PA/NP's in surgery

[ayndim]

What do they do in there? I have seen some job postings for PA/NP in Surgery. Since I don't know a whole lot about their scopes in surgery it never occured to me that they would even be in there. I imagined that they would just be doing histories, and post op care but I saw an ad that mentioned OR duties, without spelling them out.

Thanks

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[emtp2pac]

pa's in surgery, do admission h+p's, 1st assist, write op notes, round on pts on the floor, write discharge summaries, etc
there are a few surgery focused pa programs( cornell, others) and a # of post grad surgical residencies( duke, johns hopkins, yale, others).
for a list with links to surgical pa residencies see www.appap.org
I will post a summary here in a sec from one of these.
this is the one at duke:
The Duke Physician Assistant Surgical Residency is an intensive 12-month program administered by the Department of Surgery at Duke University Medical Center. PA Residents will be members of the surgical team and will be involved in pre-operative, intra-operative, and post-operative patient care. The residency is designed to provide both advanced didactic education and a focused, surgical clinical experience so that trainees and graduates will have the skills to provide high quality perioperative patient care. The residency is attractive both for new PA Program graduates who are planning a surgical career and for practicing physician assistants who wish to redirect their careers toward one of the surgical specialties or enhance their knowledge and skills through post-graduate education.
CURRICULUM:
Didactic

Lectures, seminars and laboratories have been designed to provide PA Residents with a comprehensive understanding of the pathophysiology of surgical disease processes. Instruction will cover general surgery and subspecialty topics. Emphasis will be placed on the perioperative management of surgical patients including fluids and electrolytes, hyperalimentation, acid/base balance, surgical emergencies, complications, and evaluation of specific organ systems. Cadaver laboatories will include technical skills instruction and practice time for wound closure, chet tube placement, thoracentesis, endoscopic vein harvesting, placement f peripheral lines, etc. In addition to classroom/laboratory instruction, the didactic curriculum will include weekly Attending Rounds, Grand Rounds, M&M Conference and other conferences organized by the Department of Surgery. The initial didactic curriculum will conclude with preparation for clinical rotations. Time is designated for "rounding" with the surgical team and becoming familiar with the routine of the surgical service before assuming clinical responsibilities
Clinical

Physician Assistant Residents will be assigned a workload and duties similar to those of first year (PGY1) physician surgical residents. Duties will include history & physical examinations, writing patient orders and progress notes in the hospital record, responding to and evaluating patient problems, making rounds, ordering diagnostic studies, assisting in the operating room, and performing invasive procedures with appropriate oversight by the supervising physician. Night call will be assigned on a rotating basis. The PA resident will be assigned first-call responsibilities with appropriate supervision and within the scope of his/her practice parameters. The PA Resident will avail himself/herself of additional direction and/or assistance as needed.

Clinical rotations make up eleven months of the curriculum. Core rotations include 5-6 months on the General Surgery services including Vascular, GI, Colorectal, Surgical Oncology, Trauma, and Transplant; one month on Cardiothoracic, one month at Durham Regional Hospital, one month at the Ambulatory Surgical Center, and two months of electives. Electives can be chosen from a wide range of subspecialties including Plastics, ENT, SICU, Neurosurgery, Orthopaedics, Urology, Pediatric Surgery, and others.


typical job posting:
JOB DETAIL:

JOB # 321351
TITLE: Physician Assistant
TAGLINE: Seeking 2nd PA for a 2 surgeon/1 PA practice in Cardiothoracic Surg. Fam. oriented. Great opportunity. Bnft pkg; med, dental & life ins- retirement plan.
LOCATION: Texarkana, Texas FULL TIME/PART TIME: Full Time
CLIENT: Texarkana Cardiovascular & Thoracic Surgical Associates
PERMANENT/TEMPORARY: Permanent
POSTED: 11/11/2004 EMPLOYMENT/CONTRACT WORK: Employment
REPLY SENT: NO VISA WAIVER AVAILABLE: No

DESCRIPTION:
Duties include but not limited to: first and second surgical assist, minimally invasive saphenous vein and radial artery harvesting. Various artery procedures. Full preoperative patient care, including ICU management. Call schedule. Chart dictation.
Practice located in NE TX, between Dallas, TX & Little Rock, AR on I-30. Excellent Ed. opportunities, 2ndary schools, community college, Texas A&M--Texarkana(new 4-yr campus near future), Hlthcare, Entertainment, Shopping, Sporting events, outdoor recreation

 

[ayndim]

Wow, I had no idea midlevels could do so much. Does anyone know what PA/Np's do in the ER or ICU?

 

[deleted6669]

see.www.sempa.org for info on pa's in emergency medicine. in brief:
PAs are utilized in all areas of the ED and in all settings, from being the solo provider in a rural ED to providing patient care at a Level I Trauma Center. When staffing the ED, a PA typically sees the same patient acuity mix as the physician(s) with whom they work in the physician/PA team.
The Society of Emergency Medicine Physician Assistants (SEMPA) offers guidelines on the role of PAs in emergency departments.4 According to SEMPA's guidelines, PA practice commonly includes, but is not limited to, taking patient histories and performing physical examinations; recording or dictating the information; ordering, performing, or assisting in the performance of laboratory and patient screening procedures; initiating basic and advanced life support; and initiating IV therapy by peripheral, central, intraosseous routes, and venous cutdowns.

The guidelines note that PAs commonly perform injections; arterial puncture; venipuncture; arterial line insertion; thoracentesis; lumbar puncture; wound care, including debridement; suturing; incision and drainage of abscesses; reduction of closed dislocations and fractures; application of casts and splints; nasogastric intubation; removal of foreign bodies (including sutures); EKG; urethral catheterization; arthrocentesis; endotracheal intubation; local, digital, and IV regional nerve blocks; administration of medicines; referring patients to appropriate follow-up care or community resources; and other interventions and procedures as directed by the supervising physician.

In 1999 the American College of Emergency Physicians surveyed PAs to identify their work environment, their postgraduate needs, and the procedures PAs perform. George Molzen, M.D., ACEP board liaison to the task force conducting the survey, concluded that the PAs are in emergency departments "side by side with the physicians, picking up the next patient." The ACEP report showed that patients usually are randomly assigned to PAs (see Chart 1). A high percentage of PAs performs endotracheal intubation and reduces fractures (see Chart 2).

there are also pa residencies in em. I will post some info from one of them here:
The two-year program consists of thirty-eight semester credit hours. The degree awarded is a Master of Science Degree in Medical Science from Alderson-Broaddus College. The instructional content and hospital employment experience utilizes the emergency medicine physician residency training model as developed for physician assistants by the Department of Emergency Medicine at West Virginia University School of Medicine. Physician assistants in the Emergency Medicine track will be taught the knowledge and clinical skills to competently deliver emergency services in all areas of emergency, especially rural areas where equipment and facilities are sometimes limited. Full-time employment in an approved hospital emergency department is required while completing graduate courses. Students unable to secure employment by the start of the program on June 30th will be permitted to enroll if they agree to complete program arranged student rotations until paid employment is secured. This arrangement will permit students to meet all program objectives and enable entrance into the program and emergency medicine professsion. The program will work with students to obtain full-time employment while they complete student rotations. Student rotations will be available at West Virginia University School of Medicine, Department of Emergency Medicine and at other emergency departments in West Virginia. Out-of-state student rotations will be possible if arranged by the students and approved by the program director and medical director.

* YEAR I

Introduction to Emergency Medicine
Research
Emergency Medicine Core Content I
Advanced Pharmacology
Acute Care of Emergencies
Emergency Medicine Core Content II

* YEAR II

Teaching Techniques and Assessment
Personnel and Management
Emergency Medicine Core Content III
Emergency Medicine Procedures
Emergency Medicine Core Content I

pa's work in a variety of settings in em from fast track/urgent care all the way up to solo practice in pa only emergency depts(rural) with distant supervision(typically in the form of chart review).
sample job posting from national recruiter:

SOUTHWEST GEORGIA RURAL ER!

Rural Southwest Georgia Hospital has IMMEDIATE opening for Physician Assistant in the emergency room. Join team of two other PAs in sharing coverage duties. Must have at least three years experience in an emergency room and be capable of independent practice. acls/atls/pals required. Solo position requires comfort with a full range of medical and trauma patients.
Great quality of life in rural, agricultural based community with easy access to larger cities. Excellent hospital system with long history of physician assistant utilization. Salary $75-90K to start plus production bonuses. Exceptional cafeteria-style benefit package including paid CME, professional memberships, licensure, malpractice insurance, retirement and relocation!

YOU ALSO ASKED ABOUT PA'S IN THE ICU. THERE ARE A VARIETY OF PA HOSPITALIST AND ICU POSITIONS AS WELL AS NICU POSITIONS LIKE THIS:
JOB # 320407
TITLE: NICU Neonatal Physician Assistant
TAGLINE: NICU Neonatal PA needed!
LOCATION: Connecticut FULL TIME/PART TIME: Full Time
PERMANENT/TEMPORARY: Permanent
POSTED: 11/2/2004 EMPLOYMENT/CONTRACT WORK: Employment
REPLY SENT: NO VISA WAIVER AVAILABLE: Not specified

DESCRIPTION:
NICU Neonatal Physician Assistant

Hospital of Saint Raphael, a 511-bed community teaching hospital, has an immediate opening for a Neonatal Physician Assistant to work at a Level II nursery with level III rotation at Yale New Haven Hospital. Responsibilities will include attending deliveries of newborns and newborn resuscitation; and management of infants being cared for in NICU. Must be a graduate of an accredited Physician Assistant program, with a CT license.


in anticipation of your next question, these are the approved residencies for pa's in a variety of fields:

APPAP Programs By Specialty

DERMATOLOGY
Northeast Regional Medical Center/Kirksville College of Osteopathic Medicine 816-626-2191
UT Southwestern's Dermatology Physician Assistant Training Program 214-648-8806

EMERGENCY MEDICINE
Alderson-Broaddus College 304-457-6356
Medical College of Georgia 706-721-3365
U.S. Army 210-916-3598

FAMILY MEDICINE
Nova Southeastern University Clinics 954-262-1250

NEUROLOGY
*Neurological Associates of Northeastern New York, PC 518-381-6042

OB-GYN
Arrowhead Regional Medical Center 909-580-6320


ONCOLOGY
MD Anderson Cancer Center - The University of Texas 713-792-7475

ORTHOPEDIC SURGERY
Arrowhead Regional Medical Center 909-580-6330
Illinois Bone and Joint Institute 847-578-8689
NYU Hospital for Joint Diseases 212-598-6497
Watuga Orthopaedics 423-282-9011

PEDIATRICS
Norwalk Hospital/Yale University School of Medicine 203-852-2662

PSYCHIATRY
Cherokee Mental Health Institute 712-225-2697
University of Texas Medical Branch Correctional Managed Care 903-683-5781

RURAL PRIMARY CARE AND
HOSPITALIST PROGRAMS
Alderson-Broaddus College 304-457-6356

SURGERY
Alderson-Broaddus College 304-457-6356
Duke University Medical Center 919-684-2705
Montefiore Medical Center - University Hospital for Albert Einstein College of Medicine 718-920-6223
Montefiore Medical Center - Cardiothoracic Surgery Program 718-920-2144
North Shore University Hospital - Cardiothoracic Surgical Residency Program 516-562-4970
St. Joseph Mercy Hospital Cardiothoracic Surgery Program 734-712-7202
(General)
Arrowhead Regional Medical Center - General Surgery Physician Assistant Residency (909)580-6210
Norwalk Hospital/Yale University School of Medicine (General) 203-852-2188
Grand Rapids PA Surgical Residency 616-391-8651
Sisters of Charity Medical Center - St. Vincent's Campus 718-876-1234

UROLOGY
Northwest Metropolitan Urology Associates 773-775-0800

 

[ayndim]

Do NP's do the same procedures too? Or do I need to go to PA school after nursing school? I personally think they are both equal but I am not an employer. My dream was to be a CNM. But to be honest the hours, the ever looming threat of being sued (18 years after delivery) and the malpractice insurance is making me reconsider. I am a nursing student. Although I did consider med school (yes I have the grades and intelligence to get in), the amount of time I would spend away from my children during school and residency makes me think it is not for me. So being a midlevel provider would work out well for me. Just want to get a position that is interesting. Not interested in CRNA at all but ICU or ER sounds challenging.

Thanks for all of the info.

 

[OneiroKnight]

NP scope is just as broad as PA scope. Though post graduate curriculum doesn't seem to be as developed as the PA discipline. Maybe the reasons for that are that, unlike PA school, which is broader in training, NP school focuses on the specialty during the training. If you wanted emergency or acute care, then you should get into an Acute Care Nurse Practitioner (ACNP) program or Adult Nurse Practitioner (ANP). If you chose Family Nurse Practitioner (FNP) you could also get into acute care, but the training is not as geared toward that, more of a primary care focus. I am not familiar of any residencies such as the one posted above in emergency medicine, though I think we could use them. We usually need to go back to school for a second certificate, post masters, which would be another year or two, depending on the program.

It also seems that emergency rooms have a preference for PAs vs NPs. There are probably more NPs in primary care and family practice, and maybe about equal in specialties. I think to work as an NP in surgery, in the OR setting, one needs to complete a first assist program. All this stuff depends on the state you work in.

 

[hospPA]

Hi,
I noticed you said your dream would be to be a CNM. If you want to do OB, this is one area where the nursing track training may be better than PA. Another would be CRNA. I am a PA who went to PA school after being an RN. I felt the medical training and intensity of PA school in general would be better for me. That is a personal decision. NP's can do just fine too, and generally compete for the same jobs. Certain employers have preferences for either one, generally because of personal experience. That varies.
In general, NP's are trained in specialties where PA's are trained gererally. PA's are trained in both medicine and surgery, adult and pediatric. NP's generally primary care, either adult, pediatric, or family. Usually not surgery, although many practice in this area. From my experience, most do not assist in surgery, as they have no training in school to do this. Those who do were usually ICU or OR nurses who have assisted in procedures in their previous lives and were trained there.
Obviously, my bias is PA school, unless you want to do anesthesia or OB for sure. Keep in ming though, that the less specialized your initial training is, the more latitude you have to switch. If you do ANP and later wanted to see kids, you are out of luck. With FNP or PA, you are free to switch as many times as you'd like, when you dislike or burnout of certain specialties. In general PA school is more intense, and involves much more clinical training, in the area of 2500 hours vs. 500 or so for NP training. You can succeed with either. Hope this was helpful. Good luck in your decision.
Pat