When a group of PAs in cardiovascular surgery realized their professional organizations were not going to help them, they decided to help themselves.

About five years ago, the Society of Thoracic Surgeons (STS) leadership told the Association of Physician Assistants in Cardiovascular Surgery (APACVS) that the then-new limits on physician resident work hours would create opportunities for PAs in all hospitals across the country.

But cardiovascular surgery is one of the most complex specialties for PAs, and most PA students receive a maximum of four weeks of training in cardiovascular surgery during PA school. The STS leadership told the APACVS that it needed a way to ensure that CVS PAs were adequately trained or they would help fill the void with another profession, if necessary.

"We took that challenge very seriously," APACVS president Ed Lopez, PA-C, said. "We felt that PAs needed more than on-the-job training, and that they needed some sort of postgraduate training to enter what we consider the most technically demanding specialty among PAs."

APACVS approached the National Commission on Certification of Physician Assistants, but the commission could not offer help.

"Four years ago, the NCCPA expressed the party line that also reveals the AAPA position, which is that PAs should never be 'siloed' into a professional area that they can't get out of," said Lopez, who is a member of the NCCPA board of directors but spoke only as the representative of the APACVS for this article.

"I understand where they were coming from," Lopez said, but he also realized that the APACVS had a unique need. "We felt after much deliberation that we needed to take this challenge into our own hands rather than depend on anyone else," Lopez said.

The APACVS then created a fellow membership of the APACVS (FAPACVS). In cooperation with the cardiothoracic surgery PA residency program at St. Joseph Mercy Hospital in Ypsilanti, Mich., APACVS offers a PA postgraduate program in cardiothoracic surgery that is completed online and in the PA's practice.

Potential fellows can complete the online and clinical program with St. Joseph Mercy Hospital before applying for APACVS fellow status, or they can apply for fellowship status by documenting extensive prior postgraduate education and career experience that they have already acquired.

APACVS inducted its first group of about 70 fellows at its January conference in San Diego.

"We feel that this has added credibility to our specialty in the eyes of the credentialing bodies and hospitals," Lopez said. "We realized that no one at the time had an interest or the political will to help us address our professional challenges, and thus we took it upon ourselves. I'm of the opinion that you do what is right on your own terms, if necessary, and hope that the profession ultimately understands your intentions. We felt that in preparing our own (fellowship process) and recognizing our own (PA fellows), we had nothing to fear."