Surg Tech First-Assist

[DylanAsdale]

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How do surgeons typically respond to surgical technologists? (Please note that I am pursuing first-assist, not simply a surgical scrub tech, etc.) (Also, I am not ruling out the possibility of going to med school after it either, if I find my passions would be better served as a surgeon).

What has been the most you've ever seen a surgeon allow a first-assist do? Have they ever allowed them to make the first incision, do the initial surface disinfecting, etc?

I'll be getting my certification at an actual hospital, not a community college, so I'll be able to move onto first assist faster (unless I decide to go to the extra 16 credit hours to get my associate's).

The surgeons here: would you be willing to teach the first assist more / allow them to do more if you knew they were considering medical school?

Thanks for your guys' input!

 

[FutureCTDoc]

First assist is usually done by another physician, I know on vitrectomies a surgeon usually assists at the ASC I usually shadow at. If not a scrub nurse is utilized. Surgical technologists aren't nearly as wanted and in the local ASC, they've recently expanded and have added surg techs. In my experience the RNs are a lot better at it.

 

[Winged Scapula]

First assist is usually done by another physician, I know on vitrectomies a surgeon usually assists at the ASC I usually shadow at. If not a scrub nurse is utilized. Surgical technologists aren't nearly as wanted and in the local ASC, they've recently expanded and have added surg techs. In my experience the RNs are a lot better at it.

That is inaccurate.

Most surgical assists are not physicians but rather RNFAs or PAs (especially in academic hospitals) or CSA (especially in the community). There are MD/DOs who work as surgical assists and some insurance companies, Medicare most notably, will *only* pay for a physician assist. However, the rosters at most surgical assist companies are not filled with physicians but rather CSAs, etc.

Bear in mind that many procedures and surgeries are non-assist allowable by insurance companies.

 

[Winged Scapula]

How do surgeons typically respond to surgical technologists? (Please note that I am pursuing first-assist, not simply a surgical scrub tech, etc.) (Also, I am not ruling out the possibility of going to med school after it either, if I find my passions would be better served as a surgeon).

I work closely with some very good CSAs and enjoy their company and respect their experience.

The skill level is HIGHLY variable; some are very good and actually assist, knowing what my next move will be. I can relax and trust that the case will go well. Others are sometimes more of a hindrance than an assist and that includes a couple of MDs hired by the surgical assist company.

I don't know how all surgeons "respond" to a Surg Tech but IMHO the CSAs are much much better assistants to Surg Techs (who really haven't been trained to assist much and frankly, since they are often hospital employees are watching the clock as opposed to the CSA who is there until the case is over, regardless of what time it is).

What has been the most you've ever seen a surgeon allow a first-assist do? Have they ever allowed them to make the first incision, do the initial surface disinfecting, etc?

The "initial surface disinfecting" aka "the prep" is generally done by the circulating nurse in the room. It is not the job of the surgeon or the assist to do, although I have admittedly grabbed the prep and done it myself when frustrated by the slowness of the circulator who seems more interested in charting and tapping on the computer than getting the work done. But if the surgical assist wants to prep, go for it.

Incisions? Depends on the case, the surgeon, etc. I've certainly seen PA-S harvesting vein from the leg for a CABG

I'll be getting my certification at an actual hospital, not a community college, so I'll be able to move onto first assist faster (unless I decide to go to the extra 16 credit hours to get my associate's).

The surgeons here: would you be willing to teach the first assist more / allow them to do more if you knew they were considering medical school?

Sure. But bear in mind that most surgeons, especially in community/PP aren't interested in working with a new assist. Time is money and I can tell you from (recent) experience that having a new assist wastes my time because you don't know what you're doing, you suture very slowly, etc. This is a common complaint...even with MD assists (those coming from a non-surgical field). You will have to earn your stripes and although I am willing to teach ANYONE who wants to learn (not just an assist who might want to go to medical school), there are time constraints.

By way of example, I ran over an hour behind yesterday because I have a med student with me and wanted him to do some suturing, etc. Its not a big issue if I'm late, but since anesthesia wants to go home, the families of patients are getting anxious about what's taking so long, etc. I have others to consider when allowing assists to do more.

Finally, many very young surg techs talk about going to medical school. Few ever do (just like most pre-meds). So excuse us if we nod and smile when you tell us you're interested in medical school.

 

[FutureCTDoc]

That is inaccurate.

Most surgical assists are not physicians but rather RNFAs or PAs (especially in academic hospitals) or CSA (especially in the community). There are MD/DOs who work as surgical assists and some insurance companies, Medicare most notably, will *only* pay for a physician assist. However, the rosters at most surgical assist companies are not filled with physicians but rather CSAs, etc.

Bear in mind that many procedures and surgeries are non-assist allowable by insurance companies.

In ophthalmology I know that most physicians doing more complex surgeries especially vitrectomies prefer having another MD or DO preferably an ophthalmologist do it. In my father's practice we utilize a MD as an assist. The assist is an ophthalmologist, who is semi-retired. In the case of vitrectomies you want someone who knows what they're doing. Based on what you're saying I'm guessing you're talking about G Surg where the Assist fee is too low to merit having one.

 

[Winged Scapula]

In ophthalmology I know that most physicians doing more complex surgeries especially vitrectomies prefer having another MD or DO preferably an ophthalmologist do it. In my father's practice we utilize a MD as an assist. The assist is an ophthalmologist, who is semi-retired. In the case of vitrectomies you want someone who knows what they're doing. Based on what you're saying I'm guessing you're talking about G Surg where the Assist fee is too low to merit having one.

I understand that many physicians may prefer another surgeon as an assist. However, your earlier post indicated that most assists are physicians, implying that this is true for all types of surgery, and not that it was a preference. That may be the case for ophtho. However, ophtho is a very small field and your (father's) experiences are not those of the field of surgery in general. Frankly any assist who is well trained in the particular procedure one is doing is preferable - regardless of the letters behind the name. The fact is that in general surgery, ortho, neuro, etc. assists are often NOT physicians. I suspect that most of your father's patients are Medicare. As I noted above, if an assist is allowed, Medicare only reimburses if that assist is a physician, which explains why your experience may be skewed. However, many surgical assist companies will send non-physicians on a Medicare case and just eat the cost, figuring that its good for business and that they'll make it up on the big paying spine cases.

In addition, the issue is not that the "assist fee is too low to merit having one" in general surgery but rather insurance companies decide what CPT codes merit an assist. I don't get to decide whether an assist is paid for, nor do I get to decide what they are paid. As a matter of fact, in many cases, if you bill as a second surgeon, they will deny it - stating that the procedure doesn't call for a "second pair of skilled hands." Insurance billing doesn't work that way.

 

[maxheadroom]

First assist is usually done by another physician, I know on vitrectomies a surgeon usually assists at the ASC I usually shadow at. If not a scrub nurse is utilized. Surgical technologists aren't nearly as wanted and in the local ASC, they've recently expanded and have added surg techs. In my experience the RNs are a lot better at it.

Gotta agree with WS on this one. While it might be different in South Florida Ophtho, it's pretty rare to see a MD as an assist in most ORs or ASCs these days. I spend a fair amount of time at an ASC where the Ophtho guys work a lot and they do their cases with either a RNFA or a CSA.

 

[FutureCTDoc]

Gotta agree with WS on this one. While it might be different in South Florida Ophtho, it's pretty rare to see a MD as an assist in most ORs or ASCs these days. I spend a fair amount of time at an ASC where the Ophtho guys work a lot and they do their cases with either a RNFA or a CSA.

It's not SoFl , my dad practices in New England. It depends on the case for a vitrectomy, it's worthwhile as the assistant collects about 15% for an assist fee or a little shy of $300 a case, of course this is a far cry from the ASC golden age.