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Ortho PA Scope of Practice Question


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Hello all. I'll keep this brief. I just completed my third 8 hour stint shadowing Ortho PA's over at my local surgical center in Albany. In this practice, none of the PA's see their own patients: they are used exclusively in a "surgical capacity". Before shadowing, I had thought that this surgical capacity would include some level of involvement in procedures, whether it be operation of various arthroscopic tools or setting of surgical pins (done together with the Physician). This, I thought, was the whole purpose of a PA's surgical training in school. However, after 24 total hours of observing the PA's at this practice, it would seem that a PA's role in Ortho surgery is limited to the basic "First Assist" duties. Based on my observations, these included: physically prepping the patient on the table, holding the limb steady, holding the camera steady while the surgeon works, and sewing up the wound when done. I don't mean to belittle these tasks, but after 30 or so surgeries of these same simple, repetitive things, I'm suddenly very worried about my career choice. The PA's were also all very grateful that the Surgeons took the time to train them in the intricacies of each procedure, but I can't understand the purpose of this if they will never get to perform any of the steps at all. I never cared about being the "team captain", but I had hoped to have a future level of involvement above this.

 

For the experienced among you: is this the typical type of work that you do? I have great respect for the knowledge of all the Ortho PA's that I followed, but I got the impression that 90% of what they had learned could never be used in their scope of practice. :-_-:

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PAs won't be doing much orthopedic surgery on their own. If you want to be lead surgeon in procedures, go to medical school.

 

However LOTS of ortho PAs first assist in surgery, but also independently see patients both for evaluation, pre-op, and post-op...but I think the surgeon at least sees the patients once before going into surgery.

 

If you want more autonomy than that then go into FP or EM. Specialist physicians are there because THEY specialize in doing that particular job which requires a lot of specialization...and their PAs are part of the team that makes the physician more effective. Generalist positions, like FP and EM, generally require less specialization (although still some), and PAs have more autonomy.

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PAs won't be doing much orthopedic surgery on their own. If you want to be lead surgeon in procedures, go to medical school.

 

However LOTS of ortho PAs first assist in surgery, but also independently see patients both for evaluation, pre-op, and post-op...but I think the surgeon at least sees the patients once before going into surgery.

 

If you want more autonomy than that then go into FP or EM. Specialist physicians are there because THEY specialize in doing that particular job which requires a lot of specialization...and their PAs are part of the team that makes the physician more effective. Generalist positions, like FP and EM, generally require less specialization (although still some), and PAs have more autonomy.

 

Ah, I see. It's not so much that I wanted to do surgery on my own, I just thought that the PA would have a greater role in the surgery (people had often thrown around the term "assistant surgeon" to equate what a PA does). Damn, I usually manage my expectation so carefully. Guess I didn't fully understand what I was getting into. :saddd:

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It all depends on where. You were shadowing at a surgery center which is mainly a "move the meat" type practice. There are a lot of surgical (ortho and otherwise) that do lots procedurally and pre/post-op. The ultimate example of this is the military where I've seen an ortho pa do a hand tendon repair with an EM physician as the first assist.

 

ETA: obviously the above isn't the norm, but if you go PA and do a PA surgical residency, you could definitely find a job that gives plenty of autonomy in the OR.

 

 

Sent from my iPhone using Tapatalk 2

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  • 4 weeks later...

Not all orthopedic surgeries are the same. For example, assisting in a knee scope is different than revision joint replacements. If you have the opportunity to see some larger cases I think you'll change your tune. For brief scopes, I often do not assist (my time is better spent rounding or doing other things). For larger inpatient cases, you often need 4 pairs of hands (MD, PA, scrub and 2nd assist). While operating from across the table from my supervising physician on those cases, we are constantly working in tandem with one another and it's a totally different game.

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My uncle recently underwent quadruple-bypass open heart surgery.

 

The cardiothoracic surgeon served as the lead surgeon and initially met with my uncle and his family to explain the procedure. However, the CT PA was the one who saw my uncle during follow up visits before the surgery, where she explained that she would be the one harvesting the vessel from his thigh while the surgeon worked on his heart.

 

Not sure if this is the norm, but the surgery was carried out in Minnesota.

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Ah, I see. It's not so much that I wanted to do surgery on my own, I just thought that the PA would have a greater role in the surgery (people had often thrown around the term "assistant surgeon" to equate what a PA does). Damn, I usually manage my expectation so carefully. Guess I didn't fully understand what I was getting into. :saddd:

 

depends on the surgeon and the pa. some surgeons use PAs as human retractors. others use them as true first assists. I have a buddy who did a pa surgical residency. when he and his md patner do bilateral knees or hips he does one and the surgeon does the other.

at one of my urban trauma ctr jobs the ortho pas do all the procedures not involving the o.r.(tendon repairs, finger amputations, reductions, etc).

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  • 2 years later...

My uncle recently underwent quadruple-bypass open heart surgery.

 

The cardiothoracic surgeon served as the lead surgeon and initially met with my uncle and his family to explain the procedure. However, the CT PA was the one who saw my uncle during follow up visits before the surgery, where she explained that she would be the one harvesting the vessel from his thigh while the surgeon worked on his heart.

 

Not sure if this is the norm, but the surgery was carried out in Minnesota.

 

why is this under "ortho"?

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  • 2 weeks later...

I agree with noapostropheplz, I don't assist with scope as they are fairly straight forward so usually I'm never at the surgery center to assist unless its a rotator cuff repair or an ACL reconstruction. Usually during that time I'm rounding and discharging patients at the hospital. 

 

I'm in Los Angeles and have been working in a private practice setting with one attending for 1 year. Our bread and butter is total joints (shoulders, hips, knees) with trauma cases and a few sports medicine cases. Usually the surgical tech knows the surgery so set up is covered, I'm there to smooth out prepping, work in a first assist capacity and close the cases. I'm then responsible for rounding each morning at the hospital and discharging then making it to clinic on time. 

 

In the clinical setting I see follow up visits and my attending sees all new patients. He takes call from the ER as he likes to know what he's in for but if there is a relatively benign consult, I'll see them after clinic hours. Together we see about 30-35 patients a day. 

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