
Perfusionists are key members of hospital operating room teams
Transcript
[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient," with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Today we're talking about the field of cardiopulmonary perfusion with Dr. Bruce Searles. He's a certified clinical perfusionist and the director of cardiovascular perfusion in the Upstate College of Health Professions. Welcome to "The Informed Patient," Dr. Searles.
[00:00:30] Bruce Searles, PhD: Hi Amber. It's great to be here. Thank you for the invitation.
[00:00:33] Host Amber Smith: So can you describe what cardiovascular perfusion is?
[00:00:38] Bruce Searles, PhD: Sure. Cardiovascular perfusion is the profession for the clinical perfusionist. And as such, a clinical perfusionist is somebody who is a specialist -- we're going to do a lot of word soup here this morning -- the specialist in extracorporeal technology. So we operate devices that are the most extreme life support systems. We're often involved in cardiac surgery teams, assisting the cardiac surgeon, anesthesiologists, and all the other health professionals that are in that room, the nurses, the PAs, the, the scrub techs, the respiratory therapists.
[00:01:12] Host Amber Smith: Well, what does extracorporeal mean? You used that word.
[00:01:17] Bruce Searles, PhD: Extracorporeal. That's a fun word, isn't it? So if you divide that up, extra is outside of, and corporeal is the body. So it indicates that we're going to use some technologies to plug into the person's cardiovascular system, and we're going to circulate their blood outside of their body and then put it across different artificial organs. In particular, we have this thing called an oxygenator, which is like an artificial lung. And we're going to use pumps, which are essentially artificial hearts. And on occasion we'll use hemoconcentrators, which are artificial kidneys in a sense.
So we will take the patient's blood outside their body, move them across some artificial organs to perform certain physiologic functions that the patient isn't able to perform for themselves at that moment.
[00:02:05] Host Amber Smith: So does that allow the heart and the lungs to be still for the surgeons?
[00:02:10] Bruce Searles, PhD: That is, for the surgical procedures in the operating room, that's one of our primary goals is to provide a motionless and bloodless field.
If you can imagine the challenge that a cardiac surgeon has, they're going to surgically gain access and visualization of a human being's heart, and then they want to do some very delicate vascular surgery on this muscle that's jumping all over the place inside the chest. So through the magic that is cardiopulmonary bypass, and the skillset of a cardiovascular perfusionist, then we can provide the surgeon a motionless and bloodless field, we'll circulate their blood outside their body, around their heart and their lungs. And that's what cardiopulmonary bypass is.
And then we can, in cooperation with the surgeon, apply some medications to the heart, which cause the heart to stop beating. Anesthesia will turn off the ventilator. The lungs aren't breathing, the heart's not beating, and the surgeon has the heart isolated from the rest of the patient's vascular system.
[00:03:12] Host Amber Smith: How long ago did this specialty begin?
[00:03:15] Bruce Searles, PhD: So, in 1953, way back in 1953, on May 6th, our pioneer that we give credit to birthing the field, his name was John Gibbon, he performed the first successful cardiopulmonary bypass procedure on an 18-year-old in Jefferson Medical College in Philadelphia, Pennsylvania.
That was following 20 years of research in which he imagined it must be possible. But, it took him some time to demonstrate that it could be done.
[00:03:45] Host Amber Smith: And is this used mostly just in heart surgery or are there other procedures that this might be needed for?
[00:03:51] Bruce Searles, PhD: The bulk of the clinical perfusionist work usually does happen in the operating room, as a member of the cardiac surgery team.
But we do have the opportunity to work outside of the operating room with other specialists. So some days I may find myself in the catheterization laboratory, helping a cardiologist with a diagnostic cardiology procedure. Other days we'll be in the intensive care unit with some patient who has profoundly failing hearts or lungs, and we can help them with some procedures called ECMO, E-C-M-O, extracorporeal membrane oxygenation. Or maybe we would be operating a device called a VAD, a ventricular assist device, V-A-D. All of these are extracorporeal technologies. They all are different devices plugged into the patient's vascular system, circulating their blood outside their body.
[00:04:43] Host Amber Smith: So it sounds like things have advanced since the field began.
[00:04:48] Bruce Searles, PhD: Oh yeah. Interestingly, in thinking about this interview, I was reviewing some history, and it occurred to me that the cases that they originally did, the very first case was an ASD (Atrial Septal Defect) closure, 45 minutes on bypass, 20-23 minutes dependent on when the heart stopped, 23 minutes. Those cases today would be our absolute easiest cases. And back then they were, they were barely attainable. The mortality rate in 1953 was over 50% for these procedures. And as our technology has gotten better, the surgeons have been able to dream about their surgical skills and improve their surgical skills. And now the cases we do all day, every day, were unimaginable when the field was originated. We do much, much sicker patients through more complicated surgical procedures. It's really been amazing to watch the field advance over the 30 years that I've been in it.
[00:05:45] Host Amber Smith: What is ASD?
[00:05:46] Bruce Searles, PhD: An ASD was a pathology, as an atrial septal defect.
The very first patient had an ASD. They had communication between the two upper chambers of the heart, and technically now we look at that as a pretty simple procedure. They open up the heart, they put a couple stitches in it to stop the communication and then close the heart back up again. But back then, that was absolutely revolutionary, the idea that you could operate on the inside of a human's heart.
[00:06:16] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Bruce Searles, a certified clinical perfusionist and director of cardiovascular perfusion in the Upstate College of Health Professions.
Now let's get into what it takes to become a cardiovascular perfusionist. So I'd like to ask you to tell us about the educational program at Upstate. What sort of students are you looking for?
[00:06:42] Bruce Searles, PhD: At Upstate Medical University in the College of Health Professions, we have one of the nation's oldest educational programs for clinical perfusion.
We're currently offering a master's degree, and we'll have many more candidates than we have seats. So we have a competitive interview process. And who we're screening for are people who have the obvious credentials of a very good academic background, good grades in science courses and knowledge of the field.
Many candidates come to us with some clinical experience already in some other profession, nurses or respiratory therapists, or we have a lot of perfusion assistants that apply to us as well. So it's very common that you have a good GPA, with a good science degree and you have clinical experience, though the experience is not a requirement.
So what we use the interview for, to whittle down our applicant pool, is to find people who can communicate well, their passion for the field and knowledge of the field, people who can provide and demonstrate that they are independent learners. Because there's going to be a lot of opportunities as you go through the program and the profession to learn things, and we want people who seek out those opportunities and do it because that's how they're wired on the inside, not because somebody told them, go in there and learn this thing. So we want autonomous workers, independent thinkers.
And we're also screening for a certain personality type. As you can imagine, clinical perfusion is working in a fairly stressful environment. Now, when I interviewed for this program back in 1991, I met with Jeanne Lange, the program director at the time, and she introduced the field to me, and she, probably an attempt to stump me during the interview, she said, "perfusion has been described as 90% boredom and 10% terror. Why would you want to be a perfusionist?"
And you know, for me and many of us, the answer to that question is embedded in the question. It's that 10% terror. Every job has a certain amount of repetition, and as you become good at it, it's not necessarily challenging anymore. So no matter what you do, you get good at it, and it becomes a little bit ordinary.
That's the 90% boredom. But it's the 10% terror, the opportunity every day we go to work that something really, really significant could happen. And I have to be ready for that. I have a very unique skillset as a clinical perfusionist. And if I'm called to use all of it all at one time, it's because somebody's trying really hard to die, and I'm going to try really hard to stop that.
[00:09:21] Host Amber Smith: So this is a, you said, master's degree program. How many semesters is it?
[00:09:27] Bruce Searles, PhD: Our master's program runs over about 21 months. It starts in the fall semester and runs through five semesters. So we start in September. There is a full summer semester, and it finishes around May.
[00:09:42] Host Amber Smith: What about graduate positions? Do you have any of those?
[00:09:47] Bruce Searles, PhD: Oh, sure. So thank you for asking. Our program is a master's degree, and we're currently accepting about 20 students per year. And while we're interviewing, we're looking for about 19 individuals who are, as we just described, very, very smart, very skilled, very dedicated.
But while we're doing that, we're also specifically looking for another unique candidate. We have one seat reserved for an international scholar. We are happy to have a program in which we can accept an internationally trained, an experienced clinical perfusionist to become part of our educational cohort, just like all the other students. But given that they have experience in operating extracorporeal equipment, we can apply them as a graduate teaching assistant in our simulation laboratories. So it becomes a reciprocal arrangement, and we're helping them whether pursue their education and American credentials. And at the same time, they're helping us teach our students.
It expands the opportunities for diversity of experience and opinion for the other 19 students. And it expands the reach of our faculty, to haveour simulation curriculum delivered at a high level to all of our students. And it's great for the international candidates who sometimes have difficulty finding a pathway to get into our country and receive our education.
It would be wonderful if some of those candidates wanted to take that education and return to their countries and open schools. We're really big into promoting education in areas of the world that aren't as fortunate as us. But we recognize some of these candidates are also probably going to immigrate here and stay here for life.
[00:11:37] Host Amber Smith: Can you walk us through what the students can expect during their training? How much of this is lecture and how much of it is hands on?
[00:11:46] Bruce Searles, PhD: Yeah, sure. So we kind of divide it up into year one and year two. And in year one the candidates come from wherever they are. And, by the way, most of our candidates, most of our accepted students are out-of-state students because there are only 20 schools in the nation. So just about anybody that goes to perfusion school had to move to a different state to get into some school somewhere. So our candidates come from all over and come to Syracuse and they'll spend the first two and a half semesters here on campus with us.
If you were to take a day in the life of a first year perfusion student, then it's probably 45% of the time they're in the SIM (Simulation) lab practicing their skills in a high fidelity environment; 45% of the time they're in lecture, in traditional classrooms with lectures and presentations and tests just like you normally expect in education.
But then there's about 10 more percent of the time that they spend in clinical observation. They'll have opportunities to go to the hospital watching clinicians work in the operating room, in the cath lab, in the ICU, et cetera. So that's the first year.
And by the time they've completed the first year, then we transition to the clinical preceptorship portion of the of the education. And now the SUNY students are going to go to at least four different hospitals and practice for rotations that last about seven weeks at at a time. So we have five rotations. You have to hit four hospitals. You'll be on the road moving from hospital to hospital for about 35 weeks.
Our rotations are, potentially, spread all over the country. We have 30 clinical affiliates, from Portland, Oregon to Portland, Maine to Dallas, Texas, and New Orleans and North Carolina. We're really spread all over the country. And our graduates come from all over the country, and they return to all over the country after they graduate and they get their training all over the country.
[00:13:39] Host Amber Smith: Interesting. So after graduation, are there residency requirements or exams or licensure? How does that work?
[00:13:48] Bruce Searles, PhD: You're not quite done when you think you're done. So, you complete your education at one of those 20 schools that are accredited by the Commission for the Accreditation of Allied Health Education Programs. If you graduate from any of those programs, then you are qualified then to sit for the certification exams of the American Board of Cardiovascular Perfusion. And the ABCP offers a two part examination process. You can't take those immediately upon graduation. They're only offered twice a year, so six months apart. So you can graduate, you can get a job, you fill out the paperwork, and you take the test the next time it's offered within six months to 12 months.
And then, if you are working in a state that requires a licensure, then all states that license perfusionists use the American Board exam as the gateway. So the plan is graduate, get a job, get certified, complete your license. Now you're finally done.
Beyond that, there's continuing education requirements for the rest of your profession, and there's actually clinical service requirements in our profession. If you're not doing clinical work, if you're not actively involved in at least 40 perfusion procedures a year, then you'll lose your certification. So, many of us who have more academic jobs, where I don't necessarily report to an operating room every day, I've got to find time to get out and get back into a hospital if I'm going to keep my certification.
[00:15:16] Host Amber Smith: I see. Well, let's talk about the sorts of jobs that someone can expect once they're certified and and ready to work. Will they be working in a hospital?
[00:15:26] Bruce Searles, PhD: Hospitals really are where we show up to do our, to apply our craft, if you will. Now, we're parts of teams that work in intensive care units and operating rooms, so that requires a hospital. Your employer may be that hospital, or your employer may be a contract company. There are several perfusion contract service organizations that employ sometimes just a few perfusionists. Maybe it's a small company that has one contract at one hospital, but there are several nationwide companies that have perhaps contracts with 100 hospitals and employ thousands of perfusionists.
So one way or another, you work for somebody who pays your paycheck, but you show up to a hospital to do that work. Other opportunities for perfusionists other than working in the hospital, which most do, would be if you if you have a role in a clinical contract company, then there's always opportunities to advance through administration and be in charge of administrative and operational decisions that that company has to make with equipment, getting equipment and keeping the equipment ready for clinical service and hiring and firing people, getting contracts with hospitals.
Other things that clinical perfusionists do besides operate equipment in the operating room would be to work for medical device companies that develop and sell products for perfusionists. So the LivaNovas and the Getinges and the Medtronics of the world need clinicians to advise them on product development. And then they need people who will represent those products back to clinicians. And some perfusionists go that way.
And then there's like 20 of us that have jobs like mine, or directors of schools and work for universities, and do education for students.
[00:17:10] Host Amber Smith: What is the starting salary range?
[00:17:14] Bruce Searles, PhD: Typically about $120,000, with tremendous variability. Obviously if you're going into a major metropolitan area, then it'll be a lot higher than that. And sometimes you find salaries that are a lot higher than that in the middle of nowhere because it's hard to attract people to the middle of nowhere. So, 120 is a safe bet. You would feel well respected if you're offered something just cracking over a hundred thousand. But there's opportunities to make more than that.
Now, another thing to think about with a salary is that there's often a base salary. That's what I just described, 120. But to be a member of the open heart surgery team, there's a call responsibility. So you will work when scheduled and then other times as needed. So if you're going to take call, then there's usually some remuneration for the inconvenience of promising to return to work at a moment's notice, and then maybe working for another half a day if you do get called in. So it's usually we would express the salaries as that base, plus call recall.
[00:18:16] Host Amber Smith: Do the perfusionists have much interaction with the patient?
[00:18:21] Bruce Searles, PhD: You can divide that up in with different levels of understanding. I need a patient, and I need to be close to them. So I work with patients very closely geographically. I'm six feet away from them. But all my patients are sedated, perhaps anesthetized. Just about all the patients are intubated. They're not having conversations with me, and I'm not talking to them. Most of them don't even know that I'm there.
So I work closely with patients. But I don't really get to know my patients. If you're interested in a career where you get to look into your patient's eyes and see their appreciation or can be empathetic with their pain, this is totally the wrong profession. I have a human being in front of me that is very important to me, and I'm going to apply all of my skills to them, but I don't know them as a person. I know them as a fellow human being.
[00:19:10] Host Amber Smith: It sounds like it's been a satisfying career for you though.
[00:19:15] Bruce Searles, PhD: I do really enjoy the profession. It kind of goes back to the 10% terror part.
As an educator, I do spend a lot of time in my office working on papers, grading students' papers, and grading tests and administering a program. And some days you leave that particular part of the job and think, wow, that was a lot of paper pushing today. But I never go to the operating room and wonder if what I did was important.
You know, I had a role in a team that took a patient who was ill to a near death situation. We plugged into their circulatory system and stopped their heart and lungs. The surgical team does something hopefully to improve their health, and they can only do that because I can take care of the patient in the meantime. And at the end of the day, we wean them all back onto the patient's independent circulatory system and send them up for recovery.
It's extremely satisfying. It could be one of the most important days in that patient's life.
[00:20:17] Host Amber Smith: Well, this has been very interesting speaking with you. I appreciate you making time.
[00:20:21] Bruce Searles, PhD: Thank you for the invitation.
[00:20:23] Host Amber Smith: My guest has been Dr. Bruce Searles. He's a certified clinical perfusionist and the director of cardiovascular perfusion in the Upstate College of Health Professions. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron. Find our archive of previous episodes at upstate.edu/informed. If you enjoyed this episode, please invite a friend to listen. You can also rate and review "The Informed Patient" podcast on Spotify, Apple podcasts, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.