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cotton field illlustration
ECU's new post-graduate residence program for physician assistants is the only program of its type in the U.S. Its goal is to bring cardiovascular care to eastern North Carolina's rural areas, like the cotton farm pictured above. (Illustration by Lisa Kuehnle, Photo by Cliff Hollis)

Unique Program Trains in Matters of the Heart

By Crystal Baity

East Carolina University has developed the only post-graduate residency in cardiology for physician assistants in the country.

The goal is to place specially trained physician assistants in rural areas supervised by cardiologists who likely will be practicing in another town. The need is acute in eastern North Carolina, which has high rates of heart disease, said Dr. Wayne Cascio, cardiology division chief and professor of medicine in the Brody School of Medicine at ECU.

Cascio and Larry Dennis, chair of the Department of Physician Assistant Studies in the School of Allied Health Sciences, collaborated on the development of the two-year program that functions like a cardiology fellowship.

Physician assistants have delegated authority to practice medicine and prescribe medication under the supervision of a physician. “Every physician assistant who practices in the state must be licensed by the North Carolina Medical Board,” Dennis said.

“A P.A. can run a clinic in Ayden, for instance. Physicians don’t have to be on site. The physician-physician assistant team concept is the essence of what we do.”

Cascio estimates an additional 30 cardiovascular health care providers are needed in the North Carolina counties east of I-95 alone. “We need practitioners to keep people from getting cardiovascular disease and, if they get sick, we need practitioners to treat them.”

At the same time, fewer physicians are training in cardiology. Across the country, there was a 13 percent decline in the number of cardiologists in training between 1994 and 2002. Fewer heart specialists combined with an increasing older population creates an additional burden. Each year, 700 to 800 cardiologists enter the workforce; only about 580 pass their boards. Significantly more leave the profession, Cascio said.

“We’re losing more than we’re generating and the consequence is that we have a real demand on cardiologists,” he said. As a result, cardiologists are sought after, demand high salaries and tend to locate in urban areas.

“You might have an easier time getting a board-certified cardiologist to Greenville but in the outlying areas it is almost impossible.” Specially-trained physician assistants can fill the void, Cascio said, much like family nurse practitioners and other health professionals practicing in rural areas.

In the program, P.A. residents will focus on primary prevention in heart and vascular disease, treating high cholesterol and checking risk factors. They also will monitor patients who already have disease including hypertension, diabetes, congenital heart disease or abnormal heart rhythms and vascular disease. They will learn to assess risks and perform limited clinical diagnostics such as treadmill testing and echocardiograms, Cascio said.

Dennis’ role has included helping develop the program concept, defining licensure requirements and providing general advice and direction. Cascio has developed the curriculum. At press time, students were being recruited to start the program in July 2006. The incentive for a P.A. would be having specialized training and additional certification. “The other advantage too is if someone is interested in cardiology and internal medicine and is interested in staying in the area, you’ve got a ready-made job,” Dennis said.

During residency, students will be employed by Pitt County Memorial Hospital, a strong supporter of the program.

Scott Jones, senior vice president of operations at PCMH, said the hospital is excited to be a part of the innovative program.“Part of our mission is to improve the health status of residents in eastern North Carolina and this is a very effective way of doing that,” Jones said.

ECU’s program is unique because many of the post-graduate residencies available to physician assistants are in surgery, Dennis said.

Residency training for physician assistants is not required by any state. Training usually occurs on the job including the intense clinical rotation required for graduation, Dennis said.

In recent years, ECU’s P.A. program has transitioned from a bachelor’s to a master’s degree. The coursework has increased from 80 to 99 hours and the department has added eight courses. It is the only P.A. program in the UNC system. The others are at Duke University, which founded the first P.A. program in the United States in 1965, Wake Forest University and Methodist College.

This page originally appeared in the Dec. 9, 2005 issue of Pieces of Eight. Complete issue is archived at