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SurgPA05

Assistant at surgery: Multiple personnele for one position

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First thing to know about the role of an assistant at surgery is that several different types of medical personnele fill the role. Credentialing of these different people and their scope of practice varies from region to region, state to state and hospital to hospital......a fact that has served to cause some concern in medical regulatory agencies (Medicare) given the relative inconsistency of the regulation, credentialing and certification/licensure of persons who fill the role. That said, I will give a list of the types of personnel who fill the role of surgical assistant and a brief synopsis of their education and scope of practice.

 

1. CST/CFA - Certified Surgical First Assistant: Two years of education and certification as a surgical technologist with focused education in surgical procedures, instrumentation and protocols with additional training in surgical assisting techniques (wound closure, hemostasis, tissue handling etc). They must pass national certifying exam in surgical technology and surgical first assisting as administered by the Liaison Council on the Certification of Surgical Technologists (LCC-ST). CFA's are certified nationally and are licensed in some states. CFA's may only perform tasks in the OR and have no scope of practice outside of the OR.

 

2. CRNFA - A registered nurse, (nurses do not receive formal training in the OR in nursing school but may attend on-the job-training to become circulating nurses in hospitals) who has served as a nurse in the operating room and taken a competency certification exam for nurses in the OR (CNOR). Once having taken the CNOR they may attend additional classes in nurse first assistant training from various independent agencies and become eligible to take the certified nurse first assistant exam (CRNFA) administered by the association of operating room nurses (AORN). Nurses are already registered/licensed as nurses in their respective states. They may perform tasks in the OR and outside the OR which are consistent with nursing duties.

 

3.SA-C: Certified Surgical Assistant. This is a provider who has had on the job training as a surgical assistant and takes a course in surgical assisting and then a certifying exam given by the American board of surgical assisting (ABSA). SA-Cs are often confused with Physician Assistants due to their similar appearing credential acronym. SAs are not Physician Assistants. Their scope of practice is within the OR only.

 

4. PA-C: Surgical Physician Assistant: A physician assistant who practices in surgery, sometimes regionally referred to as SPA. A surgical PA is a PA trained and certified just like any other PA except they practice in a surgical practice, either for a medical group or employed by a hospital. So as a PA, they may see patients in an office setting for pre-op evaluations, order/interpret diagnostic tests, perform post op rounds, manage patients medically in the hospital, perform and dictate histories and physicals and operative notes and any other tasks assigned them by their supervising physician. Basically they are able to practice medicine under the supervision of a physician. This also includes intra-operative tasks as well. There are currently three accredited PA schools in the US that are surgically focused. This means that in addition to the general medical education received by all PAs, these schools provide additional training in the management of surgical patients and in surgical techniques and procedures. Also there are post-graduate programs for PAs who attended a traditional PA program but wish to receive additional training in surgery after they graduate. Currently PAs are the only non-physician providers of surgical assistant services which are reimbursable by Medicare and Medicaid.

 

It is completely at the surgeons discretion as to what tasks any assistant performs in the OR regardless of their station (CST, CFA, SA-C, CRNFA or PA-C). Some assistants do little more than hold retractors and cut suture, some perform much of the procedures themselves. This again is basically dependent upon how comfortable a surgeon is with the assistant's training and expertise in performing various tasks as well as what any particular provider is credentialed by the hospital to do.

 

Surgical Assisting is and has been a relatively unregulated area of medical practice with respect to scope of practice definitions for various providers and the lack of nation-wide standards, licensure and certification of those who fill the role. This however, is changing. The GAO office of Medicare has recently released a memo and among other things mentioned, suggested that their be moves taken to better regulate and define the role of an assistant at surgery and the scope of practice of the various practitioners who fill that role. So basically it’s a race to see who can prove they have the best and most appropriate education to serve in the role. To see another post on the role of PAs in surgery go here:

 

http://www.physicianassociate.com/f...read.php?t=2193

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Guest aaga

please could somebody tell me which states license CFA as physicians assistants

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CFAs are not physician assistants and do not recieve the amount or quality of education that PAs do....I can speak rather definitively on this subject given that I too was a CFA and am now in PA school. Although I'm sure your question was well meaning....it is analogous to asking which states license RNs as physicians....the two professions are very different in many ways...the only thing that is similar is that at times they fill the same role as assistant in surgery, but as you may or may not know, that's where the similarities end. Take another look at the original post to see the difference in scope of practice between CFAs and PAs to get a better idea of what PA's are educated and credentialed to do vs. what CFAs are trained to do.

 

If you have further questions let me know.

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Guest psyop

What are the 2 other certified PA programs that have a surgical focus besides Cornell? I know that a community college in my home town of Cleveland, Ohio used to have a surgically based program, but it is no longer accepting applications.

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u. of alabama and cuyahoga(sp?) community college in ohio.

keep in mind that you can go to any pa program and take all your electives in surgery and/or do a postgrad surgical residency( see http://www.appap.org for a list with links)

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Cuyahoga Community College in Ohio is no longer a Surgical PA Program. UAB and Cornell still continue to have a surgical focus.

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Guest punch

I am responding to SurgPA05's latest response on the assistant personnel, with one correction. You left out CSA, Certified Surgical Assistant. This designation is obtained by foreign doctors, PAs who train in the OR, and in my case by studying this course. The NSAA governs this designation, and the requirements are stringent. SA-C is an insult to our profession. Any tech can take 9 hours on line, and scrub for 125 cases to take their exam. Our quals, require two years of study, and we are rewarded with a Master's. My scope is not limited only to the OR, but also to clinics, office and ambulatory settings. Our training consists of 1000 cases in the "big" sub-specialties. Plus, we have limited drug perscritpion authority.

 

I have run across many PAs who have taken the CSA exam for the job opportunities.

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u. of alabama and cuyahoga(sp?) community college in ohio.

keep in mind that you can go to any pa program and take all your electives in surgery and/or do a postgrad surgical residency( see www.appap.org for a list with links)

 

Please be advised that Cuyahoga Community College,TRI-C, Is longer accepting applications for their surgical PA program. I spoke with Sharon Luke, Program director, and had this fact confirmed. Also, Sharon said they are in the process of looking into making the program a Masters level.

 

Rob

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In case anyone would like to see the actual "requirements" to sit for the CSA exam here is the NSAA link that explains them:

In a nutshell you must:

 

Take four freshman level science courses and have a physician who will sign an avidavit that you assisted in surgery in some capacity for 750 hours.

 

There is no master's preparation or degree

There is no scope of practice outside the OR unless the individual already posesses another credential such as a nurse, PA etc..

There are certainly no medicinal prescriptive priviliges

There is no formal educational requirement or program for CSA

Basically its simply a test made up so surgical techs or FMGs can have an a few extra initials to write behind their name on hopes that they might be privileged to assist in surgery....only reason I know this is because I used to be one before I went and graduated from PA school.

 

Look, I have no beef with non PA surgical assistants per se.....but I do have a problem with them when they overstate their credential and scope of practice....Sorry Mr. Punch...you can't BS a BSer. And if you continue to post your gross mistatements about your professional qualifications then I will have no choice but to say "Neigh!" to you. (obscure Monty Python Reference)

 

http://www.nsaa.net/membership.shtml

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Question. UAB's program is a PA-C program with a focus on surgery, rather than a SA-C? The way in which you defined SA-Cs to me sounds more like a OR Tech, am I wrong? I can't imagine SA-Cs being on par with a PA-C and not managing patients pre and post-operatively.

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Guest amckneel

Yes, UAB's program is a PA-C program with a focus on surgery...I know because I graduate from it in August.

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Guest james

One of the more valuable lessons the surgeons I work with taught me, "A monkey can assist in surgery, a good first assist could do the case themself."

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I think that the confusion may lie in the acronym designation that SA-C use. SA-C's are not physician assistants and did not attend an NCCPA/APA accredited school. There are no formal SA schools per se. There are three on line/distance program that offer a set curriculum that you can complete at your own pace and then take a test to use the SA-C designation. SAs are/were usually surgical techs or foreign graduate physicians who took the course and passed a certification test.

 

Programs like UAB, and Cornell are APA accredited physician assistant programs that require and provide all of the general medicine instruction that every PA program must contain to be able to graduate PAs plus extra content and instruction in surgical techniques and patient care.

Hope that clears it up.

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Actually,

 

In regards to the original poster......one correction should be noted.

 

A Nurse Practitioner may also be reimbursed my Medicare/Medicaid for First Assisting duties.

 

So in fact there are a total of 3 individuals who may be reimbursed by Medicare/Medicaid. 1. MD/DO 2. PA-C 3. NP-C.

 

Now some private pay/third party insurers may reimburse other types of assistants such as SA-C, CSTS, RNFA's but this varies from state to state, insurace company to insurance company.

 

I am an NP-C and work in General/Bariatric Surgery.

 

TD

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I am an NP-C and work in General/Bariatric Surgery.

 

TD

 

i am wondering why so many NPs make their way over here?

 

chris

 

p.s. I did see that in 2003 NPs were able to bill for surgical assist fees at the VA. This doesnt make much sense to me since NPs dont get any surgical training. Hmmm.

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CMS doesn't see a difference between PA's and NPs. We are midlevel providers.

 

Some NPs were surgical nurses before going back to school...the others that participate in the OR likely learn the way that most surgical PAs do-OJT.

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Guest zulu62

I had this discussion with my daughter a few months back. She just went through OR tech school, thinks OR is the only way to go. She's already accepted for RN school to start in a few weeks.

 

She wanted to d/c the RN program and go to some 1st Assist program out in west Texas..... as a shortcut.

 

I played the money card and vetoed that. The nurses are taking over anyway, she might as well be in the club. I had concerns about the 1st Assist thing as a sustainable, long term career. There appears to be to many professions trying to make a living doing the same thing.

 

I think the nurses will win.... like they always do.

 

 

CMS doesn't see a difference between PA's and NPs. We are midlevel providers.

 

Some NPs were surgical nurses before going back to school...the others that participate in the OR likely learn the way that most surgical PAs do-OJT.

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Actually,.

 

A Nurse Practitioner may also be reimbursed my Medicare/Medicaid for First Assisting duties.

 

I am an NP-C and work in General/Bariatric Surgery.

 

TD

 

This is true. However, this is a PA forum so I was only addressing reimbursement concerns for PAs and what sets them apart from other allied health "practitioners" such as SA-C, CFA, CSA, RNFA etc...everyone knows that NPs are reimbursable from medicare for services provided, including assisting in surgery.

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. I had concerns about the 1st Assist thing as a sustainable, long term career. There appears to be to many professions trying to make a living doing the same thing.

 

I originally replied to this thread with about a 5 page reply on first assisting business nuances and different business arrangements and why a majority of PAs don't have a clue how much they're worth or don't pursue their maximum earning potential.....but it was erased and I don't have the patience to repeat everything....but I will say this with regard to independent first assisting....I made almost three times as much money first assisting before I went to PA school than I currently do working my a$$ off as a PA (that's about to change BTW) by billing insurance for my cases.....I worked an average of 4 days a week and only did surgery....no rounds, no office, no calls, no ICU coverage....just the fun stuff....only reason I went to PA school was my docs hired PAs, put them on a salary of 75-90k and they worked twice as hard as I did with assisting, rounds, office etc and were being payed half to a third of what I made and guess who was getting the rest...the docs....a busy surgical PA easily brings in over 200k in first assistant fees ( if billed for correctly) and the docs payed them a salary and sat back and collected over 200k for them each....just like many surgeons with PAs who don't' know any better do.....so not only do those PAs pay for themselves, they net money for the docs all while busting their $%......meanwhile a surgical tech or nurse with some experience in surgery and who assists and had the smarts to bill insurance....does the cases and makes anywhere from 160-200k+.....I say if she can get established with some docs and independently bill....more power to her!

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Guest zulu62

It seems like doc's get upset, or the greed factor kicks in if anybody else has a chance to make money besides them in this business.

 

 

I originally replied to this thread with about a 5 page reply on first assisting business nuances and different business arrangements and why a majority of PAs don't have a clue how much they're worth or don't pursue their maximum earning potential.....but it was erased and I don't have the patience to repeat everything....but I will say this with regard to independent first assisting....I made almost three times as much money first assisting before I went to PA school than I currently do working my a$$ off as a PA (that's about to change BTW) by billing insurance for my cases.....I worked an average of 4 days a week and only did surgery....no rounds, no office, no calls, no ICU coverage....just the fun stuff....only reason I went to PA school was my docs hired PAs, put them on a salary of 75-90k and they worked twice as hard as I did with assisting, rounds, office etc and were being payed half to a third of what I made and guess who was getting the rest...the docs....a busy surgical PA easily brings in over 200k in first assistant fees ( if billed for correctly) and the docs payed them a salary and sat back and collected over 200k for them each....just like many surgeons with PAs who don't' know any better do.....so not only do those PAs pay for themselves, they net money for the docs all while busting their $%......meanwhile a surgical tech or nurse with some experience in surgery and who assists and had the smarts to bill insurance....does the cases and makes anywhere from 160-200k+.....I say if she can get established with some docs and independently bill....more power to her!

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I originally replied to this thread with about a 5 page reply on first assisting business nuances and different business arrangements and why a majority of PAs don't have a clue how much they're worth or don't pursue their maximum earning potential.....but it was erased and I don't have the patience to repeat everything....but I will say this with regard to independent first assisting....I made almost three times as much money first assisting before I went to PA school than I currently do working my a$$ off as a PA (that's about to change BTW) by billing insurance for my cases.....I worked an average of 4 days a week and only did surgery....no rounds, no office, no calls, no ICU coverage....just the fun stuff....only reason I went to PA school was my docs hired PAs, put them on a salary of 75-90k and they worked twice as hard as I did with assisting, rounds, office etc and were being payed half to a third of what I made and guess who was getting the rest...the docs....a busy surgical PA easily brings in over 200k in first assistant fees ( if billed for correctly) and the docs payed them a salary and sat back and collected over 200k for them each....just like many surgeons with PAs who don't' know any better do.....so not only do those PAs pay for themselves, they net money for the docs all while busting their $%......meanwhile a surgical tech or nurse with some experience in surgery and who assists and had the smarts to bill insurance....does the cases and makes anywhere from 160-200k+.....I say if she can get established with some docs and independently bill....more power to her!

 

In colorado there is a big push to do away with independent assists. The problem is accountability. The PA's or RNFA or CST's need a supervising physician to be credentialled. However when there is a problem, the supervising physician is not there and the surgeon of records states they are not the supervising physician. What I see here is a move to one of two things. Either you are a hospital employee or you are employed by the physician. Either way you are accountable. Just my two cents. YMMV.

 

David Carpenter, PA-C

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No disrespect but if you think the 1 or so months of surgery rotation in school you receive qualifies you anymore than I than we could have a long discussion about this. Just like any new PA coming out of school when I graduated NP school I was fortunate to find a surgeon willing to train me and the rest is history. I had 8 years of experience in a combat support hospital and a surgical rotation as well in school. It really varies from person to person and their aptitude in surviving OR life.

 

TD

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I wanted to quickly apologize. After reading my previous statement I realized it might sound a little snotty.

 

I gravitated to this board as I am somewhat unique in the fact that I am an NP-C working in surgery and there are very few NP's doing this and many many PAs who do.

I have very been very fortunate as some of you this year to realize my earning potential and have also created my own firstassist business.

 

So far things are working out very very well. Takes about 3-5 months for reibursement to start coming in. The money seems great but I am hoping the taxadvantage of being incorporated really makes this a wonderful thing.

 

We should definetly discuss how each of us conducts our assisting so that we can all maximize our reimbursement.

 

TD

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No disrespect but if you think the 1 or so months of surgery rotation in school you receive qualifies you anymore than I than we could have a long discussion about this. ...

TD

 

No disrespect taken. Just wanted to make a point that the average PA student usually has more than 4 weeks of surgical experience under their belts by graduation.

I had two surgical rotations (10 weeks) and was in the OR for about 4 out of 6 weeks of my OB/Gyn rotation. All together I had 14 weeks of surgical experience which is much closer to the average PA student's experience than a single sugery rotation.

Thanks for sharing your experiences here. Best wishes.

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ALSO ... a pa with an interest in surgery may get the following:

general surgery rotation

ob surgery rotation

ortho surgery rotation

elective surgery rotation

 

= 20-24 weeks of surgical experience.

pa's with a specialty interest in school are definitely way ahead of those who do not have a focus in school. I knew that I wanted to do em and got 27/54 weeks= > 1000 hrs directly related to em out of > 2200 hrs of clinicals :

em community hospital ( 3 months)

em trauma ctr(5 weeks)

trauma surgery( 5 weeks)

peds em( 5 weeks)

 

in addition to ob, psych, fp, im.....

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