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Radio Frequency Ablation (RFA)

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Hi everybody,

Recently joined a surgical group in CA. Our group performs radio frequency ablation (RFA) for varicose vein's. My question is...does anyone perform these procedures or only the surgeon does them?

 

Also, I've quickly noticed there are some cases I can't assist (ex TIF) because I don't have scope credentialing. Does anyone know if there are courses I can take? I did some research and saw some PA's do perform colonoscopies (from what I've seen it's mostly through Kaiser), but I want to be able to perform EGD's so I can assist.

 

Thanks

Oli

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Not sure about CA but I do know of a number of PA's who do RFA after being properly trained. The likelihood of being able to do it totally depends on the willingness of the surgeon to train you and the hospital to credential you. The surgeon I work with would train me but the hospital won't allow PAs to do the procedure (or many others for that matter). Recently interviewed for a CV Surg position in OR where they were willing and able to train me to do this. Ended up not taking the position for other reasons though.

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Our local HMO has PAs doing it essentially independently with IR on campus supervision.

We started it in our practice and the hospital only credentialed the docs to do it

I have done them in the OR with our surgeons and it is EASY, especially if you are facile with vascular needle-guidewire access (which is 90% of the job)

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I'm a cardiovascular sonographer looking to apply to PA school next year and for the cardiology practice I work for, we do a TON of endovenous ablations for varicose veins. We have 3 PA's and 1 NP and yes, they all do the ablations solo (without the doc). Usually during the procedure, its a 3-4 man team (PA, me, and 2 MA's - 1 sterile, 1 not). In the beginning, the PA's would shadow and watch and if we had easy cases, our docs would let them take over and do a leg or two. However, I'm not sure how it is everywhere else, but before our PA's and NP could solo they sent them to the VNUS conferences that are held every so often.

 

As for the procedures themselves, they're not too bad. In fact, when one of the PA's first solo'd a case with me, I would at times be the one to guide (by U/S) and insert the catheter while holding their hands. It takes time to develop obviously, those who have good hand-eye coordination will pick it up quicker.

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cjaydb,

where are you located? I am a registered vascular tech in VA and just applied to PA school, I would like to be able to own one of these practices eventually.

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I'm currently living and working in Hawaii on the island of Oahu. At the moment, there are maybe 3-5 doctors/practices now that are utilizing RFA/laser ablations here. Surprisingly, it's relatively new here to the islands. When the practice I work with first started it 2 years ago, they were the 2nd practice to start doing it. Varicose veins are a good cash cow, reimbursements are upwards of $2k a leg. Throw in perforators and the small saphenous ablations and one person (who obviously really needs it) can bring it quite a nice income.

 

We also do sclerotherapy injections for spider veins (all cash $300 a session 30 minutes, since insurance doesn't cover), albeit it's quite uncommon that we do them. Yea, you all might be thinking what the heck are cardiologists doing dabbling in this? Lol I thought the same, but hey, I guess reimbursements have gone down so much that it's forcing doctors to find alternative sources of income.

 

Another thing, I'm pretty sure its required for the supervising doc to be on site during the procedures. They don't necessarily have to be in the same room, but in our situation they're busy seeing other patients the next room over. Then again, it may differ in other states so I'd look into that more just to be sure.

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