Physician Assistant Surgical Residenc? Yes or No?

[Medfieldfuture]

Hi, as the title sayswhat would some physicians and P.A 's think of this? As we all know all physicians are always busy, but surgeons are somewhat more busier than non surgical physicians. What my question to everyone on this is, would you guys think IF physician assistants were to take a 1 or 2 year residencyin surgery? But I'm not talking about major procedures, I'm talking about simple procedures like hernias, bowel obstructions ,appendicitis, and maybe some c-sections, that would be able to do to free up the surgeons to be able to preform more complex and difficult surgeries. Again the P.A 's would be limited to a very small variety of surgeries that I think most surgeons wouldn't even mind an intern doing those procedures. What would you think of the idea to start a surgical physician assistant residency for 1-2 years to do more simple, non life threatrning surgeries (even though any surgery can be life threatenig) to free up surgeons for more extensive and complicated surgeries? In advance thanks for all the replies (even the negative ones) but than you anyways.

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[mcloaf]

1-2 year residency in surgery?

Surgery residencies for physicians are 5+ years after they've spent more time in school than PAs.

I've received great care in the ER from PAs and I appreciate the work they do, but I'm definitely not letting one near me with a scalpel unless there's an MD/DO looking over their shoulder.

 

[JPodel]

Thank you but no thank you. That would not add up as it is still a surgical procedure in which the patient is under anesthesia. I would not want anyone but a surgeon who has had 5+ years after med school operating on anyone.

300th post shout out as well!

 

[Medfieldfuture]

So nobody thinks it would be a good idea for Physician assistants to take a 2 year residency to preform very simple surgeries that even interns could be able to do?

 

[mcloaf]

So nobody thinks it would be a good idea for Physician assistants to take a 2 year residency to preform very simple surgeries that even interns could be able to do?

It's not clear to me where you got the impression that interns do solo unsupervised surgeries.

 

[JPodel]

What do you mean when you say interns would be able to do? Like first year resident's? I may not be a 100% right but I don't think a first year resident can start doing procedures such as appendectomies by themselves, correct me if I am wrong.

 

[Medfieldfuture]

No I'm using that as an exaggeration, but if you come to think about it if PA's had that residency it would give them more of a knowledge if how to do procedures. Lets be realistic we all know that most doctors lets PA's cut open and close up the patients all by themselves and all those good things in between, why no give them an even more ability to do procedures if they have the ability to even do that. I mean if it happens that something goes wrong in a simple surgery we all know that a doctor is just a "page beep" away

 

[The Beyonder]

No I'm using that as an exaggeration, but if you come to think about it if PA's had that residency it would give them more of a knowledge if how to do procedures. Lets be realistic we all know that most doctors lets PA's cut open and close up the patients all by themselves and all those good things in between, why no give them an even more ability to do procedures if they have the ability to even do that. I mean if it happens that something goes wrong in a simple surgery we all know that a doctor is just a "page beep" away

You seem to be greatly underestimating the litigiousness of our society and the time it takes to learn to be a competent surgeon.

 

[JPodel]

Surgeons rarely let PA's do that stuff and even when they do, the surgeon is always present. I just don't see society and law allowing PA's just being by themselves regardless of how long of a residency they do during a procedure. That's why we have competent surgeon that have gone through some of the hardest and detailed training. Let's allow surgeons to keep doing their thing, we wouldn't want to snatch their job away and give it to a PA now. If the PA want's to be a part of surgery even more than what they currently do, they should go get themselves an MD. Then nobody will stop them from doing more procedures.

 

[medic25]

FYI, PA's already have surgical residencies; there are several nationwide, and the oldest program has been around for over 40 years.

http://www.montefiore.org/postgraduate-residency-physician-assistants-surgery

 

[Medfieldfuture]

No I understand what it takes to be a very competent surgeon as I have several family members that doctors themselves and surgeons, so trust me I know from first hand experience, I'm saying if a PA went through extensive training in VERY MINIMAL SMALL surgeries not huge transplant and cardio vascular surgeries but small ones that they could free up their main physician so they could do surgeries like I mention above that PA's with this extensive training would NOT be able to do because if limitation of practice scope. We are all used to doctors performing surgeries but we're also talking about very competent individuals that are very capable to do these task because of the simple reason, and we all know this they are trained in medical doctor model or am I wrong about that? That's why I'm asking this because if they are taught in the medical model why can they not take even more extensive learning to do very small surgeries?

 

[Mt Kilimanjaro]

So much hubris in the OP it's difficult to know where to begin. Let's just say there's a reason general surgery residencies are 5 years long.

 

[JPodel]

I don't think they would reassign scopes of practice to PA's so that they can perform by themselves even if it is a minimal procedure. It would be a huge legal issue and a lot of other stuff. And about freeing up physician time, I don't think that is a big problem in general surgery as a lot of the procedures are scheduled. And for the more specialized surgeries, they have specialist so they wouldn't be doing small things to begin with so there would be nothing to pass onto the PA.

 

[JPodel]

I say if the PA's want to perform surgical procedures such as Appendectomies and such, they should have to sit through the MCAT and go through med school because it wouldn't be fair to surgeons that had to go through all of that just so PA's can do it for them.

 

[Medfieldfuture]

All I'm saying is so PA's could help even more in surgeries that's it but I can understand your point

 

[NorthernLights1]

Fairness has no bearing on the discussion. The legal and competency reasons alone are enough to make the idea untenable. Note: I'm not saying PAs aren't competent (they are awesome!), but as has been mentioned, it's a bit of a ridiculous idea.

Even the "small" surgeries OP mentions are dangerous enough that a surgeon should be the only one performing them. You're cutting someone open for pete's sake, go to school for a decent amount of time first.

 

[yehhhboiii]

No I understand what it takes to be a very competent surgeon as I have several family members that doctors themselves and surgeons, so trust me I know from first hand experience, I'm saying if a PA went through extensive training in VERY MINIMAL SMALL surgeries not huge transplant and cardio vascular surgeries but small ones that they could free up their main physician so they could do surgeries like I mention above that PA's with this extensive training would NOT be able to do because if limitation of practice scope. We are all used to doctors performing surgeries but we're also talking about very competent individuals that are very capable to do these task because of the simple reason, and we all know this they are trained in medical doctor model or am I wrong about that? That's why I'm asking this because if they are taught in the medical model why can they not take even more extensive learning to do very small surgeries?

That's not what first hand experience is.

 

[survivordo]

So nobody thinks it would be a good idea for Physician assistants to take a 2 year residency to preform very simple surgeries that even interns could be able to do?

I am a surgical intern. You would not want me taking out your appendix or repairing your hernia. I would MAYBE consider letting a 3rd year do my appendix. The cases might appear easy when watching someone that knows that they are doing but they really are anything but. The main fear of letting an inexperienced PA perform these is that they would not be able to handle complications.

When I'm signing a patient up for an appy or lap chole they always say "it's an easy surgery right?" my response is always "these are the most common general surgical procedures we do" in reality it is easy... for someone who has had 5 years or surgical residency and X many years as an attending. Sure a well trained monkey might be able to perform your lap chole, but what happens when you get in there and it looks like a bomb went off? You want your PA taking care or you now? What about when you have a bunch of dead bowel in a femoral hernia that you can't quite get to, do you want your PA performing the ex-lap?

(a somewhat insulted) Survivor DO

 

[NYEMMED]

No PAs shouldnt be allowed to do anything solo in surgery. Their education and training is not up to par for that. There is NO such thing as a simple surgery. Your first day on a surgery rotation you will learn everything can and will have complications that only experience will get you through. In the first place surgical PAs do very little in actual surgery. They retract, help suture, maybe tie a few things off, and close the wound. The surgeon makes the cuts (opening), and the PA is an extra set of hands. If PAs want to be doctors then they need to go to medical school and become doctors.

 

[WDeagle]

This makes no sense. Why would I need to have a PA around to do my easy cases when I still have to supervise them and I could do the case faster and probably better? That sounds totally inefficient and would cost me money in the OR plus I would have to pay your salary. I need a PA to write orders, see consults, take care of the floor work, and help out in clinic and then maybe assist in the OR when its a bigger case. Basically I need someone to do all the things I don't like doing so I can be in the OR which if you are a surgeon is what you like to do obviously. What I don't need is to pay someone to do what I want to do so I can go do all the things I don't want to do.

Even to be a surgical assist a PA is overtrained and overpaid. You can train a tech for that. You cannot train a tech to run the floor, see consults, write orders, and see patients in clinic. That is what the PA is for.

 

[Ost3oclast]

This makes no sense. Why would I need to have a PA around to do my easy cases when I still have to supervise them and I could do the case faster and probably better?

This is all we need to say. We know that a physician is going to have to supervise a PA doing surgery anyway. Its a horribly inefficient and dangerous idea. Its already been said, if a PA/NP/ND/MA/BSN wants to do a doctors job, go to medical school. Why is this so difficult for people to grasp?

 

[Doctor Strange]

I don't understand why you keep making PA threads in the pre-allo forum. Kindly get out.

 

[Ost3oclast]

Also, OP, you already started a thread dealing with this exact issue (last post 4 hours ago) being discussed. Why don't you go ask PA's what they think of having more autonomy in the OR? Its pretty obvious what we think....

 

[Ost3oclast]

I don't understand why you keep making PA threads in the pre-allo forum. Kindly get out.

Beat me to it 🙂

 

[pandahunter]

makes me think the OP is:

1) actually not pre-med and is in PA school

or

2) Couldn't get into or is considering PA as an alternative career option and is fishing for some optimism that he/she will be able to do surgeries despite not making it into med school.

 

[Buzz Me]

I mean if it happens that something goes wrong in a simple surgery we all know that a doctor is just a "page beep" away

You want to avoid complications during the case. Cut the bowel during an appendectomy, or divide the common bile duct during a laparoscopic cholecystectomy, and it doesn't matter if you can get an attending surgeon in the room within 5 minutes. You've already done the patient a HUGE disservice and potentially endangered their life.

 

[1012526fs]

This makes no sense. Why would I need to have a PA around to do my easy cases when I still have to supervise them and I could do the case faster and probably better? That sounds totally inefficient and would cost me money in the OR plus I would have to pay your salary. I need a PA to write orders, see consults, take care of the floor work, and help out in clinic and then maybe assist in the OR when its a bigger case. Basically I need someone to do all the things I don't like doing so I can be in the OR which if you are a surgeon is what you like to do obviously. What I don't need is to pay someone to do what I want to do so I can go do all the things I don't want to do.

Even to be a surgical assist a PA is overtrained and overpaid. You can train a tech for that. You cannot train a tech to run the floor, see consults, write orders, and see patients in clinic. That is what the PA is for.

This is exactly what Surgical PA's are for. I'm currently a PA and see no point in replacing surgeons with PA's. However, PA surgical residencies already exist and do so to further train PA's in providing surgery clinic services, sometimes being a first assist as required by the surgeon, but mostly to do floor work, see consults, post-ops, etc. to free up the surgeons for more OR time.

OP, stop trying to get people to agree with you. What are you hoping for anyway?