Physician Assistants in Cardiac Surgery: Insights from a German University Hospital

The rising complexity of cardiac surgery patients, coupled with new regulations reducing working hours for surgical residents, and increased healthcare costs, has led to the growing introduction of physician assistants (PAs) into cardiacsurgery teams in German hospitals. This study aims to systematically explore the experience of introducing PAs into the cardiac surgery workforce in a tertiary university hospital in Germany, identifying what is working well and areas for improvement, as well as offering suggestions for appropriate measures.

The study was of an observational nature and comprised both quantitative assessments and qualitative interviews. For the quantitative component, a survey was distributed internally to employees of the cardiovascular surgery department. The survey was first distributed within 1 month of the first PAs starting in our department ("baseline") and again 1 year later ("follow-up" [FU]).

Forty-one healthcare professionals completed the baseline, and 37 completed the FU survey. Overall satisfaction with PAs was high across all professional groups. Among residents,73.3% reported being satisfied at baseline and 70% at FU. All cardiovascular surgeons (6/6) and PAs (10/10) reported high satisfaction at both time points, and 90% of nursing staff reported being satisfied or very satisfied at baseline, with no dissatisfaction reported at baseline or FU. All PAs reported providing workload relief and feeling fully integrated into the team, while two-thirds of residents reported workload relief due to PAs assuming ward-based clinical and administrative tasks. PAs were consistently perceived as improving continuity of care as a stable point of contact for patients and nursing staff.

PAs substantially strengthen cardiac surgery teams in the German healthcare system. To successfully establish the implementation of PAs, the challenges of long-term retention incentives and clear delineation of responsibilities have to be addressed.