dr Guyton to the rest
of the system as needed. Furthermore, each respective hospital
has a chief PA who reports either to Mr. Causey, Dr Guyton, or
the chief of cardiothoracic surgery at their hospital.
The PAs who we have at the VA and at Grady are funded by
those institutions, and so they dont fall within the auspices of
the role that Mr Causey holds, and they are directly under the
chief of cardiothoracic surgery of that hospital.
DR GEORGE R. DAICOFF (St. Petersburg, FL): We have used
PAs in our private practice for more than 25 years, and I agree
with everything you have said except one thing. We do not allow
the PAs to give informed consent, that is, to talk about the
diagnosis, risks and benefits of the operation. I think that is still
the responsibility of the surgeon.
THOURANI AND MILLER 199
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PHYSICIANS ASSISTANTS IN CARDIOTHORACIC SURGERY
5. Williams WH, Kopchak J, Yearby LG, Hatcher CR Jr. The
surgical physician assistant as a member of the cardiothorcic
surgical team in the academic medical center. In: Carter RD,
Perry HB, eds. Alternatives in health care delivery: emerging
roles for physician assistants. St. Louis, Missouri: Warren H.
Green, 1984:201-9.
6. American Academy of Physician Assistants Census Report
2003. Available at: http://www.aapa.org/research/03census-
intro.html#highlight. Accessed October 13, 2003.
7. APACVS salary and benefits survey. Available at: http://
www.apacvs.org/Section2/2-3.htm. Accessed October 11,
2003.
8. Evans S, Sarani B. The modern medical school graduate and
general surgical training: are they compatible? Arch Surg
2002;137:274 7.
9. Salazar JD, Lee R, Wheatley GH, Doty JR. Are there enough
jobs in cardiothoracic surgery? The thoracic surgery resi-
dents association job placement survey for finishing resi-
dents. Ann Thorac Surg 2004;78:15237.
10. Heinrich JJ, Fichandler BC, Beinfield M, Frazier W, Krizek TJ,
Baue AE. The physicians assistant as resident on surgical
service: an example of creative problem solving in surgical
manpower. Arch Surg 1980;115:310 4.
11. Brandt LBB, Beinfield MS, Laffaye HA, Baue AE. The train-
ing and utilization of surgical physician assistants. Arch Surg
1989;124:348 51.
DR THOURANI: That is an excellent point, and I whole-
heartedly agree with you. If it was perceived that the surgeon
has relinquished his role as a communicator with the patient or
family, then I apologize for that misnomer. Obviously all of the
residents and attending surgeons talk extensively with the
patients regarding the benefits and risks associated with sur-
gery. However, our PAs sometimes in the middle of the day or in
the office do obtain consents.
DR ROBERT B. LEE (Jackson, MS): I had the pleasure of
discussing this a bit with Dr Thourani before his presentation,
which was quite excellent, but one of the things that I thought
was most important that he brought out was the economics of
utilizing PAs in an academic situation where the hours are now
limited, and that is also going to apply to private practice. With
the reimbursement for all of us going down, the PA salaries have
slowly gone up and not yet plateaued, and if you look at a mean
of $80,000, that is coming close to 30%, maybe 20%, a little bit
less, of some cardiothoracic surgeons total income. Have you
taken an institutional approach to look at the limiting of PA
salaries or how you are going to compensate them in the future
with your health care dollars decreasing?
DR THOURANI: Doctor Lee, those are excellent comments.
That is, I think, one of the problems that is coming forth with the
implementation of reduced resident work hours. This is quite
important as there is a trend for new and possibly expanding
roles for cardiothoracic surgical PAs. To counteract the increase
in compensation for PAs, some institutions have started to
investigate a PA residency system. This allows for lower pay of
a fully accredited PA for that predetermined residency time
period. As far as I am aware, our institution has not imple-
mented this system. Perhaps Dr Guyton or Dr Miller would care
to comment.
 200 THOURANI AND MILLER
CARDIOVASCULAR
PHYSICIANS ASSISTANTS IN CARDIOTHORACIC SURGERY
DR JOSEPH I. MILLER (Atlanta, GA): Let me clarify that for
you. That is not a fair question to put to him. The PA salaries at
Emory University have declined by 17% to 20% over the last 5
years. They were cut automatically because we couldnt afford to
let them continue to rise. They have been totally plateaued for
the last 3 and a half years. There is a max regardless of time that
they dont go above.
We employ both the group at the University Hospital and at
Crawford Long out of our own sectional funds that the staff
surgeons generate. At the Childrens Hospital they pay for three
and we pay for three, but the others are that. But the PA salaries
now have plateaued, and they have not continued to rise.
The salaries that you see there, Bob, and I realize what you are
saying about how much a cardiothoracic surgeon makes, but
also, by the same token, we are doing almost 5,000 cases per year
among 16 people and trying to maintain services and work
hours. So we have plateaued the salaries and they are down
17%, and that has been true, and now they are maxed out.
The Society of Thoracic Surgeons Policy Action Center
The Society of Thoracic Surgeons (STS) is pleased to
announce a new member benefitthe STS Policy Ac-
tion Center, a website that allows STS members to
participate in change in Washington, DC. This easy,
interactive, hassle-free site allows members to:
Personally contact legislators with ones input on
key issues relevant to cardiothoracic surgery
Write and send an editorial opinion to ones local media
2006 by The Society of Thoracic Surgeons
Published by Elsevier Inc
Ann Thorac Surg
2006;81:195200
DE HUGH M. VAN GELDER (St. Petersburg, FL): The PAs out
in the community have opened their own businesses, and in
fact, because of that, they are not under contract by HMOs. In
certain instances, they can make more money on a case than
we do as the surgeon without any liability, and by allowing
that to continue to happen, we just kind of ruin the entire
system for ourselves, and we cant allow that to continue to
happen. We are the guys who went out there in the training,
we are the guys who do the operation, we are the ones who
the patients are being sent to, and for people to make more
money off of a case than we do is ridiculous in todays society.
In our corporation, we have our own PAs, but there are
physicians in the community who do not have their own PAs
because they are not large enough to be able to handle the
cost of what it is to run a PA, and so they look for first
assistants. These corporations are there to first assist, but like
I said, they do not have contracts with the insurance compa-
nies and therefore they can make more money per case than
we do.
E-mail senators and representatives about upcoming
medical liability reform legislation
Track congressional campaigns in ones districtand
become involved
Research the proposed policies that help or hurt
ones practice
Take action on behalf of cardiothoracic surgery
This website is now available at www.sts.org/takeaction.
Ann Thorac Surg 2006;81:200 0003-4975/06/$32.00