Surgical 1st Assistant question:

[Rocketdog]

Checking out non-MD medical professions and decided to see if 1st Assisting in surgery would be a good for me me as a career? I'm asking Surgeons and other medical professionals because I'd like an answer from people who utilize 1st assistants on a daily basis and know the profession well.

I'm starting to "frown" on spending the next 4 to 8 years in school to practice as an MD/DO when I want to be involved in surgery or a surgical specialty of some sort. I'm at a point in my education when I need to either apply for medical school or choose a (slightly) different career path and see what 1st assistants do on a daily basis.

Are 1st assistants well respected and compensated reasonably well for their time? Do 1st assistants have to complete a surgical residency after graduate program graduation?

Most of the previous posts about 1st assisting are quite old, would like to find a fresh perspective!

Thank you!

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[607955]

If you want to assist in surgery becoming a PA is the way to do it. 2 yrs post graduate and you're done! Man I should've gone the PA route, oh well back to studying.

 

[Winged Scapula]

Checking out non-MD medical professions and decided to see if 1st Assisting in surgery would be a good for me me as a career? I'm asking Surgeons and other medical professionals because I'd like an answer from people who utilize 1st assistants on a daily basis and know the profession well.

I'm starting to "frown" on spending the next 4 to 8 years in school to practice as an MD/DO when I want to be involved in surgery or a surgical specialty of some sort. I'm at a point in my education when I need to either apply for medical school or choose a (slightly) different career path and see what 1st assistants do on a daily basis.

Are 1st assistants well respected and compensated reasonably well for their time? Do 1st assistants have to complete a surgical residency after graduate program graduation?

Most of the previous posts about 1st assisting are quite old, would like to find a fresh perspective!

Thank you!

The term surgical assist can apply to a number of training tracks:

1) RNFA - registered nurse, first assist; may or may not do nursing care in addition to FA

2) PA - typically hired by surgical practices to do all the work of a PA outside the OR with FA

3) CFA - certified first assist; see here for more information on this training track http://www.caahep.org/Content.aspx?ID=52

4) MD/DO - usually "retired" physicians

As noted above by @southernIM, there is a huge difference between being a surgeon and being a surgical assistant. Surgical assistants do not complete a "surgical residency" like surgeons do but may have additional training beyond their foundation education. Like everything some are respected and some are not. I work with them everyday and there are certainly ones I prefer.

In terms of reimbursement, assisting on high paying cases (classically the Ortho spine ones) can pay well. The retired Ob (in his mid 50s) I work with tells me he makes more assisting than he did in his private OBG practice. YMMV. However there are some restrictions, for example, I am told that CMS will only pay for a physician, PA or RN first assist, so for some cases as a CFA you might not be paid (if you are a salaried employee then that doesn't change).

The old threads on this topic are useful because the information hasn't changed.

 

[ram006]

@Winged Scapula @southernIM

borderline highjack related to your post - Have you ever heard of residents being first assist instead of moonlighting. It seems like it would be more compatible with work hours restrictions and pays pretty well. I've tried looking up ways to become "certified" but they always involve some expensive test, classes, etc.

 

[Winged Scapula]

@Winged Scapula @southernIM

borderline highjack related to your post - Have you ever heard of residents being first assist instead of moonlighting. It seems like it would be more compatible with work hours restrictions and pays pretty well. I've tried looking up ways to become "certified" but they always involve some expensive test, classes, etc.

I've never seen it but that doesn't mean that it couldn't be done, work hour restrictions notwithstanding.

One of the physicians that works with the company I use did three years of a surgical residency and then either dropped out or quit. I only mentioned this because he never finished any residency and does this as his full-time job.

I think the major issue would be the lack of hours that you would be able to provide. These companies have to get you credentials and have physicians on staff agreed to supervise you etc. – that's a lot of work for someone who might only be able to do a few cases here and there. You'd also need an unrestricted license and an NPI number to Bill.

 

[core0]

The term surgical assist can apply to a number of training tracks:

1) RNFA - registered nurse, first assist; may or may not do nursing care in addition to FA

2) PA - typically hired by surgical practices to do all the work of a PA outside the OR with FA

3) CFA - certified first assist; see here for more information on this training track http://www.caahep.org/Content.aspx?ID=52

4) MD/DO - usually "retired" physicians

As noted above by @southernIM, there is a huge difference between being a surgeon and being a surgical assistant. Surgical assistants do not complete a "surgical residency" like surgeons do but may have additional training beyond their foundation education. Like everything some are respected and some are not. I work with them everyday and there are certainly ones I prefer.

In terms of reimbursement, assisting on high paying cases (classically the Ortho spine ones) can pay well. The retired Ob (in his mid 50s) I work with tells me he makes more assisting than he did in his private OBG practice. YMMV. However there are some restrictions, for example, I am told that CMS will only pay for a physician, PA or RN first assist, so for some cases as a CFA you might not be paid (if you are a salaried employee then that doesn't change).

The old threads on this topic are useful because the information hasn't changed.

Just a correction. Medicare will only pay for physician, PA or NP as first assist. An RN without an NP won't be reimbursed. As far as other insurances your mileage will very.

 

[Winged Scapula]

Just a correction. Medicare will only pay for physician, PA or NP as first assist. An RN without an NP won't be reimbursed. As far as other insurances your mileage will very.

Thanks for the clarification.

 

[Kahreek]

First assistants, i heard that in oklahoma they started doing cholecystectomies on their own supervised by a general surgeon, who has quadrupled his income since then.
not

 

[Kahreek]

Well excuse my silliness.
But why

I've never seen it but that doesn't mean that it couldn't be done, work hour restrictions notwithstanding.

One of the physicians that works with the company I use did three years of a surgical residency and then either dropped out or quit. I only mentioned this because he never finished any residency and does this as his full-time job.

I think the major issue would be the lack of hours that you would be able to provide. These companies have to get you credentials and have physicians on staff agreed to supervise you etc. – that's a lot of work for someone who might only be able to do a few cases here and there. You'd also need an unrestricted license and an NPI number to Bill.

Why would an OB/GYn specialist retire at age of 50 and become a 1st assistant?

 

[Winged Scapula]

Well excuse my silliness.
But why

Why would an OB/GYn specialist retire at age of 50 and become a 1st assistant?

1) high malpractice rates; can be in excess of $250K/year for OB and Nsgy
2) tired of all the litigation
3) surgical assisting allows one to make their own schedule; work when they want, don't work when they don't want to
4) he makes MORE money than he did as an OB (due to no overhead, no malpractice)

There is a retired FM as well that I work with frequently.

 

[ram006]

First assistants, i heard that in oklahoma they started doing cholecystectomies on their own supervised by a general surgeon, who has quadrupled his income since then.
not

If that's true, that ***** is part of the problem.

 

[Winged Scapula]

First assistants, i heard that in oklahoma they started doing cholecystectomies on their own supervised by a general surgeon, who has quadrupled his income since then.
not

I would like to see a link for that.

Given that a CBD injury is one of the most frequently litigated surgical injuries, I can't imagine that the hospital would even allow that to happen.

 

[wholeheartedly]

The PAs here who work in surgery really seem to love their roles. Definitely worth looking into. My hospital always has positions posted for things like ortho PAs and Neuro PAs, operative and non operative.

 

[Smurfette]

The PAs here who work in surgery really seem to love their roles. Definitely worth looking into. My hospital always has positions posted for things like ortho PAs and Neuro PAs, operative and non operative.

If there are constantly positions opening up, they probably DON'T love their roles and keep quitting.
Our orthos seem to go thru PAs pretty quickly because they have to take call with their ortho doc.

 

[wholeheartedly]

If there are constantly positions opening up, they probably DON'T love their roles and keep quitting.
Our orthos seem to go thru PAs pretty quickly because they have to take call with their ortho doc.

Normally I'd agree with you, but it's not due to turnover. Just additional positions opening as the service decides utilization of PAs is working for them.

Although, yes, if you want to work in the OR you aren't going to have as cushy a schedule so that's definitely a consideration.

 

[Kahreek]

1) high malpractice rates; can be in excess of $250K/year for OB and Nsgy
2) tired of all the litigation
3) surgical assisting allows one to make their own schedule; work when they want, don't work when they don't want to
4) he makes MORE money than he did as an OB (due to no overhead, no malpractice)

There is a retired FM as well that I work with frequently.

i guess they made terrible career choices then. If somehow they couldn't have made more money and work less in a higher hierarchy place and secure a true retirement.
Why not starting working as a 1st assistant from the get go.

 

[Kahreek]

I would like to see a link for that.

Given that a CBD injury is one of the most frequently litigated surgical injuries, I can't imagine that the hospital would even allow that to happen.

of course I was being facetious, making an analogous comparison to anaesthesia. Look at the final word in my post.

 

[ram006]

i guess they made terrible career choices then. If somehow they couldn't have made more money and work less in a higher hierarchy place and secure a true retirement.
Why not starting working as a 1st assistant from the get go.

Prob bc they wanted to be a doctor. First assistants don't actually take care of patients. Some people actually do really enjoy the patient doctor relationship.

 

[Kahreek]

Prob bc they wanted to be a doctor. First assistants don't actually take care of patients. Some people actually do really enjoy the patient doctor relationship.

So they become 1st assistants because they wanted to be doctors. OK Not convinced.

 

[ram006]

So they become 1st assistants because they wanted to be doctors. OK Not convinced.

Wait what?

 

[Kahreek]

Still, why not from the get-go after residency for example. Seeing all these benefits:

1) high malpractice rates; can be in excess of $250K/year for OB and Nsgy
2) tired of all the litigation
3) surgical assisting allows one to make their own schedule; work when they want, don't work when they don't want to
4) he makes MORE money than he did as an OB (due to no overhead, no malpractice)

I guess this must be exceptions.

 

[Mad Jack]

i guess they made terrible career choices then. If somehow they couldn't have made more money and work less in a higher hierarchy place and secure a true retirement.
Why not starting working as a 1st assistant from the get go.

Not everyone wants to work in a hierarchical practice or manage others. It seems this person wanted to do OB, then decided to do something completely different that had none of the downsides if OB after they'd had their fill of their dream field. Surgical assisting sounds like a great second career for such a physician, as all the stuff they likely grew sick of- long call, malpractice issues, long hours, high responsibility- isn't really an issue as a first assist.

So they become 1st assistants because they wanted to be doctors. OK Not convinced.

It's entirely possible to get sick of anything after 15 or 20 years and want to do something else. People can drastically change over their lives, and what they thought they might enjoy when they were 22 and applying to med school might very well change by the time they're 50. There's nothing wrong with realizing you'd rather be doing something else with your time at this point in your life and moving on. It's certainly far better than the alternative of continuing to do something that makes you unhappy until you die, all on account of an application you sent out decades ago.

 

[Kahreek]

Well I guess it boils down to this :
i guess they made terrible career choices then. If somehow they couldn't have made more money and work less in a higher hierarchy place and secure a true retirement.

 

[Winged Scapula]

So they become 1st assistants because they wanted to be doctors. OK Not convinced.

Your naïveté is showing.

While I'm not sure why I need to defend someone else's choices, this particular physician trained 30 years ago. The practice of medicine, the regulations required and patient expectations were significantly different than what exists today. Malpractice insurance and litigation rates were a fraction of what they currently are.

And sometimes people's needs and interests change over time. Leaving his practice allows him to travel with his family, spend more time training for triathlons, and as he says, "medicine just wasn't fun anymore."

All of those are good enough reasons for me.

 

[Mad Jack]

Still, why not from the get-go after residency for example. Seeing all these benefits:

Maybe they actually, you know, wanted to practice the field of their dreams a bit before realizing it wasn't for them. Maybe practice was better in the early 90s when they started. Maybe they used to like the doctor-patient relationship but too many bad cases of former beloved patients turned litigants soured them on it. Who knows. But to say "they're happier now, why didn't they do this all along" neglects the entire journey that made them realize they could be happy first assisting, and the facts that people and the practice of medicine change with time. It isn't a cut and dry thing like you make it out to be.

 

[ram006]

So you're reasoning is if there are so many negatives that come along with OB, why not just finish residency and be a first assist?

 

[Kahreek]

Your naïveté is showing.

While I'm not sure why I need to defend someone else's choices, this particular physician trained 30 years ago. The practice of medicine, the regulations required and patient expectations were significantly different than what exists today. Malpractice insurance and litigation rates were a fraction of what they currently are.

And sometimes people's needs and interests change over time. Leaving his practice allows him to travel with his family, spend more time training for triathlons, and as he says, "medicine just wasn't fun anymore."

All of those are good enough reasons for me.

I understand his position, very well, I just find sad he needs 30 years to figure out all that.

 

[Winged Scapula]

Well I guess it boils down to this :
i guess they made terrible career choices then. If somehow they couldn't have made more money and work less in a higher hierarchy place and secure a true retirement.

This has nothing to do with him working in a job with "hierarchy" and not being able to retire. While I don't know his financial details I have no reason to believe that he wanted to retire and not work at all. I have no evidence that he left his practice because he made a bad choice or was financially insolvent. Or maybe he does need a little extra money – after all he looks pretty fit and healthy and has probably got another 30 years left to live, which is a long time.

There are plenty of these guys around: he's far from the only former physician who works as a surgical assistant.

 

[Kahreek]

So you're reasoning is if there are so many negatives that come along with OB, why not just finish residency and be a first assist?

yes.

In other topic in this forum, I was defending a user that was accused of choosing a specialty based on the number of hours worked. Many people said, blah blah, it is better to work 80h/week doing your dream. I said, you cant know for sure what is your dream or specialty vocation when applying for residency.

 

[Winged Scapula]

I understand his position, very well, I just find sad he needs 30 years to figure out all that.

No I'm afraid you don't. It's not like it took him 30 years to figure it out. Things change slowly over time; at some point you tip over into the loss column and you need to make a decision about what to do.

You're acting like he's been miserable for 30 years and finally decided to do something different and that he should've made the decision to be a surgical assistant 30 years ago.

Your argument makes no sense.

 

[Kahreek]

What are you even talking about? Not only are you naïve but you're acting like an dingus.

This has nothing to do with him working in a job with "hierarchy" and not being able to retire. While I don't know his financial details I have no reason to believe that he wanted to retire and not work at all. I have no evidence that he left his practice because he made a bad choice or was financially insolvent. Or maybe he does need a little extra money – after all he looks pretty fit and healthy that is probably got another 30 years left to live which is a long time.

There are plenty of these guys around: he's far from the only former physician who works as a surgical assistant.

As some user here posted eloquently
“Man.
Because he sacrifices his health in order to make money.
Then he sacrifices money to recuperate his health.
And then he is so anxious about the future that he does not enjoy the present;
the result being that he does not live in the present or the future;
he lives as if he is never going to die, and then dies having never really lived.”
Ghandi

 

[Kahreek]

No I'm afraid you don't. It's not like it took him 30 years to figure it out. Things change slowly over time at some point you tip over into the loss column and you need to make a decision about what to do. You're acting like he's been miserable for 30 years and finally decided to do something different and that he should've made the decision to be a surgical assistant 30 years ago. Your argument makes no sense.

Maybe it will take you 30 years too, to figure that out. Things do change over time, but time doesn't.

 

[ram006]

yes.

In other topic in this forum, I was defending a user that was accused of choosing a specialty based on the number of hours worked. Many people said, blah blah, it is better to work 80h/week doing your dream. I said, you cant know for sure what is your dream or specialty vocation when applying for residency.

Ya. I agree with others, you're misinterpreting the reason people transition to lower stress positions. Things evolve over time.

I somewhat agree with the second part of your post( the bit about not knowing what your dream specialty is before you actually get out there and start actually being a doctor) but that's a bit of a moot point in this discussion.

 

[Mad Jack]

Well I guess it boils down to this :
i guess they made terrible career choices then. If somehow they couldn't have made more money and work less in a higher hierarchy place and secure a true retirement.

I understand his position, very well, I just find sad he needs 30 years to figure out all that.

To some people a career is more than a means to pay the bills and bankroll their retirement. He might very well have enjoyed OB practice for a solid decade or two then changed his mind as things got worse. You make it sound as if the guy did something he hated for decades then realized he was better off as an assistant, which is very unlikely to be the case.

Anyway, to the OP: physician assistant is the way to go if you want to first assist. Just be ready for long hours if you want to make the real money. I work with a lot of PAs who are well respected members of the surgical team, both in the OR and ICU. They also work 60+ hours a week and take call to assist on certain cases, so they're looking at the surgery lifestyle with substantially less pay and autonomy. I've never known a PA who clocks OR time that has all that great of a schedule, as you finish when the cases do and the shifts are usually long to begin with even if the cases wrap on time. There's probably cushier jobs out there at elective surgicenters and whatnot, but I don't know any PAs in that sort of setting.

In any case, the biggest advantage you'll gain as a PA is flexibility. If you decide the OR life isn't for you, transitioning to EM, FM, or IM is as simple as applying for a new job.

 

[Winged Scapula]

As some user here posted eloquently
“Man.
Because he sacrifices his health in order to make money.
Then he sacrifices money to recuperate his health.
And then he is so anxious about the future that he does not enjoy the present;
the result being that he does not live in the present or the future;
he lives as if he is never going to die, and then dies having never really lived.”
Ghandi

And how is that relevant?

If anything this bolsters my argument that he left his practice because he no longer found it fulfilling and realized that he had a lot of life left and he should enjoy it.

 

[Winged Scapula]

Maybe it will take you 30 years too, to figure that out. Things do change over time, but time doesn't.

Stop being intentionally obtuse.

 

[Mad Jack]

Maybe it will take you 30 years too, to figure that out. Things do change over time, but time doesn't.

Are you touched or something? It seems you don't understand that people change, interests change, etc. You can be very happy doing something today that will make you unhappy 20 years down the line. For most people, no single career or interest will keep them happy in perpetuity.

The other thing you should note is that many people actually enjoy working, and continue to work into retirement because it provides them with a sense of satisfaction that they can't get elsewhere. Lazing around all day is fun for a bit, but given a couple months of it, most retirees stay itching to do something, no matter how secure their finances. Man did not evolve to lounge about all day.

 

[Kahreek]

This thread made my realize i want to first assist in winged scapula team.
ligating my morning, riding dirt bike into arizona desert sunset in the afternoon.

 

[ram006]

This thread made my realize i want to first assist in winged scapula team.
laquering my morning, riding dirt bike into arizona desert sunset in the afternoon.

Applying a clear or colored wood finish to your morning?

 

[Kahreek]

😀 damn you all

 

[ram006]

😀 damn you all

Wait wait wait... laquering your... morning wood?

 

[Kahreek]

 

[ram006]

suuuuuuper creepy