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Ortho PA scope

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I was discussing surgical roles of ortho PAs recently. I've heard some surgeons allow PAs to assist with plating, drilling, second side joint replacement, etc, while other surgeons prefer the more traditional assistant role of PAs just retracting and closing. The state regulations I found stated that PAs can perform ANY task delegated by SPs so long as it meets certain criteria (within physician's scope of practice, supervised, and within PA's skill set). We can also perform minor surgery, of course, as well as assisting. But they did not specify anything about major surgery, specifically.

 

Does anyone know about the legality of PA assisting and if doing more than the traditional retracting/closing is lawful or unlawful? What is "assisting" exactly? I'm assuming the hospitals also have their own bylaws as well. For instance, if a PA performs part of the surgery, does that reach past the assistant role and embarks on the second surgeon territory? Can there be legal recourse if a PA is found to have done more than just assisting? 

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As long as the surgeon is there, you can do whatever you want. There are CT surgery PAs who harvest the vein themselves while the surgeon opens the chest. Heck, I cute bone with the saw as a student on rotations! (heavily supervised of course)

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EVH is a different beast, and some hospitals require some sort of EVH course or proficiency proving your ability to harvest. There aren't any specific restrictions for ortho that I'm aware of.

 

Regarding orthopedic surgery, I had a surgeon suggest that a PA performing part of the surgery could implicate the team down the road. Not to say that the PA isn't competent enough to perform part of it, but let's say there's a complication and it comes to light that the PA performed part of the surgery. Would that mean anything? After all, PAs are "assistants" and not surgeons, so in the law's eyes, how are PAs allowed to perform surgery rather than just assisting? Do you catch my drift?  

 

My main concern is where is the line drawn between the assistant role and second surgeon role. I'm all for doing more in the OR and advancing my skill set, but I also do not want to implicate our team nor do I want to practice unlawfully. Is it enough for the surgeon to say that my doing part of the surgery IS assisting and therefore within legal parameters?

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I really think it depends on the doc you are working with. My doc and I have been together a year now and slowly starting to get to do more in the OR. Of course most of it is still retracting and closing, but with all the cuff and labrum work we do, I end up drilling and placing most of the anchors for the labrum and some of the cuffs. I've put in a few K-wires but thats it.

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a good friend of mine is a surgical pa who did a surgical residency(Norwalk). when they do b/l procedures (hips, knees, etc) on the same day he does one side, the doc does the other. he is 22 yrs out of school, but has had this scope since finishing residency.

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1 hour ago, EMEDPA said:

a good friend of mine is a surgical pa who did a surgical residency(Norwalk). when they do b/l procedures (hips, knees, etc) on the same day he does one side, the doc does the other. he is 22 yrs out of school, but has had this scope since finishing residency.

And I'm assuming that he hasn't had any legal issue with him doing that in his 22 years, right? I know a few PAs who have a similar scope as your friend, minus the residency. But just because someone does something, it doesn't necessarily make it legal. Ya know? I wanted to reach out to see if anyone knew of any possible legal recourse to PAs doing that much work in the OR.

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he has not had any problems doing this with multiple spine and general ortho surgeons over the years in multiple states (CT, MA, RI, VT). As I understand it, anything delegated is legal.

there is also a surgical pa out there acting as primary surgeon for transplant harvesting without problems.

http://columbiasurgery.org/joseph-costa-dhsc-pa-c

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3 hours ago, ort890 said:

I really think it depends on the doc you are working with. My doc and I have been together a year now and slowly starting to get to do more in the OR. Of course most of it is still retracting and closing, but with all the cuff and labrum work we do, I end up drilling and placing most of the anchors for the labrum and some of the cuffs. I've put in a few K-wires but thats it.

That's the impression getting, that it's surgeon-dependent. I just can't seem to find any information suggesting that there is or isn't an issue with us doing more in the OR...

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2 minutes ago, EMEDPA said:

he has not had any problems doing this with multiple spine and general ortho surgeons over the years in multiple states (CT, MA, RI, VT). As I understand it, anything delegated is legal.

there is also a surgical pa out there acting as primary surgeon for transplant harvesting without problems.

That's the way I read the regulations, too. Thank you for the information.

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