salus69 Posted April 18, 2004 Share Posted April 18, 2004 I am considering becoming a PA and I was curious as to what duties does a surgical PA have? In surgery are you the surgeon ALWAYS operation on the patient together or are some minor surgeries done soley by you? Thank you. Link to comment Share on other sites More sharing options...
SurgPA05 Posted April 18, 2004 Share Posted April 18, 2004 Thanks for your inquiry: Your question, although seemingly simple can actually be quite complex to answer given the variable roles and situations encompassing SPA practice. For the most part PAs perform assistant surgeon duties in the OR under the supervision of a surgeon. This can mean either direct or indirect supervision. For example PAs may provide the initial exposure for an operative procedure provided their supervising physician is immediately available and in the OR unit. Also and quite frequently, PAs close the patient without direct supervision, but with the surgeon nearby (ie. PACU, ICU, etc..). Also PAs frequently primarily perform parts of the operation under indirect supervision, meaning that the PA does a part of an operation him/herself without the surgeon, or more frequently while the surgeon is performing other parts of the operation. Examples include when the PA harvests the saphenous vein independently while the thoracic surgeon opens the chest and dissects the internal thoracic artery, or when a PA in orthopedic surgery prepares the tendon graft during an ACL reconstruction independent of the surgeon, or when a PA performs their side of the dissection and ligation of the uterine arteries and ligaments in an abdominal hysterectomy......and on and on. Surgery, perhaps more than any other area of medicine requires a team effort and in particular requires two practioners who are very familiar with the procedure and techniques to efficiently and competently perform an operative procedure. At times the logistics of any operation requires that one person who has the best vantage point or exposure perform the necessary task and many time this is simply a function of which side any one person might be standing on the OR table. So if it is easier for the guy on the left side of the table to get to that bleeder and tie it off, or to dissect the tissue or place the screw or what have you, that person on the left side of the table should be as competent at that task as the other person....this is sort of the crux of having a good "assistant".....really the best assistant is someone the surgeon can trust to do the job he does given that many times the "assistant" is called upon to perform any and all tasks the surgeon does. The procedures that PA's perform, without direct supervision usually occur outside of the OR and usually in the pre or post-operative phase. These would include insertion/removal of chest tubes, Swan-Ganz catheters, central venous lines, and Intra-aortic Balloon pump. Also many procedures performed by PAs encompass care in an acute care settings such as application of traction devices, closure of lacerations and wounds, reduction of nondisplaced or non-operative fractures and placement of casts/splints etc.. Also many procedures are performed by PAs in a non-acute care setting, like clinics and offices such a removal of skin and subcutaneous lesions, laceration/wound closures, joint injections and aspirations and the list goes on and on........I hope this was helpful and that you get a feel for what PA's do. I feel I must add that although PAs can and do perform many complex and invasive procedures, it should be noted that ultimately they must have some degree of physician supervision, whether indirect or direct, whether actual or implied......by definition PAs are not independent practioners, but that does not mean they don't perform tasks/procedures independently. Below are links to scope of practice descriptions for PAs in various surgical specialties from the American Association of Surgical Physician Assistants: http://www.aaspa.com/cts.htm http://www.aaspa.com/ns.htm http://www.aaspa.com/os.htm 1 Link to comment Share on other sites More sharing options...
salus69 Posted April 18, 2004 Author Share Posted April 18, 2004 Thanks for the very informative post. Salus69 Link to comment Share on other sites More sharing options...
Guest fincherdc Posted March 24, 2005 Share Posted March 24, 2005 As was mentioned by the moderator, individual experiences vary greatly. I just graduated last year and am now working in cardiothoracic surgery and really enjoy it. You have to enjoy the OR environment to enjoy being a surgical PA. I have seen ortho PAs at work and can tell you that the ones that I have seen, see pts. in the office, apply casts, give steroid injections, assist in surgery, usually by holding legs, arms, retractors, etc. and closing. I have only met one general surgery PA and I don't know exactly what she did. In cardiothoracic surgery (my field), you probably get the most opportunity to do many procedures on your own. I will often harvest saphenous vein while the surgeon is working in the chest, this includes everything from pre-op doppler to find the vein, making the initial cut, harvesting the vein, perparing it for grafting and closing the leg back up. I have also put in central venous lines and chest tubes, all in my first 2-3 months on the job! I also round on patients in ICU, nursing floors, do pre-op H&Ps, discharge, pre-op, post-op orders, and see patients in clinic one day a week. One of my favorite things about surgery is that you concentrate so much on what is going on, that time flies very quickly while you are in the OR. I also like to fix things with my hands, it is very satisfying to directly fix things with your hands. I feel like this job gives me a lot of variety, but I know it isn't for everyone. Link to comment Share on other sites More sharing options...
caine Posted March 25, 2005 Share Posted March 25, 2005 Hey, Fincher did you do a CT residency or did the doc train you to do all the procedures Thanks Link to comment Share on other sites More sharing options...
Flotsam Posted March 25, 2005 Share Posted March 25, 2005 General Surgery PAs can have a significant amount of autonomy. In my job, I may be in the OR one minute (where my role has varied from 1st assist to "primary surgeon", depending on which attending I am working with, and the nature of the case). I could be on the floor, involved in the primary management of the surgical patients, seeing consults on the floor or in the ED, etc... I routinely put in central lines, put in chest tubes, perform I&Ds, debridement, etc... After my first month of employment, I was taking independent night call (with attending and senior surgical resident backup by phone). I would highly suggest an academic environment for new grads - there are lots of jobs out there where you work as a resident externder (thanks to the new work hours rules). It's a great place to learn the ropes - the residents & attendings are used to teaching, and you'll get a variety of approaches to problems & procedures. I've found my job to be rewarding in many ways. I've developed my clinical acumen (although some of it has been "trial by fire"), developed an excellent working rapport w/ the attendings & residents (for many of which I and my fellow gen. surg. PA were the first PAs they had worked with). PA positions have continued to flourish at my hospital - with most services showing increased interest, if not actively recruiting them. When I started, there was only a couple of PAs who occasionally moonlighted in the ED, but no permanent staff. Now there are PAs in Ortho, gen Surg, Cardiology, Anesthesia, Neurosurg, the NICU (Once the domain of the NP at our hospital) - I keep running into new ones every year. Sam 1 Link to comment Share on other sites More sharing options...
Guest fincherdc Posted March 29, 2005 Share Posted March 29, 2005 It was all on the job training; I happen to work at a VA hospital though. VAs are pretty much universally teaching hospitals so I was lucky to run into this job. I have noticed from looking around before this job though, that most private practices/hospitals in CT surgery want you to have some experience. Link to comment Share on other sites More sharing options...
Guest Joebird Posted December 5, 2005 Share Posted December 5, 2005 So my question is if you become a Surgical PA and then later on decide you would rather work in something other than surgery (such as in the ER) Are they able to do that??? Or would that require additional classes??? Link to comment Share on other sites More sharing options...
CTS-PA Posted December 6, 2005 Share Posted December 6, 2005 "...Are they able to do that??? Or would that require additional classes???" Yes, they can do that. No, additional classes are not necessary. Link to comment Share on other sites More sharing options...
SurgPA05 Posted December 6, 2005 Share Posted December 6, 2005 So my question is if you become a Surgical PA and then later on decide you would rather work in something other than surgery (such as in the ER) Are they able to do that??? Or would that require additional classes??? Surgical PAs are PAs just like any other. They have recieved the same generalist training as all PAs are required to complete in order to be be designated and licensed as PAs, they simply work in a surgical practice just like a PA may work in any field....and yes a PA who works in surgery may work in any other field and the same is true for any other PA who choses to work within any other specialty. For instance I currently work in a spine surgery practice but also moonlight on weekends at an urgent care clinic....that is one of the most tangible positives for PA practice...job portability. 1 Link to comment Share on other sites More sharing options...
Guest sosoraff Posted September 25, 2006 Share Posted September 25, 2006 does it ever occur that patients refuse to be surgically treated by a PA?? I know some areas on the map are more "PA friendly" then others. But it most occur that sometimes a patient will be un-educated on the PA profession and therefore not quite trust a PA to do their surgery. Whats the secret to getting their approval and/or being a succesful PA in this manner. Thank you all for the help. Link to comment Share on other sites More sharing options...
andersenpa Posted September 25, 2006 Share Posted September 25, 2006 I've never had this problem. In my opinion if the patient trusts the surgeon to peform the operation, they trust his/her jugdement to choose their assist..... Link to comment Share on other sites More sharing options...
Guest bsnfreeman Posted September 25, 2006 Share Posted September 25, 2006 Forgive my naivete, but in considering PA schools, and reading about the amount of OJT, are programs like UAB's surgical program worth the effort, or do MD's really consider where you were educated? Link to comment Share on other sites More sharing options...
firefowl Posted March 20, 2007 Share Posted March 20, 2007 Ooh, ooh, I'd like to hear the response for this question! Thank you Link to comment Share on other sites More sharing options...
andersenpa Posted March 20, 2007 Share Posted March 20, 2007 A Surgical PA program provides exposure to a wider array of surgical specialties; this doesn't necessarily translate into a greater skill set acquired. Between to otherwise equal candidates, the one with a Surgical program on their CV might have an edge..... However as a new grad, even from a surg program, you are still green and will likely go through your first job as a route to gain experience and make yourself more marketable. My answer- I don't think it matters. Go to a program w/ good gen surg, ortho and ER rotations and the option to do an elective in a surg specialty, using the rotation sites to make contacts for future jobs. Link to comment Share on other sites More sharing options...
SurgPA05 Posted March 20, 2007 Share Posted March 20, 2007 . My answer- I don't think it matters. Go to a program w/ good gen surg, ortho and ER rotations and the option to do an elective in a surg specialty, using the rotation sites to make contacts for future jobs. I normally agree with anderson, however in this case, as a graduate from a surgical program I have to differ. I actually had formal didactic classes in pre-op evaluation, basic and advanced surgical techniques, invasive skils workshops and separate 6 week clinical roations in cvt, gyn, general, vascular, ortho and neuro surgery and surgical ICU along with the other obligatory rotations in primary medicine so if you compare the generalist education of a standard PA program with a program like cornell or UAB I think a graduate actually comes out with much more on their plate in terms of education and even skill set with regard to surgery than a graduate of a standard PA program. However I will temper those statements to reitterate the sentiment intimated from anderson which is that regardless of your didactic schooling most of what you really need to know to competently practice within a surgical (or any) specialty is learned on the job. However it is my opinion that a graduate from a surgically focussed program definitely would have a "leg up" on the non-surgical graduate for about the first year after school...then the difference would probably be less noticeable. That's my $.02 Link to comment Share on other sites More sharing options...
Guest bsnfreeman Posted April 3, 2007 Share Posted April 3, 2007 Thank you SurgPA05 and Andersonpa for your response and candor. I wasn't sure my question would ever be addressed, so thank you. In talking to physicians and PA's alike on my own, it seems they would agree with you. I am a big fan of education and think I would love to go into a surgically concentrated program, but it sounds like the effort and pains of moving my family to either UAB or Cornell and paying OOS tuition only to be more marketable in the first year doesn't appear to be a practical choice. If, however, I lived in AL or NY I wouldn't hesitate to apply to these schools. Link to comment Share on other sites More sharing options...
Guest q8paramx Posted February 22, 2008 Share Posted February 22, 2008 For physicians, before one becomes a cardio-thoracic surgeon, he must undergo training first in general surgery. Meaning cardio-thoracic surgery is a subspecialty in the field. Is it also the same as in PA training? Link to comment Share on other sites More sharing options...
coloradopa Posted February 22, 2008 Share Posted February 22, 2008 For physicians, before one becomes a cardio-thoracic surgeon, he must undergo training first in general surgery. Meaning cardio-thoracic surgery is a subspecialty in the field. Is it also the same as in PA training? PA training is generalist training that is then supplemented either through post grad training in the specific field or on the job training by the practice. So there is no need to do additional surgical training before doing CVS. David Carpenter, PA-C Link to comment Share on other sites More sharing options...
Guest ypennesi Posted February 23, 2009 Share Posted February 23, 2009 Which school did you attend surgpa05? If I were to attend a program with a surgical concentration like UAB, do any of you think it would be a good idea to also attend a PG surgical residency? Besides Cornell and UAB, are there any other programs in the country with a surgical focus? Link to comment Share on other sites More sharing options...
andersenpa Posted February 23, 2009 Share Posted February 23, 2009 Besides Cornell and UAB, are there any other programs in the country with a surgical focus? Nope.................. Link to comment Share on other sites More sharing options...
physasst Posted February 23, 2009 Share Posted February 23, 2009 Nope.................. Well, Cuyahoga Community College, at least when I went, had both a PA, and SPA track. I know because they took the same classes as us, but had some additional surgical classes, and their rotations were structured differently than ours. Link to comment Share on other sites More sharing options...
andersenpa Posted February 23, 2009 Share Posted February 23, 2009 TriC has surgical electives currently, but not the content of the 2 surgically focused programs. Link to comment Share on other sites More sharing options...
Guest ypennesi Posted February 24, 2009 Share Posted February 24, 2009 Geeez, I guess I HAVE to get into UAB then. I do not want a certificate of completion, I definitely want a master's degree. Link to comment Share on other sites More sharing options...
coloradopa Posted February 24, 2009 Share Posted February 24, 2009 Geeez, I guess I HAVE to get into UAB then. I do not want a certificate of completion, I definitely want a master's degree. If you limit yourself to one program you dramatically limit your opportunity to get into a PA program. Considering that UAB and Cornell together produce less than 2% of PA graduate but more than 1/3 of PAs practice in surgery, its obvious that PA students that are not graduates of UAB or Cornell are getting employment as surgical PAs. The other issue is that you really don't know what you want to do right now. You may have an idea that you want to surgery but find some other area of medicine that you like more. Dare I say it even Em:rolleyes:. You will have the same opportunity to work as a PA in medicine from the UAB program but less exposure to medical specialties. In addition to UAB consider programs that have multiple elective rotations which will allow you to get more surical exposure or additional areas of medicine. Right now getting into PA school is a 50/50 shot if you apply broadly. Limiting yourself to one program will dramatically decrease your chances of getting into a program. David Carpenter, PA-C Link to comment Share on other sites More sharing options...
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