hand orthopaedics: what's it like compared to other joints?

[PAtoB]

Considering possibility of pursuing a couple of ortho surg hand speciality positions. No experience working with the hand, but am coming strictly from a foot and ankle background. Any other hand folks out there who can offer insight? I recognize the obvious differences in joint complexity and pain med usage comparison to both, but beyond that, what's it like working in hand compared to other ortho specialties? thanks in advance for any input!

 

Also note: all avoidance of using the word job in that graph! hahaha

[Reality Check 2]

Not too many PAs in HAND ortho as compared to general or a specialty like total joint.

 

About 80% of all hand surgical codes DO NOT allow an assistant or assistant reimbursement, unless doing 100% trauma such as spaghetti wrists and replants, etc. 

 

That means less billing by the PA and more office, as I have seen it. A lot of ortho reimbursement is OR. 

 

So, ask about the duties, responsibilities and make sure you aren't a glorified scut monkey or cast tech.

 

None of the Hand Surgeons in my town has a PA - at all. 

 

Just my take......

[EMEDPA]

a lot of these positions are through plastics also, not ortho. and plastic surgeons tend not to like anyone getting a piece of their pie...

[SedRate]

I don't have experience in hand/plastics specifically but I have a couple colleagues who did hand. Lots of clinic and rounding. As the above posters said, not a lot of reimbursement on the hand side but better on the plastics side. Some hand surgeons are ortho trained and will take ortho call, and some hand surgeons will take care of injuries up to the elbow as well as nerve injuries, depending on the hospital and surgeon. Also depends on the amount of call and how much of an outpatient practice they have where they might do office carpal tunnel releases, joint injections, etc. So it really depends on the surgeon, group, and hospitals you're working with/at. In general, hand gets lots of work comp patients and IV drug users.

[Arthropathy]

I have only had 1 job so take this with a grain of salt.

 

I work for a general ortho/hand surgeon. We are in a multi physician ortho group. We take general ortho call as well as hand call. Other hand call guys are plastics so we end up with the majority of hand patients in the community. We do hip fractures, ankle fractures, patellas etc that come in on call day. But all of our elective cases, so like 95% of our surgeries are hand/wrist/elbow cases.

 

I am in clinic 3.5 days a week. I see most of the ER follow ups as he doesn't want to deal with anything that isn't upper extremity. But most of my case load is hand/wrist/elbow. Lots of injections. Lots of work comp.

 

The surgeon does 1 day a week in the OR without me for "minor" procedures and 1 day a week I join for the larger cases. I can bill for a lot if these as a 1st assist but some I cannot. We typically have 2 rooms going so I am still valuable for efficiency and we can do an extra case or 2 even if I am not billable

 

My compensation is average. My reimbursement is average compared to other PAs in my group. I think in the next year as I mature as a PA I will become a top earner. We are in the process of data mining how my first assist reimbursement affects my bonus and will likely weight these cases with regards to my production bonus.

 

All in all I really like my job. Hand surgeries are pretty awesome. I get a good variety because I only assist on billable cases. I get to sit in the OR, and cases are pretty quick. I do lots of procedures in the office (volume not variety). I think my situatiom might be atypical in that I have a great boss who gives me a lot of autonomy and treats me as a colleague, and he is the only hand surgeon in the community so we are busy busy busy.