Extent to which PA's participate in surgery

[kbarsness]

I'm currently in my 3rd year of my college undergrad and I'm starting to think about which specific area I would like to work in as a PA. I was wondering to what extent PA's can participate in surgery? I think orthopedics would be interesting, or working in the ER. My roommate who is currently in nursing school said I should be a scrub nurse? Are there major differences? Do PA's get to really get their hands in on surgery or do they mostly just assist? I haven't had the opportunity to shadow in either areas so I really don't have a good idea.

[medman2007]

May want to check out the Surgical specialty section of this site. Vast majority of PAs I've worked with and/or shadowed over the years worked as First Assist thus played major roles in the surgeries (mostly Neuro, CT, plastics and Ortho). However, very dependent on surgeon, specialty, etc. Most, if not all, we relied upon heavily for postop mgt, dx of complications and proper tx/mgt.

 

Scrub Nurses are valuable members of surgery team, but very different from PA

[Beorp]

I'm currently in my 3rd year of my college undergrad and I'm starting to think about which specific area I would like to work in as a PA. I was wondering to what extent PA's can participate in surgery? I think orthopedics would be interesting, or working in the ER. My roommate who is currently in nursing school said I should be a scrub nurse? Are there major differences? Do PA's get to really get their hands in on surgery or do they mostly just assist? I haven't had the opportunity to shadow in either areas so I really don't have a good idea.

 

Rather than a scrub nurse (passing things to the surgeon), I think your friend may have been thinking of RNFA (http://www.aorn.org/CareerCenter/CareerDevelopment/RNFirstAssistant/).

[andersenpa]

It varies practice to practice. Additionally, some specialties have more expectations from PAs than others. Ortho, neuro and CT are the biggest specialties for PAs. Even within one practice, some surgeons will use the PAs in a more involved manner than others.

 

The major difference between a PA and a surgical tech/scrub nurse or RNFA is the perioperative care. PAs have the ability to care for the patients along the entire continuum from preop to clinic follow-up. The others work only in the OR.

 

you said "Do PA's get to really get their hands in on surgery or do they mostly just assist? "

 

Again the level of invovlement determines how much you do. The "just assisting" can be complex and it can be rote. Depends on the specialty and setting.

[Doc Savage]

As a student in my surgery rotation I have been getting my "hands in"! They let me use the Bovie (electrocautery tool) the Maryland and other fiber optic Laproscope tools and things, suture, cut etc. The delicate stuff the surgeon does... but right now I would not want that any other way. We had a "routine" lap chole, to make a long story short the guy had ignored his gall bladder pain for over a decade, when we got in it was so scarred in and inflammed that it got complicated. The surgeon may have "nicked a sinusoid" trying to get the scarred gall bladder out... two and a half liters of blood lost, a buck-walter, a few units and pressors, some hemostatic agents, and 2 hours later we were finally closing.

[winterallsummer]

From what I've heard, it depends largely on the surgeon you work with. They may let you co-operate with them as a co-surgeon. Or for example working in a big hospital you may only be allowed to do first assist.

[JCrownover]

I have worked as a scrub tech for over 10 years, in two states. I also had two surgical rotations during PA school and am going to start a surgical residency real soon. What I can tell you is that the practice setting has everything to do with your level of involvement (both as a tech and as a PA).

 

For example, in California as a tech, I was not allowed to do anything that would 'alter' a patient (Including throwing sutures, injections, etc. Staples were placed by the tech because the surgeon would direct placement with forceps. Similarly, techs also use the bovie on an instrument the surgeon is using to grasp tissue thus directing the electrocautery). In Montana the operating room techs were "allowed to do as the surgeon directed them". I got these two pieces of information from my state Surgical Tech associations at the time I was working in those states. Further - even with permissive state laws, a surgical tech then has to have willing and patient surgeons to teach these 'higher skills'. I began learning how to suture and inject while working in MT.

 

I did not have a lot of exposure to surgical PAs in California (all of my shadowing was in Montana). You would think that with really permissive surgical tech laws in MT, that PAs would have a lot of independence but that was not my observation. While I was a tech in MT I witnessed only minimal surgical independence such as injections, wound closure and 1 or 2 instances of incisions made by the PA. Essentially, as a tech there I was doing everything the PA was doing with the exception of the incisions.

 

Again this has to do with practice setting. You must have a good surgeon/PA relationship (trusting, supportive of education, etc) for the PA to grow and gain the skills to become good & be independent. I had a phenomenal CT rotation where I saw my preceptor (PA) working at a level of independence I didn't think was possible. But then - that person also had an outstanding relationship with the supervising physicians.

 

With all that being said, I'm pretty sure you would NEVER see a surgical tech or surgical scrub nurse doing a sternotomy in the U.S.

[JCrownover]

I think if you are interested in becoming a surgical PA, that working as a scrub tech would provide good health care experience in addition to reinforcing your decision to follow the surgical PA path.

[andersenpa]

I have worked as a scrub tech for over 10 years, in two states. I also had two surgical rotations during PA school and am going to start a surgical residency real soon. What I can tell you is that the practice setting has everything to do with your level of involvement (both as a tech and as a PA).

 

For example, in California as a tech, I was not allowed to do anything that would 'alter' a patient (Including throwing sutures, injections, etc. Staples were placed by the tech because the surgeon would direct placement with forceps). In Montana the operating room techs were "allowed to do as the surgeon directed them". I got these two pieces of information from my state Surgical Tech associations at the time I was working in those states. Further - even with permissive state laws, a surgical tech then has to have willing and patient surgeons to teach these 'higher skills'.

 

I did not have a lot of exposure to surgical PAs in California (all of my shadowing was in Montana). You would think that with really permissive surgical tech laws in MT, that PAs would have a lot of independence but that was not my observation. While I was a tech in MT I witnessed only minimal surgical independence such as injections, wound closure and 1 or 2 instances of incisions made by the PA. Essentially, as a tech there I was doing everything the PA was doing with the exception of the incisions.

 

Again this has to do with practice setting. You must have a good surgeon/PA relationship (trusting, supportive of education, etc) for the PA to grow and gain the skills to become good & be independent. I had a phenomenal CT rotation where I saw my preceptor (PA) working at a level of independence I didn't think was possible. But then - that person also had an outstanding relationship with the supervising physicians.

 

With all that being said, I'm pretty sure you would NEVER see a surgical tech or surgical scrub nurse doing a sternotomy in the U.S.

 

 

Take her advice, she was a kick a$$ PA student! now ready to rock Emory's world.....