How do PA's help Surgeons...?

[OwlMyste]

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I got a Question...PA's help in different type of medicine...(obgyn, surgery, etc.)...My major in college will be PA,...And I was wondering...In what ways do PA's help the surgeons in the O.R.? That way I can have an Idea of what to expect...I have also heard [from other posts] that PA's and LPN's making 80K-120K per year...I know that PA's can make atleast 80K per year, I've read up on that...but I have never heard of a single PA making 120K per year... anyone that could help clarify this for me please?

Because If I decide not to be a surgeon, I want to be a PA in the O.R. ...I find Surgery facinating, thats why...🙂

 

[SomeFakeName]

PAs usually do the grunt work during the operation that the surgeon may feel is beneath his/her level🙄

For instance, on some of the cardiac surgery cases I've seen, the PA opened the chest (sternotomy) and dissected away the pericardium to expose the heart. Then as the surgeon was harvesting the internal thoracic artery to use as the bypass graft, the PA was busy harvesting the great saphenous vein to use as the other byapss graft. Basically doing what an assistant surgeon would be doing.

I've never actually seen a PA sew the bypass graft, however I have heard that some surgeons let PAs sew the graft under their direct supervision. One surgeon I observed let the PA open the chest, dissect away the pericardium, harvest the ITA and GSV, and close up the chest at the end. Besides putting the patient on bypass and taking them off at the end, the surgeon spent all of 15 minutes sewing the grafts.

PAs are becoming more and more common, especially in private practice, because they are much cheaper to hire than a fully-qualified assistant surgeon and can do ALMOST as much as an assistant surgeon when properly trained and supervised. However, nobody in their right mind would let a PA do the intricate steps in a surgery...for that you gotta go through the surgical training and become a legite surgeon.

 

[Winged Scapula]

As SFN notes, the depth and breadth of a PA's involvement in the OR will vary from attending to attending and the experience of the PA.

I've seen PAs do the same as SFN notes (basically nearly all of the CABG) and I've seen others serve as a glorified scrub nurse, just handing the surgeon instruments and most others somewhere in between, doing some of the suturing, etc. Our university program doesn't employ a lot of PAs, although I have contact with them in some of the surgical subspecialties (ie, Neurosurg and CT) and at the local community hospitals.

PAs will also occasionally do H&Ps, mark surgical sites, see patients in clinic, etc. besides just working in the OR. Frankly, we could use some more (especially to do the paperwork and marking sites which takes up a fair bit of residents time).

Can you "major" in PA in college? I thought it was a specialty training program. At any rate, the level of responsibility is much less than that of the attending surgeon in the OR. Be a surgeon if you want to operate.

 

[OwlMyste]

also...do Surgical Physician Assistants get as much sleep deprived as the Regular Surgeon there?

 

[eddieberetta]

Originally posted by SomeFakeName
PAs usually do the grunt work during the operation that the surgeon may feel is beneath his/her level🙄
...
However, nobody in their right mind would let a PA do the intricate steps in a surgery...for that you gotta go through the surgical training and become a legite surgeon.

Presently, PA's perform duties similar to intermediate-level residents. In addition to the OR duties, they see patients in the ER and clinic and "review" their findings with the attending.

Of course, the way things are going, in 10 years there may "PA-practitioners" whose mandate is to diagnose illness and perform surgery (sound familiar?).

If we need more residents, why don't we just hire them?

 

[Winged Scapula]

Originally posted by OwlMyste
also...do Surgical Physician Assistants get as much sleep deprived as the Regular Surgeon there?

I guess it would depend on the program, but at mine, the PAs are essentially on a 8-5 (or maybe 7-5) schedule. If they do have them take in-house call (which is pretty rare here), they go home post-call first thing in the am. So frankly for the salary, their hours are pretty good from where I sit.

 

[vuillaume]

I think the most important decision point for deciding whether you want to be a Physician's Assistant or an actual physician is whether you want (a) maximal intellectual stimulation, (b) responsibility, and (c) autonomy.

If you want to be able to treat work as a 9-to-5 job and draw firewall between work and home, then being a PA is great in allowing you to be involved in health care, being paid reasonably well, and being able to leave work at work. On the other hand, you always have to answer to your boss (the "A" in PA), you are not the ultimate arbiter about treatment planning, and you'll be relegated to the relatively "routine" aspects of surgery (which can get old quickly).

I think PA's are fantastic, and extremely helpful as medicine gets increasingly complex and overburdened with issues that don't have to do with applying steel to skin. I just know that I want to patients to be *my* patients in terms of responsibility and decision-making, perform research that hopefully advances the state-of-the-art, and teach. You can only really do all those things as an MD.

No doubt teaching hospitals are going to increasingly need PA's and NP's to deal with work-hour requirements, so there certainly will be a market for them.

 

[OwlMyste]

Originally posted by Kimberli Cox
Can you "major" in PA in college? I thought it was a specialty training program

yup, you can major in it...I was a little surprised myself, but I know of three places that offer it...One a Junior College, and one a medical college, and the other a University...here are their websites...

http://www.gdn.edu <--this is the Juniior College I applied and got accepted to, they have an Associate Degree in PA.

http://www.mcg.edu <--this college I think ofers just a Bachelors Degree in PA.

http://www.southuniversity.edu <--this is the University that offers both a Bachelors Degree and a Masters Degree in Physician Assistant...The one I checked was at the Savannah Georgia location...


Interesting, as wel as surprising...isn't it? I thought so...😎

 

[droliver]

Actually, there are now surgical assistants with even less education then PA's that a number of the CTVS surgeons are using now. It is becoming more popular b/c they are cheaper. Not surprising as everyone is tightening up their cost margins

 

[southerndoc]

Originally posted by OwlMyste
http://www.gdn.edu <--this is the Juniior College I applied and got accepted to, they have an Associate Degree in PA.

http://www.mcg.edu <--this college I think ofers just a Bachelors Degree in PA.

http://www.southuniversity.edu <--this is the University that offers both a Bachelors Degree and a Masters Degree in Physician Assistant...The one I checked was at the Savannah Georgia location...

It's my understanding that both MCG and South University are going to masters only programs.

 

[Winged Scapula]

Owl...

Thanks for the info. While I suppose if you majored (ie, got a 4 year degree) in PA, it would provide you with a Plan B should you not get into medical school (or should you change your mind), don't feel that doing so will increase your chances of getting into medical school.

You should major in something that interests you and allows you to complete the pre-med required courses. Should you end up in medical school, university will be the last time you will have a chance to study something other than medical issues. Give some thought to majoring in English Lit, Archaeology, etc. if your interests lie in such areas. While a PA degree may benefit you as I've said above, it does not confer significant benefits for medical school admission.

BTW, there is a PA forum here at SDN. You might find more information to your enquiries there.

 

[OwlMyste]

Originally posted by Geek Medic
It's my understanding that both MCG and South University are going to masters only programs.

Thanks for the info, Geek Medic...I didn't know that...So where could I get a Bachelors Degree in PA?

 

[themadmedic]

How much a PA can do depends on the PA and the supervising physician...and to some extent state law.

Work hours depend of course upon the characteristics of the practice...

Most PAs in surgery do H&Ps, first assist, and see patients in clinic. They can pull call and do consults as well. Services provided by PAs are billable, reimbursed by medicare at 85% of the physician fee schedule. PAs do diagnose and perform procedures-as delegated by their supervising physician.

For more info on PA programs, the AAPA has more info on their website at www.aapa.org

Droliver, it is true that scrub techs are doing more in surgery as well...not sure if their services are billable or not.

Some PAs make in excess of $100K a year-mainly due to experience and/or productivity bonuses...

 

[maxheadroom]

All of the PAs that I know have a bachelor's degree before they go on to a PA program. As good as PA jobs are, I expect that competition is kind of high, so having a BA is probably an unwritten rule.

I wouldn't do a BS in PA as a premed. Decide which you want -- PAs don't have a lot of the basic sciences that you need as a premed.

 

[OwlMyste]

Originally posted by Kimberli Cox


BTW, there is a PA forum here at SDN. You might find more information to your enquiries there.

Yes I saw that...thats the first thing i went into when I had the Q...but there were only like...4 posts in there, and the chances of getting my Q answered would prolly be slim to none...so I decided to ask it from the Surgeon's point of view...🙂

 

[themadmedic]

There are a lot of programs out there that still offer BS degrees for PAs...not a big difference in training as all programs must meet the same objectives-however the profession is moving toward a MS as standard...

Even for the BS degree programs-many have previous degrees or several years experience in health care...

 

[zpdoc]

Someone I knew in high school went to Springfield college in massachusetts to become a PA. It was supposed to be a great program for PAs...I don't know, check it out.

 

[Ramphaus]

First of all, i read much more than I write on this site.

Second of all, I feel compelled to say something since I did exactly what we're talking about here. I would say that I side with the distinguished Dr. Cox.

I majored in PA Studies at Saint John's University in New York. This was my PRE-MED degree. I knew that I wanted to go to med school, and so at the time I thought "Hey! This has got to be great preparation for med school!" And to an extent this is true. I am currently a third year at that little med school in Durham, NC.

Cons: PA school as an undergraduate major is hard as @#$! most people's GPA's were around 3.0 or lower by the time they finished. me and 2 other folks were the only ones out of 120 that had GPA's 3.5 or higher. The 2nd year of PA school (aka the 4th year of college) was spent 80-100 hours a week in one of various inner-city hospitals in NY. So, I couldn't study and take the MCAT like a normal person. So I had to wait until I graduated. That process, as we all know, takes 2 years. In the interim I worked as a PA in CTS.

Another con is that nowadays I wish I had majored in Shakespeare or something less sciencey...does that make sense. I'm inundated with so much science now that I feel like i'm not the well-rounded person that I used to be - and it bothers me.

Another con is that there are some classes like physics and such that you will have to take outside your already crowded schedule.

Another con is that you may find some of the basic science courses in first year med a little more difficult for you than for others as it will have been the second time for many of them, and the first time for you. For instance, I almost passed stones over Genetics, which at Duke is taught as if everyone taking the class was going to be doing basic-science genetics for rest of his or her life. It made me want to end mine right then.

Pros: There ain't a single student who can touch you on clinical rotations.

As for salary, those that you spoke about exist. I made 108K my first year out, and 120K my second. BUT...BUT...I was house-staff for in-house call Q3 as the "third" phantom resident.

As for responsibilties, it depends on your attendings. I happened to work with cool guys who taught a lot and let me do a lot. Opening, closing, proximals...distals (shh....). And all of the ICU managment...lines tubes, you name it.

After several stat pages for PEA and my assessment that certain patients had tamponade (this is just one of many examples) and just cracked their chest in their bed ON THE FLOOR, sticking my hands inside and massaging...one time I was kneeling on the bed asking for suture to go around my finger which was precariously placed in a 1 cm hole in the LV free-wall...after those types of things, clinical rotations as a medical student - where you have little to NO responsibility - was cake.

If I had to do it again though, I would be have majored in shakespeare like my girlfriend.

Might not have been exactly 6 cents, but hopefully more than just 2.

 

[patriot_missile]

Hi,
Please tell me about this 4-yr PA program. Does it mean after you finish the St John's program you are qualified to work in a rural er as a PA for example?

Also if you want to be a surgical assistant, should you do a 1yr PA residensy straight after this 4yr program?

Also i am already enrolling at a different college, and obviously a different major. But if i wanted it to, would it be possible to trasfer to this program for the year 2?

And yes i do have interests outside of medicine, thats why i planned to major in math. But if i can get such a steady job with flexible hours and relatively nice pay after only 4 years, i might have to think over my plans.
Thanks

 

[MacGyver]

Originally posted by SomeFakeName
However, nobody in their right mind would let a PA do the intricate steps in a surgery...for that you gotta go through the surgical training and become a legite surgeon.

You say that now, but I predict 20 years down the line this will be quite different than it is currently.

 

[ArrogantSurgeon]

Not even in a hundred years would anybody in his or her right mind let anybody except a surgeon perform the delicate/complex parts of an operation on them or their loved ones.

Are you going to allow a PA to clip a brain aneurysm or try to close a septal defect on a newborn? Even board-certified surgeons with years of experience have trouble doing these at times, let alone allowing them to be attempted by a PA. The PA can do all the routine parts of the operation that he/she is allowed to do by the surgeon, but not the complex stuff. Unless of course they have training equivalent to a surgeon, in which case they WOULD BE A SURGEON, and not a PA. Besides, the head surgeon sometimes doesn't allow the resident or fellow assisting him/her to do complex steps in an operation, what makes you think they'd let a PA do it?

Believe me, when it is you or someone you care about who needs an operation, especially if that operation is complex, you'll want the best surgeon you can find to do the delicate parts of the procedure, if not the entire procedure.

 

[droliver]

The technical aspects of just about anything can be taught, even the most complex of surgery to laypeople. What would be very diffucult (or impossible) to impart is the judgement you develop from surgery training

 

[Old Doc]

http://www.physicianassociate.com/forums/

 

[MacGyver]

Originally posted by droliver
The technical aspects of just about anything can be taught, even the most complex of surgery to laypeople. What would be very diffucult (or impossible) to impart is the judgement you develop from surgery training

True. Thats why PAs with good experience (maybe 10+ years) eventually will allowed to have the same practice scope as some surgeons.

 

[droliver]

No, I think you miss the point. There is no mechanism for the PA to get to that level of clinical training that we (the medical community) agree is indicated to be a practicing surgeon. The "PA with good experience" model is similar to the old apprentice-type training model that preceeded the modern Halstead system of surgery training. Going to that would clearly be a step backward for the final product. I mean to emphacise that the cognative discipline of surgery is much more elusive then the technical side

 

[Skylizard]

Originally posted by MacGyver
...Thats why PAs with good experience (maybe 10+ years) eventually will allowed to have the same practice scope as some surgeons.

I think we are back to the narrow view again. You seem to really ignore the concept of SCOPE OF PRACTICE. Just as a CRNA does NOT have the breadth of SCOPE OF PRACTICE that a MDA/DOA has, so too, a PA does NOT have the same breadth of SCOPE OF PRACTICE that a surgeon has. They may have experience which gives them technical skills. However, medicine as a whole is broader then that and requires of its technical practitioners skills and abilities beyond the OR. Surgeons do NOT spend 4 years in medical school in the OR. Surgeons do not spend all 80-120 hours of their 5-7 years of residency in the OR. Oral board exams and written board exams in surgery rarely if ever require a candidate to tie a "single hand knot". You will be asked things about electrolytes and TPN and basic sciences. Much of our training in medicine is "experiential" but is also on a continually expanding foundation of clinical & "basic science" that we keep abreast of and must do so. The "experiential" learning is actually quite organized with intervening clinical & "basic science" training (lectures, research, reading, etc...) to tie it all together and this takes place over the numerous years of our training starting in under-grad and extending into and beyond residency. We are not just "shadowing" some doctors and picking up random points of knowledge if our residency is working the way it is supposed to be working. To try and limit this sort of topic...once again, to just the technical OR stuff you propogate a dangerous misperception. That being that somehow one can become a good "physician" in surgery or anesthesia or Ortho, etc simply by completing undergrad and then spending a few years with a surgeon. I agree with the following

Originally posted by droliver
...the cognative discipline of surgery is much more elusive then the technical side

I would go one step further and apply this accross the board to physicians in general.

As per the original questions:

Originally posted by OwlMyste
...My major in college will be PA,...And I was wondering...In what ways do PA's help the surgeons in the O.R.?...Because If I decide not to be a surgeon, I want to be a PA in the O.R. ...I find Surgery facinating, thats why...🙂

I think it is important for you to get answers to these questions. I think ultimately how much or how little a PA does is dependent on the individual surgeon and the contractual agreement achieved at the time of employment. Salary will depend on the contract too. You should not base any career decisions largely on what you expect your salary to be as this will change greatly depending on economy, demand, and individual responsibilities. I have noted your profile says:

OwlMyste Profile
...I am Graduating High School on May 23, 2003!!!...
Undergrad School & Degree Nursing...

I note this because clearly you are early in your career, whatever that may ultimately turn out to be. Now is definately the time to go to career counselors at your school, get information from your school's career planning office, and maybe shadow some Nurses, PAs, and physicians. There is a great deal of published material out there that deals with these questions and you will likely get more accurate data from those sources. I have no titles for you. Your career/guidance counselor however will.

Some in this forum have talked about PAs doing "grunt work". I dare say the very definition suggests that PAs are in some way present to do "grunt work". Remember, they are NOT junior surgeons/physicians they are Physician Assistants. I think ultimately this comes down to doing those tasks that the physician (Derm, opthy, ortho, IM, surgeon, CT surgeon,...) does not want to do and feels the PA is capable of doing.

...PAs usually do the grunt work during the operation that the surgeon may feel is beneath his/her level...I've seen others serve as a glorified scrub nurse...

Ultimately, a good PA will do just about any task that will enable greater effciency and organization for the surgeon or surgical group. Most PAs I know find harvesting vein from a leg to be a privilege because it is a form of vascular surgery and a privilege for a non-surgeon to be allowed to perform this task to completion under the supervision of the surgeon. The same goes for chest "cracking". I do not see this activity as "grunt work". These are actually critical surgical procedures. Honestly, if a PA wanted to be allowed to do anastamosis routinely then they should pursue the training to be a MD/DO and then complete surgical residency. Remember, we in the surgical field may get bored with vein harvests but a vein harvest I would argue is more complex and more difficult to do well then the day to day grind of resecting a lipoma in the thigh. Monotony exists at all levels of the surgical career. The surgeon will get bored with doing lap-choles, etc... However, everyone in every field needs to be aware of what the day to day fundamentals of their job will entail and if that would be enough for you?