SENIOR PHYSICIAN ASSISTANT/CARDIOVASCULAR
Brigham & Women's Hospital(BWH)

GENERAL SUMMARY/ OVERVIEW STATEMENT:

The physician assistant (PA) is a licensed provider who has acquired a broad range of knowledge and skills through the successful completion of a physician assistant program. The PA is responsible for the assessment and management of various populations of patients, medical and/or surgical, including diagnostic and therapeutic interventions, development of appropriate plans of care and ongoing evaluation. The physician assistant works under the supervision of an attending physician and reports directly to the department administrator or chief physician assistant administratively.

The PA will perform in accordance with all state and federal regulations and institutional policies including but not limited to the BWH PA Scope of Practice, Prescriptive Guidelines, approved clinical privileges, and BWH PA policy.

The Senior PA position is designed for those physician assistants who have both advanced clinical skills and demonstrated administrative experience to take on additional clinical, administrative, and/or leadership responsibilities outside of the standard PA scope. The Senior PA position entails those responsibilities defined by the department/division that will become part of the performance evaluation process; one must complete a formal interview process to receive an offer for this position.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Principal Clinical Duties and Responsibilities:

• Provides direct care, counseling, and teaching to a designated patient population in the ambulatory, inpatient, operative, and/or procedural setting
• Performs complete histories and physical examinations
• Orders, interprets, and evaluates appropriate laboratory and diagnostic tests
• Develops appropriate plans of care and follow-up based on the outcomes of diagnostic, laboratory, and physical examination findings
• Orders medications and writes prescriptions according to organizational and regulatory policies and procedures
• Consistently provides high quality and timely documentation including admission and progress notes, procedure notes, operative notes and discharge summaries
• Performs bedside procedures as are appropriate to the patient population
• In some settings, the PA may first assist in the operating room or procedural areas
• Practices cost effective medicine in an efficient manner, maximizing available resources
• Discusses patient data with other physicians and professionals as appropriate in a multidisciplinary setting
• Demonstrates expert clinical judgment skills to function in an independent role
• Additional duties and responsibilities as required by the department/division

Non-Clinical Duties and Responsibilities:

• Demonstrates professional collaborative and consultative relationships with other providers
• Follows all designated prescriptive practices and monitoring requirements with the designated supervising physician and administrative report
• Participates in departmental and organizational committees and programs as appropriate and attends all required meetings, in-services, and professional trainings
• Presents annually, or as needed, at a Chief PA meeting(s) and/or PA Steering Committee meeting
• Reviews progress quarterly, or as needed, with departmental leadership
• Maintains superior interpersonal and communication skills as a member of the healthcare team in order to collaborate effectively with patients, families, staff, and community health workers
• Remains actively involved in continuing education with a commitment to self and departmental growth
• Adheres to all established safety policies, procedures, and precautions; identifies potential or actual unsafe situations in the environment and takes measures to rectify the situation
• Demonstrates understanding of procedures, policies, and documentation required to ensure compliance with hospital standards of care
• Additional duties and responsibilities as required by the department/division

For all positions that include direct patient care, indicate with an "X" the age(s) of all patient populations served

No Direct Patient Care

All age groups

Adolescence (13 to 17 years)

X

Neonates (birth to 1 month)

Young Adult (18 to 25 years)

X

Infant (1 month to1year)

Adult (26 to 54 years)

X

Early Childhood (12 months to 5 years)

Senior Adult (55 to 64 years)

X

Late Childhood (6 to 12 years)

Geriatric (65 years and up)

X

Qualifications
QUALIFICATIONS: (MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.)

• The appropriate candidate will have successfully completed a graduate level physician assistant program (Masters degree) accredited by the Accreditation and Review Committee for Physician Assistants (ARC-PA) or such other accrediting agency as may qualify a graduate to sit for the NCCPA certifying examination
• BS/MS joint programs and those candidates with a BS and PA certificate are eligible, but ONLY for those who graduated BEFORE 1995
• Must have at least ten years of experience practicing as a PA to qualify for the Senior PA position; additional education may be considered
• Must have evidence of administrative responsibility
• Certification by the National Commission on Certification of Physician Assistants (NCCPA) must be obtained prior to first day of employment
• Must hold a current valid license or be eligible for licensure as a physician assistant in the Commonwealth of Massachusetts
• Must have or eligible for, and maintain, a current DEA registration and Massachusetts Controlled Substance Registration
• Must complete 100 hours of CME according to national and state regulations during each two year period of employment
• Must complete the BWH Professionalism Program within three months of date of hire
• Must complete the BWH Procedural Sedation Training if deemed necessary
• Candidates must have at least two letters of recommendation for reference

SKILLS/ ABILITIES/ COMPETENCIES REQUIRED: (MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.)

• Must have the ability to work in a high stress, dynamic, busy clinical setting with changing organizational climate
• Must have the ability to be self-directive and to demonstrate initiative in addressing the responsibilities of the position
• Must have the ability to utilize appropriate problem-solving and conflict resolution skills
• Must be energetic and quality driven and have a proven ability to be a productive member of a team dedicated to providing optimal patient care
• Must be proficient with BWH computer systems as needed to independently perform daily tasks (EMR, Epic preferred)
• Must maintain the highest degree of professional judgment under the supervision and guidance of a licensed physician

WORKING CONDITIONS: Describe the conditions in which the work is performed.

Work settings may include ambulatory clinics and treatment rooms, inpatient areas, intensive care units, operating rooms, and/or procedural areas. There may be loud noises, noxious odors, and temperature extremes. A large portion of the workday may be spent either standing or walking and the position may require heavy lifting of equipment and patients.

The PA may be exposed to radiation, potentially infectious bodily fluids, and sharp instruments such as needles and scalpels. Knowledge of Universal Precautions and proper use of surgical sharp instruments may be required. The consequences of contamination from bodily fluids or from being stuck with a sharp instrument include the possibility of physical harm to the employee or others. BWH is a fast paced, dynamic environment with a very large and complex patient volume; exposure to stress in the workplace is expected.

SUPERVISORY RESPONSIBILITY: List the number of FTEs supervised.

The Senior PA may have elements of supervisory responsibility; please refer to the addendum section for details.

FISCAL RESPONSIBILITY: Indicate financial "scope" information, i.e.: size of budget, volume, revnue, etc.

The fiscal investment to build 9 additional cardiology beds in Shapiro, and to fund the staffing of these beds with a FY20 budget that exceeded $3 Million, speaks to the dire needs of inpatient Cardiovascular Medicine.

ADDENDUM: Document any additional skills, abilities, criteria, requirements, and/or details pertinent to this role.

Background and History

The Dexter Advanced Practice Provider (APP) General Cardiology Inpatient Team was born during the first surge of COVID in the spring of 2020. The team is commissioned as a full-service inpatient cardiology team trained to provide exceptional care to complex patients with cardiovascular medicine disorders.

Prospectively collected DOM data show that since its formation, the Dexter Team has admitted and discharged more patients per month, with shorter lengths of stay, and with equivalent patient acuity (as judged by the Case Mix Index), compared with the three House Staff General Cardiology Inpatient Teams. APPs on the Dexter Team place compassionate patient care at a premium. They take the time and effort to explain diagnostic and therapeutic options to their patients and patients' families. They work collaboratively to engage their patients and families to participate in shared decision-making and to understand the evolving hospital course. The APPs have a strong work effort, extraordinary collegiality, and a continuous yearning to learn about advances in cardiovascular medicine.

The Senior PA will focus on the following areas:

Quality improvement

The Senior PA will lead the Dexter Team in following the professional society guidelines for managing major cardiovascular illnesses such as acute coronary syndrome and heart failure. This initiative requires establishing a solid information platform upon which internal team audits to "Get with the Guidelines" can be conducted, with the objective of implementing continuous quality improvement. Projects to decrease length of stay will be achieved, in part, by preparing Conditional Discharge orders for all patients. The goal of the Conditional Discharge orders is to decrease hospital length of stay. The Senior PA will teach other team members how to best use the Conditional Discharge. In addition, the Senior PA will collaborate with others to measure the impact and magnitude of time saved with earlier discharge.

Technological innovation

The Senior PA will facilitate both training and integration of Point-of-Care ultrasound (POCUS) into daily rounds and will ensure that the proper educational certifications are obtained. The next project might be utilization of electronic stethoscopes to improve cardiac auscultation.

Education and teaching

The Senior PA will encourage members of the Dexter Team to teach and to mentor PA students as well as the two PA-Cs who were selected to participate in the new BWH PA Fellowship Program, which is set to debut in February 2021.

Career Development

The Senior PA, in conjunction with the Clinical Director of the Cardiovascular Division, will work individually with each member of the Dexter Team to emphasize career development. This can usually be best accomplished by subspecializing in one area of Cardiovascular Medicine such as clinical research, administration or education. Another career route is to subspecialize in one area of clinical Cardiovascular Medicine such as bedside cardiovascular imaging, Vascular Medicine, Heart Failure, Electrophysiology, or Preventive Cardiology.

Work Schedule

While the PA can expect a relatively predictable work schedule planned in advance whenever possible, scheduling variations may occur in order to cover evolving clinical needs as they become apparent to the department/division/clinic. The PA may be asked to take call, pick up additional shifts, work variable hours, and/or provide backup coverage as needed.

Requirements:

Status reviewed annually by MD lead to confirm that engagement remains commensurate with Senior PA JD via presentation at Chief PA meeting OR PA Steering Committee meeting

Report out project status quarterly to MD lead

The Senior PA shall provide leadership and participation in selected organizational committees, councils, and initiatives.

The Senior PA shall be capable of independently orienting, onboarding, and/or training new hire PAs within the department/division.

The Senior PA shall be actively involved in ongoing quality improvement and patient safety initiatives.

Experience managing cardiovascular medicine patients is required for this role.

EEO Statement
Brigham and Women's Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, ancestry, age, veteran status, disability unrelated to job requirements, genetic information, military service, or other protected status.

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