A Day in the Life of an Interventional Radiology PA: Edward Mathes, PA-C

If you love procedures, pay attention. Edward Mathes is a PA who works in the field of Interventional Radiology (IR) and was kind enough to answer some questions for our “A Day in the Life of a PA” blog series! He gives great insight into his specialty, the types of procedures he does, and even some advice for those who refer to IR.

Tell us a little about yourself, which PA program you graduated from and when you graduated.

I graduated from the Hahnemann Medical College PA Program, Philadelphia, Pa in 1981. Prior to that, I worked as an orderly at a local hospital, an EMT for a commercial ambulance service.  I then spent 3 years as an active-duty Army Medic in Germany, went to PA school, then 15 years in the Army Reserves as a PA.

What is your current specialty? Why did you choose this specialty?

After 15 years in Surgery (Hospital based) and 10 years in a private Internal Medicine Practice, a position opened in Radiology at out local University hospital. I always had an interest in Radiology.  In the 1990’s, I was a Radiology Review column editor for the JAAPA.   I was looking to leave IM and a position opened in Radiology. I was hired to manage the new PET-CT/3-T MRI center for the hospital.  After 2 years there, our chairman felt my skills would better serve the University elsewhere, so I transitioned into interventional radiology. I have been there 10 years now.

What type of environment do you work in (hospital, clinic, administration, or a mix)?

Primarily hospital-based, a mix and in- & out-patients.

What is your schedule like? Do you work Monday through Friday, weekends, holidays, night shifts?

Currently, I’m on a four 10-hours day shift, Mon-Fri. This is new.  Up until last year it was a scheduled 50-hour work week, Mon-Fri, 7:00am to whenever….usually 5:00 give or take an hour.

Do you take call?

No.

Describe a typical day like for you? Do you start in a clinic or hospital setting, do you stay there for the entire day? What time do you start and finish?

We start at 0700 with our “morning report”…. the Attending(s) assigned that day, typically 2-3 residents, our Fellow, myself and our other PA review the day’s cases.  I typically spend another 1/2 hour going over inpatient requests for procedures that came in overnight.  This entails chart and imaging review, occasionally speaking with the referrer or seeing that patient pre-approval.  I then “approve” cases to be added to the schedule, and set aside select cases “for attending review” .

Next I go to our pre-procedure area, introduce myself to the patients, explain the procedure, get consent, perform an abbreviated H&P/Sedation assessment, then head to the procedure room to do EMR data and order entry.  I then do the procedure.

Post-procedure involves writing and dictating a note, orders, talking to family, seeing the patient before discharge, reviewing discharge instructions,etc.

On the bigger cases,  I’ll call or email the referrer to thank them for the referral and let them know it’s done and how it went.  For less complex cases, like tunneled central venous catheters, paracentesis/thoracentesis, etc, I won’t call/email, just a chart note.  Unless, of course, there was an issue or complication the referrer should be made aware of.

I typically perform 6-10 procedures a day.  These can run the gamut from simple thyroid nodule biopsy to a difficult CT or Ultrasound guided biopsy or drainage procedure, splenic lesion biopsy, or celiac nerve block. I recently added bone-lesion biopsy to my privileges list and those have kept me busy.  I do most everything except angiography.

In between cases, I may see a patient consult on an inpatient unit or a follow up patient in our department-based clinic.

I sit on 2 tumor boards which meet weekly.

I have one research project going that needs a few minutes attention daily.

I am available by phone/pager if someone has a question or issue they can’t resolve by “normal” means….typically getting a patient seen in a timely fashion.

I mentor students from several PA programs.

Are you an hourly or salaried employee? Do you think your wage is comparable to your specialty in your location?

Salaried employee.

Our hospital system has a Center for Advanced Practice that encompasses most of the 500 or so PAs and NPs that work here.  I recently transitioned from the faculty group to that center for administrative purposes. They made a market adjustment to my salary and benefits package that brought me up to the regional standard.

How autonomous are you, what types of things do you involve your supervising physician for and what do you do on your own? Is this typical for your specialty or more specific to your situation?

I am fairly autonomous.  Not sure if it’s “typical” for my speciality as there really are very few PAs working in IR.

We are a group of 8 Physicians, 1 full-time PA(me), one part-time PA, one NP.  We also have 2 PAs that do neuro-interventional exclusively.  The 8 Physicians cover 5 facilities: 4 hospitals and 1 free-standing dialysis access center. The PAs are all based at the main facility. Our NP covers patients at an outlying hospital and our clinic.

For procedures, most of our cases have already been reviewed and “approved”…meaning,  it is an appropriate procedure on the appropriate patient for the appropriate reason.  I will discuss a case with the Attending for a few reasons.

1. I’m really sure it’s an appropriate procedure/patient.
2. I have an approach (to a lesion) that I know is correct but I’d appreciate confirmation/validation.
3. The attending has issues with some of the things I do so I involve them.
4. I’m having a problem during the procedure that I tried but can’t work through.
5. Any complication.

An example would be, I recently reviewed a request for inguinal lymph node biopsy (isolated inguinal lymph node, no other symptoms, no history of cancer in a 62 y/o male).  On reviewing imaging, I was concerned the “lymph node” was actually a high femoral artery pseudo aneurysm post coronary artery angiogram from 2 years ago. A quick look with ultrasound confirmed this.  We treated with ultrasound-guided thrombin injection and compression.

Do you currently participate in any administrative tasks or have a leadership position, formal or informal?

Formal:

• Thoracic and GI Tumor boards.
• I am involved in a few Cancer Center studies….I typically review tissue specimen volume requirements and handling   For the study and determine if IR can meet those needs.
• Mentor students

Informal:

I have been there longer than 6 of our 8 physicians. I am there every day, while the physicians rotate among facilities. So I become the de-facto contact person for a lot of our daily issues and for hospital staff.

Do you think this augments or hinders your other responsibilities?

I’ve spent 10-years building relationships of trust and good service with our referrers.  Because of this, I have patients referred to me preferentially. So from that standpoint, augments my practice.

What advice would you give to a PA who is considering working in your specialty?

You really need a good basic education in medicine I believe my 25 years in surgery and internal medicine prepared me for IR.

PAs considering IR really need to know their limitations, stuff their ego in their back pocket, not be afraid to ask questions or ask for help, admit when you don’t know something or are flat-out wrong, always strive to learn, push your limits, handle stress, and know this:you have to be better than them because you will be held to a higher standard.

Of course, this is advice that could be applied to any PA in any specialty.

What is the one thing you wish PAs in other specialties knew before calling or referring to your practice?

We’re busy. We do 60+ cases a day. We really try to provide a high level of service.  Sometimes demand outpaces our ability to supply.  Understanding goes a long way.

Also….don’t embellish the patient’s condition just to get them on our schedule.  Be honest with us and we will reciprocate.

Is there anything else you’d like to add?

A career in IR can be very rewarding.  Of all my positions over 37 years of practice, I’ve enjoyed this one the most.

I want to thank Edward for taking the time to reach out to EmpoweredPAs and volunteer his time and insight. As an ER PA, I love performing different procedures, it was interesting to learn the nuances of his specialty! If you’ve ever considered a career in IR, I hope this post has helped you in your journey!

-Courtney

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