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Hear My Silence

First Incision in Surgery

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Hello,

 

I ran a search, as I always do before posting a thread, and found no topic covering this subject. I found that odd, so forgive me if I missed a thread discussing it.

 

Anyway, the question is this: are physician assistants who serve as surgical first assistants allowed to make the first incision on the surgical patient in an U.S. state? If so, is Oregon among the states that do allow it?

 

Just curious.

 

Oh, another question. It's a little off track, but why isn't there a specialty forum on this site for physician assistants in otolaryngology? Because so far that seems like the most attractive field to me. You know, a mix of surgery and hospitalist roles with a dash of outpatient duties and a pinch of inpatient duties. It just seems very verstile and that attracts me. But then again, I'm just a lowly pre PA. What do I know.

 

 

 

~HMS~

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That really depends on what you are referring to as the "first incision". If you mean the main incision such as in a laparotomy, then likely no. If you mean the first incision of a vein harvest during a CABG, then yes. Many cardiovascular PA's vein harvest by themselves while the surgeon is gaining thoracic access to the heart. If you are wanting to make important cuts, sutures, repairs or removals, don't be a PA. Go to MD/DO school. If you want to be intimately assisting throughout the case and closing the fascia/skin after the case, then a surgical PA is for you.

 

You can request a specialty by adding it in the technical question/website issues part of the forum (towards the bottom of the main page). What you described as a mix of inpatient/outpatient duties and surgery/hospitalist roles can be said about many fields for a PA. One example is trauma surgery. We did as much blood pressure management as we did running traumas. I highly suggest shadowing PAs in the different fields you are interested in, as this will be the only true way to judge a field. Remember, people will always talk up their own field of choice, and rightly so....they chose it.

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I think it depends on the environment, I just joined a surgical practice as a switch in specialty from being an ER guy. I have been here three weeks, and haven't done any cutting yet, but the goal of the department is to have the PA's take over the lumps and bumps clinic (cyst, lipoma, skin CA, portacath) all the procedures that don't need to go to the OR. The clinic has a mini OR as the major procedures room, is staffed by a scrub tech and circulator and it (for all intents and purposes) is surgery minus the anesthesiologist, these masses can be large (Lipomas aren't always small) and they can be involved to remove. Marking, incision, dissection, and closure will be all me. It's a little scary at my current sugical nievety, not as simple as 1,2,3.

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heent-sounds like a great job, congrats.

 

Thanks, hopefully it all works out. It's a mixed bag of Docs, a few are under the the correct impression that they are training me to "replace" a doc, as they are currently all assisting eachother (we have a few residents that rotate through here, but a large surgical service for 2-3 residents a month so nothing life altering) and that it will take some time to get me in the OR assisting like a surgeon, other then that it has promise to turn out to be a good gig, unfortunately part of the funding for myself and the other PA who joined 3 months before I did came from the anesthesia/pre-op budget and 3 afternoons a week I will be making preop telephone visits (scheduled for 2 hours each afternoon) it's a cost effectiveness and patient satisfaction measure to take care of all the pre-op ROS/Chart clean/Q&A/presurg instructions without having to book an office visit; and I am one of a dozen PA's as a guinea pig. Only time will tell if it's functional (I have yet to be booked for telephone clinic yet, but my practice colleague, who is just out of the Yale Norwalk residency thinks they are a big waste of her education)

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