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I am a pre-PA and am interested to learn about compensation packages from those of you who are employed by university health systems, particularly the University of California and particularly those who practice in a surgical subspecialty. A basic search through several UC medical center websites gives me an idea as to what a first year graduate would earn hourly at each of these sites, but no additional information about CME, licensing, or whether quarterly reconciliation bonuses are part of the pay scheme.

 

When I shadowed in the CVICU of one UC medical center, the PAs there were reportedly working 80-100 hours per week. Whether or not that number is inflated is beside the point; however, I would be interested to learn about those weekly hours beyond 40 (and those spent on call) are compensated.

 

Just to be clear to those lifers on the Forum, I have no interest in working those kinds of hours. I am not focused on trying to make the most money I can right out of the gate and kill myself in the process. Just trying to learn from those of you who have experience working in university hospital systems. Interested to know what the advantages are in terms of compensation, life-work balance and what the most obvious pitfalls are. In sum, is it more trouble than what it is worth it to work for a university health system?

 

Note about me: I currently work for a non-profit charity that provides plastic and reconstructive surgical services to victims of natural and man-made disasters. Working in an administrative capacity for this organization is what has energized me to seek clinical training as a PA. Its nice that PA compensation can be lucrative, but my chief focus in switching careers is to make a difference in the lives of my patients, whether domestic or international.

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I worked at UC as.a PA and they were exempt employees....no overtime or call pay. I do not think that has changed. The salaries for senior PAs go pretty high but of course it is California so the cost of living and the state income tax bites.

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      An introduction to the OR team


       
      By Robert M. Blumm, MA, PA-C, DFAAPA


       
      Whether you are a PA student scheduled to start a surgery rotation or an NP interested in moving into surgery, an understanding of the surgical team is beneficial. This article outlines the hierarchy and operation of the typical surgical suite.


       
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      The Preoperative Holding Nurse

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      The Circulating Nurse

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      The Scrub Nurse

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      The PACU or Recovery Room Nurse

      The PACU or recovery room nurse accepts the patient from the OR and immediately provides a secure environment for proper airway, oxygenation, suction and care. This nurse is an expert in critical care and is responsible for the safety of the patient while he or she is in this area as well as the safe movement of the patient from the PACU to any other area of the hospital. The PACU Nurse can be a source of information for postoperative orders and medications and your right hand if an emergency occurs.

       

      The Surgical Technologist

      The surgical technologist has the same responsibilities as the scrub nurse, but he or she has less responsibility in an emergency because he or she is working under nursing and has limitations on the ability to administer drugs and blood products. The surgical tech is a trained (often certified) member of the team who can provide insight into the needs of the surgeon, his or her approach, his or her mannerisms in surgery, his or her areas of intolerance, and the specific requirements of the first assistant.


       
      The Anesthesiologist

      The anesthesiologist is a physician who is an expert in pulmonary medicine and the science of providing sleep and analgesia for the patient who is undergoing surgery.4 The anesthesiologist consults with the patient prior to surgery to discuss the planned procedure and anesthetic.5 He or she determines whether the patient should have local, regional, spinal or general anesthesia. This decision is based on the patient’s medical and surgical history, family history and psychological status. The anesthesiologist maintains constant awareness of the cardiopulmonary status of the patient.

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      During the surgery, the anesthesiologist maintains an open airway, proper breathing and circulation and keeps the patient in a highly oxygenated state to administer drugs as needed.

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      The First Assistant

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      Physician assistants who specialize in surgery have a specialty organization, the American Association of Surgical Physician Assistants (AASPA), which provides continuing education and networking opportunities.10 The surgical PA orders tests, interprets test results and writes admitting orders, progress notes and postoperative orders. Surgical PAs determine when a patient may ambulate or be discharged, write prescriptions, perform discharge summaries and plan postoperative follow-up.11 Nurse practitioners may also function in this role.

      All hospitals establish criteria for who may “first assist” and on what cases. NPs apply for credentials in the same manner as PAs and must specify a supervising surgeon. This requires the NP to have a relationship with a surgeon or surgical group. For information on advanced practice nurses transitioning to a first assist role, see the following article: http://www.medscape.com/viewarticle/499689.


       
      Preventing SSIs

      There is no better manner in which to conclude this overview of the OR team than to focus on prevention of surgical site infections. Surgical site infections affect 750,000 patients every year in the United States.12 These infections can increase length of stay in a hospital for up to 10 days. Increased length of stay adds $20,842 to the average patient’s hospital charges.12 These excess charges are now absorbed by the institution, not the insurance company. Appropriate implementation of the perioperative role can render these infections preventable. Visit www.AORN.org, the website for the Association of periOperative Registered Nurses, to find advice for preventing surgical site infections. Pay specific attention to recommendations for hand washing, hair removal, prepping and draping. Additional guidance is available from the Centers for Disease Control and Prevention at www.cdc.gov/handhygiene/24.


       
      Robert M. Blumm is a surgical physician assistant who lives in Amityville, N.Y. He has served as president of the American Association of Surgical Physician Assistants, the Association of Plastic Surgery Physician Assistants, the New York State Society of Physician Assistants and the American College of Clinicians. He is a member of the editorial advisory board for ADVANCE for NPs & PAs. Blumm has completed a disclosure form and reports no relationships related to the content of this article.


       
      References

      1. Kurzweg FT. The patient, his surgeon and the record. In: The Surgeon’s Handbook. Garden City, N.Y.: Medical Examination Publishing Company , Inc.; 1982: 3.

      2. Position statement of the Association of periOperative Registered Nurses. One Perioperative Registered Nurse Circulator Dedicated to every Patient Undergoing a Surgical or Other Invasive Procedure. http://www.aorn.org/Clinical_Practice/Position_Statements/Position_Statements.aspx. Accessed Dec. 27, 2011.

      3. Centers for Medicare and Medicaid Services. Conditions of participation for hospitals: surgical services. http://www.cms.gov/manuals/downloads/som107ap_a_hospitals.pdf. Accessed Dec. 27, 2011.

      4. Sweeny F. Who’s the person giving my anesthesia? In: Sweeny F. The Anesthesia Fact Book. Perseus Publications; 2003: 3-12.

      5. University of Cincinnati Residents, Berry S. The Mont Reid Surgical Handbook. 4th ed. Mosby;1997.

      6. Sumpter R. Anesthesia. In: Labus JB. The Physician Assistant Surgical Handbook. W.B. Saunders; 1998: 19.

      7. All about anesthesia. American Association of Registered Nurse Anesthetists. http://www.aana.com/forpatients/Pages/All-About-Anesthesia.aspx. Accessed Dec. 27, 2011.

      8. Facts about AAs. American Academy of Anesthesiologist Assistants website. http://www.anesthetist.org/factsaboutaas/. Accessed Dec. 27, 2011.

      9. Weis MK. The first assistant and collaborative practice. In: Rothrock JC, Seifert PC. Assisting in Surgery: Patient-Centered Care. Competency & Credentialing Institute; 2009: 387-405.

      10. American Association of Surgical Physician Assistants website. www.aaspa.net. Accessed Dec. 27, 2011.

      11. Blumm RM, Condit D. Surgical physician assistants help solve contemporary problems. Bull Amer Coll Surg. 2003;88(6):14-18. http://www.facs.org/fellows_info/bulletin/2003/blummcondit0603.pdf. Accessed Dec. 27, 2011.

      12. Manz EA, et al. Clipping, prepping and draping for surgical procedures. Managing Infection Control. 2006;August: 84-97.

    • By UCFPA
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