How much autonomy does a surgical PA really get in the OR?

[debastet]

I'm very interested in becoming a PA but one thing is holding me back: surgery. I love it - love the idea of cutting open a patient, removing/fixing the problem and then sewing them back up. I use to dream of specializing in craniofacial reconstuctive surgery, designing procedures specifically for patients with genetic anomalies, and being a plastic surgeon (maybe it's the artist in me...) but at almost 27 it's too late for med school, especially with 2 years of pre reqs ahead of me. SO as far as I have seen, PAs don't really have much freedom in the OR. Aside from using a pulsavac, closing, and basically being an SA, doesn't look like there's much critical thinking involved. Can anyone expand on this and possibly bring me some hope?

[andersenpa]

First off 27 is not too young for anything if that is THE thing you want to do.

If you want autonomy IN THE OR, then surgical PA is not the best choice. Go to med school.

 

Having done both general surg and cardiac, you will get more freedom and technical scope in cardiac- primarily endoscopic vein harvesting. Of all the surgical specialties its one of the few things that is almost exclusive to PAs and docs just don't do it. It's a true surgical PA niche.

 

That being said ALL surgery requires critical thinking even if you're not the lead operator at that point in the procedure. A good first assist holds/retracts/cuts/suctions. A GREAT first assist anticipates, looks 3-4 steps ahead, and has solutions to problems. A GREAT surgeon will be open to those solutions (as long as they are good solutions!)

 

The bigger role for a surgical PA is in the perioperative period...pre and post....where there is the greatest autonomy.

[EMEDPA]

27 is not too old to consider medschool. I know lots of folks who have gone back in their 40's and 50's. a former lpn I know recently graduated from fp residency at 52.

[burnpac]

First off 27 is not too young for anything if that is THE thing you want to do.

If you want autonomy IN THE OR, then surgical PA is not the best choice. Go to med school.

 

Having done both general surg and cardiac, you will get more freedom and technical scope in cardiac- primarily endoscopic vein harvesting. Of all the surgical specialties its one of the few things that is almost exclusive to PAs and docs just don't do it. It's a true surgical PA niche.

 

That being said ALL surgery requires critical thinking even if you're not the lead operator at that point in the procedure. A good first assist holds/retracts/cuts/suctions. A GREAT first assist anticipates, looks 3-4 steps ahead, and has solutions to problems. A GREAT surgeon will be open to those solutions (as long as they are good solutions!)

 

The bigger role for a surgical PA is in the perioperative period...pre and post....where there is the greatest autonomy.

 

Agree with andersonpa. I work in craniofacial train wreck recon, and my surgeon and I have been in practice together for 4 years. We don't even need to talk very much in surgery anymore as we can anticipate each other's needs and moves. I do whatever needs to be done at that step of surgery if I'm in position to perform it. I also do plastic surgery consults on the floor and make the decision for surgery in most cases without input from the surgeon. Together, we compliment each other and move cases efficiently. I'm trusted to do whatever needs to be done during the procedure. The only caveat is that the case has to stop if he has to scrub out and step out of the room due to the regulations in CA. That said, on many minor burn and other cases, he sits at the desk and dictates while I do the case with our residents or PA students.

[EMEDPA]

Fair to say that yours is not a typical job though, right Steve? it's taken you 20+ years to work up to a position like that and certainly not something someone should expect to do as a new grad or even within 5 yrs, correct?

[MedicinePower]

If I was 27 I'd not hesitate to go to med school. Now in my 30s and with the hopes for a family PA school is the happy medium.

[burnpac]

Fair to say that yours is not a typical job though, right Steve? it's taken you 20+ years to work up to a position like that and certainly not something someone should expect to do as a new grad or even within 5 yrs, correct?

 

Actually, not really. I was recruited to my present position as I had been referring to this group for years. I scrubbed surgery for the first time four years ago, and the surgeon with whom I work have established our private practice together over the last two, doing a lot outside of burns.

 

I do admit that I'm in a very good position, but all the PAs that I know who work in surgery at our facility are highly valued as a part of the surgical team.

 

I would expect a new grad, who gets a surgical job, to reach a level of competency and trust in the same amount of time that I did, which is about 3-4 years. That does partly depend on the surgeon.

[debastet]

Thank you all for your feedback. Burnpac, mind if I PM you with more questions?

[andersenpa]

Fair to say that yours is not a typical job though, right Steve? it's taken you 20+ years to work up to a position like that and certainly not something someone should expect to do as a new grad or even within 5 yrs, correct?

 

5 yrs of consistent work is enough time to get competent enough the be at the level that steve describes.

[burnpac]

Thank you all for your feedback. Burnpac, mind if I PM you with more questions?

 

I would be happy to talk to you anytime.

[Friction]

Does anyone know if the military uses PAs in a reconstructive surgery role? More specifically within the Navy, as that is where I hope to stay. I know the Army uses PAs a bit differently than the other branches do.

[bobsquit3]

The PAs at Duke (at least in Vascular and Neuro) have an incredible amount of autonomy. The neuro PA does his own spinal fusion surgeries and the vascular PA does splinting and angioplasty by himself. That could be very unique, but is fun to know what the upper limit is!

[kevinchs03]

Agree with andersonpa. I work in craniofacial train wreck recon, and my surgeon and I have been in practice together for 4 years. We don't even need to talk very much in surgery anymore as we can anticipate each other's needs and moves. I do whatever needs to be done at that step of surgery if I'm in position to perform it. I also do plastic surgery consults on the floor and make the decision for surgery in most cases without input from the surgeon. Together, we compliment each other and move cases efficiently. I'm trusted to do whatever needs to be done during the procedure. The only caveat is that the case has to stop if he has to scrub out and step out of the room due to the regulations in CA. That said, on many minor burn and other cases, he sits at the desk and dictates while I do the case with our residents or PA students.

 

 

Hi PA Hanson, thank you for that very insightful response. It sounds like you have a wonderful job and you truly love what you do. I am currently a PA-S and like debastet, I too am very interested in pursuing a career in surgery, but I have worried about the autonomy in the OR. Your response has provided a new light for all Pre PAs and PA-S out there who have a desire to do surgery. I hope to pursue a surgical PA residency/fellowship after I finish PA school. Can you shed some light on that topic? Do you think they are beneficial and worth it? Thank you.

[DJ Bunnell MSHS PA-C]

I have been watching this thread with interest. I think that I would like to question the word autonomy when it comes to the OR. I think it is the wrong term. I practice in Cardiothoracic Surgery and have a fair amount of autonomy that I would further describe as the ability to make judgment calls and decsions about patient care. I do it with the understanding that I work on a team and would not go too far out of bounds without having a conversation with someone. I think that the actual operation can be better described as a team sport where I have been able to continually perform at a higher level as my skills improve and as my surgeons and I build a trust between us. When someone asks if I can operate by myself my reply is that I cannot and neither can my surgeon because we both need each other.

[burnpac]

Hi PA Hanson, thank you for that very insightful response. It sounds like you have a wonderful job and you truly love what you do. I am currently a PA-S and like debastet, I too am very interested in pursuing a career in surgery, but I have worried about the autonomy in the OR. Your response has provided a new light for all Pre PAs and PA-S out there who have a desire to do surgery. I hope to pursue a surgical PA residency/fellowship after I finish PA school. Can you shed some light on that topic? Do you think they are beneficial and worth it? Thank you.

 

Call me Steve. If you are truly interested in surgery, the best route would be to find surgeon willing to train you. I have no experience with surgical residencies as I Didn't attend one. All my experience over my career has been OTJ.

[burnpac]

Random -- Great explanation of the team practice concept in surgery. That is exactly what my relationship is like with my surgeon. This extends to everything in medicine and better describes the current trend in medicine towards team practice. "Autonomy" doesn't begin to describe the interworking's and interrelationships of the members of the medical team. Our emphasis and focus needs to be on enhancing team performance and worrying less about so-called autonomy.

[OrthoSurgeryPA]

Does anyone know if the military uses PAs in a reconstructive surgery role? More specifically within the Navy, as that is where I hope to stay. I know the Army uses PAs a bit differently than the other branches do.

 

Not that I am aware. Surgical side is ortho primarily and that may or may not be limited as career advances (promotions)

Navy = Primary Care...especially first tour.

This may change as the community comes to terms with the Army DSc and Air Force Gen Surg fellowship.

Check the NAPA site for more details on scuttle butt about what lies on the horizon.

[debastet]

In regards to autonomy, I suppose I mean the amount of freedom a PA gets in deciding where the surgery is going. Not only "designing" the surgery itself but at times wielding the scalpel and solving the physical problem. (I know a PA is never going to do a cardiac bypass surgery by themselves, but what about minor procedures?)

 

You'll have to forgive me if I sound a little naive but I'm just trying to have someone fill in the gaps of my knowledge... :) Lets say, for example, a patient presents with a fractured tibia. Can the PA make the decision to do surgery (running it past the SP, of course), as well as what kind of surgery (using plates, screws, etc), and then go forward with it? As I have witnessed, it's the SP making the calls and holding the drivers and drills in the OR. Would there be a situation where the PA would be handling the implants or would there be limitation? From most of the responses, it sounds like being a surgical PA may be what you make of your opportunity in your particular situation and the amount of teaching and freedom your SP is willing to provide.

[EMEDPA]

YUP, all very situational based on the particular pa, their training, and the sp and his style.

I have known residency trained ortho surgical pa's who do fully 1/2 of an operation while their sp does the other 1/2. (b/l hips or knees for example). I have also known lots of surgical pa's who only did scut and acted as human retractors in the o.r.