PAs Role as transplant surgeons

[deleted6669]

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http://europepmc.org/abstract/MED/24090582
discuss.

 

[Baller MD]

If it must happen, better PAs than nurses.

 

[deleted6669]

Bio of the PA involved in study:
http://asp.cpmc.columbia.edu/facdb/profile_list.asp?uni=jc2009&DepAffil=Surgery

 

[Pir8DeacDoc]

If it must happen, better PAs than nurses.

NP's have more training and practical experience than PA's do. Head to head, a new NP is more equipped to take care of patients than a new PA.

 

[el_duderino]

NP's have more training and practical experience than PA's do. Head to head, a new NP is more equipped to take care of patients than a new PA.

But they're talking about performing surgery, not "taking care of patients."

 

[ACSurgeon]

NP's have more training and practical experience than PA's do. Head to head, a new NP is more equipped to take care of patients than a new PA.

How do you define "taking care of patients?" Nurses have more nursing experience. Their NP training is much less rigorous than that of PAs. Also, NPs vary in terms of how long they worked as an RN before becoming an NP. Some go straight through, so were ICU nurses for a dozen years. This will impact how ready a new NP is to take care of patients. I agree through, NPs will be able to 'guess' what the correct treatment is based on prior experience - although if the patient is a little atypical I would be they'd guess wrong. I would trust a PA to reason through things more than I would an NP (fresh out of school).

Finally, I would bet that at 6mo-1 year after graduation, PAs far exceed NPs with clinical decision making. Years down the road, I'm sure this equalizes again…

No data, just my biases.

 

[ACSurgeon]

http://europepmc.org/abstract/MED/24090582
discuss.

A well trained PA can be an excellent technician. They are good at what they do. Remember, it takes more to be a surgeon than being able to do an operation.

 

[Slack3r]

NP's have more training and practical experience than PA's do. Head to head, a new NP is more equipped to take care of patients than a new PA.

 

[Pir8DeacDoc]

that's a helpful response. I'm guessing you're a PA.
I honestly don't really care about the issue. But, would assume that since one person has a bachelors in nursing and then real world nursing experience, that counts more than someone with a bachelors in who knows what. The regulatory folks must agree at some level as the need for oversight is greater for a PA than an NP (who are allowed to practice independently in 19 states).

Anyway, feel free to provide concrete facts to the contrary, as it's an issue I know little about. But I'm glad I could at least stir up some action around here- things were getting too quiet.

 

[maxxor]

NP's have more training and practical experience than PA's do. Head to head, a new NP is more equipped to take care of patients than a new PA.

Have you looked at the NP curriculum? Here's the curriculum of an NP program that allows someone to walk in off the street with no prior nursing experience to become an NP within 3 years.

http://www.smartcatalogiq.com/Catal...aster-of-Science-Programs/Family-Specialty-NP

Compare this to your typical PA or MS3 who does a lot more clinical rotations during their full-time clinical year. If NPs and PAs are adequately "equipped to take care of patients" than I don't see why graduated medical students can't either.

 

[Pir8DeacDoc]

Have you looked at the NP curriculum? Here's the curriculum of an NP program that allows someone to walk in off the street with no prior nursing experience to become an NP within 3 years.

http://www.smartcatalogiq.com/Catal...aster-of-Science-Programs/Family-Specialty-NP

Compare this to your typical PA or MS3 who does a lot more clinical rotations during their full-time clinical year. If NPs and PAs are adequately "equipped to take care of patients" than I don't see why graduated medical students can't either.

Never really seen any curriculums. Thanks for the link. My understanding was NP's, much like CRNA's, had to have a certain amount of nursing experience prior to becoming an NP. It would appear that is not the case, at least from what I can tell from your link. That's interesting news.

That's not really the issue we're discussing, but medical students do take care of patients every day, it's called internship and residency. Just like midlevels, there's a lot of oversight in your work, but you can eventually get away from that with as little as one year of residency.

 

[maxxor]

That's not really the issue we're discussing, but medical students do take care of patients every day, it's called internship and residency. Just like midlevels, there's a lot of oversight in your work, but you can eventually get away from that with as little as one year of residency.

I imagine it is excruciatingly difficult to actually get a job as a non BE physician.

 

[thedrjojo]

http://europepmc.org/abstract/MED/24090582
discuss.

I've met the guy. He has done a ton of recoveries, and is really a special case that he is highly experienced. There has to be a serious learning curve for this type of gig, probably have to be a cardiothoracic first assist for multiple years and have many proctored recoveries prior to this working. Not sure how recreatable this experience is, nor how applicable it would be in other situations (other organs to be recovered which are harder to procure than lungs with more anatomical variety).

 

[Pir8DeacDoc]

I imagine it is excruciatingly difficult to actually get a job as a non BE physician.

You'd be correct, but it is possible in some states.

 

[SouthSideSteve]

The regulatory folks must agree at some level as the need for oversight is greater for a PA than an NP (who are allowed to practice independently in 19 states).

lol. You seem very ignorant regarding midlevels. Our OR secretary is doing a direct entry NP degree. She will graduate without ever touching a patient (save for the 400 or so clinical hours required).

Independent practice doesn't mean they are more capable, it just means patients suffer.

 

[Pir8DeacDoc]

lol. You seem very ignorant regarding midlevels. Our OR secretary is doing a direct entry NP degree. She will graduate without ever touching a patient (save for the 400 or so clinical hours required).

Independent practice doesn't mean they are more capable, it just means patients suffer.

Thanks for the helpful commentary on my ignorance. I don't employ a mid level and have rarely worked with any. Pardon me for not being up on the exact degree path for something that has no effect on my life. I don't really care what there qualifications are. Just stirring up a little conversation.

 

[dienekes88]

The title is a bit disingenuous. I have recovered about a dozen or so hearts and a handful of lungs (after doing a bunch of recoveries with senior residents to become certified). I would not call myself a transplant surgeon by any stretch of the imagination, because... I'm still a resident, and I haven't had the opportunity to implant. Having said that, I think that lungs are trickier than hearts, so good on him for clearly mastering this!

For better or worse, I'm sure the fellow arm of that study actually included 5 or 6 different people (or more) for 90 lungs, so each of them only ended up doing maybe 15 or 16 lungs on average, which is less than 10% of the experience of the PA. If you look at a place like the Shouldice Hernia hospital, you'll see that you don't even need to be a surgeon to do an inguinal hernia with excellent results. You just need to know how to do an inguinal hernia. The same goes for lung recovery. Or heart recovery. Nothing can replace experience.

I met a "procurementist" one time when I was out for a donor. I think he was from MUSC if I remember. He was a non BE physician (foreign trained).

Actually sounded like a pretty sweet gig I have to say. Obviously involves a lot of call/weird hours. But good pay, fun exposure anatomically, and no stress/liability

Disagree with no stress/liability. There never seems to be enough left atrium to split between the heart and the lungs. Just like there is always a huge battle over the IVC between the liver and the heart. Additionally, there are many potential points for injury even for someone who is experienced in organ recovery.

 

[Socrates25]

Wow yet another completely misleading title by emedpa.

I wasnt aware that harvesting donor organs is the same thing as being a "transplant surgeon"

Emedpa could have titled his post "PAs harvesting organs" or something similar but instead chooses a deliberately inflammatory title with the insinuation that this PA is the same thing as a transplant surgeon.

Of course if you read emedpa's posts on the PA forums he constantly brags about how he cracks open chests solo with no doc present so his bias should be obvious to everyone.

 

[deleted6669]

Of course if you read emedpa's posts on the PA forums he constantly brags about how he cracks open chests solo with no doc present so his bias should be obvious to everyone.

While I have first assisted with thoracotomies and placed chest tubes I have never claimed to have done a solo thoracotomy and would not do so. I'm sorry if some felt the title of my thread was inappropriate. I was only trying to stimulate discussion about this aspect of pa surgical practice. The article I quoted describes the PA as the surgeon in these cases:
"the physician assistant served as senior surgeon".